Quitting is like practicing a sport or learning an instrument. Most smokers try several times before finally quitting. Some do quit for long periods, even a decade, but begin again. Stress, or even a cigarette offered at the wrong time, can resume the habit. However, with each try smokers learn something new and get a step closer to quitting for good. Perhaps the key involves never giving up.

In the past 40 years, a huge amount of research has been done on smoking and how best to stop. The results are clear. Help is available for those who want to quit. Although some methods work more consistently than others, we all must find our own best approach. This may differ from smoker to smoker.

Part of the process in quitting a long-term habit involves moving through several stages.

A challenge will occur in your life that questions the issue of smoking. Perhaps you will have lung problems, your family may worry about your habit, or a friend might die of lung cancer. As a result, you re-evaluate the role that smoking plays in your life.
You become aware of the risks and benefits of smoking. The more you know about risks and potential health problems for you and those around you, the more likely you are to successfully quit. Education can come from many sources, including your family doctor, written articles or classes.
Preparation is the next step. You must plan how to deal with particular temptations that trigger smoking.
Taking action starts with setting a quit date and sticking to it.
Maintenance involves understanding that temptations and slips will happen along the way. Use these as opportunities to learn more about your habit and the way you handle it, rather than as total failures.

Smoking and how to stop have been extensively studied. Many different techniques exist to help quit smoking. They include medications, nicotine replacement, self-help, mass media, negative association, competitions, and exercise. Research on taxation of tobacco, non-smoking policies in schools and communities, and preventing sales to minors has been done. All are effective. Studies exist on how doctors, nurses, dentists and pharmacists can help, and on ways to counsel those who are worried or depressed.

Telling those around you that you are quitting can be very useful. Friends will then know not to smoke in front of you or offer a cigarette. You can also choose to meet in non-smoking areas. Since support is so essential, couples often decide to quit together.

The Cochrane Collaboration is a worldwide network of health professionals, methods experts and statisticians. This group searches all of the world literature on a health topic and analyzes each study. Many different participants, treatments and results are explored. Much of the information presented here comes from the Cochrane library.

What has research found about effective ways to quit?

Medication matters

The most effective quitting methods involve medications – using varenicline (Chantix™), nortiptyline, bupropion (Zyban™ or Wellbutrin™), or nicotine replacement such as a patch (see table). Usually, these must be used for about 12 weeks, although some continue for a longer period.

By the end of a year, the chance of quitting successfully is three times greater using varenicline than doing nothing. Nortriptyline doubles the chance, and bupropion works almost as well. Nicotine replacements, available in gum, nasal spray, patch, under the tongue or inhaled forms, also come close to or double the success rate. However, only the nicotine patch and gum are currently available in Canada. Research has found that combining bupropion with the patch is even more effective.

Support counts

Encouragement also makes a big difference. If your doctor spends three minutes encouraging you during office visits, you are almost twice as likely to succeed. Advice from a nurse has success rates fairly close to advice from physicians. In most studies, the doctor or nurse asked about smoking and attempts at quitting. If the patient had tried to quit, encouragement and a stop-smoking message were given. One key to success involved giving an invitation to set a firm quitting date. Sometimes, pamphlets on quitting were provided.

Receiving calls from a counsellor, taking part in therapy or using a stop-smoking line are also useful. In trials using trained tobacco counsellors, smoking history and reasons for quitting were discussed. The counsellor also helped identify triggers and gave problem-solving strategies.

Tips on Butting Out

To successfully quit, smokers need encouragement and appreciation of their efforts to stop. Men tend to smoke for about 16 years, women for 20. Most smokers (90 per cent) do eventually quit. Of those who quit, nine out of ten eventually do it on their own, using a cold turkey approach. Having an added incentive such as a medical condition boosts the chances. As with most addictions, only about five per cent can quit without help.

In group therapy trials, participants usually signed a contract or declared they were quitting. The idea of nicotine fading, changing to a lower-nicotine brand of cigarette, was introduced. Records of the number of cigarettes used were kept, and smoking triggers monitored. In group meetings, participants shared and discussed problems and experiences. Together, they explored ways to get support from family, friends, and coworkers. High-risk situations were identified, with possible solutions found and rehearsed.

What doesn’t work?

In a limited number of small studies, the effects of acupuncture, hypnosis, or medications for anxiety on quitting smoking were researched. None have been shown to work, although some people did report success.

Ask for assistance and encouragement

If you want to quit smoking, using methods and therapies listed here may help. Which would best fit your personality and lifestyle? Keep in mind that since only five per cent of smokers are able to quit in a year, it is important to keep trying. Talk to friends and coworkers who have successfully quit about how they did it. You might want to start by talking with your family doctor, who can help you find the most useful supports to stop smoking. Your good health is a great reward.
.........

For more information on the Cochrane Collaboration Library, consult www.cochrane.org and read the free abstracts under the topic ‘tobacco.’ Those with access to a university library can look up the full text of the Cochrane systematic reviews about smoking prevention and quitting. Some governments, including Manitoba and Saskatchewan, have made the Cochrane Collaboration library available to the public free of charge.

Calling it Quits Research suggests effective ways to quit smoking