How To Quit Smoking

They say you have to want to quit smoking. But what smoker doesn’t want to quit?
By Arthur Allen
WebMD Feature
Reviewed by Jonathan L Gelfand, MD

I started smoking when I was a bored and lonely 17-year-old irrigating alfalfa fields in Utah for money and reading Zen and the Art of Motorcycle Maintenance for enlightenment. I smoked watching magpies splash in the ditch, and for 20 years I kept sucking those nasty things for reasons of self-loathing and distraction, and mainly because I couldn’t stop. In 1996, just before my son was born, I put a lid on it. I wasn’t going to contaminate my babies with second-hand smoke. And it wasn't hard to figure out how to quit smoking.

I was on the patch for a while. Then I chewed the little Nicorette pellets, stashing them in my car and my satchel and by the bed, finding chewed pieces stuck to my shirts and the inside of the clothes drier.

In 2001, I was hospitalized with a freaky bout of toxic shock for three weeks and was dialyzed, oxygenated through a tube, and fed 40 different medicines. That got the nicotine out of my system for good. Or so it seemed.

While spending the summer of 2004 in Tokyo, where everyone smokes, I started up again, telling myself I could leave the habit on that side of the Pacific. Duh!
So now I’m a five-a-day man — cigarettes, not packs — and I kick myself each time I light up. It’s a tiresome habit, and I’m going to quit smoking again. Real soon.

A good reason to quit smoking: If you smoke, your kids will
They say you have to want to quit smoking. The thing I’ve never really understood, though, is the meaning of “want to.” All smokers want to stop smoking. You’d have to be born on the moon not to know that smokes give you cancer and emphysema, cut years off your life, drive away pretty girls, and waste your money. I don’t want any of that.

I don’t even like smoking past the second drag and often toss the thing only halfway burned. I even smoke in secret if my kids are around. (Maybe I get some kind of pleasure from doing it — perhaps because it makes me feel like an outsider, residually cool, in touch with my feckless youth.) And yet, there is that moment of satisfaction when I light up — or to be precise, seven seconds later, the time it takes for the nicotine to reach my brain.

“What it boils down to is this,” says Robert Klesges, a clinical psychologist at the University of Tennessee Health Science Center in Memphis. “You have a list of reasons to quit, and that list has to be longer than the list of reasons to continue.” Then he says, “The best way to predict whether your kids are going to smoke is if you smoke. If you don’t want your kids to smoke, put that down on the list.”

Who is most likely to quit smoking?

So I guess it’s a matter of willpower — except that psychological predispositions matter too. Smokers are much more likely to be depressed than non-smokers, and among schizophrenics, the rate of smoking is close to 90%. Is it because smoking eases their pain, or is smoking a symptom of someone who, at some level, doesn’t think life is really worth living? Although I’m not particularly nuts, I do approach the question with a degree of fatalism. I’ve smoked about 75,000 cigarettes. Each one has left a poisonous black slick on my lungs. It’s hard not to feel that the damage is already done.

And “willpower,” as measured by the stated decision not to smoke, isn’t a deciding factor in how successful you’ll be at quitting smoking. “You absolutely have to decide to quit,” says Jonathan Foulds, director of the Tobacco Dependence Program at the University of Medicine and Dentistry of New Jersey. “But if you ask people when they start a program, ‘How much do you want to quit?’ usually their answer doesn’t predict success nearly as well as how addicted they are.”

The best indicator of whether you will be able to quit smoking, it turns out, is how long it takes before you fire up the first coffin nail in the morning. At Foulds’s clinic, which sees 500 to 600 prospective quitters a year, patients who light up within five minutes of waking have only a one-in-five chance of kicking the habit. People who can wait half an hour or more quit smoking a third of the time.

Another key question is the smoker’s ability to withstand discomfort. One scientist found that the longer a smoker could hold his breath, the more likely he was to be able to quit smoking. “Nicotine withdrawal is uncomfortable,” says Foulds. “People need to prepare themselves that, come hell or high water, nothing is going to get them to smoke.”

Number one tip: Don’t try to quit smoking alone

And of course, there are chemicals that make it less uncomfortable to stop. When smokers enter cessation programs, they generally get drugs or nicotine replacement therapy along with counseling. People who try to quit smoking without either have a 7% success rate. The rate doubles with pharmaceutical help and triples with pharmaceutical help and counseling, says Foulds.

“In our clinic, we use Zyban [an antidepressant shown to help people quit smoking] plus the patch plus one of the other replacement therapies,” says Foulds. “We figure it’s a lifesaving intervention, so why do it halfheartedly? These medicines are not very dangerous in themselves, so there’s no reason to hold back.”

It’s perfectly all right to be on nicotine replacement for as long as necessary to quit smoking. Nicotine has some obvious benefits — it makes you more alert and seems to decrease the risk of Parkinson’s and Alzheimer’s disease. And although it may increase blood pressure, its negative effects are trivial compared to the thousands of other poisons in cigarette “tar,” which is responsible for cancer, heart disease, and most other ill effects of smoking. “If it’s a question of smoking or spending your life on nicotine replacement, I choose the latter,” says Klesges.

Zyban, the brand name for bupropion, apparently works by activating reward centers in your brain similar to the way nicotine does. A new drug, varenicline, marketed as Chantix, blocks the receptors that get turned on when you smoke, making smoking less pleasurable.

Studies seem to show varenicline is more effective than Zyban, but with a cost. About a third of those who stayed on varenicline reported nausea. “A colleague of mine who did one of the early trials said he could tell which patients were getting the drug [and not the placebo] because they were turning green,” says Klesges. Still, varenicline may be an option for some people.

The “never borrow a cigarette” rule

Once you’ve stopped, obviously, it’s essential to stay stopped. Relapses are common, but Klesges has a system for keeping them to a minimum. The rule is never relapse on a borrowed cigarette. If you need a cigarette desperately, leave wherever you are and buy a pack at a store. Smoking is a sudden urge, one that can fade on the way to the 7-Eleven. If it doesn’t, throw away the 19 left in the pack that you don’t smoke.

“I’ve never had anybody follow these rules and relapse,” Klesges says. “But a lot of people don’t follow the rules.”

A footnote: Three days after I submitted this story, on my 48th birthday, I stuck a 14 mg nicotine transdermal patch on my arm. I’m on my second day. Wish me luck.