Frequently Asked Quitting Questions
Here are Neil Perlman’s responses to the most commonly asked Quitting
Questions.
If you do not see the answer to your question, have any personal insight
into these issues, or would like back-up or clarifications, please contact
Neil Bradford Perlman, M.D. by e-mail at
nperlman@electromedtechnologies.com.
Frequently Asked Questions
- Why a watch?
- What’s the best way to quit smoking? “Cold turkey” or
gradually?
- How many people who quit begin smoking again?
- Why is nicotine so addictive?
- What if I only decrease my habit from, say, two packs to
one pack a day?
- Is chewing tobacco more or less addictive than
cigarettes? And what about cigars?
- I don’t inhale, so I’m OK. Right?
- Why is it so hard to quit smoking?
- I’ve quit. How long until I start seeing any
improvements to my health and what will they be?
- Does smoking really cause cancer?
- I’ve been smoking for over 20 years. Should I even
bother quitting?
- I’m over 50 and I have emphysema. I might as well keep
smoking. Right?
- I quit smoking after my heart attack. Will I live
longer?
- What if I cheat while quitting?
- How many times do I try to quit and fail before I’m
wasting my time even trying?
- How long does it take to get the nicotine out of my
body?
- What is NRT? Should I use it?
- I pressed the 'cigarette' button by accident. What do I
do?
Q: Why a watch?
A: The short answer: because people are constantly looking at their
watches.
Let me explain. To quit smoking, half the battle is breaking the
physical nicotine addiction. The other half is the psychological smoking
habit. These challenges are not the same.
After ten years of working as a physician, I know that patients are more
successful in quitting smoking when the physical act of quitting is paired
with some type of psychological therapy – whether it’s provided by a
physician, a pharmacist, a smoking cessation class, or even a personalized
message mailed to the smoker. These personal observations have been affirmed
time and time again by clinical studies.
However, very few people attend support groups or consult professionals on a
consistent basis.
Providing ongoing psychological reinforcement works but until now, no one
has developed a way to provide this reinforcement on a long term,
continuous, and cost effective basis. That’s why I thought of a watch.
Because most people already wear a watch, it would be unobtrusive. Since
people look at their watches regularly, I could put a message – as well as
other helpful features – where and when people need them most.
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Q: What’s the best way to quit smoking? “Cold turkey” or
gradually?
A: The ‘best way’ to quit is cold turkey. Flush your cigarettes down
the toilet and resist the temptation to ever light up again.
However, it’s
rarely that easy. You should do whatever works for you. Try cold turkey
first and if that doesn’t work, keep trying methods until you find one that
does.
In my experience, I have seen the highest level of success from
‘combination’ therapy.
Cold Turkey – The good news here is that the nicotine
withdrawal (cravings) will only last a week. The bad news is that very few
people manage to quit and stay quit from the cold turkey approach.
Nicotine Replacement Therapy (NRT) – Patches, gums, and
sprays fall into this category. Instead of getting your nicotine from a
cigarette, you get it from another source – in increasingly smaller and
smaller doses.
Medications – The most common drug combats your brain’s
desire for dopamine in order to fight cravings and minimize nicotine
withdrawal symptoms.
Counseling – Medical and lifestyle therapists – even
acupuncturists and hypnotists – try to strengthen your willpower and provide
– one hopes – positive feedback.
Combination Therapy – Multiple studies have shown that
combining several therapies works much better then any one alone. Overall,
medications and nicotine replacement therapies have shown better results
when combined with each other and/or counseling.
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Q: How many people who quit begin smoking again?
A: Far too many. While it depends on the program, most studies show
that at least 50% of the people who successfully quit smoking will begin
were smoking again within 6 months. Some of the studies show relapse rates
over 90%.
This high relapse rate is the major reason for continuing supportive therapy
long after a person quits smoking. This can be done through monthly
physician visits, regularly attending smoking cessation classes, or some
other form of follow-up care.
This is also the major reason I invented the QT-Watch.
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Q: Why is nicotine so addictive?
A: Inhaled nicotine is rapidly absorbed into a smoker’s blood stream.
The absorbed nicotine then causes the brain to increase its level of the
neurotransmitter dopamine. This causes a pleasurable sensation.
After prolonged cigarette use, the brain will come to expect and desire a
higher level of dopamine. If a person stops smoking, the level of dopamine
falls, causing a craving for nicotine.
The more you smoke, the higher the brain sets your dopamine level and the
more you will crave nicotine.
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Q: What if I only decrease my habit from, say, two packs
to one pack a day?
A: Do it.
The less you smoke, the less damage you are doing to your body. It will slow
the progression of emphysema and lower the amount of carbon monoxide in the
body. Studies show that 1 pack per day smokers have a slightly lower rate of
cancers than a 2 pack per day smokers.
Additionally, the less you smoke, the easier it will be to eventually break
your smoking habit. If you smoke a pack a day or less, you can – with
commitment and assistance – break the habit. If you smoke two packs a day
you still can quit, but it will be far, far harder. As a doctor, I have had
much less success breaking the habits of patients who smoke more than one
pack a day.
So if you can smoke less, do so. Smoking one pack a day vs. two packs is a
good start. You’ll feel better, decrease your odds of cancers, be less
harmful to the people around you, and are more likely to be able to quit
entirely.
Since there is a considerable decrease in the risk of cancer by going from a
1 pack a day smoker to nothing. That should be your ultimate goal.
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Q: Is chewing tobacco more or less addictive than
cigarettes? And what about cigars?
A: Like cigarettes, chewing tobacco contains nicotine. The nicotine
is absorbed though the cheeks and gums, instead of through the lungs like
from cigarettes. Don’t fool yourself thinking chewing tobacco is less
addictive. It is not. You are simply trading one nicotine delivery method
for another.
You didn’t ask about cancer, but I will tell you anyway. Since chewing
tobacco releases no smoke, you have less of a chance of developing lung
cancer then smokers who inhale. However, you will increase your risk of
developing mouth and gum cancer.
Cigars are basically overly-large cigarettes, and therefore each cigar
contains far more nicotine than a single cigarette. While you may smoke
fewer in a day – perhaps even a single one after dinner – you are still
creating the same addiction.
When it comes to nicotine, there is no good choice
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Q: I don’t inhale, so I’m OK. Right?
A: Wrong. You are breathing in your own second-hand smoke and, though
somewhat less-efficiently, are still getting more than enough nicotine into
your blood stream to become addicted.
And as far as cancer goes, studies clearly show that second-hand smokers
(this would be you as the non-inhaler – as well as those around you) have
shown higher rates of cancers then non-smokers.
Here’s a test you can take: Don’t smoke a cigarette for a full day. If you
can do this, then you are a non-smoker and should stay that way – while you
still have the choice. If the cravings are too bad and you cannot stop
yourself from lighting up, then you are an addicted smoker – whether you
inhale or not – and should quit.
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Q: Why is it so hard to quit smoking?
A: Because smoking cigarettes is a powerful combination of drug
addiction and social activity. You need to break both the social habit and
the craving (called ‘nicotine withdrawal’) in order to quit and stay quit.
The nicotine addiction can be overcome by gradual reduction, nicotine
replacement, or the cold turkey method.
The other problem is the psychological addiction. This can be treated with a
strong desire to quit plus, positive reinforcement. I believe that a major
reason for failure is that other smokers wittingly or unwittingly encourage
the recently quit smoker to start up again.
If your partner or best friend smokes, convince that person to quit at the
same time and you will have a far easier time of it.
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Q: I’ve quit. How long until I start seeing any
improvements to my health and what will they be?
A: After the first day, the effect nicotine has on your blood
pressure resolves.
After 2 days, your senses of smell and taste will start to improve.
After one week the amount of carbon monoxide in your body will start to
decrease and the level of oxygen in your blood will increase.
After 1 year your risk of heart disease goes to half normal.
After 5 years your risk of a stroke returns to normal.
After 10 years your risk of lung, mouth and throat cancer returns to normal.
After 15 years, your risk of heart disease returns goes back to normal.
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Q: Does smoking really cause cancer?
A: A big yes.
Smoking has been directly linked to cancers of the lungs, larynx, esophagus,
mouth, and bladder. In addition, smoking contributes to cancer of the
cervix, pancreas, and kidneys. On average, smoking causes 430,000* deaths
each year, in the United States. (That’s one every 82 seconds!) 155,000 of
these deaths are cancer related and 79% of these are from lung cancer.
Every four and a half minutes, in the United States alone, someone dies from
lung cancer caused by smoking.
* AVERAGE ANNUAL NUMBER OF DEATHS, 1990-1994, CDC, MMWR Mar. 3 1999; 48;
131-38
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Q: I’ve been smoking for over 20 years. Should I even
bother quitting?
A: Yes.
Assuming you are an average smoker, you started smoking at the age of 18 and
now smoke a pack of cigarettes a day. This would make you 38 years old with
a “20 pack year” history of smoking.
A “pack year” is the number of years you have smoked multiplied by the
number of packs of cigarettes per day (20 years x 1 pack per day = 20 pack
years).
Since emphysema does not usually develop until someone has accumulated 50
pack years, quitting today may prevent you from ever getting emphysema.
Also, since most men do not start having heart attacks until their mid 40’s,
stopping cigarettes should delay or prevent your risk of heart attacks.
Furthermore, should you quit now, by the time you are 50 years old, not only
will your risk of dying from a heart attack decrease, but so will your risk
of lung, throat and esophageal cancers.
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Q: I’m over 50 and I have emphysema. I might as well
keep smoking. Right?
A: Wrong. Even if you have emphysema, you will benefit by quitting.
Smoking will make your emphysema much worse. I see patients that have lost
60% of their lung capacity due to emphysema. While these patients can still
go to work, drive a car and even walk up one flight of stairs, every percent
of lung capacity is precious to them. Which is why I try the hardest to get
these patients to quit.
Every percent decline in your lung capacity will significantly decrease your
quality of life. If you quit right now, you might save yourself from
requiring oxygen or becoming housebound in the very near future.
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Q: I quit smoking after my heart attack. Will I live
longer?
A: Most likely.
If you have had a heart attack, your biggest risk of dying is the next heart
attack. By quitting smoking, that risk is significantly decreased.
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Q: What if I cheat while quitting?
A: There is a big difference between cheating and failing, yet
repeated cheating will lead to failure.
The goal of smoking cessation therapy is to alter a person’s daily routine
for the better. A plan must be specifically designed for each individual,
since one plan will not work for everybody. If an occasional cigarette is
smoked beyond what the plan called for, that may be called cheating. If this
is a one-time occurrence, no long-term harm is done. However, if “cheating”
is frequent, the plan could be considered a failure.
The QT-Watch was designed to help people quit, even if they begin to “cheat”.
When you begin using your QT watch, you will establish your goals for
quitting. The QT watch will then monitor how well you stick to your plan,
and will assign you a “Quitting Score” based on your level of success. If
you begin to “cheat”, your “Quitting Score” will decrease and the messages
you receive from the QT watch will adjust accordingly. Different groups of
messages are designed for different stages of success in the smoking
cessation program. All of the messages have the ultimate goal of long-term
smoking cessation.
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Q: How many times do I try to quit and fail before I’m
wasting my time even trying?
A: Keep trying until you succeed. You are never wasting your time
when you try to quit smoking.
On average, a person will try seven times before they ultimately succeed in
quitting smoking. That’s on average, meaning many of people have succeeded
after a dozen or more attempts, while others find success more quickly.
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Q: How long does it take to get the nicotine out of my
body?
A: Nicotine is processed very quickly- it will exit your body within
a day of its consumption. However, this rapid metabolism also causes
nicotine withdrawal symptoms to start the day you quit. Fortunately, these
symptoms can be controlled with nicotine replacement therapy or will resolve
on their own within a week.
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Q: What is NRT? Should I use it?
A: NRT stands for ‘Nicotine Replacement Therapy’. If NRT is what it
will take you to quit smoking, then you should try it.
NRT is the provision of nicotine by a means other then a tobacco product.
Currently available methods are a nicotine patch, nicotine gum, nicotine
nasal inhaler and nicotine lung inhaler.
NRT provide a way of reducing nicotine withdrawal symptoms by gradually
weaning the amount of nicotine consumed each day. When studied, about 1/3 of
all people using NRT have been able to quit smoking. The type of NRT to
select is an individual choice. The gum is tougher to chew then regular
chewing gum. It is just chewed a few times, releasing a burst of nicotine.
Then it is held between the cheek and gum again until needed again. The nasal inhaler is
used as needed instead of a cigarette. The lung inhaler is shaped like a
cigarette and inhaled to replace a cigarette. Although 1/3 of people using NRT report success, many of not most of these people start smoking again
within one year. That is why follow-up therapy with a physician, smoking
cessation class or the QT-Watch should be continued long after you quit.
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Q18: I pressed the 'cigarette' button by accident. What
do I do?
A. If you press the cigarette button by accident, it is OK. Simply do
not press the button the next time you have a cigarette and you will be back
on schedule. Please do not smoke an extra cigarette.
If you are already in "non-smoking mode" (that is, you have successfully
stopped smoking) the QT-Watch will think you smoked and give you a factual
and motivational messages tomorrow.
The following day the QT-Watch will reset back to non-smoking mode. Although
your time from last cigarette will be decreased, your amount saved will only
be minimally affected.
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