Quit­ting cig­a­rettes is the sin­gle most whole­some new year’s res­o­lu­tion

The Weekend Australian - Travel - - Health - SI­MON COWAP

QUIT­TING smok­ing is one of the most pop­u­lar new year res­o­lu­tions, and it is now time to check on its progress. If you have al­ready started, then you are at what coun­sel­lors call the ‘‘ ac­tion stage’’. But if you are wa­ver­ing, or were think­ing maybe you’d hold it off un­til next year, then you’re at the ‘‘ con­tem­pla­tion’’ stage.

While mo­ti­va­tion alone is not al­ways enough to suc­cess­fully quit smok­ing, it is es­sen­tial to get­ting the process started. Peo­ple of­ten need a more per­sonal un­der­stand­ing of why they smoke and what it costs them. We all know at some level that smok­ing is bad for us, so there must be pow­er­ful rea­sons why we do it any­way.

Typ­i­cally the im­me­di­ate con­se­quences of smok­ing are re­garded as good: it helps peo­ple re­lax and so­cialise, while the long-term con­se­quences — both health and fi­nan­cial — are re­garded as bad.

While mo­ti­va­tion is im­por­tant, quit­ting still tends to pit long-term against short-term, de­layed grat­i­fi­ca­tion against im­me­di­ate plea­sure, rea­son against re­flex. Sadly, brain­stem usu­ally trumps cor­tex, mak­ing willpower alone an un­re­li­able in­stru­ment. This is one rea­son why the per­son who quits once and for­ever is a rar­ity — most of us make sev­eral at­tempts be­fore quit­ting for good. (This is true for most drug de­pen­den­cies.) So each re­lapse is not a fail­ure, but a mile­stone on the road to even­tual suc­cess.

Smok­ing is both an ad­dic­tion and a habit, so both be­havioural strate­gies and med­i­ca­tion are help­ful for aug­ment­ing our willpower and im­prov­ing quit rates.

Be­havioural strate­gies in­volve look­ing at what sit­u­a­tions trig­ger smok­ing and how to avoid them. This of­ten means not hang­ing out with other smok­ers, and go­ing to places where smok­ing is not per­mit­ted. It also helps to work out which are the most keenly an­tic­i­pated cig­a­rettes of the day — the one with cof­fee at morn­ing tea, or a beer af­ter work on Fri­day — and work­ing out al­ter­na­tives in ad­vance. Un­for­tu­nately al­co­hol is a great dis­in­hibitor; it muf­fles our pesky frontal cor­tex, the bit of the brain that’s al­ways telling us to be sen­si­ble. While it can be good to be let off the leash some­times, it doesn’t help when you’re try­ing to quit, so avoid­ing or lim­it­ing al­co­hol is a good idea.

Ac­tual crav­ings are more a man­i­fes­ta­tion of de­pen­dence than habit, but be­havioural strate­gies such as the four Ds can still help. Th­ese

wob­bly re­fer to de­lay, deep breath­ing, drink wa­ter and dis­trac­tion. Urge surf­ing is an­other term for de­lay­ing. The na­ture of crav­ings is that they build to a peak and then de­cay, so if you de­fer light­ing a cig­a­rette for five min­utes it’s likely you won’t want it so much.

Med­i­ca­tions play an in­creas­ingly im­por­tant role. The avail­able op­tions are nico­tine re­place­ment (NRT), as gums, patches or in­halers; Zy­ban (bupro­pion), and more re­cently Champix (vareni­cline).

NRT is ex­tremely safe, re­flected in its non­pre­scrip­tion sta­tus. It al­most dou­bles the unas­sisted quit rate. Bupro­pion, orig­i­nally cre­ated as an an­tide­pres­sant, is as ef­fec­tive as NRT. It can cause in­som­nia, dry mouth, headache and rarely, seizures. It is con­traindi­cated in those who have a his­tory of, or are at risk for epilepsy. Vareni­cline is a par­tial nico­tine re­cep­tor ag­o­nist and has been as­so­ci­ated with higher quit rates than bupro- pion. It fre­quently causes nausea, and there have been re­ports of de­pres­sion and sui­cide, mak­ing it con­traindi­cated in peo­ple with mood disor­ders. Bupro­pion and vareni­cline are pre­scrip­tion-only med­i­ca­tions. While they can have side ef­fects, used ap­pro­pri­ately all three med­i­ca­tions can be safe and ef­fec­tive anti-smok­ing aids — far safer than con­tin­ued smok­ing.

If you smoke, quit­ting is al­most cer­tainly the sin­gle best thing you can do to im­prove your health. If you have re­solved to quit, best of luck and make sure you use all avail­able help. If you’re still con­tem­plat­ing, weigh up the pros and cons and see if you think smok­ing is re­ally worth it.

For in­for­ma­tion and sup­port visit your lo­cal doc­tor or call the Quit­line on 131848, or visit the Na­tional To­bacco Cam­paign web­site Quitnow at www.quitnow.info.au

Si­mon Cowap is a GP in New­town, Syd­ney.

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