Medical information  
 Terms Glossary
 First Aid
 Diet Information
 Preventive Medicine
 Immunization Schedules
 Biological Warfare Effects & Treatment
 Men's health
 Atlas of skin diseases
 Drug encyclopedia
 Atlas of human anatomy
 Alternative medicine
 Baby's developmental milestones
 Medical laboratory tests
 Smoking and health effect
 Advice for travelers
 Hearth attack: risk chart
 Diabetes: risk chart
 Cancer: risk chart
 Alcoholism and treatment
 Topic of the Week
 Medical Topic
 Latest News
 News Archive
  » Smoking and health effect  »  Treatment Parameters For Nicotine Addiction
Regulation of nicotine intake for smokers, and implications for health
  • Smokers tend to regulate or titrate their nicotine intake to maintain body levels within a preferred range
  • Smokers who switch to cigarettes which on machine smoking deliver less nicotine and tar tend to compensate for this by smoking the cigarette more deeply or more intensively
  • Smokers of low yield cigarettes actually achieve little, if any, reduction in intake of nicotine and tar, and the health benefit accrued from switching to such cigarettes is, if anything, small
  • The availability of low yield cigarettes may actually be counter productive in public health terms if they encourage health conscious smokers to switch to low yield brands instead of giving up completely

Management of nicotine addiction

  • Effective interventions to reduce nicotine addiction are available at both population and individual levels
  • The fact that smoking is so common in Britain means that even interventions that have small effects on smoking prevalence can, if widely applied, yield substantial returns in terms of the numbers of people who give up smoking
  • Nicotine replacement therapy approximately doubles the effectiveness of most other currently available smoking cessation interventions
  • Smoking cessation interventions, including nicotine replacement therapy, are extremely cost effective, costing society between £212 and £873 per year of life saved in 1996 prices
  • The cost-effectiveness of smoking cessation interventions using nicotine replacement therapy compares very favourably with most other medical intervention.
  • Effective smoking cessation services should therefore be universally available to smokers through the NHS
  • Smoking cessation services must be able to adapt to accommodate new effective therapies and interventions in the future
  • Further research into the use and safety of nicotine replacement therapy relative to continued smoking during pregnancy is needed Regulatory approaches to tobacco products in Britain
  • Cigarettes are extremely damaging to consumers and yet have enjoyed unparalleled freedom from consumer protection regulation
  • Much of the regulation applying to tobacco in Britain has been in the form of ‘voluntary agreements’ with the tobacco industry
  • The use of additives in cigarettes has not been subject to appropriate assessments of public health impact
  • The policy of progressively reducing tar yields from cigarettes, and of printing tar yields on cigarette packs, is based on flawed measurement methodology and may be ineffective in terms of achieving public health benefits
  • Pharmaceutical nicotine delivery products (eg nicotine replacement therapy) are subject to regulation by the Medicines Control Agency and are required to meet the same safety standards as any other drug; however, cigarettes are exempt from these controls
  • Cigarettes are tobacco-based nicotine delivery products and should be subject to the same safety standards as any other drug.
  • A co-ordinated nicotine regulation framework needs to be established in Britain to resolve anomalies in the sale and promotion of nicotine delivery products, to maximise current and future public health

Preparing To Quit (Steps To Take)

Getting ready: The five stages of quitting

Quitting happens in five stages. What stage are you at?

Stage One: I'm not thinking about quitting, at least not in the next six months. In this stage, you may feel it is hopeless to even think about trying to quit smoking. You may even feel your smoking is not a problem.

Stage Two: I'm thinking about quitting someday, but not right now. In this stage, you know that you have a problem and are trying to figure out how to solve it.

Stage Three: I want to quit within the next month, and I want to know more about how to do it. By now, you are ready to plan your quit program and to set a specific quit date.

Stage Four: I have just quit and I am going through withdrawal. My body is reacting in uncomfortable ways. This can be a tough stage. You may have been through withdrawal before but started smoking again. That's probably because you did not go through all the other stages first.

Stage Five: I have quit smoking and I want to know more about how to never smoke again. Some people find this the hardest stage of all. You've reached your goal, but you have to really work at staying smoke-free.

Quit day is here! What to expect as you take your first step!

Today is a day that could change the rest of your life. Today is the day you start to take back control of your life from smoking and cigarettes. Here are some things that can help you take this important first step.

First thing in the morning, put away anything that could tempt you to smoke -- or even remind you smoking. Have someone else hide or throw out all of your cigarettes, ashtrays, lighters and matches. Whatever you do, be sure to keep them out of sight.

Expect some withdrawal. As a smoker, your body came to depend on nicotine. When you quit smoking suddenly without replacing that nicotine (through nicotine gum or patches), you will experience the effects of withdrawal. You may have physical and psychological reactions. For example, you will probably get cravings -- a strong urge to smoke. You may also become irritable, nervous or depressed. Some people get muscle spasms, night sweats and hacking coughs.

Don't worry if any of these things happen to you. They are normal and expected. They are just signs that your body is adjusting and starting to cleanse itself. They are signs that you are on your way to achieving your goal.

Reactions vary from one person to another. Women are often affected more than men because of the way female bodies process nicotine. Reactions are also influenced by how addicted you are. If you smoked less than ten cigarettes a day, you might not feel any withdrawal symptoms at all. If you smoked more, you may notice more effects. But no matter what symptoms you get, remember that withdrawal usually lasts less than one week. Look ahead, stay focused, and don't give in!

Dealing with cravings and other signs of withdrawal may be a real challenge today, but it's one you can meet. Whenever you get a craving, take action and fight back. Do something that is not related to smoking in any way. Take a walk, drink a glass of water or take some slow, deep breaths. Enjoy some low-fat snacks like carrots, air-popped popcorn or sugarless gum.

Whenever you get a craving, think of the "four Ds":

Do something else;
Delay thinking about or reaching for a cigarette;
Deep Breathing; and
Drink Water.

Meet each craving with firm determination. Most cravings last only a few minutes, and hardly ever more than ten. Look past the craving and remember it will be over soon. In the meantime, do anything to distract yourself. The worst withdrawal symptoms will fade in a few days.

Whatever you do, do not start feeling sorry for yourself! That is when you are most likely to give in to have a cigarette. If you do, you will feel even more discouraged. You may want to give up. Don't let that happen! Remember the four Ds and stick with it one minute, one craving, one step at a time.

  • Stop and Think: Spend some reflective time with yourself and really become clear about wanting to live. You have to become your own ally on the deepest levels. Affirm your will to live and give yourself the gift of a smoke-free life.
  • Write Down Why: Think of all the reasons you want to quit. It helps some folks to write these reasons down and keep them with them for when they question their resolve. Read them often. This is about wanting to live a long, healthy life.
  • Pick a Day: Now it's time to set the day you smoke your last cigarette. I recommend at least two weeks away to give you time to prepare. But do set that date. Tell everyone you know you are quitting and write it on your calendar. It's a birthday or a "rebirthday." You need to see it as the day you took your life back from nicotine addiction. Many people celebrate it for years after they quit.
  • Toss the Gear: Begin to get rid of all your smoking paraphernalia. The ashtrays, the pretty lighter, the case, the cigs stashed in the car, the garage, the desk, everywhere. Out, everything. Keep only one pack of cigs and a plain matchbook to use until your quit date. This is hard because you may be attached to some of these things. But they have to go. They'll only remind you of your old friends, the cigs.
  • Plan for Cravings: Get to know the enemy -- your addiction to cigarettes. You need to know when the cravings will be the most difficult so you can plan for how to manage them until they go away. Have things ready at hand for when the cravings hit:
    • Peppermint toothpicks are popular to help keep your mouth busy.
    • Aroma therapy works well for some. Try carrying a bottle of peppermint and one of vanilla, or whatever your favorite smells are. When you have a terrible craving, reach for your bottle and take a deep whiff. It will distracted you long enough for the craving to pass.
    • Another distraction is touch therapy. Keep a bottle of hand lotion nearby and when the craving hits, slather some lovely lotion, on your hands, neck, legs, face - it will distract you for a few minutes until the craving passes.
    • Some find the use of an antidepressant helpful to handle the emotional stress of quitting. Zyban is one that many people use effectively, especially during those first hard weeks. After a few months, most people are able to stop using it pretty easily. Check with your doctor.
    • If you decide to use a nicotine patch, gum, or inhaler, remember they are actually nicotine replacements. They let you quit smoking cigarettes completely, and gradually wean your body off the nicotine. They can be very helpful for awhile, but you haven't really escaped your addiction yet. That won't happen until you become completely nicotine-free.
    • Use any nicotine replacement carefully. It's possible to get too much nicotine from these crutches. That is especially important for anyone with a chronic condition, such as high blood pressure.
  • Weight Is Not the Issue: Yes, people often gain a few pounds (the average is around five) when they quit. Your metabolism is normalizing after being artificially stimulated from the cigarettes. Don't beat yourself up about being hungry or having a mouth that can't be quiet. Just do your best to eat healthy and know that after you quit you'll have the time, energy, and motivation to knock off those extra pounds. The dangers of smoking so far outweigh gaining a little extra weight!
  • This Is WAR: If you really intend to quit, then you have to get really serious about this. It is war. You must think of cigarettes as a lover that wants to kill you. Your desire for cigarettes sneaks up on you, seduces you, stimulates you and makes you feel good temporarily, and then slowly destroys your lungs, heart, vessels and organs. It's literally stealing your life.
  • Don't Stop Trying! Don't be discouraged about being addicted. That's what you're up against. While your rational mind is saying QUIT and all your values about life and living feel violated every time you smoke, remember this is a vicious demon. Nicotine addiction is worse than heroin. You are the victim of a billion-dollar industry that has devoted years to creating a deadly, toxic designer drug that kills. Fight back.
  • CELEBRATE! You are a nonsmoker! This is a rebirth for every cell in your body. Take the time to sit quietly and just breathe. Tell your lungs you'll care for them, you'll endure the nicotine withdrawal and allow them to heal. Make a fist and hold it over your heart. That's about how large your heart muscle is. Tell your heart, no more toxic gasses flowing through. There will be no heart damage any more. These are wonderful empowering messages to give yourself. You are up against escape from an addiction worse than heroin. Give yourself lots of credit for doing this. It may be the most important thing you ever do to preserve your life.

You would probably be amazed if you really could count how each day you are reclaiming your life. Knowing the days, hours, minutes, and money saved reminds us of how long we've been free of this demon nicotine, and it can also remind us of how long our miraculous body has been recovering and reclaiming our health.

And while it's great to know how much lifetime and money you've saved by not smoking a number of cigarettes-- you know what? -- some of the greatest benefits just can't be turned into numbers. Be sure to notice and track them as well:

  • Take a deep breath. Do it outside and smell the spring in the air.
  • Let your teeth sink into a piece of juicy, fresh fruit and feel your taste buds come alive.
  • Some folks find out from their intimate partner about the benefits of quitting smoking to one's sex life.
  • Your hair, clothes, car, and workplace probably don't smell of stale cigarettes anymore, and those nasty ashtrays aren't littering your life.

Giving up this addiction comes with a continual flow of benefits in our lives. Some are harder to quantify. They begin happening internally as soon as you take your last puff. Your lungs feel the new cells created every day, increasing your ability to take in oxygen; your heart doesn't have to deal with hot, toxic gasses flowing through; your kidneys aren't processing the metabolism of hundreds of unwanted chemicals ... IT'S A HUGE, HEALING HAPPENING.

You did it. You quit for life. Good for YOU!

Catherine A. Salveson, RN, PhD, is director of clinical practice for the Oregon Health Sciences University school of Nursing in Portland. She has been active in public health for more than 20 years.