I quit smoking yesterday, and today has been even more difficult than yesterday. Can you offer any suggestions about the depression associated with quitting smoking? I tend to have a difficult time with the depression.
My girlfriend is supposedly trying to quit smoking. She has smoked for about seven years now, and has cut down considerably. She now goes three or four days without a cigarette, but when we go out to the bars, she’ll smoke five or six. She’s trying to cut down to less and less. Is that a good way to quit? I’ve tried to tell her that she’ll never quit gradually like that. Please give some advice to help me guide her to quit.
Almost all authorities now agree that smoking is the single worst thing one can do for one’s health, and that it is truly an addiction — worse even than the addiction to heroin, according to some. It causes lung cancer, but many people don’t realize that the heart attacks attributed to smoking cause even more deaths than the lung cancer. Also not commonly recognized is that lung cancer now causes more deaths in women than breast cancer. This is very disturbing when one reads that adolescent girls are taking up smoking even faster than boys, and when one realizes how the tobacco companies’ ads target adolescents and young people.
New evidence is also accumulating that smoking is a factor in the development of cancer of the cervix, and it has been known for some time that it is a factor in bladder cancer. I think that we will ultimately find that it is a factor in many other cancers which will help to explain why, for instance, many women get infected with the wart virus HPV 16, but only a few develop cancer of the cervix.
Other reasons for quitting — emphysema, you’ve seen people who have to drag an oxygen tank around with them; mouth, throat and tongue cancer, (try eating after your tongue has been removed); Buerger’s disease, a frequent cause of leg amputations; and impotence, (when your arteries down there are clogged, Viagra doesn’t help much.
Both the letters I chose to write about today mention common issues with people who are trying to quit. In one, the depression that develops, which can be quite overwhelming; and in the other, the attempt to cut down rather than to quit abrubtly.
I totally agree with the boyfriend of the young woman who is cutting down rather than quitting. It can’t be done, not for long at least. When I myself was trying to quit in college, I did what she is doing, swore I would only smoke when I went out for some beers with friends. After I found myself going out every night for some beers, and finding it hard to wait for the bar time, I realized that that approach wasn’t going to work.
I think with willpower one can cut down, but maintaining that willpower for months or years while still exposing oneself to the addiction by having the occasional cigarette is too much. I have never known someone who quit successfully using the cutting down approach. It’s got to be abrupt, but it doesn’t have to be cold turkey anymore; there are now many aids to quitting.
One aid that I would certainly suggest to our first writer is bupropion (Zyban or Wellbutrin). This is an antidepressant and can be very effective in relieving the depression that sabotages many people’s attempts to quit. It must be prescribed by a doctor, and should be started a week before actually quitting, to build up the antidepressant effect. It does not stop the withdrawal symptoms (the urge to smoke), but does ease the psychological burden.
Other aids are the various nicotine replacement systems; Nicorette gum, the various nicotine patches, and a nicotine nasal spray and nicotine inhaler. I have had many patients, even very heavy smokers who quit by using the patches, so I still suggest them first, but the nasal spray or inhaler can be useful for people whose skin won’t tolerate the patches.
All these products really stop the urge to smoke. Since one can put the patches under clothing, no one needs to know what you are doing. Always start with the strongest patches, and work down through the strengths, using each strength for at least a month. Buproprion and the patches can be used together safely. What one cannot do is put on the patches and continue to smoke.
Want to think about some aids that don’t require taking medication? I successfully quit after being hypnotized. It didn’t stop the desire for a cigarette, but somehow gave me the strength to resist it, and most importantly, it kept me from being tempted to take a puff weeks or months after quitting — even in party situations. Many hypnotherapists who do smoking cessation advertise in the Yellow pages. Accupuncture has had successes with smoking as well as for other addictions, and many clinics specializing in quitting can be found in the Yellow pages.