So you have decided to give up smoking. That is undoubtedly a great decision, but the difficulties start from day one.

Cigarettes truly are addictive, and smoking does reliably and quickly relieve stress and enhance the positivity in one’s outlook. Therefore, quitting is accompanied by the pains of withdrawal and resulting emotional downs.

Yet it is still possible to keep on track to achieve successful quitting. The first step is to have a clear personalized plan in place. This should help you firstly to resist the immediate urge to smoke, and secondly, to successfully resist the repeated temptation to start again.

Identifying triggers and cues

What makes you crave cigarettes? Thinking this through will help you avoid the triggers, such as the morning cup of coffee or evening glass of wine which makes you reach for the cigarettes. Instead, for instance, take a walk or have a warm bath at the designated time of the day.

This change will help break this habitual association. A journal is crucial in identifying the cravings, their intensity and the setting. This way both light and strong triggers can be identified and successfully tackled by lifestyle modifications.

Quit day

Set a date when you are going to stop smoking and make it soon, and on a peaceful day. Prepare for known difficulties, like withdrawal symptoms and cravings. Let others know your plans so they can help keep smokers away from you and encourage you.

Moreover, throw out all the cigarettes and even the smell of cigarette smoke. If necessary, get over-the-counter or prescription nicotine release products. Stress management may be useful as well; thus instead of smoking, try different relaxation methods.

Reasons for relapse

Nicotine produces physical and psychological addiction because of the effects it has on the brain. Once nicotine levels drop in the body, this produces aforementioned feelings of cravings, as well as physical withdrawal symptoms. To deal with these, a twofold approach is needed.

Facing nicotine withdrawal

The physical symptoms of nicotine withdrawal start within an hour of quitting, and may be at their worst in two or three days. They may last for up to a few weeks. However, bear in mind that they always pass. You just need to last them out, and to alert others to the chances that you may struggle emotionally for some time.

The symptoms include:

• Cigarette cravings
• Mood changes such as anxiety or nervousness, tiredness, lack of concentration, depression, irritability and restlessness
• Physical symptoms such as increased appetite, insomnia, headaches, tremor, constipation, low heart rate or increased coughing

To handle these, new coping strategies are ideal to disarm the triggers, whether stress, boredom, or anxiety.

Secondly, avoid trigger habits or cue routines to weaken the brain link between smoking and that cue. For instance, you could end a meal with a piece of cheese or dark chocolate, fruit, or just walk in a green no-smoking zone.

The plus point is that vegetables, fruit and cheese don’t go well with cigarettes, making it easier for you. Water is preferable to an alcoholic drink, a cola, tea or coffee, or soft drink, for the same reason. In addition, water may ease certain discomforts that arise as a result of nicotine withdrawal (such as coughing, constipation and urge to eat).

Remind yourself that nicotine withdrawal cravings will cease in about 5-10 minutes, so distract yourself till then. For instance, you could watch that video you have been planning to watch for the last couple of days, catch up with a friend, manipulate some modelling clay, or almost anything that will need your attention and catch your interest. Another good way is to enter a no-smoking zone.

The four Ds summarize a winning strategy in this situation:

• Delay for 10 minutes
• Deep breathing – or breathe through a straw
• Drink water in sips
• Do something else to distract yourself

Write down a list of the top five reasons for quitting in your case, and have it ready to reinforce your motivation. And always, always, get support – either online or face to face.

How long till I feel better?

Nicotine withdrawal symptoms will last for only a few weeks at most. The physical symptoms recover much faster. The following table may be helpful:

Time since quitting	Benefit
Six hours	Stable heart rate and blood pressure
One day	Almost nicotine-free blood
One week	Better taste and smell, better removal of external dust, tar and mucus by the lungs
Three months	Less respiratory symptoms, better immunity, better circulation to limbs
Six months	Less stress
One year anniversary	Better lung function
Five years	Heart disease risk lower, cervical cancer risk normal
Ten years	Lung cancer risk lower
Fifteen years	Normal risk for stroke or heart attack

What other benefits are there for me?

You will obviously no longer have to make sure you do not smell of smoke, or that you have access to cigarettes wherever you go. Furthermore, you no longer endanger others by your second-hand smoke. Other benefits are that you will save a huge amount of money, and your self-esteem will rise, while you can now run or climb stairs without wheezing.

Will I gain weight if I quit smoking?

Smoking cigarettes suppresses the appetite. However, most people put on only a couple of kilograms in the first six months after quitting, and this also goes down over time. Of course, food tastes better once your taste buds are refreshed, but this should not make you turn to food instead of tobacco as your coping strategy.

Instead, adopt other healthy pleasures, such as a walking, listening to music or reading a good book. Additional advice is to avoid processed and sweet/fatty foods, eat mindfully and drink a lot of water.

Do medications help?

Several medications are successfully used to help smokers quit the habit, especially in a physician-monitored program. Some prescription medications can help smokers quit, but should be used for as short as possible.

Nicotine replacement gums, patches, lozenges, inhalation or nasal sprays all aim at relieving the physical symptoms by steadily releasing small amounts of nicotine over a period of time. This avoids tar and smoke inhalation.

Vaping, or e-cigarettes, prevents the intake of tar and toxic gases from cigarette smoking. However, they are associated with:

• Negative health effects from nicotine in the cartridge liquid
• Chronic lung disease from the flavorants in e-cigarette liquids
• Occasional formaldehyde from the e-cigarette vaporizers

Are there any alternative therapies to help quit successfully?

Some methods used to stop smoking without nicotine replacement or vaping include:

• Hypnosis that induces a state of deep mind relaxation where suggestions that help create an aversion to cigarettes and a stronger determination to stop smoking can be introduced
• Behavioral therapy helps learn new ways to cope and breaks the habits and associations related to smoking
• Motivational therapies which focus on the gains from quitting

What about smokeless tobacco?

Smokeless tobacco is tobacco designed for chewing and is high in nicotine. In fact, it may release 3-4 times more nicotine than you would get from a cigarette. However, albeit the adverse effects of smokeless tobacco on cardiovascular system are lower when compared to smoking per se, but are still higher than those in non-smokers.

What if I slip?

A slip does not mean you have failed. Instead, try to analyze the situation so you can observe what went wrong, and adjust your smoking plan to avoid the same thing next time around. The most important thing is to always get up if you fall. Throw away the remaining cigarettes so they cannot tempt you.

Reinforce your resolve by keeping track of the number of no-smoking days you racked up so far. If a friend or family member is trying to quit, support them in all these ways. Encouragement, talking them through difficult times, and avoiding smoking situations are all helpful. Finally, do not preach or threaten, as it may just worsen the situation.

Further Reading

• All Lung Cancer Content
• Lung Cancer
• Lung Cancer Causes
• Lung Cancer Symptoms
• Lung Cancer Diagnosis

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.