“How can I quit Smoking?” – Current strategies for kicking the habit

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This is a repost from an answer on quora that I wrote back in december. My former research lab did studies about the cardiovascular effects of smoking with nicotine replacement, and over the years I’ve trained several dozen smokers – many of whom have quit or reduced their smoking drastically.

Background Concepts

Smoking has been on the down and out since the Surgeon general put out his famous warning in the 60s. As far as I know the literature is a little conflicted, smoking education and anti-smoking adverts seemed to have little effect at the population level, and bans in restaurants, bars, and airplanes had a MUCH more noticeable impact, although they were not nearly so effective in Europe as in America, and Asia continues to accelerate its Tobacco use despite education and bans appearing more and more rapidly.

There are several models for cigarette addiction, and it is likely that they all reflect some aspect of the truth, finding the one that matches  your addiction will probably help you determine which strategies to employ and in what order.

1) Nicotine addicts – Smokers seek to maintain some specific level of nicotine content in the blood, will smoke more or less throughout the day in order to rapidly reach and then maintain this level.Nicotine replacement is most important for these individuals since the cravings fluctuate with nicotine levels more than behavior.

2) Habitual Users: Some individuals simply associate certain activities with smoking, and often need to replace or redesign their enjoyment of them in order to fill that niche. These sort of things are more manageable by pre-planning, accountability to friends, and replacing fixations.Common examples are:

  • Driving – getting a new car, deciding not to smoke with the windows up, keeping something to chew on/  hold in your cup holder
  • Drinking Socially – Avoiding bars where you always run into old friends for smoke, not going out on patios, going to bars without a smoking area can help
  • While working (smoke breaks) – Take time to get up and walk around regularly, and don’t be afraid to start up a conversation with someone who isn’t smoking – or a smoker you usually talk to but in a different context. Often it’s more about the mental break than the nicotine.
  • After eating, waiting for the bus, in lines, when you wake up, before you sleep, whenever you take out the trash etc etc   These ones require a little bit more accountability, having a friend around to remind you (maybe one who knows but won’t call you out in front of people directly) helps keep the fight centered on your goals, not your will power.

3) Stress managers: Some people respond to stress by taking smoke breaks or using nicotine. Sometimes they have work schedules that do not leave time to eat, or they work late and it helps, or they use cigarettes to manage social anxiety when out on the town. This type of person benefits most from creating healthy habits and getting appropriate help with eating, working out, and mental/emotional support. In my experience many of this type of smoker actually use smoking as a control mechanism, since they feel like their whole day is outside of their control they use cigarettes to break up time in a way that has nothing to do with a clock or their work or anything like that.

Personal Experience

Our study focused on the use of 3x a week resistance training as well as nicotine replacement via skin patches. There is no doubt that the patches helped a lot of people, but the combination of patches and training was trending towards significantly superior on the last abstract I helped with.

I believe that any type of exercise has health benefits for a smoker, but cardiovascular exercise is very self-selective – the smokers who stick with running are the ones who are diehard determined or the ones who are already good at running. This leaves a lot of people high and dry and without the benefits exercise can have for reducing cravings, increasing happiness, and accelerating return to normal cardiovascular function.

“But resistance training doesn’t work the cardiovascular system, and what about weight gain from quitting ?”

For sedentary people, especially ones with risk factors like smoking, the most important factor is the ability to start and to progress NOT the standalone importance of any single movement. If jogging hurts your knees and you don’t have time to keep walking more, carefully advanced resistance training can improve health and mitigate side effects – even if you have to start with very light loads.

On top of the specific response to the training style, having regular, scheduled and supervised workouts provides a structure that I think really helps a lot of smokers deal with the ‘loss of control’ they feel when they try to quit. Many smokers chunk their day up by time between cigarettes, and it’s any resistance seems doomed to eventually fail as they fall into inconsistent routines. Having a scheduled workout gives you a reason to get to bed on time, and gives direct consequences to things like not eating, or making really terrible food choices. We did no dietary interventions, but most people simply don’t want to eat 2 double cheeseburgers before I’m going to have them doing lunges and step ups and other coordination intensive movements.

The rhythm of exercise, recovery, and repeat is a nice cycle to put the cigarette urges into context (chunking life by days or weeks makes minute to minute conflicts less important).

I also noticed that many smokers might rationally understand they can be healthier, but they don’t even know the ways they are suffering until things change. If you try to go running and cough up a ball of tar, it might discourage your – but starting very small and seeing yourself progress is an incredibly empowering feeling.

Strategies from former-smokers I have lived, worked, and spoken with:

  • If the first cigarette of the morning is where you need to make your final stand for the day, putting on a nicotine patch before bed can help with morning cravings
    • This can disturb sleep or cause vivid dreams, I met one man who had detailed flashbacks to his military service when he wore the patches at night but his response was  ‘still better than smoking’ so your mileage may vary
  • Cleaning up your car or other traditional smoke spot helps externalize the desire to quit and reduce cravings
  • Supplement nicotine in a way that matches your habits – E-cigs are showing surprising potential for people who really struggle with the oral fixation, patches are great for cravings, and the gum has shown some promise but I don’t know anyone who has used it successfully
  • There are medications that can reduce cravings or the desire/reward of smoking including Chantix and Wellbutrin, but these come with their own side effects which can vary significantly due to how sensitive the reward pathways of the brain are.
  • Wellbutrin is often used as a anti-depressant/anxiety medication, so it is most helpful to individuals who “self-medicate” with cigarettes but of course a psychiatric professional should be consulted about how appropriate any sort of drug therapy might be for you. People I’ve talked to all say it rapidly reduced their amount of smoking, and report it ‘changes the taste’ of cigarettes, but it does not help with the habitual/ritualistic smoking such as during lunch breaks or while driving
  • Separate your nicotine cravings from your habitual behaviors, since they each have their own techniques that are useful
  • Find a form of physical activity you love, and commit to improving slowly at it over time, it will help your health/energy and give you more self-confidence to make bigger changes.

Quitting smoking can be a tricky process that is taxing on your personal life and relationships, but they best thing you can do is give it a try today. Supposedly it takes around 7 attempts before you have even odds of success – which sounds discouraging but frees you to think of failed attempts as normal steps in the process instead of loading yourself with guilt. I hope you find this useful,

-Mike

This article was written by Michael Chronley, CSCS, Fitness & Nutrition Advisor.

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