Smoking Cessation

Party season is in full flight but it’s also around this time of year that we start to look forward and make plans for the year ahead. If you smoke and want to quit, maybe set it as your 2020 new year’s resolution? Your friends, family, colleagues (and bank account!) will thank you for it!

Why should I Quit?

The deleterious health consequences of smoking are innumerable. Smoking causes approximately 6 million deaths worldwide annually; it increases risk of heart disease, lung diseases like COPD and emphysema, stomach ulcers and peripheral vascular disease (which can lead to limb amputations; sometimes it really is life vs. limb). Smokers are also at increased risk of lung cancer and head and neck cancers.

Pregnant women who smoke are at increased risk of complications including preterm birth, miscarriage, and stillbirth. Their babies are also more likely to be underweight.

It’s not only smokers who suffer; it’s their family, friends, colleagues and children too. Children exposed to second-hand smoke have an increased risk of sudden infant death syndrome (SIDS), asthma, recurrent ear infections as well as developing heart disease and cancer later in life. Adults who are exposed to second-hand smoke are more likely to suffer from heart attack, stroke and lung cancer than those who aren’t.

Third Hand Smoke

Whilst smokers often think that if they don’t smoke in the vicinity of their loved ones and colleagues, they aren’t harming them. However, we now know that’s unfortunately not the case. Third hand smoke is the particulate matter from cigarettes that lingers in hair, clothes, furniture and walls. We know the smell when we walk into a room where someone regularly smokes. We can smell it from smokers on their hair and clothes long after they’ve smoked. We now know that this third hand smoke is also harmful to health. It can irritate airways of young children in particular.

I know most of the above information isn’t news to anyone. Smokers know smoking isn’t healthy. But this doesn’t make quitting any easier. Most want to quit but it’s a complex process that involves physical, psychological, emotional and behavioural changes that can be effected by social situations; it requires an enormous amount of willpower. It’s not as easy as simply wanting to stop because you know it’s unhealthy. It requires forward planning and support is needed- from family, friends and colleagues. And, of course, your GP can help too.

What are the Benefits of Quitting?

We often talk about the damage smoking does. But what about the positive changes that occur when smoking ceases? 

• Within 9 months of quitting, you regain your sense of taste and smell
• Within 3 months you can breathe more easily
• Within 5 years your risk of stroke is the same as a non-smoker’s
• Within 10 years you’re 50% less likely to die from lung cancer. 

Preparing to quit

I must admit that I’ve met patients over the years who quit “cold turkey”, usually after an event like a heart attack. But in most cases, change doesn’t happen overnight. If you’re not ready to quit, it won’t happen. I’m often asked by loved ones of smoker how they can get them to quit. But if the smoker themselves doesn’t want to do it, it will be like getting blood from a stone. The person themselves must have the willpower to do it and prepare in advance. 

Stages of change

Being mindful of the stages of change can help us support smokers and help smokers themselves to better understand the process of quitting. These include:

– Pre-contemplation (not ready to quit)

– Contemplation (considering a quit attempt)

– Preparation (actively planning a quit attempt)

– Action (actively involved in a quit attempt)

– Maintenance (achieved smoking cessation)

Set a quit date

Once someone decides they want to kick the habit and they’re ready to do so, it’s recommended to attend your doctor for support and set a quit date – usually two to four weeks time. That’s why you need to start planning for your New Year’s Resolution now!  Those who quit smoking with the help of their doctor are more likely to succeed than those who go it alone. Doctors can provide advice, assistance and cessation tools. We can also let these patients know what to expect. Knowing barriers and triggers that might arise is important so they can be recognised and a plan put in place to deal with them if and when they occur. 

Mindset and Preparing To Quit

Behavioural interventions are proven to help smoking cessation and self-talk is all important. A good way of motivating yourself to make any lifestyle change is to think of The R’s.

Risks: “If I continue to smoke, I know I’m putting myself at increased risk of cancer”

Rewards: “If I quit I’ll feel better and I’ll save money….my friends and family will also benefit from improved health”

Roadblocks: “I have a coffee and a cigarette morning with Karen. What will she think if I don’t do this with her anymore?”. Be prepared for how you might handle this roadblock. Maybe suggest you go for a walk at lunch hour instead? Whatever you think your roadblock will be, be prepared for how you’ll handle it. Fail to prepare, prepare to fail.

Repetition: Whenever you feel weak or you might relapse, repeat the risks and rewards to yourself. Write them down or say them in your head. 

I also like the DARN method for implementing change…

Desire- how much do you want to change? What would it mean to you to be a non-smoker?

Ability – what will provide you with the ability to implement change? Hint: Support from you doctor, forward planning and nicotine replacement therapy can help.

Reasons – what are the reasons you want to change?

Need – why do I need to change?

Triggers

Being prepared for what to do when triggered to smoke is critical. Have a plan for what you’ll do when triggered. Go for a walk. Run an errand. Fix a light bulb! Engage in positive self-talk “this will get easier. I can do this”. If you feel the urge to do something with your hands, drink a glass of water or make a cup of tea. Some recommend taking up colouring or knitting as a way to distract yourself when triggered. This occupies hands. For those who feel the need to do something with their mouth. Chewing gum can help. Whatever it is you do is up to you! Just don’t pick up a cigarette. Even one puff can trigger a full relapse. 

Stress Management

Smokers often reach for a cigarette during stressful situations. We all have something we revert to when stressed. And quitting itself is stressful. This is why stress management is all important during the quitting process. Taking up exercise can help manage stress as well as meditation, mindfulness and yoga. Over the years, I’ve gotten in to the habit of simply stepping outside my front door and walking when I’m stressed. Fresh air and some exercise can really re-set your thinking.

What happens when the body when I quit? 

It would be disingenuous of me to say that there won’t be physical changes to the body when you quit smoking. Nicotine is addictive and withdrawal symptoms can occur. If I was given a 10e for every time someone said to me “my uncle quit and he got sicker than ever before” I’d be rich! Some quitters do experience unpleasant and difficult symptoms like worsening cough, restlessness, poor concentration, low mood and insomnia. These peak at about 2 weeks and can go on for a few months in some cases but they do eventually fade. 

Severity of withdrawal symptoms can be predicted by how heavy the smoking habit is; they tend to be more severe in those who started younger, smoke more, and those who smoke early in the morning. Cognitive Behavioural Therapy can help combat these symptoms so it’s worth discussing this with your GP if you think you might be at risk. 

Weight gain is a major concern for many. However, weight gain experienced by quitters isn’t exponential. It typically plateaus at about 3 months and it can be reversed with healthy diet + exercise.

Nicotine Replacement Therapy and Medication

Nicotine Replacement Therapy is the gold standard of treatment for smoking cessation. There are many products out there. Some patients like patches. Some prefer the inhaler or the gum. The dose of nicotine you’ll require depends on how many cigarettes you smoke daily; your GP can help you calculate what dose will best suit you. In some cases, medicines can be prescribed to help. Medication can be taken for a few weeks up to a few months, depending on patient preference, and with their doctor’s guidance. 

Follow Up

Giving up cigarettes is a process that needs to be managed like any other ongoing illness. Follow up with your doctor within 3 months (when most relapses occur), or sooner if needs be, is recommended. It’s a good opportunity to discuss problems encountered and anticipating any upcoming challenges. There may be a need to readjust nicotine or medication dose. 

Relapse

Relapse occurs commonly. It happens. Don’t feel disheartened or ashamed. Pobody’s nerfect! Go back to your GP to discuss why you think it happened. What were the circumstances surrounding that first puff? Identifying what went wrong in that moment and coming up with a plan to tackle that can make the following attempt a success. Patients who are more prone to relapse are those who are suffering strong withdrawal symptoms and those who experience low mood or weight gain. If you recognise these, attend your GP for support and solutions. Get back on the horse again.