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Stopping Smoking Is No Job for Quitters : Health: What to do when nothing calms the craving? Try something else. Start over. Keep at it. Motivation is of prime importance.

THE BALTIMORE SUN

First, the bad news: Every year, about 17 million Americans try to quit smoking. A year later, almost 16 million of them have started smoking again.

But when you consider that smoking is responsible for about 430,000 deaths a year, even if just a small percentage of smokers can quit every year, “you’re saving a lot of lives,” said Dr. Donald Jasinski, director of the Center for Chemical Dependence at Francis Scott Key Medical Center in Baltimore, and a nicotine-addiction researcher.

“To quit smoking” is always one of the more popular New Year’s resolutions, but this year, smokers should be even more motivated: The Environmental Protection Agency has classified secondhand smoke as a carcinogen responsible for the deaths of about 3,000 non-smokers a year. The ruling is expected to result in a host of laws that further restrict the already dwindling number of places where smoking is allowed.

But, as always, the problem remains: how to quit? It’s not easy; if it were, why would 50 million Americans, in the face of documented medical risks, expanding non-smoking zones, increased cigarette taxes and intense social pressure, still smoke?

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It’s not for lack of programs, books, patches, support groups, tapes and other devices and methods, including hypnotism, which purport to help them quit--for a price, usually. But which ones work?

“Different things work for different people,” said Dana Shelton, an epidemiologist with the Centers for Disease Control and Prevention, who has surveyed the literature on the efficacy of various smoking-cessation strategies.

Ironically, for all the methods out there, the vast majority of successful quitters did it on their own, usually cold turkey, Shelton discovered. But that doesn’t mean other methods are worthless; those ex-smokers may have tried other methods and benefited from them in previous attempts to stop smoking before finally quitting on their own, she said.

Shelton offers these tips for smokers trying to choose among the myriad programs: - Ask for information from the American Lung Assn. and the American Cancer Society. Although they are likely to promote their own programs, they have a lot of good, sound information they can send you, she said. “They have done a lot of research and their programs contain a lot of what that research has found,” Shelton said.

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* Find out if the program includes a specific date for quitting. “Smoking-cessation programs are more effective if there is a target date for quitting,” she said.

* Ask what happens after that date. “Relapse prevention should be part of the program. They have to let smokers know what to expect down the road,” she said.

* Ask about the program’s success rate, and be wary of programs claiming near 100%. “You see ones that say, ‘We have a 97% quit rate.’ Ask when they surveyed the quitters. If you survey them a day or two after the program ends, of course it will be high,” she said. The standard measure of success is one year of abstinence, she said.

* Don’t despair if you aren’t successful the first, second or third time around. Keep trying different methods until one sticks, she said.

“People on the average make five or six separate attempts to quit before they’re successful,” agreed Neil Grunberg, a professor of psychology at the Uniformed Services University of the Health Sciences, in Bethesda, Md., who is an expert in smoking behavior. Smokers need to individualize their approaches, even if they’re joining a group or following a particular method, because people smoke for so many different reasons and in so many different situations, he said.

Still, there is perhaps one thing that characterizes the ones who manage to quit for good, he said.

“The individual who successfully quits,” he said, “is highly motivated.”

Here are some of the most popular methods:

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* Nicotine Patch: Susan Davis’ children used to squirt out her cigarettes with water pistols or throw entire packs under a horse’s hoof at the stable, trying to get her off her two-pack-a-day habit. Her doctors warned her of a pre-emphysema condition and high blood pressure.

But it wasn’t until her employer, Francis Scott Key Medical Center, began offering a wellness program involving nicotine patches and a support group, that Davis finally gave up her more-than-20-year addiction to cigarettes. She recently ended a two-month regimen of wearing the patch, which slowly releases nicotine into the bloodstream to satisfy the smoker’s craving, and has been off cigarettes ever since. The patches are available only by prescription and cost about $115 for a month’s supply.

“By giving them nicotine by another route, you suppress the withdrawal symptoms they get when they stop smoking,” said Jasinski, who has researched the patch for the pharmaceutical industry. “If you look at people who attempt to quit smoking, about 50% will relapse in two days. There is a withdrawal reaction that peaks on the second day, and many people can’t get past that.”

But even if a smoker gets past those two days, with or without the assistance of a patch, there are other roadblocks, such as breaking the psychological habit of smoking that has developed over the years, Jasinski said. That is why the patch should be used in conjunction with some kind of counseling or support, he said.

* Hypnosis/Acupuncture: The quest to quit has led many smokers to alternative treatments, acupuncture and hypnosis among them.

Peter Marinakis, a former psychotherapist and acupuncture practitioner in Maryland, said acupuncture can help smokers quit by easing their physical craving for nicotine as well as their psychological craving for smoking. Typically, needles will be inserted in several points in the ear that correspond with other parts and functions of the body, such as the lungs and the heart.

Like acupuncture, hypnosis is outside the mainstream of medicine but has its adherents.

Ira Albert, a psychologist, said that hypnosis can work with some people because it deals with the subconscious.

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“On the conscious level, everybody knows they should stop smoking, but they can’t. With hypnosis, we can get to that subconscious, which is really important when it comes to smoking,” Albert said.

There is little data on how effective these alternative treatments are because relatively few people attempt them and even fewer researchers have studied them.

* Support Groups: Quitting en masse can be done through any number of programs offered by private companies and groups.

“Volunteer agencies are among the best places to look because they’ve done a lot of research and their programs contain what that research has found,” said Shelton, of the Centers for Disease Control.

“You’re in a shared system of support,” said Karen Ann Bochau, program coordinator for the American Lung Assn. of Maryland, and a former smoker who quit after 13 attempts. “When you really get stuck on something, other people can help you.”

* Self-help: Materials are available in bookstores and through groups such as the American Cancer Society.

* Nicotine Gum: Nicotine gum has lost some of its allure since the invention of patches, but some doctors continue to prescribe it. And, said one researcher, the gum has been found to have a side benefit desirable to many: It seems to cut down on the weight gain that many ex-smokers experience when they quit.

“We’ve done some research that has found that if you use an adequate amount of gum, 10 pieces or more a day, it seems to slow down the weight gain,” said Maxine Stitzer, a psychologist in the behavioral sciences unit at Johns Hopkins Hospital. “That doesn’t seem to happen with the patch. Maybe it’s because you’re keeping your mouth busy by chewing gum instead of eating.”


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