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Smoking Cessation

By Joseph Fedak

Recently I attended a statewide member advisory board meeting for one of the insurance companies that provide Medicaid insurance for mental health treatment.  I would like to share part of a program that the board members viewed.  Jaspreet S. Brar MD, MPH, and PhD presented the program from the Western Psychiatric Institute & Clinic, Pittsburgh, PA.  This segment is on smoking cessation.  I am sharing this with you because I learned some new information that may help those who wish to stop smoking.  The program is a self-management program for wellness.

Why is smoking cessation important?

Smoking is the most preventable cause of early death in the United States.  Compared to non-smokers, smoking is estimated to increase the risk of—-

  • Coronary heart disease by 2 to 4 times.
  • Stroke by 2 to 4 times.
  • Men developing lung cancer by 23 times.
  • Women developing lung cancer by 13 times.
  • Dying from chronic obstructive lung diseases (such as chronic bronchitis and emphysema (COPD)) by 12 to 13 times.

Smoking and mental illness.

  • Research has shown that contrary to popular notion, people with mental illness do not have worse symptoms after quitting.
  • Smoking increases the breakdown of some psychiatric medications.  Lower doses may be needed after quitting.
  • The chances of quitting smoking are increased if a medication (including Nicotine Replacement Therapy, NRT) is taken along with cognitive and behavioral treatments.
  • Medications approved by the FDA for smoking cessation can be used safely in people with mental illness (this includes Chantix and Zyban).
  • It is not unusual for more then one type of smoking cessation medications (including NRTs) to be used simultaneously (example…Chantix and the patch).

It is important to know that there is no right or wrong way to quit smoking.  Use a method that you are most comfortable for you.  If you are unsuccessful the first time, use it as a learning experience and try again.  Think about what happened? How you were feeling? Where were you and with whom? Were you using medications or NRTs?  How can knowing this help in future attempts?

Think of the rewards of quitting smoking.

  • As levels of carbon monoxide and nicotine go down, your body will start to heal.
  • The healing begins within 12 hours of quitting.
  • Your sense of smell and taste will improve within a few days.
  • You will breath easier.
  • Your cough (smoker’s hack) will gradually begin to go away.
  • You will no longer have to deal with the mess, smell and expense of smoking.
  • Quitting can reduce chances of having a heart attack.
  • The chances of getting COPD, emphysema and lung cancer will be reduced.
  • You will have more energy to do the things you enjoy.
  • You will have fewer coughs and colds, and fewer wrinkles.
  • You will have more control over your life and save money.
  • Others will not be exposed to second-hand smoke.
  • By quitting smoking, you will be a better role model for family members and friends.

Prepare yourself for quitting by remember to START.

  • S – Set a quit date.
  • T – Tell family, friends, co-workers and treatment team that you plan to quit.
  • A – Anticipate and plan for the challenges you will face while quitting.
  • R – Remove cigarettes and other tobacco products from your home, car and work.
  • T – Talk to your doctor about getting help to quit.

Before your quit date, keep a journal of when and why you smoke. Think about your triggers and have a plan in place to deal with the triggers before you stop.  Schedule your cigarettes and tell yourself when you will smoke.  Cut down by a few cigarettes if you can.  Try not to “wake to smoking”.  Wait a few minutes each morning between rising and smoking.

Common feelings of smoking withdrawal include…

  • Feeling depressed.
  • Not being able to sleep.
  • Getting cranky, frustrated, or mad.
  • Feeling anxious or nervous.
  • Feeling Restless.
  • Having trouble thinking clearly.
  • Feeling hungry or gaining weight.

Tell your doctor if you experience any of these feelings.  There are medications and coping skills that can help you to feel more comfortable.

On your quit day…

  • Keep busy.  Go to the movies, exercise; go for a walk or a bike ride.
  • Spend time in places where smoking is not permitted.
  • IF you miss holding a cigarette, hold something else like a pen, pencil or paperclip.
  • If you miss having something in your mouth, try a sugar-free lollipop, or carrot stick, etc.
  • Drink plenty of water or fruit juices but avoid alcohol.
  • Stay away from what tempts you to smoke.
  • Reward yourself with the “cigarette money” that you have saved.

When you crave a cigarette…

  • Try to wait it out.  Craving usually last 3 to 5 minutes.
  • Keep other things handy that you can pick up.
  • Wash your hands or take a shower.
  • Practice relaxing by taking deep breaths.
  • Picture a soothing pleasant scene and focus on it.
  • Light a candle or incense.
  • Change your location, Go somewhere you cannot smoke.
  • Remember the rewards of quitting.

Quitting for good and sticking with it…

  • Find new things to do.
  • Participate in activities like swimming, walking, exercising, etc.
  • Develop new hobbies like solving puzzles, needlepoint, gardening, etc.
  • Brush your teeth often and use mouthwash.
  • Get plenty of rest.

Other things to remember…

  • If you have a cigarette after your quit date, it is not a big deal.  A slip is a small set back.
  • Find the trigger that made you smoke and come up with a plan to cope with the trigger should it happen again.
  • If you have been prescribed medication, take it for the duration it was prescribed for and do not stop even if you have quit smoking.
  • If you think you are gaining weight, make an exercise schedule.  Start slowly and gradually build.  DO NOT SUBSTITUTE FOOD FOR CIGARETTES.
  • Think of the long-term rewards of quitting.

The following is a partial list of resources available to assist in smoking cessation…

I hope this information is helpful if you are looking into smoking cessation.  Good luck in your efforts.

Joseph J. Fedak

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