A very informative article copied from The New York Daily News Website.
Take a look at the success rates of different methods of quitting - near the end.

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From: New York Now | Health |
Tuesday, January 25, 2000

Quit While You're Alive
How to find the right method —
for you — to kick the habit

By EAMON LYNCH
Daily News Staff Writer

If three packed jumbo jets crashed in America every day, would you be more wary of flying? If you're a smoker, your answer should be no, since smoking-related illnesses claim over 1,100 lives in America daily — more than the number who would perish in that many air disasters.

However, smoking doesn't just kill. It can cost you your neighbors, your kids and some great sex. British researchers recently said that smoking a cigarette takes 11 minutes off your life, with an entire pack costing 3 hours 40 minutes — time to "watch ‘Titanic,' run a marathon or have tantric sex," the scientists claimed.

Smokers are increasingly being sued by residents in neighboring apartments who claim the ventilation system reroutes smoke into their homes and in more than a dozen states courts have ruled that whether a parent smokes is relevant to deciding child custody cases. None of that seems to faze Mary McCabe of Manhattan. "You're not even thinking about sex. You're gonna have a cigarette!" she says, firing up another butt.

About 25% of Americans — roughly 50 million people — smoke, according to Dr. Neil Schachter, director of respiratory care at Mount Sinai Hospital. "It's a dynamic situation," he says. "There are people dying, there are people quitting, and there are new smokers. It's an equilibrium."

While the numbers remain steady, attitudes toward smoking have changed. "The majority of the population doesn't smoke and the majority considers it a dirty habit," Schachter says. "It's not something you do in the office or in most public places. Given the current social-political environment, most of the adults who can easily stop have done so. What we tend to see now are people who are very difficult to treat."

McCabe is one of those people. Last week she embarked on her fifth attempt to break a habit she began at 16. She once quit for six years after hypnosis. "I was not around any smokers and there was no smoke in my environment," she says. "But the minute smoke was back in my environment, I was back smoking."

Acupuncture kept her clean for a year the first time she tried it, five months the second time. In 1998, she used Zyban but relapsed after six months. She's now on Zyban again. "I really want to quit," she says.

That desire to quit is the key, experts say.

"The most important part for a person who wants to quit smoking is that the person is motivated and committed to what is a difficult process," says Dr. Michael Fiore, a cessation expert who chairs a government panel examining the best quitting methods for smokers.

A 1996 survey by the American Lung Association indicated that 96% of smokers thought they could quit only if they were mentally prepared. Other studies suggest that most smokers make an average of five attempts to quit, some as many as 11 — a fact illustrated by a friend who was asked recently if nicotine gum helped her stop smoking. "Oh, yeah!" she replied. "I quit with it three times."

John — a member of Nicotine Anonymous who requested his last name not be used — failed many times before he finally stopped. "I went to a guy in Boston called the Crazy Russian," John says. "He was a Soviet mentalist, not a hypnotist or faith healer. I don't know what he did, but I paid him a significant amount of money to do it. I lasted six or seven hours." Soon after that experiment, John went to his first N.A. meeting on Long Island. Three weeks later, he quit his 16-year habit. That was in 1992.

"I was 32 at the time and I can't think of anything so frightening in my life," he remembers. "I promised my wife I would stop smoking before our first child was born and she was pregnant at the time."

At N.A., he says, people didn't tell him he was sick for smoking butts that he had found in the street.

"I mean, I was sick. But they understood all that," he says. "I was always a person who, when someone else stopped smoking, I secretly hoped they would fail. At Nicotine Anonymous, they genuinely want you to stop smoking."

Like most smokers, McCabe fears the consequences to her health. "I'm constantly worrying about how far I'm going to go before I get lung cancer," she says. "Am I going to wait until it's too late? As you get older, you start thinking about your mortality a lot more. You begin to worry that this will be the time you go to the doctor and he says, ‘Wait a minute. There's something really wrong here.'"

According to Schachter, the benefits of quitting begin immediately. "There's a risk of sudden death due to arrhythmia that drops off very dramatically in the first few months after you stop smoking," he says. "There is a definite benefit that accrues, and I think that by 10 or 15 years [of not smoking], most of the effects are gone."

"Even if you've failed in the past, it's a great time to try to quit," Fiore adds. "It's the best thing you can do for your health."

Fiore is frequently asked by patients what the success rate of a cessation product is and his response is unchanging: "For you, it's going to be either 100% or 0%. What is going to make the biggest difference is how committed you are."

Despite the ever-growing market of cessation devices, Fiore cautions against expecting a quick fix.

"There are no magic bullets out there. Nothing will automatically turn a smoker into a nonsmoker," he says. "All of them require the smoker go through what is frequently a difficult withdrawal process. It's like with alcohol, you have to consider yourself potentially addicted for the rest of your life."

The future does hold some promise as scientists hope to begin human trials of a nicotine vaccine within the next two years. Because the body does not produce a natural antibody to nicotine, the drug has been combined with a bacteria which the immune system then recognizes as foreign and develops anti-bodies to combat.

Ideally, when a person innoculated with the vaccine smokes, the antibodies will latch on to the nicotine and prevent it from reaching the brain. It's unclear how long a vaccine will offer protection, and it would not reduce the nicotine cravings, just kill off the enjoyment of the drug.

If you can't enjoy the drug, researchers hope, then what's the point in taking it?

The Chronic Addict

Chuck Furer starting smoking at 12 when he threw a cocktail party for his friends in his parents' garage.

Before long, his yellowed fingers became a trophy among his friends. Forty years later, smoking had so damaged his circulation that doctors warned him to quit or face the amputation of his lower right leg and several toes from the left foot. His response was to check the deals at a prosthetics store.

"I was hooked," he says with understatement.

The 55-year-old accountant survived a heart attack and a stroke and was diagnosed with diabetes and arterial sclerosis. But his addiction was chronic: He smoked in the shower, set off alarms on airplanes, even refused clients if he couldn't smoke in their office. He lost one job when he lit incense sticks to disguise his cigarettes and set off the sprinklers. He drove 30 miles at night through a Canadian blizzard for a pack of Marlboros. He was busted on his first day in the Army for smoking while hiding in a dumpster.

Despite all that, Furer crushed out his last cigarette on Nov. 12, 1997.

"I did literally every thing known to mankind," he says. "I went to a psychiatrist, I took drugs, I got shocks in my head, I did the gum, I tried acupuncture, I was hypnotized, I did so many patches I got nicotine poisoning. I was wearing two patches, chewing the Nicorette gum and smoking. It was just pathetic."

After the warning from his doctors, Furer's wife — tired of trying to persuade him to stop — threatened to leave him rather than see him "mutilated." It was then that Furer began praying that he would want to be smoke-free. "Not to become smoke-free," he points out. "Just to want to be smoke-free."

In the fall of 1997 — with his health, marriage and career on the line — Furer decided he was mentally ready. Joining a 12-step program, he embarked on another attempt to quit. "I did every single thing I had done in the past, but this time I did it with a willingness to be smoke-free," he says. On his first day without cigarettes, he and his wife hid in a downtown movie theater with a huge bag of popcorn. He saw four pictures. "But I had gone a day without a cigarette," he remembers, still awed at the achievement.

What most scared Furer were the urges, the nicotine D.T.'s. "I was terrified that every day I got up for the rest of my life I would have to go a round with Mike Tyson," he says. "But what most people don't realize is that the urge to smoke passes. … The rest of it was a piece of cake to me."

Hardly. Furer's new smoke-free regimen included massages, acupuncture, breathing exercises, wearing a charm, chewing gum, new eating habits, meetings, prayers, therapy, calls to non-smokers, constant brushing of his teeth, naps, even dousing his hands with a sweet cologne. It worked.

After more than two years smoke-free, Furer's circulation is improving. He saved his leg, his marriage and his career by quitting. "I thought I was worthy of having a miracle in my life. I didn't know you had to ask for it though," he laughs. "But when I asked for it, I got it."

Cessation Methods

Nicotine Gum

Approved by the Food and Drug Administration in 1984, nicotine gum is the oldest nicotine-replacement therapy. It comes in two strength levels and reduces cravings by releasing nicotine into the bloodstream. It can be prescribed by a doctor or dentist and users must first quit smoking.

The gum is chewed deliberately and when a tingling in the mouth indicates the release of nicotine, the gum is left to sit until the sensation stops. The process is repeated for about 30 minutes. Generally 10 to 15 pieces of gum are used daily but no more than 30. Smokers chew gum every day for a month — reducing the amount of pieces — and stop entirely after three to six months. Nicotine gum is stiff and can pose chewing problems for people with dentures or a lot of dental work.

The success rate for gum ranges from 10% to 20% (success defined as user quitting for at least a year).

Nicotine Patches

Approved by the FDA in 1991, patches release nicotine through the skin, reducing withdrawal symptoms like irritability and lack of concentration.

"They work by replacing the nicotine one normally gets by smoking a cigarette," Schachter says.

"Essentially what the patch does is provide a constant level of nicotine that relieves some of the withdrawl symptoms that stopping smoking entails."

Because smokers don't have a constant level of nicotine in their blood, using the patch aims to bring the nicotine level of a quitting smoker into the same ballpark as when they are smoking. From there, the level is then reduced. Smoking while using the patch can cause side effects including headaches, dizziness, blurry vision and mild skin itching or burning.

Success rate: 10%-20%

Nicotine Spray and Inhaler

These two more recent nicotine-replacement strategies work in a similar manner to the gum and patch. Both the nasal spray and the inhaler are prescription items.

The spray is placed in the nostril where it releases a controlled amount of nicotine into the system. "You just spray it in your nose as you would a solution to help with decongestion," Schachter says. There is some dispute to success levels. A government panel estimates a success rate of about 15%, but the Centers for Disease Control Office on Smoking and Health rates the spray at 30%.

The nicotine inhaler is used the same way as an asthma inhaler — the capsule is placed in the mouth and several "puffs" of its contents are administered. Again, it provides a reduced dose of nicotine. The success rate is similar to most nicotine-replacement systems, estimated at around 19%.

Zyban

Developed as a depressant, Zyban is a prescription pill with which smokers have had an easier time quitting. "We don't exactly know how it works," Schachter admits.

One theory is that nicotine enhances the part of the brain that anticipates pleasure, rather than enhancing the pleasure itself. "Once you reset [the brain] at a different level by becoming a smoker, you turn it off to other stimuli," Schachter says.

Zyban is thought to encourage other stimuli, making it psychologically easier to kick nicotine. Smokers begin a Zyban regimen about two weeks before their quit date and continue for a total of 7-12 weeks. The average dosage is one pill twice a day. Common side effects are dry mouth and difficulty sleeping, and there is also a risk of seizure in certain patients.

"It works to the degree that you don't really feel the effects of not smoking," says McCabe. "You have a sense of depression that you can't smoke anymore then you sit and rationalize it — ‘Wait a minute. I'm depressed about not doing something thats killing me!'"

Success rate: up to 25%.

Hypnosis and Acupuncture

Two of the oldest and most popular cessation methods are also the most hotly debated. "Nothing is old hat because nothing works 100% of the time," says Schachter. "Everyone will seek that which fits their lifestyle or sense of what they think is going to work for them."

Fiore has reviewed extensive scientific data and is less embracing of hypnosis and acupuncture. "We found no evidence to endorse those as effective treatments," he says.

Schachter admits that hypnosis and acupuncture don't have a high batting average but won't write the methods off, saying that for some people these might be the added enhancement needed.

Cold Turkey

Arguably the toughest method of cessation though many ex-smokers say it allowed them to remain in control. It is certainly the cheapest.

"When people try to quit on their own, cold turkey, the success rate is, on average, 5%," Fiore says.

Laying the Mental Groundwork

Fiore recommends a five-point approach for people who plan to stop smoking:

Set a Quit Date. Choose a date sometime in following two weeks when you will totally abstain from nicotine.

Review Past Quitting Experiences. What helped you and what hurt during previous attempts to break the habit?

Anticipate Challenges to This Attempt. All smokers know what circumstances will put them at risk of relapsing. Plan how to avoid or deal with them.

Alcohol. Half of people who relapse do so with alcohol in their bloodstream. Don't drink for three months or, if that is not possible, limit yourself to two drinks a day.

Other Smokers in the Household. It's near impossible to quit if you live with a smoker. Quit as a couple or establish ground rules where the smoker won't leave cigarettes around or keeping part of the house smoke-free.

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Smokers could benefit from even a modest addition of vitamin C to their diet, according to study by UC Berkeley and USDA

By Robert Sanders Public Affairs

BERKELEY-- A study published this week in the American Journal of Clinical Nutrition shows clearly that smoking depletes the body of vitamin C, a powerful antioxidant that protects the body from disease. However, the study suggests that moderate supplementation can help smokers boost their vitamin C levels significantly.

Antioxidants such as vitamin C, vitamin E and carotenoids are thought to help the body fight off diseases ranging from cancer to heart disease, and help stave off the degenerative effects of aging.

The study indicates, too, that previous research that found depleted vitamin E and carotenoids in smokers may have been measuring the effect of poor diet, not smoking.

The study, conducted by scientists at the University of California, Berkeley, and the U.S. Department of Agriculture's Western Human Nutrition Research Center (WHNRC) in Davis, was designed specifically to separate the effects of diet and smoking on antioxidant levels in the body.

"The first piece of advice for smokers is, of course, stop smoking," said study leader Lynn M. Wallock, PhD, a scientist at UC Berkeley and the WHNRC. "Barring that, smokers can benefit by improving their diet to include more fruits and vegetables, which contain a balance of antioxidants and other nutritional benefits, like fiber and carotenoids.

"Or, they can take vitamin C supplements. Even with modest vitamin C supplementation, smokers can improve their plasma vitamin C levels substantially. However, no regimen of diet or supplementation can make up for the adverse consequences of smoking."

The study was conducted by Wallock, Bruce N. Ames, professor of molecular and cell biology at UC Berkeley; Jens Lykkesfeldt, Stephan Christen and Harry H. Chang of UC Berkeley; and Robert A. Jacob of the Western Human Nutrition Research Center, which is located at UC Davis but operated by the USDA.

Because nonsmokers with a poor diet showed increased levels of antioxidants in their blood after taking vitamin C and E supplements in the study, the results hint also that supplements can improve the health of those with poor diets. Supplements, however, cannot provide all of the health benefits of fruits and vegetables, Wallock cautions.

The researchers screened hundreds of male volunteers to find smokers and nonsmokers with poor diets, looking specifically for low intake of fruits and vegetables. Anyone taking vitamin supplements was screened out.

The reason, Wallock said, is that many previous studies of smokers have not distinguished the effects of smoking from the effects of a poor diet, which is common among smokers.

"Smokers tend to have poor diets, so some effects that have been found may not be the result of smoking, but the result of not eating well," she said.

The volunteers selected for the study averaged 2.7 servings of fruits and vegetables per day, as compared to the 5-9 servings recommended by the National Research Council and a minimum of two servings of fruit and three of vegetables per day.

In baseline comparisons between the smokers and nonsmokers, smokers were found to have significantly lower vitamin C levels in blood plasma than did nonsmokers. However, vitamin E, beta-carotene and lycopene levels were not significantly different between smokers and nonsmokers with a poor diet. Lycopene is the major carotenoid found in tomato products, while beta-carotene is found in carrots and other orange or red fruits and vegetables.

Wallock and her team divided the 37 smokers and 38 nonsmokers into two groups. One received a combined supplement containing vitamins C and E and folate (272 mg vitamin C, 31 mg alpha-tocopherol, 400 micrograms of folic acid). The other group received placebos.

After three months, the smokers who took supplements had tripled their blood levels of vitamin C to bring them up to normal levels. Nonsmokers taking supplements benefited slightly, too.

Plasma levels of vitamin E rose in both smokers and nonsmokers, but the supplement ­ which contained a form of vitamin E called alpha-tocopherol - actually decreased levels of another form called gamma-tocopherol. Though Wallock said the health effects of this are uncertain, at least one study by Ames and Christen several years ago showed that gamma-tocopherol is nearly as potent an antioxidant as alpha-tocopherol.

Wallock continues to analyze results of the study, including the effects of supplementation on antioxidant levels in sperm.

The study was supported by the Tobacco Related Diseases Research Program, the National Institute of Environmental Health Sciences of the National Institutes of Health and the USDA Agricultural Research Service.

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