STORY BYMonths after making your New Year's resolution to quit smoking, you're still struggling to kick the habit. If quitting cold turkey isn't working – it may be time to get some help.
“Cold turkey is one of the least effective ways to quit smoking,” says Dr. Marc Mooney, a postdoctoral fellow in the Center for Substance Abuse at The University of Texas Medical School at Houston. “By adding medication, or nicotine replacement and support, you can double your success rate.”
Highly addictive, nicotine in cigarettes causes the brain to release neurotransmitters involved with pleasure and reward. This stimulates the body and gives smokers an almost immediate “rush.” Smokers come down a few minutes to hours later feeling depressed and tired. To perk up, they smoke another cigarette, beginning the cycle of addiction.
Many quitters slip up when they feel cravings, frustration, irritability and other symptoms caused by nicotine withdrawal. Smoking cessation aids help take the edge off of nicotine cravings and reduce withdrawal symptoms.
“Most relapse happens during the first two to three weeks after quitting,” says Dr. Unto Pallonen, associate professor in Health Promotion and Behavioral Sciences at the UT School of Public Health. “There is a tremendous drop in quit rates, and then they stabilize.”
If smokers can make it through those first critical weeks, they have a good chance at successfully quitting smoking, he says.
With so many ways to quit smoking – including the patch, nicotine gum and prescription drugs – selecting one can be a monumental task. Here's a breakdown of the quit methods available to smokers today.
Nicotine replacement products replace the nicotine smokers get when they puff on a cigarette. Unlike cigarettes which have a fast and powerful nicotine delivery that goes straight to the lungs and brain, nicotine replacement products deliver a smaller amount over a longer timeframe. This mitigates the addictive properties of nicotine.
Most nicotine replacement products are available over the counter. The nicotine inhaler and nasal spray are available only by prescription.
The Patch – The nicotine patch releases a steady “dose” of nicotine to the body through the skin. The patch comes in a variety of sizes, depending on how heavy a smoker you are. It should be worn continuously, but can be removed at night if you find that the stimulating properties of nicotine keep you up. Most patches need to be changed once a day.
Some people may react to the adhesive or the nicotine on the patch, with reddening and itching of the skin that is exposed to the patch. Make sure to place the patch on a different part of the skin each day. Apply on dry skin.
The average retail price for a starter box of over-the-counter nicotine patches is approximately $4 a day*.
Gum – Nicotine gum sends nicotine to the brain in a stronger, quicker dose than the patch. Still, smokers won't get the same rush from nicotine gum as they do from smoking. Smokers chew the gum when they have a craving, then park it in the side of their mouths. One piece of gum (which is available in two strengths) is one dose. You can chew up to 24 pieces a day, depending on the nicotine concentration in the gum. Using too much gum can cause side effects like hiccups and upset stomach.
The average retail price for nicotine gum is approximately $5 a day for average usage during the first six weeks of use.
Spray – The nicotine nasal spray gives smokers a quick nicotine rush. A dose is two sprays, one in each nostril. Smokers squeeze the spray whenever they feel a craving.
The average retail price for nicotine nasal spray is approximately $5 to $15 a day, depending on how frequently you use it.
Inhaler – Smokers puff on the inhaler like a cigarette. However, the inhaler delivers nicotine directly into the mouth, where it is absorbed, rather than the lungs. Nicotine enters the body much more slowly from the inhaler than from a cigarette. You get the most benefit out of the inhaler by puffing on it frequently and continuously for 20 minutes. Gently puff on the inhaler to avoid getting a headache or a sore throat.
The average retail cost of the nicotine inhaler is approximately $45 a package, for 42 cartridges. The maximum suggested dose is 16 cartridges a day. The inhaler is available only by prescription.
Lozenge – The nicotine lozenge is the newest nicotine replacement product to be approved by the FDA. It looks like a cough drop, and slowly releases nicotine as it dissolves. One lozenge is one dose, and lasts about 20 to 30 minutes. You can take up to 20 lozenges a day. As with the gum, side effects can include hiccups, indigestion and stomach upset.
The average retail price for the nicotine lozenge ranges from $6 a day for average usage to $12 a day for heavy usage, during the first six weeks of use.
Bupropion hydrochloride (Zyban), known as Wellbutrin when prescribed for depression, stimulates the release of a feel-good chemical in the brain, called dopamine. Smokers begin taking Zyban while still smoking, one week before they quit. Treatment is continued for 7 to 12 weeks, depending on how much the person smokes. The average wholesale price of Zyban is an estimated $2.50 day.
Mooney is studying whether combining Zyban with a drug called naltrexone, might improve the quit rate among smokers. Naltrexone blocks the area in the brain that responds to nicotine. The drug is used to treat people addicted to opiates, like heroin, and alcohol. Mooney is currently recruiting patients for a clinical trial on the drug combination.
(For information, call 713-500-2802.)
On average, nicotine replacement products have about a 25 percent rate of success meaning that 25 percent of people using the product had remained non-smokers after a year. Zyban alone has a similar success rate to that of traditional nicotine replacement products.
Understanding your smoking pattern can make it easier for you to choose a smoking cessation method. If you are a heavy smoker, smoking up to 30 to 40 cigarettes a day, you may want to use a combination of medications and nicotine replacement. If you will miss having a cigarette in your mouth, the nicotine inhaler, gum or lozenge might be a good choice. If you are always on the go, then the nicotine patch may be for you. Consult your doctor when choosing a method.
If you don't like one method, you can always try another.
“It is important for smokers to realize that they will likely slip, but they should try to quit again and keep going,” Mooney says. “Use it as a lesson and requit immediately.”
While smoking cessation products are helpful, they only address physical addiction to smoking. Smoking is also a psychological and social addiction. Quitting can bring big changes, from how you wake up in the morning to the people you hang out with.
“We are dealing with a behavior change,” Pallonen says. “For most of us changing our habits can be very challenging, it can be done, but it is not easy.”
No matter what method you choose to quit smoking, quitting will be easier if you have some support. Support can be informal and come from your friends and family, or you can seek help from a formal smoking cessation group, or a quitline.
Contact your local chapter of the American Lung Association or American Cancer Society for smoking cessation resources in your area. For more information on joining a smoking cessation study, contact the UT Treatment Research Clinic at (713) 500-2802.
UPDATED: 2-25-2005
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Dr. Unto Pallonen is an associate professor in the Department of Health Promotion and Behavioral Sciences at the UT School of Public Health.
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Food Irradiation
and Safety
On August 22, 2008, the Food and Drug Administration (FDA) published a final rule that allows the use of irradiation to make fresh iceberg lettuce and fresh spinach safer and last longer without spoiling.
Irradiating fresh iceberg lettuce and spinach will help protect consumers from disease-causing bacteria such as Salmonella and Escherichia coli O157:H7 (E. coli). Illnesses from these bacteria range from uncomfortable symptoms to life-threatening health problems.
The foods affected by the final rule are
Irradiation (also sometimes termed "ionizing radiation") is a process of treating products with a measured dose of radiation. Food irradiation is not new. FDA has conducted irradiation safety evaluations for more than 40 years and has determined the process to be safe for use on a variety of foods.
After studying the safety of irradiating fresh iceberg lettuce and fresh spinach, FDA has determined that these greens, when irradiated under the conditions specified in the final rule, retain their nutrient value and are safe to eat.
FDA considers irradiation a complement to, not a replacement for, proper food-handling by producers, processors, and consumers. Irradiation is just another tool to reduce the levels of disease-causing microorganisms on fresh iceberg lettuce and fresh pinach.
Irradiation does not take the place of washing. FDA continues to recommend that consumers wash fresh and bagged produce before eating unless the packaging specifically states that the product has been pre-washed.
For more information, go to: http://www.fda.gov)
