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Butting out…The HOW of quitting smoking

When you or the person you are supporting are actively thinking of butting out

When you or the person you are supporting are actively thinking of butting out and are ready to commit to action, having a game plan will greatly increase the chance of success.

How to get started 
It is important to list the reasons for quitting AND build a vision on the positive feelings and possibilities when the person is tobacco-free.

For some people it is about improving their physical health or reducing the risk on developing other chronic illness; for others it may be financial cost-saving or improved personal relationships.

Visit this list often. This will help the individual to focus and feel energized.

What options are available? 
There are a variety of options available to smokers who want to quit: quitline, quit aids, self help and counseling.  There is no single way that works for everyone. People who have the best chance of quitting are those who use both a program that offers some counseling or support, like a quitline and a quit aid.

Knowing the person’s level of addiction to nicotine may offer some insight into the choice of appropriate option(s).  Have the person answer these questions:

  • Do you on average smoke more than 15 cigarettes a day?
  • Do you usually smoke within 30 minutes of waking up in the morning?
  • Do you find it difficult to go more than 4 hours without smoking?
  • When you try to quit or cut down on the amount you smoke, do you get dizzy, irritated and frustrated and have trouble concentrating or sleeping or eating?

“No” to all the questions probably means a low level of nicotine addiction. The person can consider self-help or quit aids (medicine).

“Yes” to 1-2 questions probably means a moderate level of addiction. The individual may need counseling, quit aids (medicine) or self-help, or a combination of these to quit.

“Yes” to 3 or more of these questions probably means a high level of addiction to nicotine. The individual will need counseling, quit aids (medicine) or self-help, or a combination of these to quit.

Available Options:

Quitlines

Every province and territory has a quitline, where smokers can get free information on tobacco use and support to quit smoking. Using a quitline can double the chances of successfully quitting.

Quit aids 
These quit-smoking medicines (nicotine replacement therapy or prescription medications), when used properly, have been shown to increase the chances of successfully quitting.

Nicotine replacement therapy (NRT)
NRT works by reducing the cravings caused by quitting smoking, delivering a controlled dose of nicotine to the body over time. NRT products are available over the counter and each product is available in different doses. It is important for the person to talk to their pharmacist or healthcare provider to select the correct dose.

NRT comes in 5 forms: patch, inhaler, oral spray, gum and lozenge. Although they all contain nicotine, they are much safer than tobacco and they don’t cause cancer.

  • Nicotine Patch: applied to the skin and delivers a continuous controlled dose of nicotine.

Tip: start using the patch as soon as the person stops smoking. It is usually not recommended to smoke while on the patch to avoid excessive nicotine. The patch should be applied to a clean, dry area above the waist.

The following products may be used alone or in combination with the patch to reduce the craving.

  • Nicotine inhaler: it looks similar to a cigarette; it’s a plastic cylinder that holds a cartridge containing nicotine. It addresses the hand-to-mouth ritual.

Tip: The vapour is not designed to be inhaled like a cigarette, but rather should be puffed on lightly so that the vapour stays in the mouth. Avoid drinking acidic beverages such as coffee, tea, soft drinks, alcohol and citrus juices when using the inhaler because they can prevent it from working properly

  • Nicotine Spray: The oral spray is an instant spray into the mouth.

Tip: Avoid spraying the vapour on lips or down the throat. Do not inhale while spraying.

  • Nicotine gum: It contains nicotine that is absorbed through the cheek.

Tip: Chomp on the gum a few times and then park it against the cheek for 20–30 minutes. Chew it occasionally but don’t chew it rapidly like regular gum.

  • Nicotine lozenge: The lozenge comes in the form of a hard candy. It satisfies the oral cravings and the need to do something with the mouth.

Tip: Suck on a lozenge slowly it until you notice a strong taste, then park it between the cheek and gum. Wait a minute, or until the taste fades, and repeat by sucking it until you again notice a strong taste. Then park it again. It should take 20–30 minutes to dissolve. Do not chew or swallow the lozenge.

 

Prescription medication: 
There are 2 quit-smoking medications: varenicline (Champix®) and bupropion (Zyban®) which stimulate the same areas of the brain that nicotine does. It prevents the pleasurable effects of smoking. It helps to reduce cravings and withdrawal symptoms.

Self-help guides
Self-help booklets are good tools because they help the person create a plan to follow. There are other great forms of self-help, such as online forums, interactive websites and smartphone apps. Check out the self help booklets called “One step at a time” and the app called “Break It Off” developed by the Canadian Cancer Society.


Tips to lighten the journey of quitting:

  • Pick a quit day within the next two weeks to quit. Don't wait for the "perfect" day – just pick a date and work with it.
  • Create a smoke free environment. Set SMART goals to push smoking out of the person’s everyday life.
  • Enlist family, friends and other supporters: tell them about the plan to quit, so it feels more real.
  • Explore new hobbies to keep the hands and mind busy instead of smoking – exercise, knitting, making model airplanes.
  • On the quit date, butt out completely. Don’t smoke, not even a little. Toss out the cigarettes, other tobacco, and ashtrays.
  • Understand the triggers: avoid people and situations where the person will be tempted to smoke. Change the usual routine, so the new routine doesn’t include smoking.
  • Remember that nicotine withdrawal symptoms only last a short time. Follow these tips to cope with withdrawal symptoms. Once the withdrawal is over, the person will feel better.
  • Consider exercising more, set SMART goals to become more active. Exercise has many benefits: takes the mind off cravings, improves the person’s mood and energy level, and helps keep off extra weight. If the person is new to exercising, start slowly. A walk around the block is a good start.
  • Tell people how long the person has been quit. It's a major achievement and the person should be proud.
  • If the person slips up, don’t give up. Try quitting again. Try to figure out what the barriers were to quitting. Were the nicotine cravings too strong? Did the person go back to smoking when he/she was stressed? Talk about the experience with the person’s counselor, doctor or pharmacist. Ask how the individual can do it differently next time. Then try quitting again. Keep trying.

I look forward to receiving your comments in the Medication section of our Connect Forums.

About Freda Leung

Freda Leung is a consultant pharmacist who specializes in diabetes and geriatric medication management. She is a Certified Diabetes Educator (CDE), a Certified Geriatric Pharmacist (CGP), a Certified Respiratory Educator (CRE) as well as a graduate from “Teacher of Adults Certificate Program” from Centennial College. Freda is also a faculty member of the Institute for Healthcare Communication; a facilitator to “Choices and Changes - Clinician Influence and Patient Action” and “Brief Action Planning”, programs developed for health care professionals to support self-management in people living with chronic health conditions. Currently she is a clinical pharmacist at The Scarborough Hospital GAIN geriatric clinic. Her other professional activities include: consultation to long term care homes on diabetes management; teaching continuing education programs at The Ontario Pharmacists’ Association and speaking on topics related to diabetes, geriatric medications and health behaviour changes.

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