Table of Contents

1. The Profile of a Smoker

2. Smoking-Damaged Arteries Heal After Quitting

3. Why Quit?

4. What’s in a Cigarette?

5. Pregnant or Thinking about Having a Baby?

6. Reasons for Quitting

7. Smoking’s Impact on Others

8. Why is Quitting so Hard?

9. Smoking Triggers

10. What Are Your Triggers?

11. The Toll of Tobacco

12. The Effects of Nicotine

13. What Smoking Does to Your Body

14. Inside a Smoker’s Body

15. Nicotine Replacement Therapy

16. Learning from Relapse

17. The Psychology of Quitting Smoking

18. Quit Smoking Tip Sheet

19. Conquering Smoking

20. More Tips

21. Cigar Smoking Dangers

22. Chewing Tobacco

The Profile of a Smoker

As you might suspect, smokers come in all varieties and attitudes. But generally speaking, there’s a lot of confusion and conflict about the role that smoking plays in the lives of smokers. On the one hand, they see smoking as a pleasant, relaxing and helpful personal ritual that provides unidentifiable benefits. On the other hand, smokers know that smoking is a serious health-hazard, which in all likelihood will end up killing them. Let’s look at some of the typical varieties of smokers and see if you are one of these.

1. The Health-Concerned Smoker:

This type of smoker is very much aware of the dangers of smoking and all the many negative side-effects. However, he/she still cannot bring himself to quit. Experts believe that if you quit today, you will easily add seven years to your life.

2. Smokers Who Feel Guilty:

Many smokers feel guilty about their habit. And this feeling increases the longer they smoke. Those who tried to quit and failed feel guilty far more than those who have not tried to quit. And smokers who have children at home feel the guiltiest because they are "polluting" the air their children breathe. Guilt can often turn into self-hatred.

3. Smokers Who Respect Nonsmokers:

Many smokers are very sensitive to other people who do not smoke. A large majority of smokers refrain from smoking when they are with people who do not smoke, and most ask for permission to smoke while visiting a nonsmoking friend. In fact, many smokers feel that smoking should be regulated or banned at the workplace.

4. Smoking As A Working Class Habit:

Among the general population, it is now understood that the more affluent and better educated people do not smoke. It is estimated that 50% of men who have blue-collar jobs smoke, compared to 26% of professional men. Also, some 32% of those who did not graduate from high school smoked, while the figure for college graduates was only 19%. In other words, smoking is a blue collar habit, since fewer people in white collar professions smoke.

5. Smokers As A Persecuted Minority:

Since there is a widespread change in attitude toward smoking, many smokers feel like a persecuted minority. Many smokers point to smoking as creating a problem in their romantic relationships, even leading to breakup.

6. Anti-smoker Discrimination In The Workplace:

Many smokers feel that they are discriminated against at work because of their habit. Here is some reasons behind this attitude: since smokers as a rule have a higher rate of absenteeism, they have an increased risk of death; they have decreased productivity; they have an increased rate of maintenance; and smokers damage the environment for their nonsmoking co-workers.

7. Smokers Want More Control:

The majority of smokers want more control over their habit. Over 90% want to quit, and about 84% have made a serious attempt at quitting.

8. Smokers As Outcasts:

Being a smoker nowadays is like being an outcast, because the attitudes of nonsmokers have changed drastically. Backing these attitudes is the great amount of evidence that cigarette smoke is harmful to nonsmokers.

9. Nonsmokers Have Become More Assertive:

In addition to their own feelings of confusion and guilt, smokers also have to deal with an increasing number of anti-smoking messages and a much more open display of anti-smoking feelings. Within recent years 39 states have passed laws prohibiting or limiting smoking in public places. Also, the National Association of Insurance Commissioners recently adopted a resolution urging insurance companies to raise smokers’ insurance premiums by roughly 50%.

10. Why Smokers Can’t Quit:

The period of withdrawal poses a powerful barrier to quitting. As well, smokers often have many positive benefits that they associate with smoking. Here are some positive benefits that most smokers associate with smoking. Are any of these yours as well?

1) Smoking helps me deal with stressful situations.

2) Smoking gives me a pleasant and enjoyable break from work.

3) Smoking helps me unwind and relax.

4) Smoking helps me deal with painful or unpleasant situations.

5) Smoking prevents unpleasant withdrawal symptoms.

6) Smoking helps me deal with an overstimulating environment.

7) I enjoy the physical sensation of lighting and handling a cigarette.

8) Smoking increases my enjoyment of pleasant experiences.

9) Smoking helps me feel comfortable in social situations.

10) Smoking helps me concentrate.

11. Planning to Quit:

The majority of smokers believe that they will eventually quit, but they must choose their own time to quit, and most do so at a time when life is less stressful, and support for quitting is available.

12. How to Help a Smoker:

Most friends of smokers do not do a good job of helping take control of the habit. The most common strategy is to nag a smoker into quitting. But this tactic usually has the opposite effect. Nagging just makes smokers smoke more, it seems. Here are some hints that friends can use to encourage smokers to quit:

1) Don’t nag, insult, or try to shame the smoker into quitting.

2) Let the smoker know that he or she is valued as a person.

3) Listen non-judgmentally. Try to understand what benefits the smoker derives from this habit. Try to see the problem through the smokers’ eyes.

4) Praise the smoker for even the smallest efforts to cut down or quit.

Perhaps you have found something that you can relate to in the twelve categories. The main point is to provide you with enough information to help you quit. The most frequently mentioned areas of concern that smokers mention when they try to deal with quitting are the following:

1) How to stay a nonsmoker after I quit.

2) The most effective way to quit.

3) The most effective way to cut down.

4) How to get ready to quit.

5) Are there special needs for vitamins for smokers?

6) How to find out if I am a high-risk or low-risk smoker.

7) What smoking does to a smoker’s body.

8) Dealing with weight gain after I quit.

9) What withdrawal symptoms will I face after I quit.

10) How can I cut my smoking risk through better stress management.

Whether you smoke or not is your choice. But to make that choice effectively you must consider your alternatives, and the benefits and hazards of each. In quitting smoking (as in life) there are no magical cures or quick fixes. There are, however, some pretty powerful tools, many of them not widely known. As a health-concerned smoker, you can take control of your smoking. Your spouse, family, your friends, your physician, and others in your home and community can provide important tools, caring, and support. But the key to success is for you to take primary responsibility to make the changes you desire.

Give yourself as much time as you need. Don’t let anyone push you into attempting to quit before you feel ready. You’re have to do it your way.

Pluses and Minuses

As a Smoker

If you don’t quit, you will--if you don’t already--have permanently stale breath, morning phlegm cough, nicotine stained teeth, shorter life expectancy, stained fingers, constant financial drain, various health problems such as emphysema and/or chronic obstruction pulmonary disease (otherwise know as COPD), poor role model for your kids (if you smoke, they will too and there isn’t anything you can do about it), dirty ashtrays, bland tasting food, nasty smelling clothes, and more and more frequently in today's health conscious ethos, a lack of social acceptance.

As a Non Smoker

Fresher breath, cleaner lungs, whiter teeth, higher probability of living longer, no stains on your fingers, a hell of a lot more money, better all round health, good role model for your kids, tastier food, fresher home, fresher clothes, and a greater level of social acceptability.

These two very different images serve to highlight the fact that if you are prepared to tolerate all these negative aspects of smoking, then you really must be getting something very powerful from it. You’re spending a fucking fortune and you’re not even getting high. It’s a stupid addiction. I’m not saying you’re stupid--I was a smoker for more than 30 years, but it is stupid to continue it, and all of you know that, yet you continue to smoke. Furthermore, if you consider that you continually pay for your need to smoke, not just with money, but also with part of your life expectancy, and with some of your potential for good health, then it is easy to see that you are not just smoking for pleasure, or because you like the taste, or because it gives you something to do with your hands. The truth is, you are addicted to nicotine.. Imagine aliens up there in their space ship observing these creatures down there sticking these ridiculous little sticks in their mouths and sucking in and blowing out smoke.

If you try to quit, there is a little piece of your unconscious that will constantly try to trick you into smoking. It will do this by either,

(A)  Making you feel that nicotine withdrawal is unbearable and that stopping smoking is not worth the discomfort and effort. Or by

(B)  Creating what seems to your conscious like really good reasons for starting smoking again. It achieves this by passing these invented 'reasons' to your conscious mind in the form of a thought or an idea. For example, having made the decision to stop smoking, you might find yourself a few hours later thinking, "Hmm, come to think of it, this isn't really a good time to stop. I'll stop next week instead when I'm not under so much pressure".

You will soon learn that these so called 'reasons' created by your unconscious are always nonsense. On closer examination they will be exposed as a mechanism that allows you to resume smoking, by giving you a guilt-reducing excuse that you can use to justify your change of heart. More importantly, these reasons give you the excuse you need to smoke, and smoking will, of course, relieve your unpleasant feelings of withdrawal.

Any one of a thousand rationalizations or justifications will ensure your failure. The real reason you continue to smoke (not the one created by your unconscious) is simply this: You do not like the feelings of withdrawal.

Smoking-damaged Arteries Heal after Quitting

Reuters Health

Wednesday, December 13, 2006

NEW YORK - Early signs of heart disease in young adult smokers may quickly dissipate soon after they kick the habit, a new study from Japan shows.

Smoking disrupts the normal function of the lining of arteries, known as the endothelium, which must contract and relax to regulate blood flow. This can promote the development of atherosclerosis or "hardening of the arteries" thereby increasing the risk of heart attack and stroke, according to the authors of the report in the Journal of Nuclear Medicine.

The researchers used positron emission tomography or "PET" imaging to examine the effects of smoking cessation on the blood flow in the coronary arteries of 15 men in their twenties and thirties who reported smoking an average of 20 cigarettes per day for more than 5 years and agreed to stop smoking for at least 6 months.

The men had no evidence of heart disease and, aside from smoking, no other risk factors for heart or blood vessel disease.

According to Dr. Nagara Tamaki of Hokkaido University in Sapporo and colleagues, after just one month without cigarettes, abnormal coronary artery function visible on PET scans had normalized. The improvement was preserved six months after the study-subjects had quit smoking.

The finding that young healthy smokers have impaired artery function but that it is reversible within a month after smoking cessation, supports the value of quitting smoking to ward off heart disease in young adults. They are eager to see if similar benefits can be obtained in middle-aged smokers.

It’s highly unlikely that it is reversible in old age.

SOURCE: The Journal of Nuclear Medicine, December 2006.

Why Quit?

Decide for sure that you want to quit. Promise yourself that you'll do it. It's OK to have mixed feelings, but don't let that stop you. There will be times every day that you don't feel like quitting. You will have to stick with it anyway.

Find reasons to quit that are important to you. Think of more than just health reasons. For example, think of:

* How much money you'll save by not buying cigarettes

* The time you'll have for yourself instead of taking cigarette breaks, rushing out to buy a pack, or searching for a light

* Not being short of breath or coughing as much

* Setting a better example for your children

Write down all the reasons why you want to quit. List ways to fight the urge to smoke, too. (You will find tips for coping later in this guide.) Keep your list where you'll see it often. Good places are:

Where you keep your cigarettes

* In your wallet or purse

* In the kitchen

* In your car

When you reach for a cigarette you'll find your list. It will remind you why you want to stop.

What's in a Cigarette?

Your body gets more than nicotine when you smoke.

There are more than 4,000 chemicals in cigarette smoke. Some of them are also in wood varnish, the insect poison DDT, arsenic, nail polish remover, and rat poison.

The ashes, tar, gases, and other poisons in cigarettes harm your body over time. They damage your heart and lungs. They also make it harder for you to taste and smell things, and fight infections.

Pregnant or thinking about having a baby?

Women who smoke have a harder time getting pregnant. And you face more dangers if you do get pregnant:

* You may lose the baby or have a stillborn (dead) baby.

* Your baby may be born small.

* Your baby is more likely to die of Sudden Infant Death Syndrome (SIDS).

* Your baby may be cranky, restless, and get sick more often.

* Your baby is more likely to have learning problems.

The good news is that quitting can help you have a healthy baby. It helps to quit at any time while you are pregnant. It's even better to quit before you get pregnant.

Reasons for Quitting

1. You will feel healthier right away.

* You will have more energy and better focus.

* Your senses of smell and taste will be better.

* You will have whiter teeth and fresher breath.

* You will cough less and breathe better.

2. You will be healthier for the rest of your life.

* You will lower your risk for cancer, heart attacks, strokes, early death, cataracts, and skin wrinkling.

3. You will make your partner, friends, family, kids, grandchildren, and co-workers proud of you.

4. You will be proud of yourself.

* You will feel more in control of your life.

* You will be a better role model for others.

5. You will have more money to spend.

6. You won't have to worry about such things as: "When will I get to smoke next?" or "How do I handle being in a smoke-free place?"

Smoking's Impact on Others

Even a little second-hand smoke is dangerous.

Second-hand smoke can cause cancer in non-smokers. It can also cause breathing problems and heart disease. People who breathe second-hand smoke get colds and flu more easily. And they often die younger than those who don't breathe it.

Pregnant women who breathe second-hand smoke have many risks:

* They may lose their babies.

* Their babies may be born small.

* Their babies are more likely to die of SIDS (Sudden Infant Death Syndrome).

* Their children may be cranky, restless, and get sick more often.

* Their children are more likely to have learning problems.

Children who breathe second-hand smoke have troubles too. They are much more likely to have breathing problems such as asthma. They also get more ear and lung infections (like pneumonia).

Why is Quitting So Hard?

Many ex-smokers say quitting was the hardest thing they ever did. Nicotine is in all tobacco products. It makes you feel calm and satisfied. At the same time, you feel more alert and focused. The more you smoke, the more nicotine you need to feel good. Soon, you don't feel "normal" without it. It takes time to break free from nicotine addiction. It may take more than one try to quit for good. So if you plan on quitting, don't give up too soon. You will feel good again.

Quitting is also hard because smoking is a big part of your life. You enjoy holding cigarettes and puffing on them. You may smoke when you are stressed, bored, or angry. After months and years of lighting up, smoking becomes part of your daily routine. You may light up without even thinking about it.

Smoking goes with other things, too. You may light up when you feel a certain way or do certain things. For example:

* Drinking coffee, wine, or beer

* Talking on the phone

* Driving

* Being with other smokers

You may even feel uncomfortable not smoking at times or in places where you usually have a cigarette. These times and places are triggers, because they trigger cigarette cravings. Breaking these habits is the hardest part of quitting for some smokers.

Quitting isn't easy. It may take several tries. But you learn something each time you try. It takes will power (which isn’t the case with drug and alcohol addiction) and strength to beat your addiction to nicotine.

Smoking Triggers

Certain things trigger, or turn on, your need for a cigarette. They can be moods, feelings, places, or things you do. Meet these triggers head-on

Knowing your triggers is very important. It can help you stay away from things that tempt you to smoke. It can prepare you to fight the urge when you are tempted.

* Stay away from places where smoking is allowed. Sit in the non-smoking section at restaurants.

* Keep your hands busy. Hold a pencil or paper clip. Doodle or write a letter. Carry a water bottle.

* Stay away from people who smoke. Spend time with non-smoking friends.

* Put something else in your mouth. Chew sugarfree gum. Snack on a carrot or celery stick. Keep your mouth and hands busy with a toothpick, sugarfree lollipop, or straw.

* Drink less or stay away from alcohol. Drinking alcohol often makes people want to smoke. Drink juice, soda, or ice water instead.

* Remember: The urge to smoke will come and go. Cravings usually last only for a very brief period of time. Try to wait it out.

What are your "triggers"?

Certain things trigger your need for a cigarette. They can be moods, feelings, places, or things you do. Knowing your triggers can help you stay in control. Put a check next to your triggers.

___ Feeling stressed

___ Feeling down

___ Talking on the phone

___ Drinking liquor, like wine or beer

___ Watching TV

___ Driving your car

___ Finishing a meal

___ Playing cards

___ Taking a work break

___ Being with other smokers

___ Drinking coffee

___ Seeing someone else smoke

___ Cooling off after a fight

___ Feeling lonely

___ After having sex

My other triggers are:

___________________________           ___________________________

___________________________           ___________________________

___________________________            ___________________________

___________________________            ___________________________

Think about when you smoke and why you smoke. Do this for as long as you need to. Keep a record of every cigarette you smoke. Use the Craving Journal. You will need one copy for every day. You will find that you light up a lot without thinking about it. And you may be tempted to skip writing down some of the cigarettes you smoke. But keeping this journal is very helpful if you do it right. You'll learn about your smoking triggers. And you'll learn which cigarette times are your favorites. These facts will help you prepare to fight your urge to smoke.

The Toll of Tobacco

Bill Wilson, one of the founders of Alcoholics Anonymous, died from emphysema. Even though he greatly contributed to the alcoholism recovery movement, he was not aloe to overcome the addiction to tobacco. His desk, which can be seen at his home, Stepping Stones, has many burn marks on it from cigarettes. It is aid he had a great affinity for his cigarettes.

And Bill W. is not alone. More alcoholics and other drug addicts in recovery will die from their tobacco use rather than their other drug use. As a mater of fact, more people will die from tobacco use than die from all the other drugs, combined with fatalities from AIDS, suicide, murder and drunk driving. In the next 24 hours, 1, 200 Americans will die from tobacco use according to the American Lung Association. These are startling statistics.

Tobacco use is the number one cause of preventable death and disease in America. One would think the addiction community would be tackling this issue and promoting tobacco addiction recovery among themselves and with their patients. However, addiction professionals often work to help people attain sobriety, only to have them die from tobacco use because it was not included in treatment. This is even more tragic when research conducted by the University of Medicine and Dentistry of the New Jersey School of Public Health shows that when smoking cessation is included with the treatment of other drugs, the abstinence rate after one year is almost doubled. Recovery rates from tobacco addiction could just about double if tobacco addiction treatment were incorporated into all treatment programs.

There is much talk about treating particular populations in the world of tobacco control, like certain ethnic groups, adolescents and pregnant women. However, there is little talk about treating addicts as a unique population, despite the fact that tobacco use is a co-occurring factor in about 50-80 percent of those with chemical dependencies. The evidence clearly indicates more addicts use tobacco than the average population.

Nicotine, the addictive substance in tobacco is a vasoconstrictor, has a short half life and is very addictive. Tobacco is a most efficient delivery system for the drug, giving the user a mood altered effect in about sever seconds. While it is a stimulant, many of its users say it calms them down and helps them deal with stress.

The addiction to tobacco is cunning, baffling, and powerful. Why else would something with a tracheotomy continue to smoke? Why else would someone continue to use a drug that will make them ill, take years off their life and/or kill them? The destruction from tobacco use usually takes years to show up, so often the users think they are safe.

This is a socially accepted drug that has been part of our culture for decades. It is big business. And many of it’s users are in denial that it is a problem. Let’s look at the pattern of use.

* Obsession with the drug. Constant thoughts of "when can I smoke?" "where can I smoke?" "I can’t have cigarettes so I’ll take chew," or "I can’t smoke there, so I’m not going."

* Protection of using the drug. Simply take a look at any newspaper and see the fight against smoke-free air, restaurant and bars going smoke-free, and the increasing federal, state, and local laws regulation smoke-free public spaces. "It’s my right," they say.

* Tolerance. Most users did not start smoking a pack or two a day. They worked up to it over the years.

* Craving. Craving is an indication the person is in withdrawal and the withdrawal symptoms may be unpleasant, enough to cause anxiety about not having the drug. The person loses focus, gets agitated, and wants that cigarette or another tobacco product.

* Rationalization. "I have to die of something," "Who are they to tell me I can’t smoke or use tobacco products?" "At least it’s better than drugs and alcohol." And so on and so on.

* Behavior. How many times has a user gone through the couch, chair, or pants pockets to find the last quarter needed to buy more tobacco? Or robbed the child’s piggy bank or borrowed money to purchase the drug?

* Rituals. The resh the user gets when thinking about smoking, how they open the pack, brand loyalty, the first use of the day and the last puff at night.

* Social life. Many users only associate with other users. They only attend functions where they can smoke or spend some time thinking about how they will get their drug if in a smoke-free environment.

* Physical. Deterioration begins and the user is in denial and/or rationalizes the symptoms, "I get winded going up steps--must be old age setting in," "I am just a little out of shape" or "I always seem to have this cough; must be allergies."

* Spiritual. The user’s higher power is the chemical, or their higher power sanctioned it.

* Relapse. Nicotine Anonymous describes the challenges of relapse of tobacco users: "relapse happens in the head before it is held in the hand" and "you are always a puff away from a pack a day."

Tobacco addiction is a chronic illness that requires treatment. Recovery is possible. Let’s all take on this addiction and help people fight for their lives.From NAADAC News, by Sharon Czabafy, MSS, LSW, CAC, NCTAs

The Effects of Nicotine

Nicotine affects almost every system in the body. When you take a puff, your heart beats faster, your pulse quickens, your veins constrict, and your blood pressure increases. Your adrenal glands pump out adrenaline that increases your heart rate, relaxes many of your smooth muscles, and raises your metabolic rate. Even the electrical activity in your brain changes.

These are powerful biological effects, which make nicotine a very powerful drug. In fact, it is one of the most toxic of all drugs, comparable to cyanide. Take enough nicotine and it can kill you. But the amount of nicotine in a single cigarette is only 8 to 9 milligrams on average.

The amount of nicotine that smokers inhale from each cigarette is even smaller. Most popular brands of cigarettes deliver less than 1.5 milligrams per cigarette. This amount may be somewhat higher or lower for each smoker, depending on how deeply you puff and how many puffs you take from each cigarette.

Nicotine is so potent that even this small dose causes significant changes in the functioning of numerous organs and systems in your body. When people first take up smoking, these physiological changes seem extremely unpleasant. Beginning smokers usually experience nausea, dizziness, headache, stomach upset, coughing and other uncomfortable symptoms. But people who continue to smoke soon develop a tolerance to these symptoms, to the point where they become unnoticeable.

What does this mean for the smoker? The small dose of nicotine delivered by several puffs on a cigarette may make people feel ill the first few times they try smoking. But after they’ve been smoking for a week or so, several puffs and even an entire cigarette no longer have that effect. Now they’ll feel ill only if they smoke several cigarettes one after another (a larger dose).

Psychologically, tolerance to the unpleasant effects of nicotine allows the smoker to focus on nicotine’s pleasurable physiological effects. Many smokers don’t realize that nicotine’s effects on the heart, the nervous system, and the endocrine system are significant contributors to the relaxation, alertness, stress relief, and other pleasant feelings they experience.

This combination of physiological and psychological effects provides so many positive reinforcements that smoking quickly becomes an established addiction.

As the term tolerance implies, a smoker actually becomes accustomed to having a certain level of nicotine in his or her body. In fact, research studies have shown that (without realizing it) smokers regulate the number of cigarettes they smoke in order to maintain their own personally preferred level of nicotine. For example, smokers who are given a very high nicotine cigarette will puff less often than usual, so they don’t take in more nicotine than their preferred amount. Likewise, with a low nicotine cigarette, the smoker will take more puffs than usual, in order to get that preferred amount of nicotine. To relieve withdrawal symptoms, smokers must continue to take in their usual amount of nicotine, which is a sign of "physical dependence" on nicotine.

That’s not all. Smokers become accustomed to the psychological effects of smoking. After the smoking habit is established, the smoker needs to smoke to feel "normal." In other words, the effects produced by nicotine, and the behaviors associated with smoking, become necessary to maintain the person’s optimal state of well-being. This condition is referred to as psychological dependence, just as it is with any drug.

At the extreme, many smokers who run out of cigarettes or are unable to smoke, become totally preoccupied by thoughts of having a cigarette. This behavior is often referred to as "compulsive drug use."

What Smoking Does to Your Body

Most smokers accept the fact that smoking is harmful, but many think of this risk as something like a game of roulette: They believe that each cigarette they smoke is like placing a bet. The "prize" is a heart attack, lung cancer, or some other disease. If your "number’ comes up, you’ve had it, but if you are "lucky" and your number never comes up, you may avoid the hazardous effects of smoking altogether and live to a ripe old age totally unaffected by your smoking habit.

This is a serious misconception. Every cigarette you smoke harms your body. Here’s a better analogy:

Suppose you lived near a chemical plant that emitted a number of toxic wastes that had seeped into the town’s drinking water, so that every time you took a drink of water, it did a small amount of damage to your body. After you’d lived there for a few years, you might notice that you didn’t have quite as much energy as you used to. And after five or ten years, you might notice that quite a few of the townspeople seemed to be getting ill with one thing or another.

In the same way, every cigarette you smoke damages your body. The more you smoke, the greater the damage. True, there have been people who lived into their seventies and eighties even though they smoked all their lives, but unless they were either extremely light smokers or did not inhale, they almost certainly suffered substantial physical impairment as the result of their smoking while they were alive. If they had not smoked, they would in all likelihood have lived longer.

Smoking Risks—Rules of Thumb

* Lung cancer risk—increases roughly 50 to 100 percent for each cigarette you smoke per day.

* Heart disease risks—increases roughly 100 percent for each pack of cigarettes you smoke per day.

Switching to filter-tip cigarettes reduces the risk of lung cancer roughly 20 percent, but does not affect the risk of heart disease.

Smokers spend 27 percent more time in the hospital and more than twice as much time in intensive care units as nonsmokers.

Each cigarette costs the smoker five to twenty minutes of life.

A smoker is at twice the risk of dying before age sixty-five as a nonsmoker.

Inside a Smoker’s Body

Let’s take a look at what happens inside your body each time you light up. You may be surprised to learn how quickly tobacco smoke can produce harmful effects.

Eyes, Nose, Throat

Within a few seconds of your first puff, irritating gases (formaldehyde, ammonia, hydrogen sulfide, and others) begin to work on sensitive membranes of your eyes, nose, and throat. They make your eyes water and your nose run. They irritate your throat. If you continue smoking, these irritating gases will eventually produce a smoker’s cough. One of the reasons many smokers prefer menthol cigarettes is that menthol is an anesthetic that masks the smoker’s perception of this irritation.

Continued smoking produces abnormal thickening in the membranes lining your throat. This thickening is accompanied by cellular changes that have been linked to throat cancer.

Why Smokers Frequently Experience a Morning Cough

Because you haven’t smoked all night, the cilia in your bronchi, which were knocked out of action by the toxic effects of cigarette smoke the day before, begin to come to life and attempt to clear the accumulated mucus out of your air passages. This cleansing action brings up a thick yellow or yellow-green mucus, which triggers the cough reflex in the back of your throat.


From your very first puff, the smoke begins to chip away at your lung’s natural defenses. Continued exposure can completely paralyze the lungs’ natural cleansing process. Your respiratory rate increases, forcing your lungs to work harder.

Irritating gases produce chemical injury to the tissues of your lungs and the airways leading to the lungs. This speeds up the production of mucus and leads to an increased tendency to cough up sputum.

This excess mucus serves as a breeding ground for a wide variety of bacteria and viruses. This makes you more susceptible to colds, flu, bronchitis, and other respiratory infections. And if you do come down with an infection, your body will be less able to fight it, because smoking impairs the ability of the white blood cells to resist invading organisms: an immune system deficiency.

The lining of your bronchi begins to thicken, predisposing you to cancers of the bronchi. Most lung cancers arise in the bronchial lining.

Farther down, inside your lungs, the smoke weakens the free-roving scavenger cells that remove foreign particles from the air sacs of the lungs. Continued smoke exposure adversely affects elastin (the enzyme that keeps your lungs flexible), predisposing you to emphysema.

Many of the compounds you inhale are deposited as a layer of sticky tar on the lining of your throat and bronchi and in the delicate air sacs of your lungs. A pack-a-day smoker pours about eight ounces—one full cup—of tar into his or her lungs each year. This tar is rich in cancer-producing chemicals, including radioactive poloniumm 210.

Experiment: Breathe in a full mouthful of smoke, but don’t inhale. Blowing the smoke out through a clean white handkerchief is roughly equivalent to the amount each puff leaves in your lungs.


From the moment smoke reaches your lungs, your heart is forced to work harder. Your pulse quickens, forcing your heart to beat an extra 10 to 25 times per minute, as many as 36,000 additional times per day.

Because of the irritating effect of nicotine and other components of tobacco smoke, your heartbeat is more likely to be irregular. This can contribute to cardiac arrhythmia, and many other serious coronary conditions, such as heart attack. A recent Surgeon General’s report estimated that about 170,000 heart attacks each year are caused by smoking.

Blood Vessels

Your blood pressure increases by 10 to 15 percent, putting additional stress on your heart and blood vessels, increasing your risk of heart attack and stroke.

Smoking increases your risk of vascular disease of the extremities. Severe cases may require amputation. This condition can produce pain and can increase your risk of blood clots in the lungs.


Smoking constricts the blood vessels in your skin, decreasing the delivery of life-giving oxygen to this vital organ. As the result of this decrease in blood flow, a smoker’s skin becomes more susceptible to wrinkling. This decreased blood flow can be a special problem in people who suffer from chronically cold hands and/or feet (Raynaud’s Syndrome).

Smokers are at particularly high risk for a medical syndrome called "smoker’s face," which is characterized by deep lines around the corners of the mouth and eyes, a gauntness of facial features, a grayish appearance of the skin, and certain abnormalities of the complexion. In one study, 46 percent of long-term smokers were found to have smoker’s face.


Carbon monoxide—the colorless, odorless, deadly gas present in automobile exhaust—is present in cigarette smoke in more than 600 times the concentration considered safe in industrial plants.

A smoker’s blood typically contains 4 to 15 times as much carbon monoxide as that of a nonsmoker. This carbon monoxide stays in the bloodstream for up to six hours after you stop smoking. A 1982 University of Pittsburgh health survey found that nearly 80 percent of cigarette smokers had potentially hazardous levels of carbon monoxide in their blood. Research suggests that these abnormally high carbon monoxide levels may play a major role in triggering heart attacks.

When you breathe in a lung-full of cigarette smoke, the carbon monoxide passes immediately into your blood, binding to the oxygen receptor sites and figuratively kicking the oxygen molecules out of your red blood cells. Hemoglobin that is bound to carbon monoxide is converted into carboxyhemoglobin, and is no longer able to transport oxygen. This means that less oxygen reaches a smoker’s brain and other vital organs. Because of this added carbon monoxide load, a smoker’s red cells are also less effective in removing carbon dioxide—a waste product—from his or her body’s cells.

If you continue to smoke for several weeks, your number of red cells begins to increase, as your body responds to chronic oxygen deprivation. This condition, characterized by an abnormally high level of red blood cells, is known as smoker’s polycythemia. In addition, smoking makes your blood clot more easily. Both of these factors may increase your risk of heart attack or stroke.

Male Reproductive System

Two recent studies by Dr. Irving Goldstein and colleagues at the New England male Reproductive Health Center, Boston University Medical School, found a possible link between smoking and erection problems. In the first study, the researchers found that among a population of 1,011 men with erection problems, 78 percent were smokers—more than twice the number of men with erection problems found in the general population. The researches concluded that decreased potency might result from the negative effects of smoking on the blood vessels leading to the male reproductive organs.

In their second study, the researchers measured the blood flow to the penis in 120 men who had come to their clinic with erection problems. They found that decrease in blood flow was proportional to the number of cigarettes smoked. Dr. Goldstein believes that smoking is the leading cause of impotence in the U.S. today.

In addition to diminishing potency, smoking adversely affects the fertility of male smokers by decreasing sperm count and sperm motility as well as altering sperm shape.

Female Reproductive System

Women who smoke heavily show a 43 percent decline in fertility. Women smokers are three times more likely than nonsmokers to be infertile. Women who smoke also have fewer reproductive years: They reach menopause an average of 1 ¾ years earlier than nonsmokers.

Smokers’ Bodies Get Less Oxygen

Because carbon monoxide lowers your blood oxygen carrying capacity, the blood delivers less oxygen to all the organs of the body. At the cellular level, oxygen is used to supply organs with the energy they need. Less oxygen means less energy.

In addition, more than thirty cancer-causing chemicals travel via the smoker’s bloodstream to every organ of the body. The organs most sensitive to these carcinogens are the stomach, the kidneys, the bladder, and the cervix.

Cigarette smoking also weakens the immune system by depressing antibody response and depressing cell-mediated reactions to foreign invaders. As a result, smokers are more susceptible to a variety of infections. These impairments are reversible if the smoker stops smoking.

Why Smoking makes You Less Fit

Although a smoker’s blood carries less oxygen, the nicotine in tobacco smoke increases the heart rate, requiring more oxygen. This is why smokers become short of breath more easily than nonsmokers. The high concentration of carbon monoxide also reduces the level of oxygen that is carried to the brain. This can produce lethargy, confusion, and difficulty in thinking.

Smoking Impairs Taste and Smell

Continued smoking will also result in a loss of your senses of taste and smell. This occurs so gradually that it may go unnoticed, but the end result is the decreased sensitivity of two very important sense perceptions.

Nicotine Replacement Therapy

Before discussing this possibility is it important to remember: YOU MUST QUIT SMOKING ENTIRELY BEFORE STARTING TO USE ANY NICOTINE REPLACEMENT PRODUCT.

If you feel that you are severely addicted to cigarettes, you may wish to consider using a nicotine substitute product:

* Nicotine gum

* Nicotine patch

* Nicotine nasal spray

* Nicotine inhaler

People usually develop cravings for things that develop immediate satisfaction, such as chocolate or cigarettes. Since nicotine replacement provides nicotine, but not the quick nicotine uptake of cigarettes, it’s easier to give up nicotine replacement than it is to give up cigarettes.

With the patch, the nicotine level in your body stays relatively constant day after day. There is no immediate satisfaction, so there is less craving for a patch. As a result, "quitting" nicotine replacement after you’re securely off cigarettes is generally pretty easy.

Nicotine patches, gums, inhalers, and nasal sprays are expensive. But during the first year alone, a pack-a-day smoker who successfully quits smoking will more than pay for the medication with the money saved from not buying cigarettes.

Here are some important things that you should know about nicotine replacement products:

1) Nicotine patches and nicotine gum are available over-the-counter. The nicotine nasal spray and nicotine inhaler are currently available only by prescription from a doctor.

2) These products provide a small amount of nicotine that will help relieve many of the withdrawal symptoms that a smoker may feel when quitting.

3) The goal is to be free of both cigarettes and the nicotine substitute within three to six months.

As mentioned in the beginning of this section, you must quit smoking completely before you use any nicotine replacement. This means that you must not smoke while using these products. If you do, you may develop serious side effects caused by an overdose of nicotine.

Nicotine replacement must not be used by pregnant or nursing women. With any nicotine substitute, it’s always wise to check with your doctor to see if there are medical reasons you should not use these products.

Nicotine Gum:

This is a drug in gum form, with enough nicotine to reduce your urge to smoke. The gum releases small amounts of nicotine, which is absorbed into the body through the mucous membranes of the mouth. This cuts down on withdrawal symptoms and makes it easier to break the smoking addiction. It tastes very different from regular gum, because it is a medicine.

You can buy nicotine gum from drug stores, mass merchandisers, and supermarkets. Package instructions explain how the gum is used. Most smokers chew 10 to 15 pieces of gum a day. However, you can have up to 30 pieces. It’s important to use as many as you need to feel comfortable without cigarettes.

Use only one piece of gum at a time. Chew it very slowly until you feel a tingle in your mouth. When the peppery taste is present, shift the gum between your cheek and gum. When the tingle is gone, chew a few more times to get it back. Then shift the gum to different parts of your mouth. Repeat this procedure for about 30 minutes to release most of the nicotine. The majority of the time, the gum should be just sitting in your mouth. Do not chew continuously and swallow the saliva as you would with regular gum. The nicotine from the gum must be absorbed through the mouth – it is ineffective if swallowed. The nicotine does not reach the bloodstream if it goes to the stomach, and it can cause heartburn or hiccups.

Another important point is: Do not use nicotine gum while you are drinking. This will wash the nicotine down to the stomach. Wait several minutes after drinking liquid before chewing the gum. This is particularly important if you have been, or will be, drinking acidic beverages such as orange or grapefruit juice, since the acidic quality of these drinks changes the "environment" of the mouth and interferes with the amount of nicotine that’s absorbed.

Begin using the gum after you quit smoking, and use it every day for at least two or three months after quitting. The first three months are when relapse is most likely to happen. Remember that you must not chew the gum and smoke cigarettes.

As your urges to smoke decrease, you will gradually reduce your use of the gum. However, there are two cautions:

1) It’s better to use the gum a little longer than to risk a relapse by tapering off the gum too early and too quickly.

2) Even after you stop using the gum, continue to carry some with you just in case. Better to relapse to the gum than to cigarettes.

Nicotine Patch:

The nicotine patch is applied to your skin. Over a prolonged period of time, the nicotine dissolves right through the skin and enters the body. Nicotine from the patch replaces some of the nicotine you were getting from cigarettes. This can relieve some of the physical symptoms associated with quitting smoking, so you can concentrate on your behavioral and psychological addiction to cigarettes.

You can buy the patch without a prescription – but as always, it’s best to check with your doctor to see if the patch is right for you. You may not be able to use the patch if:

* You are taking certain prescription medicines, or

* You have cardiovascular disease or certain other health conditions.

Even if you have been told not to use the patch because of a medical condition, you may want to check back with your doctor from time to time, to see if your condition, or the medical advisories have changed. For example, physicians were initially concerned that nicotine patch use might be dangerous for cigarette smokers who have coronary artery disease. However, a recent study found that the patch is a safe way for such people to quit smoking, and may improve blood and oxygen flow to the heart. Some research has suggested that the patch is safe and effective for teenage smokers, but patch use is currently not advised for people under 18 years of age.

The nicotine patch is safe but (as with any medication) it must be used with caution. Most important, you should never smoke while using the patch.

Some side effects from normal use of the patch can include headaches, dizziness, upset stomach, diarrhea, weakness, or blurred vision. Vivid dreams also may result from an interrupted sleep pattern when you quit smoking.

Some people report a mild itching or burning on the skin where the patch is applied, which usually goes away in about an hour. If the irritation continues you can try moving the patch to a different spot. If it persists, remove the patch and contact your doctor.

Some patches contain more nicotine than others. Some smokers start with the strongest patch. Then after several weeks, you can switch to a medium-strength patch for a few weeks, and possibly a lower-strength patch for the last few weeks. On the other hand, some people prefer the simplicity of a single-strength patch.

If you do use the nicotine patch, each morning you will apply a new nicotine patch to a clean, dry, non-hairy part of your upper body or arm. Don’t apply creams on the skin where you will put the patch. Press the patch firmly on your skin. It should stick to the skin well, allowing you to do all of your usual activities, including bathing.

One brand of the nicotine patch is removed at night, lowering the level of nicotine in the bloodstream, to give the body a rest. Other brands are worn at night as well as during the daytime, and are changed every 24 hours. When you remove the patch, put a fresh patch on a new area of your upper body. Do not reuse a skin area for at least one week.

The nicotine patch isn’t magic. It can’t automatically wipe out all your cravings for nicotine. Cravings are diminished and may not last with the patch, but don’t expect them to disappear immediately. Even if you still crave cigarettes sometimes while wearing the patch, you are less likely to suffer from several of the major smoking withdrawal symptoms, such as tension, irritability, feeling sleepy, and having a hard time concentrating.

Other Products:

Nicotine replacement therapy can also be administered via a nasal spray, or by the newest method, an oral inhaler, which was approved by the Food and Drug Administration in 1997.

These products are available only by prescription. Contact your doctor to see if the nicotine spray or inhaler is right for you.

As with all nicotine replacement products, you cannot start using the nasal spray and the inhaler until you have completely stopped smoking. If you do use nicotine spray or a nicotine inhaler, you must not smoke any cigarettes, or use any other form of tobacco, such as cigars, pipes, or chewing tobacco.

The spray delivers nicotine through the nose. The inhaler delivers nicotine into the mouth, which produces a sensation in the back of the throat similar to that produced by tobacco smoke. However, both devices provide nicotine at a lower level than cigarettes, and they do not contain any of the cancer-causing tars and toxins found in tobacco products. For example, ten puffs on the inhaler provides about the same amount of nicotine as one puff on an average cigarette.

With the nicotine spray and inhaler, dosage is flexible and can be individualized according to your personal withdrawal symptoms. Both devices deliver nicotine to the blood-stream in a matter of minutes. This fast onset of action reduces nicotine cravings quickly.

Unlike the nicotine patch, gum, and nasal spray, the nicotine inhaler has the advantage of satisfying the "hand-to-mouth" ritual smokers miss when they quit. The inhaler consists of a mouthpiece connected to a cartridge containing nicotine. When a smoker puffs on the mouthpiece, the inhaled air becomes saturated with nicotine, which is absorbed through the mucous membranes of the mouth and throat, as happens with nicotine gum.

This route of absorption isn’t the same as that of cigarettes. A majority of the nicotine from a cigarette is absorbed directly into the lungs, which causes a "nicotine spike" that smokers feel almost instantly. It’s this spike a smoke gets when taking a puff or a drag that contributes to the high addictive properties of tobacco.

Is Nicotine Replacement Unhealthy?

Many people worry that nicotine replacement products are just as bad as smoking cigarettes. They’re definitely not. They do not have all the tars and poisonous gases that are found in cigarettes. They provide less nicotine than a smoker would get from cigarettes. And they’re designed to help people get off nicotine, not to keep them on nicotine.

But it is important to realize that nicotine replacement therapies will not work for everyone. They are not a cure-all. They are just temporary aids that can help you make it through the tough initial withdrawal period after you’ve quit smoking.

What needs to be understood is that nicotine is not the only dangerous element of the smoking habit. Certain moods, times of day, or activities all become strong triggers that make you crave a cigarette. Nicotine replacement isn’t a cure for these. That’s why anyone who uses the nicotine patch, gum, nasal spray, inhaler, or other products should also make a concerted effort to change their behavior patterns.

The Non-Nicotine Pill:

There is a new prescription pill that’s designed to help smokers quit. Again, it’s still not a magic pill. It does not eliminate the urges to smoke. Those urges still require a serious effort to overcome.

The pill is Zyban, the trade-name for a sustained-release tablet of bupropion hydrochloride. The same drug has been sold under the trade-name Wellbutrin SR. Now it’s being marketed as the first non-nicotine prescription treatment for smoking addiction.

How does the pill work for smokers? The drug boosts the body’s levels of two "brain chemicals," dopamine and norepinephrine – the same thing happens with nicotine. Actions of these chemicals in the brain give people a sense of energy and well-being. Nicotine produces the same feelings.

According to the advertisements, using bupropion allows smokers to get the same feeling, while weaning themselves off nicotine. For many people, this helps to reduce withdrawal symptoms and lessens the urge to smoke. But like the other nicotine replacement products, the pill should be used in combination with a quit-smoking behavior modification program.

In one study, the non-nicotine pill helped more smokers to quit than the nicotine patch. Using both the pill and the patch was even more effective, but the combination poses the risk of increasing blood pressure.

Zyban is usually taken twice a day – one pill in the morning and one in the early evening. It takes about a week for the pill to reach an effective level in the body. Therefore, smokers must start taking the pill before they quit smoking. Then you set a Quit Day within one to two weeks after starting treatment. Most smokers then take the pill for a total of 7 to 12 weeks.

The non-nicotine pill is available only by prescription. It’s especially important to get a doctor’s advice, because Zyban is certainly not right for everyone. The drug is not recommended for:

* Women who are pregnant or breast-feeding.

* People with a history of eating disorders, such as bulimia or anorexia nervosa.

* Anyone who is currently taking or has taken a monoamine oxidase inhibitor (MAO) medication for depression.

* People already taking Wellbutrin, Wellbutrin SR, or other medicines that contain buproprion hydrochloride.

* People who have a seizure disorder, such as epilepsy.

Seizure disorders are a special concern. Buproprion is known to cause seizures in approximately 1 out of every 1000 people taking buproprion hydrochloride. Although this is a small risk, it may be an important factor for people deciding whether or not to use this drug. Other common side effects include dry mouth and difficulty in sleeping.

The Role of Drugs in Quitting.

The introduction of buproprion as an aid in smoking cessation is probably a sign of things to come. Better understanding of how smoking influences the brain will probably lead to better drugs to help smokers quit. So don’t worry. Try your best now. But also recognize that your efforts to quit are going to receive more types of assistance in the future.

Buproprion also illustrates the fact that quitting smoking requires attention to both the biology and psychology of smoking. Buproprion is helpful when used with education programs and support from health professionals or with an intensive self-help program. As with all these help tools to quitting, there is still no magic cure. Buproprion will help smokers quit, but they have to take the first step and continue to work to keep temptations from undermining their efforts.

Alternative Medicine.

If patches, pills and sprays don’t appeal to you, then you might be interested in techniques that are often categorized as alternative medicine.

Two alternative therapies – hypnosis and acupuncture – have sparked particular interest as aids to quitting smoking.

Hypnosis is a state of attentive and focused concentration that is induced by the use of "therapeutic suggestion." The hypnotic trance state resembles other forms of deep relaxation. People cannot be hypnotized involuntarily and they do not follow hypnotic suggestions that are against their wishes. People who want to be helped are the best hypnotic subjects.

When employed by psychologists, physicians, and others trained in its use, hypnosis may help in quitting smoking. Ask your doctor for a referral, or contact your local or state psychological association for the names of licensed psychologists in your area who practice hypnosis. Like other therapies, though, it’s not a magic solution that can be used alone. Hypnosis cannot make you quit or automatically eliminate all your desires to smoke. It should be part of a systematic quit smoking program.

Acupuncture is an ancient Chinese therapy that involves stimulating specific anatomic points in the body. This regulates or corrects the flow of "chi" (or energy) in the body, and thus restores health. Puncturing the skin with a needle is the most typical method of acupuncture. As with all other therapies, acupuncture works best for smoking cessation when it’s used in combination with a serious effort to quit and a behavior modification strategy to support their effort.

Learning From Relapse

As a clinician, one of the most important things that can be offered to the tobacco dependent client is help with learning from lapses and relapses and returns to smoking. As a counselor specializing in working with tobacco-dependent clients, my best credential is personal experience with tobacco recovery since 1995 after having smoked two packs per day for over 25 years. With multiple quit attempts before experiencing tobacco recovery, the most important thing I learned is that relapses are learning experiences.

Most tobacco dependent people experience patterns in their use, dependence and recovery. They enter a quit-relapse cycle that they constantly repeat, and from which it is difficult to escape. With each relapse, clients seem to mentally rack up another "failure." We hear the negative label they place on the quit attempt when they return to smoking. They arrive for their counseling appointment with comments such as "I screwed up again," or "I messed up again," or "I guess I just can’t do it," or "It’s just so hard, I don’t know if I can ever quit and stay that way," or other similar comments expressing their frustration.

Tobacco recovery is a process and most people return to smoking several times before they become tobacco-free on a permanent, long-term basis. The best predictor of eventual success is continued attempts at cessation. That’s why it is so important to examine each quit attempt regardless of the outcome of the attempt. Each quit attempt is a valuable learning experience because the more times one abstains from smoking, the more practice one has at being a nonsmoker. The longer the most recent quit attempt, the better the individual can remember the skills involved in being tobacco-free.

One of the tools I developed is called a "From Relapse to Recovery" worksheet (these worksheets are available to fellow professionals). The purpose of the worksheet is to help the client examine previous quit attempts and to learn from those experiences. The worksheet provides a way to help the client to view the quit attempt as a positive, information-gathering learning experience rather than as a failure.

The six-question worksheet includes the following areas:

1. (When) Identify the month and year of the quit attempt.

2. (How) Identify the method used to become tobacco-free, e.g., cutting down on the number of cigarettes smoked; changing brands; using nicotine replacement; obtaining prescription medication; counseling; and/or alternative therapies.

3. (How Long) Identify the number of hours, days, weeks, months or years of tobacco-free time during the quit attempt.

4. (Recovery Maintenance) Identify the tools, skills and methods used to remain tobacco-free during this time.

5. (Relapse Occurrence) Identify the way the return to tobacco use occurred.

6. (The Most Important Issue) Identify what was learned from the quit attempt.

Clients are asked to fill out one of these worksheets for each previous quit attempt, as best as they can remember. Sometimes the act of completing a worksheet and writing (verses talking) about the quit attempt helps to trigger thoughts and memories of what worked and what didn’t work with previous attempts. The purpose of completing a worksheet for each quit attempt is to identify any positive or challenging patterns which may emerge.

Positive patterns include remaining tobacco-free by use of certain tools, skills or strategies. Noting these positive patterns is consistent with the motivational speaker Tony Robbins’ message that "Success is not an accident. Success leaves clues. It is the result of consistent and logical patterns of action."

Challenges include noting that relapse occurs every year around the anniversary of a loss or death; that the use of alcohol triggers smoking; that certain stressors serve as cues to return to smoking; or identifying any other patterns that the patient develops. These patterns provide important information for future relapse-prevention strategies.

Helping clients to learn from lapses and relapses reinforces the fact that tobacco recovery is a process instead of an event. Review of previous attempts can help the client recognize the progress made, lessons learned, skills acquired and tools gained with each attempt to quit.

By engaging clients in the process of the review, we actively remind them of the belief in their ability to become nicotine-free and our willingness to take this journey with them. Support is an important component of recovery. Awami Satchidananda, one of the most revered Yoga maters of our time, says that the difference between illness and wellness is that illness begins with "I," and wellness begins with "We."

Helping clients to learn from relapse encourages clients to keep trying, to not give up, and underscores the message that tobacco recovery is possible for everyone, regardless of the challenges they face.

From NAADAC News by Corrine Kalat, MS

The Psychology of Quitting Smoking

Many experts believe smoking is only about 10% physical addiction and a whopping 90% psychological addiction. Your body will recover fairly quickly from nicotine withdrawals (the worst symptoms usually abate in three days or less), but your psychological dependency on cigarettes can be much more difficult to defeat. One way to combat this is to do a bit of self-analysis before giving up cigarettes.

Make a list with two columns. Label column one "Why I Started Smoking,"and label column two "Why I Want to Quit Smoking."

In column one, list all the reasons you can remember as to why you started smoking in the first place. Was it peer pressure? Rebellion? Did you think it made you look cool? Did it make you feel like a grown-up? Really try to remember the exact reasons why you started smoking and write them all down. Now look over that list. Do any of those reasons still apply in your life today? Probably not.

If you're like most people, you will see that your reasons for becoming a smoker are no longer valid, are often just silly, and are easily outweighed by the risks to your health and your family's well-being.

Move on to column two...

Why do you want to quit smoking?

This one may seem obvious, but it can be a bit tricky. You really need to take some time and think hard about this. Don't just list the obvious health reasons. You've been reading the Surgeon General's warnings for years with little effect, so you need to come up with reasons that truly have meaning for you. The things most people write down will NOT help you quit smoking...

* I don't want to get lung cancer.

* I don't want to have a heart attack or a stroke.

* I'd like to live long enough to see my grandchildren grow up.

Those are all good reasons to quit smoking, certainly... but they deal in "possibilities" rather than specifics.

Sure you MIGHT get lung cancer, you MIGHT have a heart attack or a stroke, you MIGHT die young and miss out on seeing your grandchildren grow up... ...Or, you MIGHT NOT! You're not likely to break a strong psychological addiction based on what MIGHT happen. Your mind will work hard to convince you that it won't happen to you! Instead, list health problems that you are already experiencing.

Your list should point out things in your life that you are actively unhappy about and are STRONGLY MOTIVATED to change. In order to break your psychological addiction, you need an arsenal of new thoughts and desires that are stronger than your desire to smoke!

Here are the types of things you want to put in column two...

Why Do I Want to Quit Smoking?

1. Health Reasons

I get so out of breath when I exert myself even a little bit. Just vacuuming the house makes me pant and gasp.

My feet are always cold. This could be due to high blood pressure and poor circulation associated with smoking.

I have a nasty wet cough and I have to blow my nose way too often. Mucus build-up is the body's reaction to all the toxins and chemicals in cigarette smoke and could be a precursor to serious respiratory disease. Even if I don't get cancer, I don't want to be one of those people who has to tote oxygen bottles around everywhere.

I'm always tired. Could it be that my body is using up all its energy trying to eliminate the toxins and chemicals from cigarettes?

2. Vanity Reasons

Smoking causes premature aging and drying of the skin. I don't want to look like a wrinkled up old prune!

My fingers, fingernails and teeth are all tobacco stained. Disgusting! How embarrassing.

When I get on the elevator after a smoke break at work, everyone wrinkles their nose and tries to edge away from me because I reek of cigarette smoke. I feel like a pariah. It's embarrassing to always be the big "stinker" on the elevator. I feel like I have no self-control.

My breath is awful. Kissing me must be like kissing an ashtray. I spend a fortune on breath mints.

3. Financial Reasons

If I save all the money I used to spend on cigarettes, I'll have enough to take a vacation in Cancun (or some other warm tropical place) every winter!

I could use the money to pay off my credit cards!

I could donate money to my favorite charity or sponsor a child. My cigarette money could make the world a better place!

4. Family Reasons

My family can stop worrying about me.

My spouse will have to find something new to nag me about. Just kidding, honey!

My children will be proud of me and (hopefully) they'll never start smoking themselves, having seen firsthand what a nasty destructive habit it is.

5. Cleanliness Reasons

The walls used to be white. Now they're a nasty dirty-looking brown. I need to repaint... again!

I stink, my car stinks, my house stinks, everything I own reeks of cigarette smoke. I can't even lend a book to a non-smoking friend because they can't stand the smell of smoke permeating the pages!

6. Other Reasons

* Cigarettes often cause recovering addicts to crave drugs and/or alcohol, because they are usually used together.

* Smoking is an appetite suppressant, which often reminds recovering addicts of the ways that drugs and alcohol does the same.

* Society is making it more and more difficult to smoke indoors out of the weather.

* Smokers can now be given citations for driving while kids are in the car. Plus it’s been illegal for many years to dispose of any lit substance out of a car window.

* The smoking habit also takes an inordinate amount of time, e.g., the time taken to stop and park and go into stores, sometimes having to wait in line to buy them; specific times to smoke; and the time thinking about how and when to smoke.

Do you see yourself in any of the items listed? You may have many more reasons of your own. Find as many compelling and emotional reasons to pursue smoking cessation as you can think of and write them all down. To quit smoking, you need YOUR reason to kick the nicotine habit.

If you can re-train your mind to think of smoking as a silly and self-destructive thing to do, then you're almost sure to succeed. And if you need something to do with your hands... try knitting!

Visit the web site at for great information and products designed to help you quit smoking. Article may be reprinted as long as this notice remains with the article.

Quit Smoking Tip Sheet

Quit cold turkey. In the long run it’s the easiest and most effective technique of smoking cessation.

Do not carry cigarettes.

Quit smoking one day at a time. Do not concern yourself with next year, next month, next week or even tomorrow. Concentrate on not smoking from the time you wake up until you go to sleep.

Work on developing the attitude that you are doing yourself a favor by not smoking. Do not dwell on the idea that you are depriving yourself of a cigarette. You are ridding yourself of full-fledged smoking because you care enough about yourself to want to.

Be proud that you are not smoking.

Be aware that many routine situations will trigger the urge for a cigarette. Situations which will trigger a response include: drinking coffee, alcohol, sitting in a bar, social events with smoking friends, card games, the end of meals. Try to maintain your normal routine while quitting. If any event seems too tough, leave it and go back to it later. Do not feel you must give up any activity forever. Everything you did as a smoker, you will learn to do at least as well, and maybe better, as an ex-smoker.

Make a list of all the reasons you want to quit smoking. Keep this list with you, preferably where you used to carry your cigarettes. When you find yourself reaching for a cigarette, take out your list and read it.

Drink plenty of fruit juice the first three days. It will help flush nicotine out of your system.

To help avoid weight gain, eat vegetables and fruit instead of candies and pastries. Celery and carrots can be used safely as short-term substitutes for cigarettes.

If you are concerned about weight gain, do some moderate form of regular exercise. If you have not been exercising regularly, consult your physician for a practical exercise program which is safe for you.

If you encounter a crisis, (e.g. a flat tire, flood, blizzard, family illness) while quitting, remember, smoking is no solution. Smoking will just complicate the original situation while creating another crisis, a relapse into the nicotine addiction.

Consider yourself a "smoke-a-holic." One puff and you can become hooked again. No matter how long you have been off, don't think you can safely take a puff!

Don't debate with yourself how much you want a cigarette. Ask yourself how do you feel about going back to your old level of consumption. Smoking is an all or nothing proposition.

Save the money you usually spend on cigarettes and buy yourself something you really want after a week or a month. Save for a year and you can treat yourself to a vacation.

Practice deep breathing exercises when you have a craving.

Go places where you normally can't smoke, such as movies, libraries and no smoking sections of restaurants.

Tell people around you that you have quit smoking.

Remember that there are only two good reasons to take a puff once you quit. You decide you want to go back to your old level of consumption until smoking cripples and then kills you, or, you decide you really enjoy withdrawal and you want to make it last forever. As long as neither of these options appeal to you - NEVER TAKE ANOTHER PUFF

Conquering Smoking

Most smokers want to quit. They know cigarettes threaten their health, set a bad example for their children, annoy nonsmokers, and cost a lot of money. Quitting smoking isn't easy and it isn't fun, but millions have quit. Anyone who is determined to quit, can and will.

List all the reasons you want to quit. Don't worry about how difficult it might be. SET A TARGET DATE FOR QUITTING. Two weeks before this date switch to a brand you don't like, and keep changing every few days. Don't buy a new pack until you finish the one you're smoking. Stop carrying a lighter. Watch in the mirror as you light each cigarette. Do not empty the ashtrays.

On the day before you quit try to smoke 4 packs, saving all the cigarette butts in a quart jar of water. Tell your friends and family that you are quitting.

On the day you quit, throw away all the cigarettes, matches, lighters, and ashtrays. Make a list of things you want to buy with the money you can save. Keep very busy -- go to a movie, the library, church, take long walks, eat in the non-smoking section of a restaurant. Have the dentist clean your teeth.

The first few days after you quit spend as much time as possible in places where smoking is prohibited. Drink a gallon of water daily. Avoid alcohol and coffee. Keep a pencil, plastic straw, or similar object in your hand. Try sugarless gum or mints. Brush your teeth immediately after each meal. Temporarily avoid situations that trigger your urge to smoke. If you must be in a situation where you'll be tempted to smoke, stick close to the nonsmokers. Change the habits of your lifestyle to make smoking difficult, impossible, and unnecessary. Exercise regularly. Keep your hands busy. Find activities that are difficult to do when smoking. Get plenty of rest. Pay more attention to your appearance. Don't let anyone smoke in your home. TAKE ONE DAY AT A TIME.

When you get the "crazies," chew on such things as carrots, pickles, sunflower seeds, apples, celery, sugarless gum, etc. Take 10 deep breaths, and hold the last one while lighting a match. Exhale slowly, and blow out the match. Take a shower or bath. Learn to relax quickly and deeply. Make yourself limp, visualize a soothing, pleasing situation, and get away from it all for a moment. Concentrate on that peaceful image and nothing else. Light incense or a candle, instead of a cigarette. Never allow yourself to think that "one won't hurt" -- it will. Periodically, write down new reasons why you are glad you quit. Reward yourself for not smoking.

Most people who quit do not gain weight. Giving up cigarettes is far healthier for you than adding a few extra pounds.

If you try to quit and fail -- KEEP TRYING. Don't feel guilty. Also, refer to all the material you’ve accumulated about not smoking to keep the ideas fresh in your mind, and by all means use them.

More Tips

Ebb Off Cigarettes

* Once you've made up your mind to stop smoking, and start a no-smoking regimen, be consistent! If you try this drink, do it every night without fail. The following day, if you reach for a cigarette, you may think twice about it. You may even decide not to have that cigarette.

* Reduce the number of cigarettes you have each day, and you should be able to wean off them completely by the end of one month, if not sooner.

* Most smokers smoke "habit" cigarettes, e.g. smoking while on the phone, after a meal, or while driving. So, eliminate these habit cigarettes by changing your smoking habits. This reduces the number of cigarettes smoked without creating the feeling of loss that reducing the number of cigarettes often creates.

* Each time you buy a pack of cigarettes, change brands to one that is less appealing to you. It may reduce the pleasure of smoking, and confirm how nasty they can taste.

* Do not buy cartons of cigarettes; buy one pack at a time, and only after you have finished a full pack.

* Each day, wait an hour longer than the prior day before lighting your first cigarette.

* When you have a strong craving for a cigarette, wait five minutes; meanwhile, do something interesting, something that takes total concentration and takes your mind off smoking.

* Quit Cold-Turkey

* Some people decide to throw the cigarettes away and stop at once. Make that decision and stick to it.

* Never have any cigarettes around. Once you decide to stop cold turkey, do not buy any cigarettes or leave any in drawers or hidden places.

* Never bum cigarettes or take a "drag" when quitting going cold turkey. This haunts your memory into wanting more.

* Replace your habit of smoking with a healthier habit, such as jogging, walking, biking, sewing, painting, or swimming.

* As each day progresses when you have not had a cigarette, it gets easier to break old smoking habits.

Cigar Smoking Dangers

It’s a common misconception that cigar smoking is less dangerous than cigarette smoking. The truth of the matter is that cigars are dangerous and every bit as deadly as cigarettes. However, because upwards of 75 percent of cigar smokers are occasional smokers, they are generally exposed to smaller quantities of the poisons and carcinogens present in cigars than cigarette smokers are with their cigarettes. It’s because of this that there are fewer instances of disease and fatality due to cigar smoking.

Facts You Should Know About Cigars

One cigar may contain as much tobacco as an entire pack of cigarettes.

A single cigarette usually contains less than a gram of tobacco, while cigars, which vary in size and shape, can have between five and 17 grams of tobacco.

Cigars are Addictive.

The amount of nicotine in a single cigar is many times greater than what is found in a cigarette. A typical cigarette contains approximately 8 milligrams of nicotine, while an average cigar has between 100 and 200 milligrams of nicotine, and some have upwards of 400 milligrams. Cigar smoke is more alkaline than cigarette smoke. It readily breaks down in saliva, allowing the smoker to easily absorb nicotine through the lining of the mouth in quantities sufficient to cause addiction.

Cigar smoke is more concentrated and toxic than cigarette smoke.

ETS from cigar smoke vary from that of cigarette smoke for a couple of reasons. First, the manufacturing process for cigars requires a fermentation period. During this time, high concentrations of tobacco-specific nitrosamines (TSNA) are produced. TSNA are some of the most carcinogenic compounds known to man. Secondly, cigar wrappers are not as porous as cigarette wrappers, making the combustion of a cigar less complete. These two factors result in higher concentrations of nitrogen oxides, ammonia, carbon monoxide and tar in cigars than in cigarettes.

Cigar smoking has been linked to erectile dysfunction in men.

Smokers are twice as likely to be impotent as nonsmokers due to the adverse effects smoking has on circulation, hormones and the nervous system. Cigar smoking and exposure to second hand smoke in particular have been shown to be significant risk factors for erectile dysfunction.

Steer clear of cigars, and avoid the second hand smoke that they produce. There is no such thing as a safe tobacco product!

Cigar Smoking and Cancer

Oral and Esophageal cancer - including cancers of the lip, tongue, mouth and throat. Both cigarette and cigar smokers share a similar risk for cancers of the oral cavity and esophagus.

People who smoke one or two cigars daily double their risk of oral and esophageal cancer over nonsmokers. Those who smoke three to four cigars a day increase their risk of oral cancers by eight times and esophageal cancers by four times that of nonsmokers.

Risk factors for people who are occasional cigar smokers (less than daily) are not known.

Lung cancer – the risk is less than that of cigarette smokers, because most people do not inhale cigar smoke. It has been found however, that current and former cigarette smokers are more likely to inhale cigar smoke.

Cancer of the pancreas

Cancer of the bladder

Cigar Smoking and Heart Disease

Cigar smoking is hard on the heart. A 25 year-long study published in the Journal of the American Medical Association reported that cigar smokers may suffer as much as 27 percent more risk than that of nonsmokers for coronary heart disease. The study looked at approximately 18,000 men, between the ages of 30 and 85. Over 1500 of them were cigar smokers, and it was discovered that these people suffered more occurrences of heart disease than did their nonsmoking counterparts.

Cigar Smoking and COPD

Cigar smokers are at an increased risk over nonsmokers for chronic obstructive pulmonary diseases such as chronic bronchitis and emphysema. Most cigar smokers don’t inhale, so the risk of COPD is less than that of cigarette smokers. A U.S. study reports that cigar smokers have up to 45 percent greater risks of COPD than that of nonsmokers.

Cigar Smoking and Early Tooth Loss

There is evidence showing that cigar and pipe smoking may also lead to early tooth loss according to a study published in the January 1999 issue of the Journal of the American Dental Association. Researchers from Boston University followed 690 men over the course of 23 years and concluded that those who smoked cigars were 30 percent more likely to lose their teeth than nonsmokers. Pipe smokers were 60 percent more likely to suffer early tooth loss than nonsmokers. Cigar and pipe smokers are also at an increased risk for alveolar bone loss.

Chewing Tobacco

Chewing tobacco is a smokeless tobacco product. Chewing is one of the oldest ways of consuming tobacco leaves. Native Americans in both North and South America chewed the leaves of the plant, frequently mixed with lime. Smokeless tobacco contains 28 cancer-causing agents (carcinogens). It is a known cause of human cancer, as it increases the risk of developing cancer of the oral cavity. Oral health problems strongly associated with smokeless tobacco use are leukoplakia (a lesion of the soft tissue that consists of a white patch or plaque that cannot be scraped off) and recession of the gums. Smokeless tobacco use can lead to nicotine addiction and dependence. Adolescents who use smokeless tobacco are more likely to become cigarette smokers. In the United States, Chewing tobacco is widely associated with baseball players. One noteworthy example of baseball players and chewing tobacco was Bill Tuttle. Tuttle was an outfielder in Major League Baseball's American League during the 1950s and the 1960s, for the Detroit Tigers, Kansas City Athletics and Minnesota Twins.

Modern chewing tobacco is produced in three forms: twist, plug, and scrap. Twist is the oldest form. One to three high-quality leaves are braided and twisted into a rope while green, and then are cured in the same manner as other tobacco. Users cut a piece off the twist and chew it, then expectorating. Until recently this was done by farmers for personal consumption in addition to other tobacco intended for sale. Modern twist is occasionally lightly sweetened. It is still sold commercially, but rarely seen outside of Appalachia. Popular brands are Oliver Twist, Mammoth Cave, Moore's Red Leaf, and Cumberland Gap. A few manufacturers in the United Kingdom produce particularly strong twist tobacco meant for use in smoking pipes rather than chewing. These twists are not mixed with lime although they may be flavored with whisky, rum, cherry or other flavors common to pipe tobacco.

Plug chewing tobacco is made by pressing together cured tobacco leaves in a sweet (often molasses-based) syrup. Originally this was done by hand, but since the second half of the 19th century leaves were pressed between large tin sheets. The resulting sheet of tobacco is cut into plugs. Like twist, consumers cut a piece off of the plug to chew. Major brands are Days O Work and Cannonball.

Scrap, or looseleaf chewing tobacco (sometimes referred to as "chew" or "chaw"), was originally the excess of plug manufacturing. It's sweetened like plug tobacco, but sold loose in bags rather than a plug. Looseleaf is by far the most popular form of chewing tobacco. Popular brands are Red Man, Levi Garrett, Beechnut, and Mail Pouch. Looseleaf chewing tobacco can also be dipped.

During the peak of popularity of chewing tobacco in the Western United States in the late 19th century, spittoons were a common device for users to spit into.

In the U.S., the term "chewing tobacco" usually (incorrectly) refers to Dipping tobacco, which is not chewed or can be referred to as having a fat lipper. Sales of chewing tobacco and moist snuff (smokeless tobacco) sold by American manufacturers to wholesalers were 109.4 million pounds in 1999; that represents the lowest level of sales in more than 100 years. However, possibly due to increasing regulations on public smoking, sales have since increased. Those revenues reached $1.89 billion in 1993 and $1.94 billion in 1994. The total amount spent on advertising and promotion by the five major manufacturers declined slightly from 1997 to 1998 (from $150 million to $145 million), then rebounded to an all time high of $170 million in 2005. The most popular tobacco industry is the U.S. Smokeless Tobacco Company. They manufacture Skoal, Red Seal, Copenhagen, Husky, and Rooster. Dipping tobacco is sold in almost all places where cigarettes are sold, but chewing tobacco is more limited in distribution.

The Southern U.S. was distinctive for its production of tobacco, which earned premium prices from around the world. Most farmers grew a little for their own use, or traded with neighbors who grew it. Commercial sales became important in the late 19th century as major tobacco companies rose in the South, becoming one the largest employers in cities like Durham, NC and Richmond, VA. Southerners dominated the tobacco industry in the United States; even a concern as large as the Helm Tobacco Company, headquartered in New Jersey, was headed by former Confederate officer George Washington Helme. In 1938 R.J. Reynolds marketed eighty-four brands of chewing tobacco, twelve brands of smoking tobacco, and the top-selling Camel brand of cigarettes. Reynolds sold large quantities of chewing tobacco, though that market peaked about 1910.

A historian of the American South in the late 1860s reported on typical usage in the region where it was grown, paying close attention to class and gender:

High-Risk Populations and Current Estimates

Smokeless tobacco use in the United States is higher among young white males; American Indians/Alaska Natives; people living in southern and north central states; and people who are employed in blue collar occupations, service/laborer jobs, or who are unemployed.

Nationally, an estimated 3% of adults are current smokeless tobacco users. Smokeless tobacco use is much higher among men (6%) than women (0.4%).

In the United States, 9% of American Indian/Alaska Natives, 4% of whites, 2% of African Americans, 1% of Hispanics, and 0.6% of Asian-American adults are current smokeless tobacco users.

An estimated 8% of high school students are current smokeless tobacco users. Smokeless tobacco is more common among males (13.6%) than female high school students (2.2%). Estimates by race/ethnicity are 10.2% for white, 5.1% for Hispanic, and 1.7% for African-American high school students.

An estimated 3% of middle school students are current smokeless tobacco users. Smokeless tobacco is more common among male (4%) than female (2%) middle school students. Estimates by race/ethnicity are 3% for white, 1% for Asian, 2% for African-American, and 4% for Hispanic middle school students.