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Quitting Smoking: Tips from a Psychiatrist


As a psychiatrist specializing in addiction, I am frequently asked what drug is the most problematic in the United States. My answer often surprises people: Tobacco.

Quit Smoking

Tobacco kills some 480,000 people each year in the U.S., more people than alcohol and all other drugs combined. Almost 10 percent of the deaths are related to secondhand smoke. I get a lot of questions about tobacco, smoking and quitting smoking. Below are some of the most popular questions:

Isn't tobacco old news?

I wish. While smoking rates have gone down to 17 percent in this country, people with mental illness still smoke at high rates ranging from 50 to 95 percent. Worse yet, people with mental illness die on average 25 years earlier than the general population, largely related to tobacco use.

Tobacco is still the No. 1 preventable cause of death in this country.

What's the big deal if people keep smoking, especially if they can quit other drugs?

This is a common question, especially around mental health and drug treatment centers. I love it when my patients are able to quit other drugs, like illegal drugs or alcohol. When I don’t offer to help them quit tobacco, I may be missing what will cause them the most disability or what may kill them.

I've tried to quit before and it didn't work.

Nicotine dependence, like any other addiction, often takes more than one try to quit. I remind my patients that many other health goals take multiple tries as well. The more times a person tries to quit smoking, the closer they are to success.

I tried to quit cold turkey and it didn't work.

There are a lot of ways to quit smoking. Cold turkey is when someone just gives up cigarettes without help. Support from your doctor, groups, quitlines and online resources can help. The national quitline, 800-QUIT-NOW, or offer proven resources.

There are also seven medications that are helpful. There are five forms of nicotine replacement (the patch, gum, lozenges, inhaler and spray). Two prescribed medications help with craving and withdrawal: bupropion (Wellbutrin or Zyban) and varenicline (Chantix).

What about e-cigarettes?

Patients often ask if they can use e-cigarettes to quit smoking. There is not enough evidence for this and I always offer an evidence-based method first like nicotine replacement. Also, kids are more likely to smoke regular cigarettes if they smoke e-cigarettes. (Read more in a previous APA blog on e-cigarettes.) In early May, the U.S. Food and Drug Administration issued a final rule banning the sale of e-cigarettes to minors and requiring manufacturers to disclose their ingredients.

So, what can I do if I want to quit smoking?

There are many options, I will share a few of the most important:

  • Use support and resources—your doctor, a supportive friend, a quitline—to increase your chance of success.
  • Set a quit date.
  • Consider medication options: over-the-counter (nicotine gum, patch and lozenges) and prescription. Many state quitlines can help you get nicotine replacement for free.
  • Prepare for the quit date: remove all cigarettes, freshen your home or car, let your loved ones know your quit date, buy healthy snacks, plan activities to distract.
  • Think about triggers and how to change them: for example, if you smoke with your coffee, then think about changing your routine.
  • Prepare for withdrawal symptoms: physical symptoms may feel their worst in 3-7 days after quitting and end in a few weeks.
  • On your quit date congratulate yourself for making this big change.
  • Get back on track: if you have a slip, treat it as a slip.
  • If you do find yourself smoking again, remind yourself that it can take more than one quit attempt. Change up your plan and give it another go. Your last attempt was good practice for the next one.

By Smita Das, M.D., Ph.D., M.P.H.
Clinical Instructor, Stanford University
Member, APA Council on Addiction Psychiatry



Patients and FamiliesAddiction


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