Cigarette smoking is still the leading preventable cause of death, disease, and high medical costs, and physicians aren’t devoting much time or effort to addressing the problem among their patients beyond prescribing medications. Medications are an adjunctive treatment, not a first-line treatment. Even the clinical guidelines panel and the makers of smoking cessation medications acknowledge that medications for smoking cessation do not work in and of themselves but rather can help supplement a program of behavioral modification. Cold turkey is still the best way to stop smoking, but that also is improved if one has a buddy to stop with.
E-Packet on Smoking Cessation
Articles, fact sheets, and more information for patients and care providers describing effective methods of smoking cessation, as well as the serious harm and cost of tobacco use.
Top Tips and Tactics for Smoking Cessation
Asking the Right Question to Find The Right Answers
The dimension added here takes the physician and patient into the real-world terms people use when purchasing cigarettes. So, for example:
- “What brand do you buy?” is far more likely to engage the patient (and pique the patient’s curiosity that you might actually know a bit more about smoking than just “Quit!”).
- “How much do you buy?” (instead of “How much do you smoke?”) is a seemingly non-medical reminder that this stuff is not only deadly but costly. The most important question, though, is
- “Who among your family and friends has stopped smoking and stayed stopped?” I started asking this after reading the work of Christakis and Fowler in The New England Journal of Medicine, who found in a masterful study of 40 years of the Framingham Heart Study data (link) that people who stop smoking–guess what?–tend to hang out with other people who’ve stopped smoking. They found the same is true of obesity (link).
Self-Efficacy, Relapse, and Reinforcement
It was Dr. Ed Anselm, that said we should call this smoking cessation and relapse prevention because unfortunately, people tend to relapse. He also espoused the concept of self-efficacy, meaning the confidence that we need to have in the power of encouraging words said to patients. Physicians generally lack self-efficacy because they don’t get the dopamine reinforcement with smoking cessation that they do with, say, giving IV antibiotics and watching the patient with pneumonia or cellulitis get magically better–or giving antihypertensive or diabetic medications and seeing the numbers improve. Smoking cessation can take more time, needs a socially reinforcing environment, and isn’t a cookbook recipe.
Top Tips and Success
All in all, there are a host of simple behavioral tips to offer, the most important of which is not lighting up that first cigarette of the day. Keep postponing it. If one does break down and light up, then put it right out. Don’t smoke that first one until at least after breakfast; don’t ever take more than a few hits on a cigarette before putting it out (make it expensive), don’t smoke in the car (put the cigarettes in the trunk or simply don’t carry them around); use oral substitutes; and don’t make too big a deal about smoking. Keep in mind, too, that for all the push to recommend smoking cessation drugs to patients, the research shows only that you can double the “quit rate” with them. But what that really translates into, is that if you spend just a couple more minutes with the patient and take the issue seriously, and offer positive tips, you can do better than any medication. You are the agent of change; the medications are at best adjunctive therapy. And, yes, cold turkey is still the best way to stop and stay stopped. Also recommended is a free, nonprofit website called WhyQuit.com, which urges that no medications be used.
Switch to NON-Filtered Cigarettes
Yes, Non-Filters! Filtered cigarettes are NOT any safer. (Is less poison better poision?) All the bad stuff (Tar, Ammonia, Cyanide, etc.) STILL GETS THROUGH.
A Filter DOES make it harder to inhale. Because it is harder to inhale, you get less nicotine (the stuff you crave) per drag. With less nicotine per drag, it takes longer to satisfy your nicotine addiction. Therefore, the filter requires you to smoke more cigarettes to feel better. Filters don’t filter much, they just slow your smoking down. NON-Filtered cigarettes, on the other hand, are easier to inhale, taste “stronger”, and satisfy your nicotine craving (addiction) faster. Switching to NON-filtered cigarettes will cut the number you smoke by about ONE-HALF almost instantly! (See, that was pretty easy!)
Please repeat after me “FILTERS ARE FRAUD.”
Put Something Nice In Your Mouth!
Start the day off right! Instead of your first cigarette have your first banana ( or apple, or candy, or stick of gum, or peach, or celery stick, or swizzle stick, or a nice kiss, etc…)
Wait five minutes …. and relax!
You know that feeling. You want that cigarette. You have that nicotine fit! You need that cancer stick!!
Whoa!! Take a break.
Sit down. Look at the clock (or your watch). Take a five-minute break from smoking.
Relax. Take nice, really deep slow, clean breaths.
Pick out a happy thought (that nice camping trip, your nice cute pet) and focus on it.
Continue your nice, relaxing deep breaths for FIVE minutes.
When done … you probably won’t need that cigarette as much. (maybe time for #2 above?)
Make smoking the biggest pain in your “you know what!“
Make smoking the hardest thing in your day.
Smoke only outside (even in the rain, snow, sleet, hail, or killer bee attack!)
Hide that pack in the nastiest place: Behind the smelly kitchen garbage pail (“Smoking is Garbage”). Behind the toilet. (Cigarette smoke has Ammonia in it- the same stuff that makes urine stink!). Above the Kitty Pan! Outside, in the back yard, behind the shed, in a plastic bag, under the woodpile.
Be creative! JUST MAKE IT HARD!
Stash that Cash!
Instead of spending that $6 or so a day on a pack of cigarettes, Save That Cash!
Hide it in a jar, Deposit it in a bank account. Stuff it in your mattress.
Sit back and watch that lovely green cash pile up!
(But be careful. Someone might steal it. After a few months, you will have HUNDREDS OF DOLLARS! After a year you may have OVER TWO THOUSAND DOLLARS of cold, clean, cash!)
Most patients will save about $2,200 to.$2,500 a year. Do the math yourself.
Just Do It
To stop smoking (forever!) isn’t easy.
Just always remember to: Switch to NON-filtered (Filters are Fraud) … Put Something Nice in Your
Mouth … Wait Five Minutes … Makc smoking the biggest pain in your “rear-end” …. and don’t forget to STASH THAT CASH!
You’ll be proud of yourself!
A gallery that will cover the history of smoking cessation from the late 18th century and Dr. Waterhouse’s lecture urging students to stop smoking, to the quack cures advertised with the advent of modern medicine in the 19th century and the numerous nicotine patches gums and other treatments of the 20th century to e-cigarettes today.
An academic analysis of smoking cessation techniques and practices will serve to highlight the most effective methods and most critically how healthcare professionals can convey these methods to patients, enable support, and eventually success.
Partial bibliography of textbook chapters and articles on smoking cessation by Alan Blum, MD
Blum A: Approaches to patients who smoke. In: Rakel RE ed., Essentials of Family Practice. Philadelphia: W.B. Saunders. pp 436-439,453;1992.
Blum A: Approaches to patients who smoke. In: Rakel RE ed., Essentials of Family Practice. Philadelphia: WB Saunders. pp 588-592;1998.
Rakel RE, Blum A: Nicotine addiction. In: Rakel RE ed., Textbook of Family Practice. Fourth edition. Philadelphia: WB Saunders. pp 1612-1622;1990.
Rakel RE, Blum A: Nicotine addiction. In: Rakel RE, ed. Textbook of Family Practice. Fifth edition. Philadelphia: WB Saunders. pp 1549-1564;1995.
Blum A, Rakel R: Nicotine Addiction. In Rakel’s Textbook of Family Practice, Sixth edition. Philadelphia: WB Saunders. pp 1523-38;2002.
Blum A: Tobacco and Cancer. In: DeVita et al, eds. Cancer: Principles and Practice of Oncology. 4th edition. Philadelphia: JB Lippincott. pp 480-491;1993.
Blum A: Preventing tobacco-related cancers. In: DeVita et al, eds.Cancer: Principles and Practice of Oncology, Fifth edition. Philadelphia: J.B. Lippincott. pp 545-557;1997.
Blum A.: Tobacco promotions to minority groups. In: Report of the Surgeon General on Tobacco and Health: Reducing Tobacco Use Among African Americans, American Indians/Alaska Natives, Asian Americans/Pacific Islanders, and Hispanics. Washington: Department of Health and Human Services. 1998.
Blum A, Solberg EJ: Tobacco. In: Mengel M, Holleman W, eds. Fundamentals of Clinical Practice. New York: Plenum. 1997.
Blum A, Solberg E: The tobacco pandemic. In: Mengel M, Holleman W, eds. Fundamentals of Clinical Practice. Second edition. New York: Kluwer Academic/Plenum. pp 671-87;2002.
Blum A, Geyer JD: Tobacco and stroke. In: Geyer JD, Gomez CR, eds. Stroke: A Practical Approach. Philadelphia: Lippincott Williams & Wilkins. pp 33-38;2009.
Blum A: Butting in where it counts. Hospital Physician. 1980;16(4):22-35.
Blum A: A consumerist approach to smoking cessation. Tobacco and Health 1990: The Global War Health Dept W Australia, Perth, Western Australia, 1990;820-822.
Blum A: Consumer advocacy: a crafty approach to counseling. Patient Care. February 28, 1993:80-83
Blum A: Nicotine patches and nicotine gum: deja vu all over again? American Family Physician. 1992;45:2493-2494.
Blum A, Solberg E: The role of the family physician in ending the tobacco pandemic. Journal of Family Practice 1992;34:697-700.
Blum A: Role of the health professional in ending the tobacco pandemic: clinic, classroom, and community. Journal of the National Cancer Institute Monograph. No. 12. 1992;37-43.
Williams F, Blum A, Forbes B, Sharp L, Stewart D: (monograph) Adult Smoking Cessation Strategies: A Rural Healthcare Continuing Education Initiative. Consensus Recommendations from an Expert Panel. University of Illinois College of Medicine at Rockford and Michigan Academy of Family Physicians, 2008.