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Dr. Jack West is a medical oncologist and thoracic oncology specialist who is the Founder and previously served as President & CEO, currently a member of the Board of Directors of the Global Resource for Advancing Cancer Education (GRACE)


A Primer for Patients on How to Quit Smoking by Guest Expert Dr. Carolyn Dresler
Howard (Jack) West, MD

I asked Dr. Carolyn Dresler, a terrific expert on nicotine addiction and smoking cessation, to write a general post on how to approach quitting. She's actually a lung surgeon who also obtained a Masters in Public Health and now works as Branch Chief for the Tobacco Cessation and Prevention Program for the Arkansas State Governent. She is deeply committed to helping people, and I think she'd also be illing to answer questions people may leave. Here's her guest post:


So, you’ve decided to stop smoking? It is probably the most important step you will take in your life! Your doctor has probably told you that one of the most important steps you can take to help with your diagnosis or to improve your health is to stop smoking. This post will help to guide you on how to do it!

First of all, let us review a few facts. In the above paragraph, we talked about stopping using tobacco – whether it is from smoking or smokeless tobacco. In the United States, the most common form of tobacco use, and its most deadly, is from smoking tobacco, usually in the form of cigarettes. Cigarettes have more than 4000 different chemicals in them and these include more than 60 cancer causing chemicals. It is no wonder your surgeon told you the most important thing you can do to help yourself is to stop smoking!

Stopping smoking is usually a very difficult task. You should know that what you are about to do is one of the hardest things you have ever tried. People smoke cigarettes because of the drug nicotine which is one of the most addictive drugs we have in our society. You probably already know how hard it is, since most smokers have already tried to quit at least once or twice. If it was easy, you would have done it already!

Let us recommend a few ideas and see if these can help you on your road to becoming an ex-smoker.

First, decide on what day you are going to quit. It can be today, tomorrow, or within the next month. If you do not set a quit day in the near future, you are probably not serious about quitting. You need to be serious and very committed to quit smoking.

Next, talk with your doctor (hopefully, he or she has already talked to you about quitting smoking!) Talk to your family and friends. Tell them that you are going to quit smoking and ask them for their help.

FAMILY and FRIENDS: Sometimes people don’t want to tell other people that they are trying to quit smoking, often because they are afraid that they will not be successful. If your family and your friends want what is best for you they will help you to stop smoking – and help you through the difficult times. THIS is what family and friends are for!

Tell your family and friends that you know the next few weeks are going to be difficult for you and ask them to help you! Ask them to NOT smoke around you, to not let you be near anyone smoking. This helps to reduce temptations!

THROW AWAY ALL SMOKING REMINDERS: Get rid of all smoking materials in your home. Throw away the ashtrays, the cigarette lighters, the matches, and yes - the packages of cigarettes. (This is why you plan ahead!) Try to wash as many of your clothes, towels, wash clothes etc – because, as you know, they smell of cigarette smoke. You want to remove everything you can that might remind you of a cigarette. You do not want any more temptations!

This is where family and friends come in – they can help you remove all reminders about cigarette smoking. Don’t go to any bars or restaurants that allow smoking and try to stay away from any alcohol during the first few weeks of quitting. Many people will have a drink or two and then be tempted to ‘have just one cigarette’.

HOW YOUR DOCTOR CAN HELP: Ask your doctor to suggest a medication to help you quit smoking. Studies have shown that if you use a recommended medication, you are more likely to be successful quitting. The medication helps to relieve the cravings and symptoms you get from withdrawing from nicotine – this is really helpful! Don’t try to do ‘cold turkey’ – saying ‘I can do this on my own’. Of course you are doing it on your own! YOU are the one quitting. In addition, taking a medication will significantly increase your chance of being successful – which is what you want most.

TYPES OF MEDICATIONS: The most common type of medication for quitting smoking is called ‘nicotine replacement therapy’ or ‘NRT”. You have probably heard of the nicotine gum. NRT also comes as a nasal spray, a lozenge or a patch that you put on your skin, or in a device that you ‘smoke’ like a cigarette.’ In the United States, the nicotine gum, nicotine lozenge and nicotine patch can be bought from the drugstore without a doctor’s prescription. The device that is ‘smoked’ (called an inhaler) and the nasal spray must have a doctor’s prescription. We’ll describe more about the NRT products below.

Varenicline (called CHANTIX, by Pfizer) is a pill that is taken once in the morning and once in the evening. This medication requires a doctor’s prescription. This drug does not yet (as of 2007) come in a generic form.

To use varenicline – take 0.5 mg by mouth once in the morning for 3 days. On the fourth day – take 0.5 mg by mouth once in the morning and once in the evening. On the 7th day QUIT SMOKING and use 1 mg by mouth once in the morning and once in the evening. Use varenicline for at least 3 months. Talk with your doctor if you think you need to use varenicline longer. Your doctor can write another prescription for you.

Bupropion (also called Zyban by GlaxoSmithKline) is also taken as a pill once in the morning and once in the evening. This medication should not be taken if you have any risk of a seizure, are an alcoholic, or have anorexia. This drug does come as a generic and also requires a doctor’s prescription.

To use bupropion: Take 150 mg by mouth once in the morning for 3 days. On the fourth day, take 150 mg by mouth once in the morning and once in the evening. On the 7th day – quit smoking. Use bupropion for at least 3 months. Talk with your doctor if you think you need to use bupropion longer. Your doctor can write another prescription for you.


Nicotine gum: the labeling on the box states that if you smoke more than 25 cigarettes per day, you should use the 4 mg dose and if you smoke less than 25 cigarettes per day, use the 2 mg dose. However, many people think the 4 mg dose works better for them. You can try either – and see which one works better for you in relieving or preventing cravings for a cigarette. People who use the nicotine gum very rarely receive as much nicotine from the gum as they did from their cigarettes – so you can try the 4 mg and see how it works for you. It is very important to use the nicotine gum frequently! Most people do not take enough of the gum during the day to really be effective. You should probably be using at least 9 pieces in the first days of your quitting.

You can SLOWLY taper down – but very slowly. Plan on using the gum for at least 3 months! It does take that long to really get a good start on being a former smoker! The worst day is the first day, and then the first week. After about 7-10 days, all of the nicotine and its breakdown products are out of your system and your body is starting to become normal again. BUT – that does not mean you should stop the nicotine gum – it is still too soon! You will probably still have cravings, and the nicotine gum will help prevent them and make them smaller.

Nicotine lozenge: The nicotine lozenge has a little bit different dosing instruction: if you have your first cigarette within 30 minutes after waking up in the morning – use the 4 mg nicotine lozenge. If you have your first cigarette more than 30 minutes after getting up – use the 2 mg nicotine lozenge. Again – you can try one and see how it works for you. If you don’t like it , try the other dose. Follow the same instructions above for the gum. AGAIN – it is important to be sure and use enough lozenges each day. The most common problem is people NOT using enough lozenges per day.

Nicotine patch: The nicotine patch comes in a variety of doses and dosing instructions. Most commonly, people use the 15 mg dose (Nicotrol patch) or the 21 mg patch (Nicoderm or Habitrol). These patches should be applied to an area of clean and dry skin. You can put it anywhere on your body, but it is best to put it somewhere on your upper body. Try to put it on a place that is not hairy so it doesn’t hurt when you take it off! Don’t put it on you hips where you might sit on it and don’t put it under your breast. The best place is somewhere on your chest, upper back or arms. It is important to put the new patch on each morning in a DIFFERENT place than the patch location the day before. Some skin redness is common, and it should resolve in the next day or so – but it is important to NOT keep using the same location to put the patch.

After about 8 weeks on the highest dose patch, you can start to ‘step-down’ the dose and use the 14 mg or the 7 mg patch. These decreasing doses are intended to help wean you off of nicotine. Of course, the smaller amount of nicotine will also help with the decreasing cravings and withdrawal symptoms as you get further from your quit date.

It is very important as you are quitting to not give up!!!! Even if you slip and have one cigarette or one puff – this does not mean that you must go back to smoking regularly. If you do slip – remember WHY are you quitting and how badly you do want to quit. Then, resolve to ‘get back on the wagon’ and don’t have another cigarette. Maybe learn from the experience about what made you have that ‘slip’ and try and stay away from that temptation again.


DO call the QUITLINE in your state! Every state in the United States has a free quitline that you can call for help. The number is 1-800-quit now. Call today! These Quitlines offer various types of services – but they are all dedicated to help you quit and they are FREE! Some of them even provide free medication to help you quit. You will speak with trained counselors – people with special training to help you quit. It is a confidential service. Sometimes your doctor can refer you directly from the doctor’s office but you can also call yourself when it is convenient for you – the people at the quitlines are there for YOU. They also will help you with any medication questions that you might have.

Using the Quitline or any sort of counseling is very important when you are quitting smoking. You know that you have been smoking for many years, and that it is a very strong habit. So getting some help to break the habit is very important. You should NOT look at getting help as a bad thing. Actually, not getting help is NOT a good thing! Studies have shown that if you get help quitting smoking, you are more likely to quit smoking. So, get counseling – either at your hospital or from the Quitline. Either of them will work in helping you to break the habit!!

Make sure you tell your doctor how you are doing with quitting smoking. Your doctor understands how hard it is – and he or she will be your biggest cheerleader in helping you kick the habit!

Start now! Talk with your doctor. Get a prescription. Call the Quitline! DO the most important thing for your health that you can! GET STARTED today!

Smoking Cessation summary

(Click on summary table to enlarge)

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