Reliable information for your brain, about your brain

How to stop smoking

There are no magic wands when it comes to stopping smoking. What works for one person may not work for the next. And what didn’t work the first time around, may work the third or fourth. If this is your first attempt to stop, know that there are many people who are successful that first time. If you have tried before and want to try again, you are also not alone. Remember that each attempt brings you closer to your goal. Keep going and don’t let mistakes discourage you.

Below you’ll read about some of the factors that can affect a person’s chances of success, as well as approaches commonly used. The list is far from exhaustive.

Index of topics:

Motivation
Depression
Medication
Nicotine gum and patches
Cognitive-behavioral therapy (CBT)
Hypnosis
Exercise
My combination of approaches
My next post

Motivation

The biggest factor for successful smoking cessation is motivation. If you want to stop because someone else says you should, or if you want to but still have reservations, then you are much more likely to start smoking again. How would being smoke-free personally affect you in the short-term? Would you be able to breathe easier? Have more money? Not have to sit outside in the cold so you can smoke? Have more time? One way to determine your motivation level is to ask yourself: are you ready to throw out ALL cigarettes, lighters, and ashtrays? If so, you’re probably ready.

Depression

Fact is, smokers are more likely than non-smokers to be depressed. And depression and anxiety makes it more difficult to stop smoking. Interestingly, one study found that Caucasian and Black depressed individuals, but not Latinos, have a harder time stopping smoking when depressed. If you go to a therapist to help you stop smoking, he or she can help you decide whether or not other issues need to be addressed before starting a smoking cessation program. This will probably help your chances of successfully stopping.

Medication

Buproprion, otherwise known as Zyban and Wellbutrin, has been prescribed for depression for many years and has shown to be effective for some people to stop smoking. It works by reducing one’s cravings and withdrawal effects. In a well-cited, well-designed  study by Hurt, Sachs, Glover, et al. (1997), a large number of smokers were given various doses of a sustained-release form of Buproprion for 7 weeks. Those taking the highest doses (150 and 300 mg) had the best results. They had few side-effects and little weight gain. After the 7-week trial period, over 44% of those taking the 300 mg dose had stopped smoking. However, that number dropped to a disappointing 23% one year later. Perhaps more effective is a newer drug, Varenicline (aka Chantix). It works by reducing both cravings and the pleasurable effects of smoking. Many individuals have reported gastrointestinal issues (nausea, gas, and constipation being the most common) while taking Varenicline and in the USA it carries a “black box warning;” it may cause depression and increases the risk for suicide. Of course, as with any medication, it’s important to talk with your doctor about how to take it and the possible side-effects.

If people find that using a medication helps them stop smoking, then I’m all for it. Other than a risk for some side-effects, the biggest potential problem is that for many people who take this approach, it simply isn’t enough by itself; once they stop taking the drug, they have no behaviors that they’ve learned to help them sustain their new, smoke-free habit.

Nicotine gum and patches

Nicotine gum and patches have been a mainstay of smoking cessation protocols. Their use is recommended by the American Lung Association and many other medical professionals believe them to be essential. That’s why a recent study, published in the NY Times, was so surprising. Nearly 2000 people were studied over time and it was found that patches and gum were of no help in long-term success. Heavy smokers who used them, in fact, were twice as likely to relapse as heavy smokers who did not use them.

Cognitive-behavioral therapy (CBT)

Most smoking cessation programs incorporate both cognitive and behavioral techniques (heavy on the behavioral) into their treatment protocols and people find them helpful. Essentially, it gives a person a toolbox of coping mechanisms to rely on. Obvious recommendations, such as making sure you no longer have easy access to cigarettes, are included. But a better program will help you identify potential situations in which you would be likely to start smoking again, and formulate strategies for what do in such situations. You’ll learn relaxation techniques, how to beat the cravings, and develop a plan in case you make a mistake. CBT by itself is not necessarily more successful than other approaches, but when used in the combination with other methods, it can be very helpful.

Hypnosis

Hypnosis is a powerful way to stop smoking. A well-written article about the power of hypnosis can be found here. In a study by Carmody, Duncan, and Simon (2008), it was found that those who used hypnosis were much more likely to be smoke-free one year later when compared to a group who were given standard behavioral counseling alone. Other research has found it to be more successful than other approaches, with success rates ranging from 20-50% one year after treatment. A 2004 study by Elkins and Hasan found that over 80% of people stopped smoking after a 3-session hypnosis program, and 48% reported they remained abstinent after a year. However, some people may not want to admit to researchers or their therapists that they have started smoking again, so these numbers could be somewhat inflated. Physical measures, such as those that can detect carbon monoxide levels, are the best way to be sure that a person has stopped, but most clinicians do not have access to such devices. Still, from both anecdotal evidence and what I have read in the research literature, hypnosis appears to be the most effective way for people to stop smoking when they are motivated to stop.

If you go looking for online for hypnosis programs to help you stop smoking, you’ll find a lot of people making big promises: Satisfaction, guaranteed! 99% success rate! If you see claims like these, it is too good to be true. I recommend that you find someone who has his or her advanced degree and/or license in psychology, medicine, social work, or related field, in addition to being a hypnotherapist; there are many lay hypnotists out there who have no training in how to help people manage the psychological component of a smoking cessation program, and that’s a pretty major component to ignore. It’s best if the professional you choose has received his or her training from a reputable organization (such as the American Society of Clinical Hypnosis). While CDs and online programs may help some people, they just aren’t going to be as effective as seeing seeing someone who can tailor their program to your specific needs.

Exercise

Exercise is typically a part of smoking cessation programs and there is reason to believe that exercise can help people abstain from smoking. In one promising study, it was found that sedentary female smokers who exercised vigorously three times a week were more likely to be non-smokers one year later.  Not all studies have shown such clear cut, positive outcomes, but what does seem to be clear is that exercise helps control cravings and withdrawal symptoms and also helps people maintain their weight after they’ve stopped smoking. Exercise also improves a person’s psychological and general health. Those are a lot of good reasons to exercise, so I recommend that my clients start a regular exercise program. Still, starting and stopping two new behaviors at the same time can be challenging, so if the exercise doesn’t happen immediately, that’s okay too.

My combination of approaches

Although the research has not identified one approach as being the gold standard of smoking cessation programs, by using a combination of approaches, many people succeed in becoming non-smokers.  That’s why I use primarily hypnosis and CBT, as well as the recommendation to exercise. If a client is under the care of a medical doctor, I am open to that person using medications if he or she finds them helpful. I interview clients during their first session so that I can look for signs of depression or other issues that may need to be addressed before a successful smoking cessation program is started. Although there are one-session smoking cessation protocols, by talking with clinicians and reading the research, I have learned that a minimum of four sessions are needed for the best results. I understand when people are most tempted to relapse and take that into account as well.

With the right tools and support, you can stop smoking and breathe easier once again. Find your motivation, find a good therapist, and keep at it! I wish you the best in your efforts.

My next post

For my next post I’ll write about Postpartum OCD, something that few people know much about but is more common than most people realize.

Bibliography

Elkins, G, and Hasan, R (2004). Clinical hypnosis for smoking cessation: Preliminary results of a three-session intervention. International Journal of Clinical and Experimental Hypnosis, 52: 73-81.

Hurt, R, Sachs, D, Glover, E, Offord, K, Johnston, J, Dale, L, Khayrallah, M, et al. (1997). A comparison of sustained-release Buproprion and placebo for smoking cessation. Massachusettes Medical Society

Marcus, B, Albrecht, A, King, T, Parisi, A, Pinto, B, Roberts, M, Niaura, R, et al. (1999). The efficacy of exercise as an aid for smoking cessation in women. Archives of Internal Medicine, 159: 1229-34.

Webb, M, Rodriquez de Ybarra, D, Baker, E, Reis, I, and Carey, M (2010). Cognitive-behavioral therapy to promote smoking cessation among African-American smokers: A randomized clinical trial. Journal of Consulting and Clinical Psychology; 1, 24-33

Yessenia, C, Costello, T, Correa-Fernandez, V, Heppner, W, Reitzel, L, Mazas, C, et al. (2011) Differential effects of depression on smoking cessation in a diverse sample of smokers in treatment. American Journal of Preventive Medicine; 41, 84-7.

Zelman, D, Brandon, T, Jorenby, D, and Baker, T. (1992). Measures of affect and nicotine dependence predict differential response to smoking cessation treatments. Journal of Consulting and Clinical Psychology; 60, 943-52.

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