indiacancer.org - Tobacco and Cancer

How to quit?

	Smokers often say, "Don't tell me why to quit, tell me how " There is no one right way to quit, but there are some key elements in quitting smoking successfully. These four factors are crucial:
		Making the decision to quit.
		Setting a quit date and choosing a quit plan.
		Dealing with withdrawal.
		Maintenance or staying quit.
	Quitting Smoking: The decision to quit smoking is one that only you can make. Others may want you to quit, but the real commitment must come from you. The Health Belief Model says that you will be more likely to stop smoking if you: believe that you could get a smoking-related disease and this worries you. Believe that you can make an honest attempt at quitting smoking. Believe that the benefits of quitting outweigh the benefits of continuing to smoke. Do you know of someone, friend or relation who has had health problems as a result of their smoking. The following are the Stages of Change that a person goes through in making a decision to quit smoking: Pre-contemplator: This is the smoker who is not thinking seriously about quitting right now. Contemplator: This is the smoker who is actively thinking about quitting but is not quite ready to make a serious attempt yet. This person may say, "Yes, I'm ready to quit, but the stress at work is too much, or I don't want to gain weight, or I'm not sure if I can do it." Preparation: Smokers in the preparation stage seriously intend to quit in the next month and often have tried to quit in the past 12 months. They usually have a plan. Action: This is the first 6 months when the smoker is actively quitting. Maintenance: This is the period of 6 months to five years after quitting when the ex-smoker is aware of the danger of relapse and takes steps to avoid it. Step I - Deciding to Quit Why do you want to stop smoking? It is important to be clear about reasons. Here are some of the best reasons: Smoking kills: One in two lifetime smokers will die from their habit. Half of these deaths occur in middle age. Cigarettes are full of poisons: Tobacco smoke contains over 4,000 chemicals, as well as tar and nicotine. It contains carbon monoxide (found in car exhaust fumes), ammonia (found in floor cleaners) and arsenic (found in rat poison). At least 43 of these chemicals are proved carcinogens. They produce cancer lung, throat, mouth bladder and kidney, and contribute to other cancers. Nicotine: Nicotine is the addictive drug. Along with the carbon monoxide it increases the heart rate and blood pressure, straining your heart and blood vessels. It leads to heart attacks and stroke. It slows the blood flow, cutting off oxygen to your feet and hands. Sometimes this leads to amputation of limbs. Tar: Tar is made up of several chemicals, gases and substances that cause cancer. It coats your lungs like soot in the chimney. Carbon monoxide: Carbon monoxide reduces the oxygen supply to your muscles, brain, starving your body of oxygen - making your heart harder to maintain the oxygen needs. After some time, the lungs swell and less air enters the lungs. Smoking causes diseases: Smoking is a slow way to die. The strain put on your body often causes years of suffering Emphysema slowly rots your lungs, making you suffer from bronchitis repeatedly, finally lung and heart failure. Lung Cancer: is caused by the tar in tobacco smoke, risk being 10 times that of nonsmokers Heart disease and strokes are more common among smokers. Smoking causes fat deposits which narrow and block blood vessels producing a heart attack. One in five deaths in heart diseases is due to smoking. In younger persons, 3 out of 4 deaths from heart disease are due to smoking. Other important reasons: Confidence: Once you are able to quit you have proved to yourself that you are capable of taking control of your life and accept other challenge as well. Fitness: When you are smoking it was difficult for you to exercise with less strength in your body. Once you quit you become fully fit and healthy. Money: You have been spending large amounts on cigarettes. Once you quit, this proves an enormous financial gain, which was eroding your body and purse. You spend less on medical bills. Appearance: Your skin becomes gray and wrinkles appear around the eyes and mouth for want of adequate circulation and you age and appear aged much faster. The stains on your fingers and teeth, the smell on your breath and clothes draw attention of your family and friends. Sex life: Smokers may suffer from impotence due to damage to blood vessels in the penis. Sperm quality and density are affected. The sperm may have abnormalities. Women smokers take longer to conceive and may have miscarriages. Babies: born to mothers who smoke are likely to be premature, still born or die shortly after birth. They have a higher risk of dying from cot death. Children: of parents who smoke are more prone to get pneumonia and bronchitis in the first year of their life and later may have more frequent asthmatic attacks. They have a chance of becoming regular smokers themselves. They suffer from all the bad effects by being exposed to passive smoking. Step 2 Getting Ready to QUIT Smokers: who plan before they quit are more successful than those who don't are. Four stages of planning:
		Understand your nicotine addiction
		Know why you smoke
		Plan ways to deal with quitting
		Set a date to quit.
	1. Understand your nicotine addiction: Nicotine is a drug that produces many different effects on the body. It stimulates your system, though you may feel relaxed. Nicotine affects the chemicals in the brain and after a puff you may feel good for a moment. New smokers often feel dizzy and sick from tobacco smoke, but slowly get used to it. As they continue their body becomes dependent on nicotine and they can smoke more and more. Even after long periods after quitting a smoker who tries an occasional cigarette returns back to regular smoking.Smoking and addiction to nicotine is just similar to addiction to heroin or cocaine or other narcotic drugs. Some smokers cannot quit even though they think smoking is harmful - they don't believe that they will be affected. 2. Know why you smoke: Some of the commonest reasons why people smoke are:
		Emotions: feeling stressed, upset, angry or frustrated.
		Pleasure: to enjoy asocial pressure: being accepted by the company you keep.
		Habit: feeling used to do things while you are smoking.
		Addiction: to satisfy the craving for nicotine.
	If you keep a track of each time you have smoked, while you are preparing to quit, you will get an idea of the degree of your need on each occasion: For e.g. on each time you lighted cigarette - note your score based on the following assessment:
		1 = I could do without it
		2 = I feel like it
		3 = I need it
		4 = I really need it
		5 = I'd kill for it The above score will give you an idea of when and why the urge to smoke comes so that you can be prepared to face those occasions.
	3. Plan ways to deal with quitting: Visit your doctor: Discuss with your doctor your health problems and discuss with him about your plan to quit smoking. He may be able to assess you, advice whether you should stop all of a sudden or by nicotine substitutes, and arrange for periodical health check ups. Nicotine substitutes: If you are a heavy smoker, using nicotine gum or patches may improve chances of your success. However, many that succeed make an abrupt stop or 'cold turkey'. Your doctor or the chemist can explain how to use the patches or gum. (Nicotine patches are now available in India though expensive). Plan for the risky occasions: After you have verified and maintained your smoking score or need at particular times, you will know when the urge will come. You have to work out ahead how to handle such situations. Find a quitting partner: Set a quitting date with a friend who is also a smoker, so that you can face the problems together. You Get help from friends and family: Family should be informed ahead so that they can encourage you at difficult times, and give emotional support at crucial and difficult phases. In case it is your family which has driven you to smoking avoid them and such friends. Weight gain: One may sometimes gain weight because their appetite improves and the extra metabolic waste by smoke is reduced. This should not worry you, as it is a healthy sign. Clean up the day before your quit day. Check your house, car, office drawers, work place, where you generally smoke. Throw out all the cigarettes, lighters, matchboxes and ashtrays. 1. Set a date to quit: Once you've made a decision to quit pick a specific day within the next month as your Quit Day. Picking a date too far in the future allows you time to rationalize (convince yourself by wrong logic) and change your mind. But do give yourself enough time to prepare and come up with a plan. You might choose a date with a special meaning like a birthday or anniversary, or simply pick a date. Circle the date on your calendar. Make a strong, personal commitment to quit on that day. Make the date within 2 to 3 weeks to give you enough time to prepare yourself. Chose a time when you will become busy or occupy yourself with some other absorbing work you like. Setting a quit date and deciding on a plan is a very important step:
		Prepare for your Quit Day.
		Pick the date and mark it on your calendar.
		Tell friends and family of your quit day.
		Stock up on sugarless gum or bubble gum.
		cinnamon sticks, carrot sticks.hard sweets.
		Decide on a plan. Will you use nicotine replacement therapy (the patch or gum)?
		Practice saying, "No thank you, I don't smoke."
		Set up a support system. A friend who has successfully quit and is willing to help you.
		Successful quitting is a matter of planning and commitment, not luck.
		Decide now on your own plan including using the nicotine patch or gum, or using self-help materials such as books and pamphlets. Your plan should include one or more of these options.
	Step 3 - Quitting Are you thinking about how difficult quitting could be or are you looking forward to the challenge? Acknowledge your feelings, but stick to your decision. You are doing the right thing. How to Quit. Chose an approach that will be in your reach. There is no one right way to quit. Cold turkey: Most smokers prefer to quit abruptly and totally. They smoke until their Quit Day and then stop all at once, or they may smoke fewer cigarettes for a week or two before their Quit Day. Cut down: Another way involves cutting down on the number of cigarettes smoked each day. With this method, you gradually reduce the amount of nicotine in your body. Reduce to 5 cigarettes a day; delay your first cigarette by an hour each day. If this approach is attempted, your final quit day should be specifically two weeks ahead after you start. You might cut out Cigarettes smoked with a cup of coffee, or you might decide to smoke only at certain times of the day. While it sounds logical to cut down in order to quit gradually, in practice this method usually is not effective. On your Quit Day, follow these suggestions:
		Do not smoke. Get rid of all cigarettes, lighters, ashtrays, etc.
		Keep active-try walking, exercising, or doing other activities or hobbies.
		Drink lots of water and juices.
		Begin using the patch or gum if that is your choice.
		Avoid high-risk situations where the urge to smoke is strong.
		Reduce or avoid alcohol.
	Use the four "A's" (avoid, alter, alternatives, activities) to deal with tough situations. Understand withdrawal symptoms: Withdrawal symptoms are the way your body reacts when it does not get nicotine and the other chemicals in tobacco smoke. Think of them as recovery symptoms. Some recovery symptoms will come and go in a few days, and most are gone by 2 to 3 weeks. The emotional symptoms - like anxiety and irritability - are closely related to the withdrawal of nicotine and reactions of your body as the nicotine is eliminated from your body and not replenished. Quitting smoking is a lot like losing weight; it takes a strong commitment over a long period of time. Smokers wish there were a magic bullet-a pill or method that would make quitting painless and easy. But that is not the case. Nicotine substitutes can help reduce withdrawal, but they are most effective when used as part of a stop smoking plan that addresses both the physical and psychological component of quitting smoking. Common recovery (withdrawal) symptoms:
		Cravings. Each one lasts a short time, but can be intense. Over time these cravings become less frequent.
		Occasional headaches.
		Digestive upsets nausea, constipation, diarrhea, sore throat - these may last for not more than 4 days.
		Changed sleep pattern. Unusual strong dreams. Some sleep better.
		Coughing - means that the celia lining the bronchial tubes are once more active to cleans the accumulated tartar and mucus.
		Irritability, depression or anxiety - will lessen over 1 to 3 weeks.
		Temporary increase in appetite.
	Dealing with Withdrawal Withdrawal: from nicotine has both physical and psychological symptoms. The physical symptoms, while annoying, are not life threatening. Nicotine replacement (the patch or gum) can help reduce many of these physical symptoms. But most smokers find that the bigger challenge is the psychological part of quitting. If you have been smoking for longer time, smoking has become linked with nearly everything you do-waking up in the morning, eating, reading, watching TV, drinking coffee, etc. It will take time to "un-link" smoking from these activities. That is why, even if you are using the patch or gum, you may still have strong urges to smoke. One way to overcome these urges or cravings is to identify rationalizations as they come up. A rationalization is a mistaken belief that seems to make sense at the time but is not based on facts. If you have tried to quit before, you will probably recognize many of these common rationalizations. 'I'll just have one to get through this rough spot'. (Does a smoker ever stop with just one?) 'Today is not a good day; I'll quit tomorrow'. (We've heard that one before.) 'It's my only vice'. 'Is smoking, really bad? Uncle Harry smoked all his life and he lived to be over 90'. 'Air pollution is probably just as bad'. 'You've got to die of something'. 'Life is no fun without smoking'. You probably can add more to the list. As you go through the first few days without smoking, Write down any rationalizations as they come up and recognize them for what they are 'messages that can trap you into going back to smoking' Use the ideas below to help you keep your commitment to quitting. Avoid. People and places where you are tempted to smoke. Later on you will be able to handle these with more confidence. Alter. For example, switch to soft drinks or water instead of alcohol or coffee. Take a different route to work; take a brisk walk instead of a coffee break. Alternatives: Use oral substitutions such as sugarless gum or hard candy, raw vegetables such as carrot sticks, or sonf seeds. Activities. Exercise or hobbies that keep your hands busy (needlework, woodworking, etc.) can help distract you from the urge to smoke. Deep breathing and delay are two other useful tactics. When you were smoking, you breathed deeply as you inhaled the smoke. When the urge strikes now, breathe deeply and picture your lungs filling with fresh, clean air. Remind yourself of your reasons for quitting and the benefits you'll gain as an ex-smoker. If you feel that you are about to light up, delay. Tell yourself you must wait at least 10 minutes. Often this simple trick will allow you to move beyond the acute urge to smoke. What you're doing is not easy, so you deserve a reward. Put the money you would have spent on tobacco in a jar every day and then buy yourself a weekly treat. Buy a magazine, go out to eat, call a friend long-distance. Or save the money for a major purchase. You can also reward yourself in ways that don't cost money: take time out to read, work on a hobby, or take a relaxing bath. Coping with recovery (withdrawal) symptoms. The first few days can be very difficult. For the first few days after you quit, spend as much free time as possible in places where smoking is prohibited - libraries, museums, theaters, churches, temples. AVOID TEMPTATION.by staying away from situations you associate with pleasurable smoking. FIND NEW HABITS.and develop a non-smoking environment around you. Confront carvings:- Few can quit without feeling the cravings creeping on them. You have to bear them, till they are slowly reduced. Here are some ways. Remember 4 Ds: Delay. the impulse to smoke. Don't open the cigarette pack or lighter. In 5 minutes the urge will recede and you have won your first round and resolution to quit comes back to you. Deep breathe. Take a long slow breath in and slowly out again. Repeat three times. This probably mimics how you were smoking. Take 10 deep breaths; hold the last one while lighting a match. Exhale slowly and blow out the match. Pretend it is a cigarette and put it out in an ashtray. Take deep rhythmic breaths similar to smoking to relax. Drink water. Sip water slowly taking time and tasting the water. Drink large quantities of water and fruit juice. Do something else. Take your mind of smoking by another action - listening to music, taking a walk or visiting a friend. Keep oral substitutes handy: carrots, pickles, apples, raisins, and chewing gum. Light incense or a candle, instead of a cigarette. Strike up a conversation instead of a match for a cigarette. If you miss the sensation of having a cigarette in your hand, play with something else - a pencil, a paper clip, a marble, try toothpicks, cinnamon sticks or mints. Take a shower or bath if possible. Learn to relax quickly and deeply. Make yourself limp, visualize a soothing, pleasing situation, and get away from it all for a moment. Concentrate on that peaceful image and nothing else. Remember your goal and that the fact that the urge will eventually pass. Brush your teeth. Do brief exercise (isometrics, pushups, deep knee bends, walk up a flight of stairs, or touch your toes). Call a supportive friend. Compile a list of "Urge Activities" and start at the top when it hits. Eat several small meals. This maintains constant blood sugar levels and helps prevent the urge to smoke. Avoid sugary or spicy foods that trigger a desire for cigarettes. Don't yield. Just one WILL hurt. Having just one cigarette takes you back to regular smoking. Quitting means resisting the urge to smoke even one cigarette despite the craving, the habit and your emotional responses. Count Each day Concentrate on getting through each day without smoking. Do you remember that your first cigarette at the start has upset you and made you feel dizzy and sick? Now give time to your body to adjust to function without nicotine to which you made it a slave. Tea, Coffee and cola drinks These drinks contain caffeine, which is a stimulant. More is absorbed in the absence of nicotine. It makes you restless, irritable and sleepless. Therefore try drinking fewer and weaker cups of these drinks. Take coffee substitutes, water, fruit juices or caffeine-free drinks. Reward yourself Congratulate yourself each time you skipped an urge to smoke. Above all, reward yourself. Plan to do some fun for doing your best. Remind yourself When you falter take out your list of reasons for quitting and advantages awaiting you after you quit successfully. Refuse offer of cigarettes It would be most appropriate when you refuse a cigarette without upsetting any friend. Problem of empty hands Keep your hands busy, keys, beads or some activity with fingers. Other drugs Ex smokers cannot resist smoking if they also take alcohol. Alcohol may weaken your resolve. Avoid both. Avoid alcohol, coffee and other beverages that you associate with smoking Avoid resuming the habit by anticipating future situations/crises that might lead to smoking, and assert your reasons for not giving in. Think positive. thoughts and avoid negative ones. Step 4 Staying a NON-SMOKER Staying Quit (Maintenance) Remember the quotation by Mark Twain? Maybe you, too, have quit many times before. So you know that staying quit is the final, and most important, stage of the process. You can use the same methods to stay quit as you did to help you through withdrawal. Think ahead to those times when you may be tempted to smoke and plan on how you will use alternatives and activities to cope with these situations. More dangerous, perhaps, are the unexpected strong desires to smoke that occur, sometimes months (or even years) after you've quit. To get through these without relapse, try the following: First, review your reasons for quitting and think of all the benefits to your health, your finances and your family. What if you do smoke? The difference between a slip and a relapse is within your control. You can use the slip as an excuse to go back to smoking, or you can look at what went wrong and renew your commitment to staying off smoking for good. When smokers quit - the benefits over time 20 minutes after quitting: blood pressure drops to a level close to that before the last cigarette. Temperature of hands and feet increases to normal. 8 hours after quitting: carbon monoxide level in the blood drops to normal. 24 hours after quitting chance of heart attack decreases. 2 weeks to 3 months after quitting: circulation improves; lung function increases up to 30%. 1 to 9 months after quitting: coughing, sinus congestion, fatigue, and shortness of breath decrease; cilia regain normal function in the lungs, increasing the ability to handle mucus, clean the lungs, and reduce infection. 1 year after quitting: excess risk of coronary heart disease is half that of a smoker's. 5 years after quitting: stroke risk is reduced to that of a nonsmoker 5-15 years after quitting. 10 years after quitting: lung cancer death rate about half that of a continuing smoker's; risk of cancer of the mouth, throat, esophagus, bladder, kidney, and pancreas decrease. 15 years after quitting: risk of coronary heart disease is that of a nonsmoker's. Second, remind yourself that there is no such thing as just one cigarette-or even one puff. Ride out the desire to smoke. It will go away, but do not fool yourself into thinking you can have just one. The worst is over. The urge to smoke is less and less and soon you will not be thinking of cigarettes. But the urge to smoke can return when you least expect it. You can stay stopped. But you should be prepared for such situations. There is always something better than a cigarette. You are now a New Person. Find new methods to handle stress and upsetting emotions. By now you are familiar with your pressure schedules which prompt you to smoke. Stress is a common reason: There may be other reasons like grief, anger, guilt, hunger. Remember that smoking may make you feel better for a minute or two only. The penalties are many. There are many other ways for you to deal with these feelings without reverting back to smoking. Social pressure If your family or friends are making it difficult for you to stay quitting, explain to them. Join people who are happy to see you healthy. Unexpected difficulties Take time to react to unexpected problems. As a non-smoker, you have shown your strength and determination. You will get through this problem and in fact all problems in future with the same determination shown by you in your ability to quit smoking. Weight gain If you find weight gain is a problem, discuss it with your doctor. Remember starting smoking again will not reduce your weight. You will have both problems to handle. You are more likely to be successful with quitting smoking if you deal with the smoking first, and then later take steps to reduce your weight. While you are quitting, try to focus on ways to help you stay healthy, rather than on your weight. Eat plenty of fruits and vegetables and limit the fat. Be sure to drink plenty of water, get enough sleep and regular exercise. Walking is great exercise, and regular exercise increases your chances of staying quit. It helps in three ways: by reducing Stress: by burning calories and toning muscles; and by giving you something to do instead of thinking about smoking. No special equipment or clothing is needed for walking, other than good shoes. You can do it anywhere: the shopping mall; by getting off the bus one stop before you usually do; finding a friend to walk with during lunch time at work; walking with a friend or neighbor after work; or taking your baby out. Set a goal of 30 minutes of physical activity three or four times a week. If you do not already exercise regularly, please check with your doctor before starting an exercise program. Stress Smokers often mention stress as one of the reasons for going back to smoking. Stress is a part of all of our lives, smokers and non-smokers alike. The difference is, smokers have come to use nicotine to help cope with stress. When quitting, new ways of handling stress must be learned. Nicotine replacement can help to some extent, but for long-term success other strategies are needed. As mentioned above, exercise is a good stress-reducer. Exercise can also help with the temporary sense of depression that some smoker's experience when they quit. There are also stress-management classes and self-help books. Check your community newspaper, library or bookstore. Spiritual practices such as prayer and meditation have been used very successfully with other addictions and are an integral part of recovery programs. These same principles can be applied to quitting smoking and can help with stress reduction.
		Find new ways to deal with stress.
		Remember the 4Ds when you get the urge to smoke.
		Delay.
		Deep breathe.
		Drink water.
		Do something else.
	Find new methods of relaxing, massage, deep breathing, yoga, meditation, Change routine Avoid risky places and events Don't react to problems immediately.