Stop Smoking Clinic

Options for Smoking Cessation
Finding the best method to assist a person with smoking cessation is sometimes difficult. The Stop Smoking Clinic offers the following nine options for quitting smoking:

1. Cold Turkey
2. Chantix (varenicline)
3. Nicotine Fading
4. Nicotine Gum
5. Nicotine Skin Patch
6. Nicotine Lozenge
7. Nicotine Nasal Spray
8. Nicotine Inhaler
9. Zyban (Bupropion HCI)

1. Cold Turkey
This method requires the smoker stop smoking cigarettes abruptly. This method has been very successful for some smokers. It requires several attempts for other smokers 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. Chantix (varenicline)
Chantix is a nicotine-free pill that helps reduce craving and withdrawal, and if used while smoking, may reduce smoking satisfaction. The smoker starts taking Chantix seven days prior to the quit date, beginning with one pill (0.5 mg) for three days. From Day 4 through Day 7, the 0.5 mg pill is taken twice daily. One 1.0 mg tablet is taken twice daily beginning Day 8. Chantix should be continued for 12 weeks.

Factors to consider:

• Chantix should be taken after eating and with a full glass of water.
• Side effects may include nausea and trouble sleeping. These side effects, if experienced, often disappear after the first few weeks of therapy. If the side effects do not disappear, contact your physician to have the dose adjusted.
• If the user is still smoking after 12 weeks of Chantix, the physician may prescribe an additional 12 weeks of the drug to increase the likelihood of success.
• Chantix is not recommended for use with nicotine replacement therapy.
• Insurance may pay for Chantix.

3. Nicotine Fading
The smoker is instructed to reduce the nicotine level in the cigarettes smoked by 30 percent for the first week, by 60 percent the second week, and by 90 percent the third week. During the fourth week, the smoker quits cold turkey. The clinic staff help you decide which cigarettes to purchase during the three-week process. This method helps reduce the nicotine withdrawal symptoms.

Factors to Consider:

• The process is easy to follow.
• The smoker must have a high level of motivation.

4. Nicotine 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 three- to six-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 be highly motivated.
• 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.
• Most insurance does not cover the cost of the gum.
• The gum is available over-the-counter.

5. 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 eight 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 stop smoking completely 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.
• Most insurance does not cover the cost of the patch.
• The patch is available over-the-counter.

6. Nicotine Lozenge
The nicotine lozenge also provides a substitute source of nicotine to reduce the withdrawal symptoms during the quitting process. The smoker may use one lozenge every one to two hours, using no more than 20 lozenges per day. The number of lozenges used each day is slowly reduced during the last few weeks of 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 lozenge.
• Minor side effects may include sore teeth and gums, irritable throat, and nausea.
• Most insurance does not cover the cost of the lozenge.
• The lozenge is available over-the-counter.

7. Nicotine Nasal Spray
The nicotine nasal spray is another substitute for nicotine to reduce the withdrawal symptoms during the quitting process. One to two doses of the spray may be used every hour, with a maximum of 40 doses/day (one dose is equal to one spray in each nostril).

Factors to Consider:

• The smoker must have a high level of motivation.
• The smoker must stop smoking completely when using the nicotine nasal spray.
• Side effects may include a cough, sneezing, runny nose, watery eyes, diarrhea, and rapid heartbeat.
• The nicotine nasal spray requires a physician's prescription.

8. Nicotine Inhaler
The nicotine inhaler is yet another substitute for nicotine to reduce the withdrawal symptoms during the quitting process. A maximum of 12 nicotine cartridges can be used per day.

Factors to Consider:

• The smoker must have a high level of motivation
• The smoker must stop smoking completely when using the nicotine inhaler
• Side effects may include throat and/or mouth irritation, cough, runny nose, headache, and/or hiccups
• The nicotine inhaler requires a physician's prescription

9. Zyban (Bupropion HCI)
Zyban, a nicotine-free pill, helps 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 one to two weeks before the quit date. On the quit date the smoker stops smoking and continues Zyban as recommended by the health care provider. Zyban therapy may be seven to 12 weeks in duration.

Factors to Consider:

• Zyban is not for everyone. There is a risk of seizures 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 most common side effects with Zyban are dry mouth and trouble sleeping.
• Zyban requires a physician's prescription.
• Insurance may pay for Zyban.
• It may be used in combination with nicotine replacement products; 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. The Stop Smoking Clinic offers assistance with behavioral modification as well as stress management, weight control, and tips for preventing relapse.

Smoking cessation counseling is offered on an individual basis. A one-on-one initial assessment takes approximately 45 minutes. Fifteen minute follow-up appointments are also offered.