Quitting Smoking: More Information


Nicotine is a drug found  in tobacco. It’s as addictive as heroin or cocaine. Over time, a person can become physically dependent and emotionally addicted to nicotine. When trying to quit smoking, physical dependence can cause unpleasant withdrawal symptoms and psychological dependence makes it hard to stay away from nicotine after you quit. Studies have shown that to quit, smokers must deal with both the physical and mental dependence.

Nicotine affects many parts of the body, including the heart and blood vessels, hormones, the way a person metabolize food and ultimately affects the brain. Nicotine can be found in breast milk and even in the cervical mucus of female smokers. During pregnancy, nicotine crosses the placenta and has been found in amniotic fluid and the umbilical cord blood of newborn infants.

When a person stops smoking, it can take up to 4 days for nicotine to completely leave the body.  Nicotine causes good feelings and can distracts the smoker from unpleasant feelings. This makes the smoker want to smoke again and again. Complicating matters is the fact that smokers tend to smoke more cigarettes as they become used to nicotine. This, in turn, increases the amount of nicotine in the smoker’s blood and over time causes a tolerance to nicotine.

When a person finishes a cigarette, the nicotine level in the body starts to drop, going lower and lower. This causes the pleasant feelings that come with smoking to wear off, and the smoker starts wanting to smoke again. If smoking is delayed, the smoker may start to feel irritated and edgy.

Withdrawal symptoms can include any of the following:
Feelings of frustration, impatience, and anger
Sleep disturbances
Trouble concentrating
Restlessness or boredom
Increased appetite
Weight gain
Constipation and gas
Cough, dry mouth, sore throat, and nasal drip
Chest tightness
Slower heart rate


20 minutes after quitting
Your heart rate and blood pressure drop.

12 hours after quitting
The carbon monoxide level in your blood drops to normal.

2 weeks to 3 months after quitting
Your circulation improves and your lung function increases.

1 to 9 months after quitting
Coughing and shortness of breath decrease; cilia (tiny hair-like structures that move mucus out of the lungs) start to regain normal function in the lungs, increasing the ability to handle mucus, clean the lungs, and reduce the risk of infection.

1 year after quitting
The excess risk of coronary heart disease drops to half that of a smoker

5 years after quitting
Risk of cancer of the mouth, throat, esophagus, and bladder are cut in half. Cervical cancer risk falls to that of a non-smoker. Stroke risk can fall to that of a non-smoker after 2-5 years.

10 years after quitting
The risk of dying from lung cancer is about half that of a person who is still smoking. The risk of cancer of the larynx (voice box) and pancreas decreases.

15 years after quitting
The risk of coronary heart disease is that of a non-smoker’s.

Immediate rewards of quitting
Kicking the tobacco habit offers some benefits that can be noticed right away and some that will develop over time. These rewards improve most peoples’ day-to-day lives a great deal:

Breath smells better
Stained teeth get whiter
Bad smelling clothes and hair go away
Yellow fingers and fingernails disappear
Food tastes better
Sense of smell returns to normal
Everyday activities (such as climbing stairs or light housework) no longer leave them out of breath

Quitting Smoking
Nicotine replacement therapy can help with the difficult withdrawal symptoms and cravings that 70% to 90% of smokers say is their only reason for not giving up cigarettes. Using nicotine replacement therapy reduces those symptoms.

Many smokers can quit smoking without using nicotine replacement therapy, but most of those who attempt quitting do not succeed on the first try. In fact, smokers usually need many tries – sometimes as many as 8 to 10 – before they are able to quit for good.

Lack of success is often related to withdrawal symptoms. Most quitters go back to smoking within the first 3 months of quitting. People attempting to quit should not be discouraged with slips. Just make a plan to stop again, and make the attempt more successful by adding another method or technique.  Furthermore, withdrawal symptoms can be reduced with nicotine replacement therapy and getting support just makes it more likely that a person can quit for good.

The best time to start nicotine replacement therapy is when first starting to quit.  Nicotine replacement therapy can be started immediately after smoking that last cigarette.   No time needs to pass before putting on the patch, using the gum, lozenge, nasal spray, or inhaler. While nicotine replacement therapy helps with the physical dependence, it’s not meant to be a stand-alone method to help you quit smoking. Other methods are needed to help with the psychological (emotional and mental) part of smoking, such as a stop smoking program. These support systems coupled with nicotine replacement therapy should be continued for a few months after quitting. Studies have shown that this approach – pairing nicotine replacement therapy with a program that helps to change behavior – improves the success of quitting and staying quit when compared to approaches that use only one method.

Nicotine overdose is rare, but possible if you use them and continue to smoke. Nicotine replacement therapy products are labeled to match the amount of nicotine you get from the medication to the amount that used to be regularly smoked. If used this way, the nicotine dose remains fairly close to what the smoker was getting from cigarettes. Higher doses of nicotine can cause harm. Even just a bit too much can cause some of the mild symptoms like headache, nausea or vomiting. To avoid this, follow dosing instructions carefully. Also, don’t use heat (like a heating pad or heat lamp) on the skin at your nicotine patch—the extra blood supply could cause increased absorption of nicotine.  An overdose can cause death, although this rarely happens with adults. Because of their smaller size, overdose is more of a problem in children and pets.

Because nicotine absorbs through the skin, the proper storage and disposal of nicotine replacement therapy is important from a safety perspective. Keep nicotine replacement therapy medications and any used gum or patches and empty cartridges, bottles, etc., safely away from children and pets.

Help to stop smoking

All 50 states and the District of Columbia run some type of free, telephone-based program that links callers with trained counselors. These stop smoking phone counselors help plan a quit method that fits each person. People who use telephone counseling have twice the success rate in quitting smoking as those who don’t get this type of help. Help from a counselor can prevent quitters from making mistakes.

Telephone counseling is easier to use than some other support programs. It doesn’t require driving, transportation, or child care, and it’s available nights and weekends.

Counselors may suggest a combination of methods including medicines, local classes, self-help brochures, and/or a network of family and friends.

A number in Baltimore for help in quitting smoking is 1-800-NOBUTTS.

Medications that can help

Prescription drugs are also available to help smokers quit. Some can be used along with nicotine replacement therapy. Some must be started before your planned Quit Day.

Bupropion (Zyban)

Bupropion (Zyban®, Wellbutrin®, or Aplenzin®) is a prescription anti-depressant in an extended-release form that reduces symptoms of nicotine withdrawal. It does not contain nicotine. This drug acts on chemicals in the brain and help reduce nicotine craving. Bupropion works best if it’s started 1 or 2 weeks before you quit smoking. The usual dosage is one or two 150 mg tablets per day.

If you are able to quit smoking after 7 to 12 weeks of bupropion your doctor may have you keep taking it for some time afterward to help keep you from going back to smoking. It is also important to keep up with your other support systems during this time and for a few months after you quit.

This drug should not be taken if you have ever had seizures (it can cause or worsen seizures), have heavy alcohol use, or have some types of psychiatric illness.

Varenicline (Chantix)

Varenicline (Chantix®) is a prescription medicine developed to help people stop smoking by lessening the pleasure a person gets from smoking and reducing the symptoms of nicotine withdrawal. Varenicline should be started a week before your Quit Day.

Several studies have shown taking varenicline can more than double the chances of quitting smoking when compared to taking no medicines at all. Some studies have also found it may work better than bupropion, at least in the short term.

Varenicline comes in pill form and is taken after meals, with a full glass of water. The daily dose increases over the first 8 days it is taken. The dose starts at one 0.5 mg pill a day for the first 3 days, then the 0.5 mg pill twice a day for the next 4 days. At the start of the second week, the dose is raised to 1 mg in the morning and evening. For people who have problems with the higher dose, a lower dose may be used during the quit effort. Varenicline is given for 12 weeks, but people who quit during that time may get another 12 weeks of treatment to boost their chances of not smoking. Keep up with your other support systems during this time and for a few months after you quit.

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