Giving up smoking

Why quit smoking

You know that smoking is bad for you - but the urge to smoke is so strong that this knowledge can easily be put to one side in favour of another cigarette.

It might help to remember why it's so bad for you, why you might find it difficult to stop, and how much there is to gain from stopping. This could help you to take the step to give up for good.

And with smoking banned in all workplaces across the UK, including pubs and bars, there's another reason to quit - you won't have to keep going to stand outside if you go out for a drink.

Tobacco and health

Tobacco smoke contains the powerfully addictive drug nicotine, as well as a whole range of other harmful chemicals, including the poisons carbon monoxide, formaldehyde and hydrogen cyanide.

Smoking causes a very long list of diseases and health problems including:

• lung cancer
  
• chronic obstructive pulmonary disease
  
• heart disease
  
• stroke
  
• impotence
  
• osteoporosis (brittle bones), making them more susceptible to fractures
  
• cervical cancer in women

Smoking can also affect your breathing, taste and sense of smell.

Passive smoking

Passive or second-hand smoking means breathing other people's smoke and this can have serious health risks.

• According to Action on Smoking and Health, if you smoke at home and live with a non-smoker you will increase their risk of heart disease and lung cancer by a quarter.
  
• Smoking also has an impact on your children's health. It puts them at greater risk of developing lung diseases such as bronchitis and pneumonia, and predisposes them to cancer and chronic obstructive pulmonary disease as adults. They are also more likely to begin smoking if they see you smoking at home.

Pregnancy and quitting

If you are pregnant, there are even more reasons to give up. Smoking when pregnant can cause low birth weight, premature birth and bleeding. It is also linked with an increased risk of miscarriage.

Smoking during pregnancy also increases your baby's risk of being a victim of sudden infant death syndrome (sometimes called cot death). And if you smoke when you are pregnant, your baby is more likely to develop a range of illnesses later in life, such as respiratory infection, asthma and cardiovascular disease.

Why is it difficult to quit?

Nicotine is an addictive drug that causes both physical and psychological dependence. This is a complex form of addiction as you will have a strong desire to smoke, even if you wish to stop.

Smokers often continue smoking because they experience unpleasant withdrawal effects when they stop. Common withdrawal effects include:

• irritability
  
• difficulty concentrating
  
• craving for another cigarette

Some smokers gain weight when they give up - however, the benefits to lung function are likely to make exercise easier.

Smoking is also a habit - it becomes associated with various emotional occasions, situations and events. For some people, this psychological dependence can be even harder to break than the physical addiction.

But despite these challenges, it can be done - between 1988 and 2004 there are 1.2 million less smokers in England.

If you have already tried to give up but are still smoking, understand that this is all part of a normal giving-up process for you. Trying again is simply a continuation of your original decision to give up. Most people who give up successfully have been through several attempts to quit.

What do I gain from quitting?

By stopping smoking, you can improve your health and enjoy a longer, healthier life.

You will also save money: a 20-a-day smoker now spends over £2,000 a year on cigarettes.

As smoking also causes wrinkled, damaged skin, giving up is likely to make you look better too.

How to quit

It's important to understand your smoking before you give up. Keep a smoking diary for a week, noting down when you smoke, where you are, who you are with and how you felt before and after smoking. You may spot patterns, triggers or habits.

If you notice smoking triggers, write down how you could deal with them if you were to stop smoking - a good way to break a habit is to replace it with a new one.

It's also helpful to choose a target date for stopping smoking, perhaps a month ahead. Although gradually cutting down works for some people, smoking cessation experts generally advise that it's best to commit to a quit date and then give up completely.

Nicotine is eliminated from your body as quickly as 48 hours after your last cigarette. Your withdrawal symptoms will therefore be intense for the first two or three days, and will then subside over the next two or three weeks. Trying to cut down gradually is likely to just prolong the withdrawal process.

Getting help

Giving up smoking is easier if you have support, even if it's just encouragement from your friends and family.

Your chances of successfully quitting are better still if you take nicotine replacement products, or the prescription-only medicines such as bupropion (Zyban) (see below). Both of these help to lessen withdrawal effects. If you commit to a quitting date they can be prescribed by GPs and from smoking cessation clinics.

Using nicotine replacement therapy or bupropion (eg Zyban) can double your chances of successfully quitting. Combined with counselling and support these methods may increase your chances up to four fold.

Nicotine replacement therapy (NRT)

Nicotine replacement therapy supplies your body with nicotine, but as a smaller short-term supply than your body is used to getting from smoking cigarettes. It can help reduce withdrawal symptoms. It can be used in different forms:

• chewing gum
  
• patches that you apply to your skin
  
• inhalers
  
• tablets or lozenges
  
• nasal spray

All of these are available over the counter at pharmacies and in some supermarkets. Getting a prescription from your GP will mean that they may be cheaper than buying over the counter.

Almost everyone can use NRT, including pregnant or breastfeeding women. But if you've recently had a heart attack or have any other heart problems, it's best to talk to your GP first.

Bupropion (eg Zyban)

In some cases your GP may prescribe bupropion tablets for you, which seem to help people break their nicotine addiction. Because of the risk of adverse effects, this medication tends to be prescribed only after a full trial of NRT.

You need to start taking it one to two weeks before you plan to stop smoking and for about six to eight weeks overall.

Women who are pregnant or breastfeeding shouldn't take bupropion. It isn't suitable for people who have a history of seizures (fits) or eating disorders. It also can't be taken with certain other medicines, including some antidepressants.

Varenicline (eg Champix)

Varenicline is another tablet that can help you give up smoking. It works by reducing cravings for nicotine. Like bupropion (Zyban), your GP may prescribe you varenicline if you commit to a giving up date. You start taking it one or two weeks before stopping smoking.

Helplines, counselling and other support

There are local and national organisations, such as Quit, that can offer advice and support to help you give up smoking.

Information is available from freephone helplines. They also offer booklets and leaflets, email support and online collections of top quitting tips.

Your GP or practice nurse can also refer you to the NHS Stop Smoking Service, which provides counselling and support to smokers who want to quit. Some surgeries also have dedicated stop smoking clinics.

Alternatively you can contact these services by telephone or online. See the Further information section below. Helplines are also available in languages other than English (eg Urdu and Turkish).

Complementary therapies

Complementary therapies include acupuncture and hypnotherapy. Although there is little scientific evidence to prove that these approaches are effective, some smokers find them a helpful support.

Coping with difficult situations

Because smoking may have been part of your normal routine for so long, there will be occasions when it is especially difficult to resist cigarettes. Some tips to help you are listed below.

• For a while after you quit, try to avoid places where lots of other people smoke or that you associate with smoking. Smoking is often associated with drinking alcohol.
  
• If people offer cigarettes, ask them not to. Remind yourself that most smokers wish they too could stop. Say "No thanks, I'm not a smoker".
  
• Break the usual routines. Avoid situations that you associate with smoking. For example, if you usually smoke after dinner, leave the table and do something else instead.
  
• If you do have a lapse, don't use it as an excuse to start smoking regularly. Many ex-smokers admit to the odd mistake, but remain smoke-free. If you do lapse, think about why you smoked and then work out how best to avoid that trigger in future. Don't give up on giving up.

Further information

Quit
0800 00 22 00
www.quit.org.uk

NHS Smoking Helpline
0800 169 0169
www.gosmokefree.co.uk
 

Sources

• Congress 2004, agenda. Royal College of Nurses. www.rcn.org.uk, accessed 1 November 2006
  
• Factsheets. Action on smoking and health. www.ash.org.uk, accessed 19 June 2007
  
• Smoking and cancer: Children and smoking. Cancer Research UK. www.cancerresearchuk.org, accessed 19 June 2007
  
• Tobacco. Department of health. www.dh.gov.uk, accessed 26 June 2007
  
• Smoking cessation. Clinical Knowledge Summaries. www.cks.library.nhs.uk, accessed 26 June 2007
  
• British National Formulary (BNF). BMJ Publishing Group, 2007. 54: 268-269
  
• Varenicline for smoking cessation: Final appraisal determination. NICE. www.nice.org.uk, accessed 26 June 2007

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Dr James Quekett, Bsc, MB, ChB, MRCGP, DRCOG, DFFP, General Practitioner (GP) and GP Appraiser, Gloucestershire, and by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.