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make the decision to quit!
The decision to quit smoking is one that only you can make. The four-step process in this page can provide a road map to help you successfully quit.
decide to quit
Researchers have looked into how and why people stop smoking. They have some ideas, or models, of how this happens. The Health Belief Model says that you will be more likely to stop smoking if you:
- Believe that you could get a smoking-related disease and this worries you
- Believe that you can make an honest attempt at quitting smoking
- Believe that the benefits of quitting outweigh the benefits of continuing to smoke
- Know of someone who has had health problems as a result of their smoking
do any of these apply to you?
The Stages of Change Model identifies the stages that a person goes through in making a change in behavior. Here are the stages as they apply to quitting smoking:
Pre-contemplation: At this stage, the smoker is not seriously thinking about quitting.
Contemplation: The smoker is actively thinking about quitting but is not quite ready to make a serious attempt. This person may say, "Yes, I'm ready to quit, but the stress at work is too much," or "I don't want to gain weight," or "I'm not sure if I can do it."
Preparation: Smokers in the preparation stage seriously intend to quit in the next month and often have tried to quit in the past 12 months. They usually have a plan.
Action: This is the first 6 months when the smoker is actively quitting.
Maintenance: This is the period of 6 months to 5 years after quitting when the ex-smoker is aware of the danger of relapse and takes steps to avoid it.
Where do you fit in this model? If you are thinking about quitting, setting a date and deciding on a plan will move you into the preparation stage, the best place to start.
plan your quit day
This is a very important step. Pick a specific day within the next month as your Quit Day. Picking a date too far in the future allows you time to rationalize and change your mind. But do give yourself enough time to prepare and come up with a plan. You might choose a date with a special meaning like a birthday or anniversary, or the date of the Great American Smokeout (the third Thursday in November each year). Or you may want to just pick a random date. Circle the date on your calendar. Make a strong, personal commitment to quit on that day.
prepare for your quit day
There is no one right way to quit. Most smokers prefer to quit cold turkey—they stop completely, all at once. They smoke until their Quit Day and then quit. Or they may smoke fewer cigarettes for 1 or 2 weeks before their Quit Day. Another way involves cutting down on the number of cigarettes you smoke each day. With this method, you slowly reduce the amount of nicotine in your body. You might cut out cigarettes smoked with a cup of coffee, or you might decide to smoke only at certain times of the day. While it sounds logical to cut down in order to quit gradually, in practice this method is difficult.
Quitting smoking is a lot like losing weight; it takes a strong commitment over a long time. Smokers may wish there was a magic bullet—a pill or method that would make quitting painless and easy. But there is nothing like that. Nicotine substitutes can help reduce withdrawal symptoms, but they are most effective when used as part of a stop-smoking plan that addresses both the physical and psychological components of quitting smoking.
Here are some steps to help you prepare for your Quit Day:
- Pick the date and mark it on your calendar.
- Tell friends and family of your Quit Day.
- Get rid of all the cigarettes and ashtrays in your home, car, and place of work.
- Stock up on oral substitutes—sugarless gum, carrot sticks, and/or hard candy.
- Decide on a plan. Will you use NRT or other medicines? Will you attend a stop-smoking class? If so, sign up now.
- Practice saying, "No thank you, I don't smoke."
- Set up a support system. This could be a group class, Nicotine Anonymous, or a friend or family member who has successfully quit and is willing to help you. Ask family and friends who still smoke not to smoke around you or leave cigarettes out where you can see them.
- Think back to your past attempts to quit. Try to figure out what worked and what did not work for you.
Successful quitting is a matter of planning and commitment, not luck. Decide now on your own plan. Some options include using nicotine replacement, joining a stop-smoking class, going to Nicotine Anonymous meetings, using self-help materials such as books and pamphlets, or any combination of these methods. For the best chance at success, your plan should include one or more of these options.
On your Quit Day, follow these suggestions:
- Do not smoke. This means at all—not even one puff!
- Keep active—try walking, exercising, or doing other activities or hobbies.
- Drink lots of water and juices.
- Begin using nicotine replacement if that is your choice.
- Attend stop-smoking class or start following a self-help plan.
- Avoid situations where the urge to smoke is strong.
- Reduce or avoid alcohol.
- Think about changing your routine. Use a different route to work, drink tea instead of coffee. Eat breakfast in a different place or eat different foods.
The physical symptoms, while annoying, are not life-threatening. Nicotine replacement can help reduce many of these physical symptoms. But most smokers find that the bigger challenge is the mental part of quitting.
If you have been smoking for any length of time, smoking has become linked with nearly everything you do— waking up in the morning, eating, reading, watching TV, and drinking coffee, for example. It will take time to un-link smoking from these activities. That is why, even if you are using a nicotine replacement, you may still have strong urges to smoke.
One way to overcome these urges or cravings is to identify rationalizations as they come up. A rationalization is a mistaken belief that seems to make sense at the time but is not based on facts. If you have tried to quit before, you will probably recognize many of these common rationalizations:
- I'll just have one to get through this rough spot.
- Today is not a good day; I'll quit tomorrow.
- It's my only vice.
- How bad is smoking, really? Uncle Harry smoked all his life and he lived to be over 90.
- Air pollution is probably just as bad.
- You've got to die of something.
- Life is no fun without smoking.
You probably can add more to the list. As you go through the first few days without smoking, write down any rationalizations as they come up and recognize them for what they are: messages that can trap you into going back to smoking. Use the ideas below to help you keep your commitment to quitting.
Avoid temptation. Stay away from people and places where you are tempted to smoke. Later on you will be able to handle these with more confidence.
Change your habits. Switch to juices or water instead of alcohol or coffee. Take a different route to work. Take a brisk walk instead of a coffee break.
Alternatives: Use oral substitutes such as sugarless gum or hard candy, raw vegetables such as carrot sticks, or sunflower seeds.
Activities: Do something to reduce your stress. Exercise or do hobbies that keep your hands busy, such as needlework or woodworking, which can help distract you from the urge to smoke. Take a hot bath, exercise, or read a book.
Deep breathing: When you were smoking, you breathed deeply as you inhaled the smoke. When the urge strikes now, breathe deeply and picture your lungs filling with fresh, clean air. Remind yourself of your reasons for quitting and the benefits you'll gain as an ex-smoker.
Delay: If you feel that you are about to light up, delay. Tell yourself you must wait at least 10 minutes. Often this simple trick will allow you to move beyond the strong urge to smoke.
Reward Yourself. What you're doing is not easy, so you deserve a reward. Put the money you would have spent on tobacco in a jar every day and then buy yourself a weekly treat. Buy a magazine, go out to eat, call a friend long-distance. Or save the money for a major purchase. You can also reward yourself in ways that don't cost money: visit a park or the library, develop a new hobby, or take a yoga class.
“It's easy to quit—I've done it hundreds of times.”
Have you ever heard this famous Mark Twain quote? Maybe you, too, have quit many times before. So you know that staying quit is the final, and most important, stage of the process. You can use the same methods to stay quit as you did to help you through withdrawal. Think ahead to those times when you may be tempted to smoke, and plan on how you will use alternatives and activities to cope with these situations.
More dangerous, perhaps, are the unexpected strong desires to smoke that happen sometimes months, or even years after you've quit. To get through these without relapse, try the following:
- Review your reasons for quitting and think of all the benefits to your health, your finances, and your family.
- Remind yourself that there is no such thing as just one cigarette -- or even one puff.
- Ride out the desire to smoke. It will go away, but do not fool yourself into thinking you can have just one.
- Avoid alcohol. Drinking lowers your chance of success.
- If you are worried about gaining weight, put some energy into eating a healthy diet and staying active with exercise.
What if you do smoke? The difference between a slip and a relapse is within your control. A slip is a one-time mistake that is quickly corrected, whereas a relapse is going back to smoking. You can use the slip as an excuse to go back to smoking, or you can look at what went wrong and renew your commitment to staying away from smoking for good.
Even if you do relapse, try not to get too discouraged. Very few people are able to quit for good on the first try. In fact, it takes most people many attempts before quitting for good. What’s important is figuring out what helped you when you tried to quit and what worked against you. You can then use this information to make a stronger attempt at quitting the next time.
some special concerns
Many smokers do gain some weight when they quit. Even without special attempts at diet and exercise, however, the gain is usually less than 10 pounds. Women tend to gain slightly more weight than men. There is some evidence that smokers will gain weight after they quit even if they do not eat more.
For some, a concern about weight gain can lead to a decision not to quit. But the weight gain that follows quitting smoking is usually very small. It is much more dangerous to continue smoking than it is to gain a small amount of weight.
You are more likely to be quit smoking successfully if you deal with the smoking first, and then later take steps to reduce your weight. While you are quitting, try to focus on ways to help you stay healthy, rather than on your weight. Stressing about your weight may make it harder to quit. Eat plenty of fruits and vegetables and limit the fat. Be sure to drink plenty of water, and get enough sleep and regular physical activity.
Walking is a great way to be physically active and increase your chances of staying quit. Walking can help you by:
- Reducing stress
- Burning calories and toning muscles
- Giving you something to do instead of thinking about smoking
No special equipment or clothing is needed for walking, other than a pair of comfortable shoes. And you can do it pretty much anytime or anywhere. Try the following:
- Walk around a shopping mall
- Get off the bus one stop before you usually do
- Find a buddy to walk with during lunch time at work
- Take the stairs instead of the elevator
- Walk with a friend, family member, or neighbor after dinner
- Push your baby in a stroller
Set a goal of 30 minutes of physical activity 5 or more times a week. If you don’t already exercise regularly, please check with your doctor before starting an exercise program.
Smokers often mention stress as one of the reasons for going back to smoking. Stress is a part of everyone's lives, smokers and non-smokers alike. The difference is that smokers have come to use nicotine to help cope with stress and unpleasant emotions. When quitting, you have to learn new ways of handling stress. Nicotine replacement can help to some extent, but for long-term success other strategies are needed.
As mentioned above, physical activity is a good stress-reducer. It can also help with the short-term sense of depression that some smokers have when they quit. There are also stress-management classes and self-help books. Check your community newspaper, library, or bookstore.
Spiritual practices such as prayer and meditation have been used with much success to deal with other addictions and are a key part of 12-step recovery programs. These same principles can be applied to quitting smoking and can help with stress reduction.
Taking Care of Yourself
It is important for your health care provider to know of any present or past tobacco use so he or she can be sure that you will get the preventive health care you need. It is well known that tobacco use puts you at risk for certain health-related illnesses, so part of your health care should focus on related screening and preventive measures to help you stay as healthy as possible. For example, you will want to be certain that you regularly check the inside of your mouth for any changes and have an oral exam by your doctor or dentist if you have any changes or problems. The American Cancer Society recommends that periodic check-ups should include oral cavity (mouth) exams. By doing this tobacco users may be able to prevent, or detect early, oral changes, leukoplakia (white patches on the mouth membranes), and oral cancer.
You should also be aware of any change in cough, a new cough, coughing up blood, hoarseness, trouble breathing, wheezing, headaches, chest pain, loss of appetite, weight loss, general tiredness, and repeated respiratory infections. Any of these could be signs of lung cancer or a number of other lung conditions and should be reported to your doctor. While these can be signs of a problem, many lung cancers do not cause any noticeable symptoms until they are advanced and have spread to other parts of the body.
Remember that tobacco users have an increased risk for other cancers as well, depending on the way they use tobacco. You can become familiar with the types of cancer you may be at risk for by reading the American Cancer Society document that discusses the way you use tobacco (see "Additional Resources"). Other risk factors for these cancers may be more important than your use of tobacco, but you should be aware of the additional risks that might apply to your situation.
If you have any health concerns that may be related to your tobacco use, please see your health care provider as soon as possible. Taking care of yourself and getting treatment for small problems will give you the best chance for successful treatment. The best way, though, to take care of yourself and decrease your risk for life-threatening lung problems is to quit using tobacco.