It's not enough to simply promise to stub out the butts for your New Year's resolution -- though it is one of the most popular resolutions Americans make. If quitting smoking was that easy, it wouldn't have an abysmal failure rate: about 95 percent on any given attempt.
Just ask President Obama, who promised his wife he'd quit when he ran for president, only to fall off the wagon time and again during the early days of his administration. (Happily, he's reportedly been cigarette free for nine months.)
Massachusetts residents, though, should have somewhat of an easier time given that smoking cessation programs are covered by the 2006 health law. Folks in Boston can also get two weeks of nicotine patches for free, while supplies last, from the Boston Public Health Commission; Mass. residents in other areas may qualify too, but there are certain restrictions. Call 1-800-Quit-Now for more details.
So what does it take to really succeed at quitting? A study published Monday in the Archives of Internal Medicine suggests that simply using an Internet program that detailed various quitting approaches like nicotine therapy wasn't enough for most to keep abstaining over a period of 18 months. Using an online program combined with individual telephone support more than doubled success rates from 3.5 percent to 7.7 percent.
Of course, even with the intensive counseling, nearly 92 percent of quitters eventually went back to puffing. "That can sound discouraging but we know that tobacco dependence is a relapsing disorder like a lot of other disorders," says Dr. Nancy Rigotti, director of the Tobacco Research and Treatment Center at Massachusetts General Hospital, who wrote an editorial that accompanied the study. "Relapse is part of the process, but smokers need to keep trying. Do it again, in a smarter way using what you've learned from a previous attempt."
Some smokers find that the nicotine patch -- which delivers a small, steady dose over 24 hours -- doesn't take the edge off of their cravings, and they need to combine the patch with a shorter-acting product like nicotine gum. While the Food and Drug Administration hasn't approved using two nicotine delivery systems in combination, Rigotti says many clinicians, including herself, find that this can help those having a particularly tough time withdrawing from the chemical.
"The FDA is worried about nicotine overdose, which can cause stomach upset, nausea, and dizziness," says Rigotti, who serves as an unpaid consultant to Pfizer, which manufactures nicotine delivery products. "But smokers are pretty good at knowing how to regulate how much nicotine they take in to avoid these side effects."
Other pharmaceutical options include Chantix, also made by Pfizer, which targets nicotine receptors in the brain but doesn't use nicotine. But that could have some rare side effects like changes in behavior or suicidal thoughts. The antidepressant bupropion can also help smokers quit; that, too, has been linked to behavioral changes and suicidal thoughts.
"Most people have no problems with Chantix or bupropion," contends Rigotti, "but doctors shouldn't just write a prescription and not follow a patient. My practice is to call within one or two weeks to see how a patient is sounding. I can usually tell from that whether there are any warning signs."
Usually these smoking cessation drugs are given for three months, but Rigotti says some people might benefit from using them for six months -- and others, perhaps, for a lifetime.
"Like other psychological disorders, smoking cessation difficulties might need to be managed for the rest of your life," points out Rigotti. "And it's better to be on nicotine or an antidepressant than to smoke."
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