Smokers can quit without the process being a real drag

I first flirted with cigarettes when I was 13. My love affair with them began in earnest when I was 15. We broke up when I was 22. We saw each other in moments of weakness during my residency, an admittedly nutty time.

I was lucky. I hadn’t smoked that long, and it was fairly easy to quit. My parents had it tougher. They quit after 40-plus years of smoking, cold turkey, a notoriously unreliable way to quit.

“Quitting smoking is easy,” Mark Twain once said. “I’ve done it a thousand times.” Every year, half of American smokers try to quit. Every year, only 7 percent succeed for a year or more. This, despite our knowledge of all the bad effects cigarettes have on our health – cancer of the lung, bladder, kidney, esophagus, pancreas, stomach, mouth, larynx and leukemia; heart disease, stroke, hardening of the arteries and abdominal aneurysm; emphysema, pneumonia, and chronic bronchitis; decreased fertility, fetal death or stillbirth, low birthweight, preterm birth, placenta previa, and placental abruption; early menopause, osteoporosis and hip fracture; cataracts.

It is not that failed quitters have a character flaw. It is that nicotine is highly addictive. Nicotine causes changes in brain chemicals that make a smoker feel good, and make the smoker crave even more cigarettes. The smoker develops tolerance to nicotine, and smokes even more to maintain nicotine blood levels, finally achieving a “steady state” – one, two or three packs a day.

When the smoker tries to quit, withdrawal symptoms set in. Fatigue, depression, irritability, insomnia and increased appetite are common.

Some researchers see nicotine as more addictive than alcohol, heroin and cocaine. So it really should come as no surprise that quitting is hard.

In an article in last week’s Lancet, researchers from the New York City and New York State Departments of Health and the Roswell Park Cancer Institute describe a smoking cessation program in New York City. They used the confluence of increased cigarette taxes and the implementation of workplace smoke-free regulations (including restaurants and bars) to undertake a large-scale program that mailed six weeks of free nicotine patches (nicotine replacement therapy, or NRT) to the first 35,000 eligible smokers who called a quit line. Participants also received brief follow-up counseling calls.

Researchers couldn’t contact all 35,000 participants to see if they had successfully quit, so they attempted to contact 2,150 randomly sampled NRT recipients at six months and compared them to a group who never received their patches due to mailing errors. They were able to contact 1,305 participants.

At six months, 33 percent of recipients had quit compared to 6 percent of the nonrecipients. Highest quit rates were in those who were foreign born, older than 65, or who smoked less than 20 cigarettes a day. If they received counseling in addition to NRT, they were more likely to quit (38 percent versus 27 percent).

For purposes of analysis, the researchers assumed that the ones that they could not contact had not quit smoking. Using this assumption, which likely overestimates those who did not quit, 20 percent of NRT recipients were successful at giving up cigarettes. Using their conservative estimates, more than 6,000 New Yorkers stopped smoking. If all the non-responders quit, then 10,500 no longer smoked.

The researchers concluded that a program that held minimal barriers to participation – call the hot line, answer a few questions, get NRT in the mail, get a few counseling phone calls – can reach thousands of smokers and help save lives.

The study also confirms what other studies have told us. NRT coupled with counseling (or stop-smoking support groups) provides the best road to a tobacco-free life. Six weeks of nicotine patches costs about $120. That’s about $3 a day. How much do your cigarettes cost?

Want to quit? Start by checking out www.tobaccofreespokane.org or call the Washington State Quitline at (877) 270-STOP (7867). Good luck. And if at first you don’t succeed, keep trying!