The Desire to Stop Smoking

The desire to stop smoking
Many smokers continue smoking not through free choice but because they are addicted to the nicotine in cigarettes. A report by the Royal College of Physicians found that nicotine complied with the established criteria for defining an addictive substance. The report states: "On present evidence, it is reasonable to conclude that nicotine delivered through tobacco smoke should be regarded as an addictive drug, and tobacco use as the means of nicotine self-administration." [1]
Surveys have consistently shown that at least 70% of adult smokers would like to stop smoking.[2] A 1999 survey found that, of those who expressed a desire to quit, a third were very keen to stop.2 The same survey found that the more a person smokes the less faith that person has that he or she can stop. The most important element of the cessation process is the smoker's decision to quit, with the aid or method of secondary importance. However, those who use aids such as nicotine replacement therapy double their chances of successfully quitting.[3] Smokers wishing to quit may find it helpful to telephone the national helpline on 0800 169 0169. Pregnant women seeking help in stopping smoking should call 0800 169 9169 where specialist counsellors are available from 1pm to 9pm, 7 days a week, to give advice. QUIT also operates specialist advice lines in the main Asian languages and in Turkish and Kurdish.

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Beneficial health changes when you stop smoking

Stop smoking and the body will begin to repair the damage done almost immediately, kick-starting a series of beneficial health changes that continue for years.[4]

Withdrawal symptoms
Withdrawal symptoms are the physical and mental changes that occur following interruption or termination of drug use. They are normally temporary and are a product of the physical or psychological adaptation to long-term drug use, requiring a period of re-adjustment when the drug is no longer ingested. In the case of smoking, some of these are: [5]

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Weight gain
The possibility of weight gain is often of particular concern to those who want to give up smoking. More than 80% of smokers will gain weight once they quit smoking, but the long-term weight gain is on average only 6-8lbs for each smoker who quits.[6] However, this is the weight gain made without recourse to any special attempts at dieting or exercise and it presents a minor health risk when compared to the risk of continued smoking. In addition, improved lung function and some of the other health benefits of giving up smoking are likely to make exercise both easier and more beneficial.

Pipes & cigars
Some smokers switch to pipes or cigars in the belief that this is a less dangerous form of smoking. However, such smokers may incur the same risks and may even increase them, especially if they inhale the pipe or cigar smoke.[7]

Smoking cessation aids
There are two proven pharmaceutical aids to stopping smoking: nicotine replacement therapy and bupropion, known by its tradename, Zyban. Nicotine replacement therapies (NRT), such as chewing gum, skin patch, tablet, nasal spray or inhaler, are designed to help the smoker to break the habit while providing a reduced dose of nicotine to overcome withdrawal symptoms such as craving and mood changes. Studies have shown that NRT roughly doubles the chances of a smoker successfully quitting compared to someone using no therapy.[8]

Bupropion, (Zyban) works by de-sensitising the brain's nicotine receptors and has shown promising results in clinical trials. The course of treatment lasts around 8 weeks. It is only available on prescription under medical supervision. Zyban is safe for most healthy adults but there are side effects, the most serious of which is the risk of seizures (fits). This risk is estimated to be less than 1 in 1000 but other less serious side effects such as insomnia, dry mouth and headaches are more common. An independent review by the Consumers' Association concluded that "when used in a specialist setting and in conjunction with regular counselling, bupropion is at least twice as effective as placebo in helping patients to stop smoking".[9]
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Other cessation aids
Acupuncture and hypnosis. A review of alternative methods of aids to stopping smoking found little evidence to support the effectiveness of either acupuncture or hypnosis as a means of stopping smoking, but such methods may suit some smokers.[10]

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Herbal cigarettes. These are not recommended as an aid to giving up smoking because they produce both tar and carbon monoxide. Some brands have a tar content equivalent to tobacco cigarettes. In addition, the use of herbal cigarettes reinforces the habit of smoking which smokers need to overcome.

Clinics and self-help groups. Smokers who are motivated to quit the habit may benefit from cessation clinics or self-help groups, although smokers should be cautious about claims of high success rates made by some clinics. A review of smoking cessation products and services found that smokers are up to four times more likely to stop smoking by attending specialist smokers' clinics than by using willpower alone.[11] As part of the Government's review of the NHS, more smoking cessation clinics are being established by health authorities and primary care groups.[12]

References
[1] Nicotine Addiction in Britain. A report of the Royal College of Physicians, February 2000 [View report]
[2] Lader, D and Meltzer, H. Smoking related behaviour and attitudes, 1999. Office for National Statistics, 2000.
[3] Smoking cessation guidelines and their cost effectiveness.. Thorax 1998; vol 53: S5 (part 2) S11-S16 [Viewpdf]
[4] The Health Benefits of Smoking Cessation: A report of the Surgeon General. US DHHS, 1990.
[5] West, R. Tobacco withdrawal symptoms. St. George's Hospital Medical School, 1996.
[6] West, R. Tobacco withdrawal symptoms. St. George's Hospital Medical School, 1996
[7] Cigars: Health effects and trends. National Cancer Institute, 1998
[8] Nicotine replacement therapy for smoking cessation. The Cochrane Library, Issue 3, May 2001 [View abstract]
[9] Bupropion to aid smoking cessation. Drug and Therapeutics Bulletin. Vol 38 no.10 Oct. 2000
[10] Abstracts of the Cochrane review. The Cochrane Library, Issue 3, 2001 [View abstracts]
[11] West, R. Getting serious about stopping smoking - a review of products, services and techniques. 1997.
[12] Extract from the NHS National Plan - July 2000 [View document]