Options for Smoking Cessation

1. Cold Turkey
This method requires that the smoker stop smoking cigarettes abruptly. This method has been very successful for some smokers. Other smokers require several attempts at quitting cold turkey before they are successful.

Factors to Consider:

• This process can be managed alone
• Quitting cold turkey is a one-step process
• The cost is minimal
• The smoker must be highly committed to the goal of quitting
• The nicotine withdrawal symptoms (such as irritability, headache, or difficulty sleeping) may be severe for some - especially if the cigarettes smoked contain high levels of nicotine

2. Nicotine Fading
The smoker is instructed to reduce the nicotine level in the cigarettes smoked by 30% for one week, by 60% the second week, and by 90% the third week. During the fourth week, the smoker quits cold turkey. This method helps reduce the nicotine withdrawal symptoms.

Factors to Consider:

• Easy to follow
• Inexpensive
• The smoker must have a high level of motivation

3. Nicorette Gum
Nicotine gum provides a substitute source of nicotine to reduce the withdrawal symptoms during the quitting process. The smoker may need to chew 10 to 12 pieces of gum each day over a 3- to 6-month period. The amount of gum chewed each day is slowly reduced during the last few weeks of the therapy.

Factors to Consider:

• This process can be managed alone
• The smoker must have a high level of motivation
• The smoker must stop smoking completely when using the nicotine gum
• Minor side effects may include lightheadedness, nausea, sore mouth, hiccups and excess amount of saliva
• The gum is not recommended during pregnancy, following a heart attack or other heart problems, or if there is joint disease of the jaw
• Denture-wearers may not be able to use the gum
• Long-term smokers are more likely to become dependent on the gum
• Cost of the gum for 12 weeks of therapy is approximately $250 - $500 depending on the dose
• Most insurance does not cover the cost of the gum
• Nicorette is available over-the-counter

4. Nicotine Skin Patch
The nicotine patch also provides a substitute source of nicotine to reduce the withdrawal symptoms during the quitting process. The patch is worn for 8 to 12 weeks.

Factors to Consider:

• One patch is applied every 24 hours
• The smoker must have a high level of motivation
• The smoker must NOT smoke when using the patch
• Common side effects are skin redness at the patch site when the patch is removed and restless sleep
• The patch is not recommended during pregnancy, or if there is a history of high blood pressure or other heart diseases
• The cost of the nicotine patch is approximately $200 for 12 weeks.
• Most insurance does not cover the cost of the patch
• The patch is available over-the-counter

5. Zyban (Bupropion HCI)
Zyban is the first nicotine-free pill that helps to reduce the urge to smoke. Zyban is thought to work on the biology of nicotine addiction by acting on the "reward" and/or "withdrawal" pathways in the brain associated with nicotine addiction. The smoker starts taking Zyban within 1-2 weeks before the quit date. Then on the quit date the smoker stops smoking and continues Zyban as recommended by the health care provider. Zyban therapy may be 7-12 weeks in duration.

Factors to Consider:

• Zyban is not for everyone. There is a risk of seizure associated with Zyban.
• You should not take Zyban if you have a seizure disorder, are currently taking MAO inhibitors, Wellbutrin, Wellbutrin SR, or have an eating disorder
• The cost is dose dependent and aproximately $135 - $266 for 3 months of therapy
• The most common side effects with Zyban are dry mouth and trouble sleeping
• Zyban is available by prescription only
• Insurance may pay for Zyban
• Zyban may be used in combination with the nicotine patch; however, blood pressure should be monitored during treatment

Counseling Services
All of these options are most successful when combined with modification of behaviors that were previously associated with smoking. Additional counseling may include stress management, weight control, and tips for preventing relapse.

See related Patient Textbooks about Internal Medicine.

See related Patient Topics Child and Teen Health, Food, Nutrition and Metabolism, Internal Medicine, Preventing Disease and Staying Healthy, Pulmonary, Smoking, Smoking and Youth, Smoking Cessation, Substance Abuse, Symptoms and Manifestations, Teen Health or Wellness and Lifestyle.

See related Provider Textbooks about Internal Medicine.

See related Provider Topics Child and Teen Health, Food, Nutrition and Metabolism, Internal Medicine, Preventing Disease and Staying Healthy, Pulmonary, Smoking Cessation, Substance Abuse, Symptoms and Manifestations or Wellness and Lifestyle.

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