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Searching for A Way Out Smoking Cessation Techniques
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~.,
i
A Report w
by the American Council o
on Science and Health ~
~
4h
It's easy to quit smoking.
I know because I've done it
thousands of times.
7ffa1r! 7u,auc
Searching for a Way Out:
Smoking Cessation Techniques
This report on smoking cessation techniques was written ~by
Lee Francis, B.S., a staff member of the American Council
on Science and HealtK
ACSH gratefully acknowlodges the comments and'contribu-
tions of the following individuals who reviewed'this report:
Ihor Bekersky, Ph.D.
Dept. of Pharmacokinetics
Hoffmann-La Roche Inc.
Alan Blum, M.D.
New York State Journal of Medicine
Dee Burton, Ph.D.
American Cancer Society
Berton Freedman, M.P.H.
American Lung Association
Vincent Gardner, M.D.
Seventh-day Adventist Community Health Services
Karen Monaco
American Lung Association
William Havender, Ph.D.
Consultant, Berkeley, California
Mario Orlandi, Ph.D., M.P.H.
American Health Foundation
Cathy Becker Popescu, M.S.
American Council on,Science and Health
Nicholas Revotskie, M.D. N
Commercial Union Assurance Co. ~
c
0
Ronald T. Stanko, M.D. ~
University of Pittsburgh School of Medicine o
FredrickJ. Stare, M.D., Ph.D. , ~
Harvard School of Public Health U
Stephen S. Sternberg, M.D. Q
Memorial Sloan-Kettering Cancer Center ,o
~
Elizabeth M. Whelan, Sc.D., M.P.H. >
American Councif'on Science and Health V
Illustrated by Harry Wilson
The American Council on Science and Health
(ACSH) is a national consumer education association
directed'and advised by a panel of scientists from a
variety of disciplines. ACSH istommitted to providing
consumers with scientifically balanced evaluations of
issues relating to#ood, chemicals, the environment, and
health:
ACSH is a nonprofit association exempt from federal
income tax under Section 501 (c) (3) of the Internal
Revenue Code. All contributions are tax-deductible as
provided by 16w.
Individual copies of this reporfare available at a cost
of $2.00. Prices for 10 or more copies are avai!able on
request.
October 1984
Motivation, desire and commitment - the smoker who
chooses to quit must have strong personal reasons to
do so.
1'
Aims of This Report
The American Council on Science and Health (ACSH)
has reviewed a wide variety of smoking cessation
techniques. It is not the intent of ACSH to endorse one
particular program or method over another but
rather to provide guidance and information for those
interested in smoking cessation.
Time and'space considerations prohibit reviewing all
smoking cessation methods and programs. Some of
those presented in this booklet are ones that are
particularly well-known to the public. Others are
included because there has been conflicting evidence
over their value or effectiveness.
Introduction
If you don't smoke, chances are you have a close
friend or relative who does. If you do smoke, chances
are you'd like to quit. For anyone who has ever
watched a smoker try to break the habit, the task
seems next to impossible. For the smoker himself the
desire to quit is one thing - success is another.
Although smoking involves a powerful chemical
addiction and behavioral patterns that are tough to
break, in the last 15 years some 33 million Americans
have kicked the habit. Since 1965, ust after the
release of the first Surgeon General's Report' on
Smoking and Health, almost one-third!of all American
smokers have given up lighting up. Presently, 56
million Americans smoke.' Of this number 60 percent
have seriously attempted to quit and another 30
percent, say they would try to stop if there were an
easy way. In all, some 90 percent of American
smokers say they would like to quit.z
Over the past 20 years a variety of smoking cessation
programs have sprung up: Treatment ranges from the
use of professionally administered hypnosis and
acupuncture to scientifically planned programs
devised and offered by nonprofit, organizations such
as the American Cancer Society, the Seventh-day
Adventist Church, the American Health Foundation,
and the American Lung Association. Other
organizations such as SmokeEnders, Smoke
Watchers, and the Schick Program operate under a
for-profit status. Details about how these programs
operate are often unclear to smokers and nonsmokers
alike. Although every smoking cessation program
strives for the same result, the methods often differ
greatly.
2
IN
The Successful Quitter
All smoking cessation methods have at least one thing
in common - a flexible notion of what it takes to
become a successful quitter. As one expert in the
pharmacology of nicotine stated: "There are 56
million smokers and 56 million different individual
problems." Each person has a unique perception
about what it's like to quit, but in order to be
successful there are several overriding considerations:
/vlotivation, desire and commitment. The smoker
who chooses to quit must have strong personal
reasons to do so. M'ost cite concern about health as
the main reason for quitting. Smokers who attempt to
quit only because family members or best friends
want them to are usually doomed to failure.
Successful quitters make a firm personal commitment
to stop. Along these lines, the Seventh-day
Adventists' Five-day Plan centers around the key
words "I choose not to smoke." The American Lung
Association's self-help stop smoking manual urges
participants to fill out and sign a special stop smoking
contract as a form of commitmentl. The American
Cancer Society's FreshStart guide stresses that "this
time is going to be unique in that this time you are not
going to smoke." Hypnotherapists and acupuncturists
will not accept clients who do na have a strong
personal desire to stop. Tom Wicker, syndicated
columnist for The New York Times and'former smoker,
summed it up best when he wrote: "lf you wantto
stop smoking, you can; if you merely think you ought
to, you're kidding yourself."
Timing. Kicking the habit tends to throw a smoker's
life off track for a while. After all, smoking is quite a
habit,to break for a person who has, for example,
been lighting up 20 times a day, 365 days a year, for
20 years. Trying to break the habit in the middle of an
important business or family crisis is not going to pave
the way to success. Smoking cessation takes lots of
energy and planning. In order to succeed, the time
must be right.
Choice of method. No particular smoking cessation
method is right for everyone.Surveys show that 90 to
95 percent of all smokers prefer to quit on their own
or by using printed instructions, guides, or videos.'
The others need informal group support or _
counseling. But those who show the highest success
rates not only reflect the highest levels ofif
determination, but are also committed to personal
change and are well aware of the reasons why they
want to quit. Studies show thatthese people are open
to trying any one of a variety of cessation programs
rather than being prejudiced toward a particular
3
%N'
method, lt is essential thatthe smoker plan ahead'and
choose the method that most closely conforms to his or
her personal needs.
Do Some People Find It More Difficult
to Quit Than Others?
Yes. Most experts agree that motivation, commitment,
and planning are the keys to a successful attempt to
ditch cigarettes and most people differ considerably
in these key areas. Success in quitting is related''to
personal characteristics, the length of smoking history,
and the amount of cigarette consumption. Those
smoking more cigarettes for a greater time period
may find it tougher, but by no means impossible, to
quit.
Some studies, including the Surgeon General's The
Health Consequences of Smoking for Women, 1980,
report that cessation success rates for women lag
slightly behind the rates for men. The reasons for this
are not clear.
What Is Withdrawal and What Are the
Symptoms?
Simply put, withdrawal is the process of the body
getting used to doing withouf something that it has
depended upon for a long time. For smokers,
withdrawal hits in two ways.
When a smoker quits, the body no longer has the
stimulant nicotine to rely upon. This leads to
"physiological withdrawal" - a series of natural
body reactions to the absence of nicotine. The
symptoms of physiological withdrawal vary from '
person to person both in duration andin character ~
But, for most people who quit smoking, virtually all
physical effects subside within a week. ~
Unlike physiological withdrawal, "psychological
withdrawal" can last muchJonger - from weeks to
years. It results from the breaking of behavioral
habits that began to develop with the smoker's first
cigarette. Many smoking cessation programs attempt li
to zero in on psychological withdrawal by helping the
new nonsmoker to develop a new and more positive
self-image.
Following is a list of some of the more common
symptoms of withdrawal. Most are relatively short
lived. As one researcher phrased it: "The impressionn
might be drawn that every smoker, upon withdrawal
from tobacco, becomes irritable and anxious and is
unable to think, work, sleep, drive, or carry on a ~
normal social discourse for want of a cigarette. lJ
Fortunately, this is not the case." ~ ~
.~ ~
4
~
A common withdrawal symptom is a cough. Smoking
paralyzes the hairlike cilia structures that naturally
clean the lungs by "sweeping out" foreign matter.
Increased coughing may occur as the cilia regain full
function, removing excess tars from the lungs.
Coughing eventually subsides as natural lung function
takes over.
Craving might be present at first'as an
overpowering desire to smoke. It is often manifested'
later as pleasant thoughts about the pleasures of
smoking. Craving may last from weeks to years. It
need not last long if handled properly.
About 90 percent of all ex-smokers experience
craving and about 50 percent of all quitters who
relapse cite craving as a major factor. Some actually
experience a sense of: sadness or grief as if they have
lost a loved one. Craving is related to both
physiological and psychological withdrawal.
Cough. Smoking paralyzes the hairlike cilia
structures that naturally clean the lungs by "sweeping
out" foreign matter. Increased'coughing may occur as
the cilia regain full function, removing excess tars from
the lungs. Coughing eventually subsides as natural
lung function takes over.
Headache. The exact causes are unknown but
extra rest, deep breathing exercises, or increased
exercise may help according to the American Lung
Association.
Tingling sensation or numbness is sometimes
I L- -- -- --- '" ---- - - 5
:
~
experienced in the arms or legs and represents
s
improved circulation as a result of stopping smoking.
The body acclimates to this improvement, over time.
Nervousness and tension are related to withdrawal
from nicotine. Consumption of fruit juices in the first
few days after quitting can help to slow nicotine
release from the body thereby easing these
symptoms. Staying off caffeine can help as well since
it alone can cause nervousness. (Some, however,
swear that drinking lots of coffee actually helped them
to quit.)
Tiredness. Smokers may be used to a higher level
of arousal due to the effect of nicotine. Cutting out
nicotine is a letdown to the body. Stepped-up exercise
and an extra hour of sleep are recommended.
Lack of concentration, light-headedness, and
dizziness. The brain gets more oxygen instead of
carbon monoxide when a person stops smoking. This
takes some getting used to.
Slight sore throat. Tobacco smoke irritates the
throat but also numbs it. Discomfort is felt as the
numbness wears off and the throat begins to heal
back to its normal state.
Constipation. Increased dietary fiber can help if
constipation occurs. Otherwise a physician shouldbe
consulted if symptoms are prolonged or debilitating.
What About Weight Gain?
Weight gain is often reported among those who give
up smoking, although not all people experience this.
Quitters often try to nurse the symptoms of
withdrawal by snacking more than usual and
rewarding themsel+ies for cigarettes not smoked by
consuming extra treats. Some experience an
improved sense of taste which increases the desire to
eat. Others feel a need to put something in,their
mouths to replace cigarettes.
A recent study published in the AmericanJournal of
Public Health shows that quitters, on the average, do
gain more weight than those who continue to smoke.'
Although few studies have been done on females,
men tend to gain an average of 5.3 pounds. A survey
of male, blue-collar shipyard workers revealed that
46 percent of those who had quit smoking for one
year gained'five pounds or more; 30 percent gained
zero to five pounds; 24 percent actually lost weight or
stayed the same.
Unlike the symptoms of withdrawal, weight gain is
entirely avoidable, but 60 percent of all4emale
smokers and 47 percent,of all male smokers say they
are reluctant to quit, because of fears of weight gain.
1
nj
Quitters often try to nurse the symptoms of
withdrawal by snacking more than usual and
rewarding themselves for cigarettes not smoked by
consuming extra treats. Some experience an improved
sense of taste which increases the desire to eat. Others
feel a need to put something in their mouths to replace
cigarettes.
Since more than half of all quitters gain very small
amounts or actually lose weight, a few intelligent
controls can be very effective in avoiding weight gain
during smoking cessation. Almost every smoking
cessation program includes ideas and suggestions
which help quitters to avoid weight gain. Most stress
stepped-up exercise, low-calorie snacks, and a
balanced diet consisting of three nutritious meals per
day.
A smoking cessation program that does not deal
seriously with the possibility of weight gain is not'.
coping with an important'consequence of quitting for
many individuals.
The New York Heart Association reports no
significant cardiac risk associated with small weight
gain. Relatively speaking, a person must gain 125
pounds above normal weight to offset the benefits of
quitting a pack-a-day habit.s
7
y,
t
.
.1
Studies indicate that people quitting "cold turkey"
experience withdrawal symptoms which subside
significantly more quickly than those experienced by
people who quit by gradual reduction.
The Beginning of Quitting Techniques
The incidence of lung cancer began to increase
around the turn of this century yet it wasn't, until the
early 1950s, when the public became aware of the
link between lung cancer and smoking, that smoking
cessation programs began to develop. Public stop-
smoking clinics first began in Stockholm, Sweden in
1955. These early clinics utilized medications,
pamphlets, lectures and physician counseling to help
people kick the habit. In the 1960s these clinics spread
to other parts of Europe and'the United States.
Today, smokers can choose among three basic
methods of quitting: (1) Self-care techniques such as
devising one's own way of quitting or utilizing self-
quit guides, instructions, cassettes, videos, filters or
some other aid; (2) Participation in support groups
and smoking clinics run by nonprofit and commercial
agencies; (3) One-to-one consultation with
professionals.
Although there are a number of group and'
professional programs available, statistics show that
most smokers would prefer to quit on their own.
8
