MERRIT KENNEDY, HOST:
This is NPR's LIFE KIT to quitting smoking. I'm Merrit Kennedy. I cover breaking news for NPR. And I'm a former smoker - actually, a former heavy smoker. Maybe you've tried to quit before and you feel like you're always going back to square one. But here's something to try. Think of quitting smoking like this.
GARY TEDESCHI: Quitting smoking is a lot like going on a nice road trip.
KENNEDY: Gary Tedeschi is the clinical director at the California Smokers' Helpline. And as you may have noticed, he has a very soothing voice.
TEDESCHI: I have heard that it is soothing, just as long as it doesn't put your listeners to sleep.
KENNEDY: (Laughter) No, you won't.
TEDESCHI: That's always my concern.
KENNEDY: No, no, no. No way.
So you're on this road trip. And if you're halfway there and blow out a tire, what do you do?
TEDESCHI: Do you get a tow truck and get towed all the way back to where you started from? Or do you maybe call AAA?
KENNEDY: Or do you fix the tire yourself right there?
TEDESCHI: It's not a one-time event. It is a process. And if I could say nothing else, I would say never ever stop trying to quit because one of those quit attempts will stick.
KENNEDY: The point is to keep driving forward. And that's what this episode is for. There are things you can do and ways that you can prepare yourself to make it more likely that you'll be able to drop the habit. Scientists have been researching this for decades, and their findings are very clear. We'll break those down and give you plenty of other tips to help you along the way.
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KENNEDY: So if you've had a setback before, don't let that discourage you from trying again, because quitting for any length of time is a win. And maybe you learned something from the previous attempt that could help you quit for good. Or who knows? Maybe you're going to be one of those very lucky people who find quitting easy. But let's be honest here, many of us find it really hard. In fact, we heard from people who said it was the hardest thing they've ever done. And one of the things that can help is having it very clear in your mind why you're stopping.
So if you're even listening to this, you probably want to quit. So I'm not going to spend much time convincing you to quit. You already know that it's horrible for your health and that smokers' lives are more than a decade shorter than nonsmokers'. But I do want to mention a way of thinking that I found helpful when I was getting ready to stop, and it's from a book called "Allen Carr's Easy Way To Stop Smoking." Here he is in a TV interview.
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ALLEN CARR: The normal method of stopping is to say it's killing you, costing you a fortune. I knew that, but I still couldn't stop. What you have to do is remove the illusions which make people smoke.
KENNEDY: I certainly thought smoking was helping me deal with stress. Carr says it's doing just the opposite. He points out that, actually, it's dependence on nicotine that gives you that stressed-out feeling that you need to smoke, so of course lighting up makes you feel better. But the best way to get rid of that anxious feeling is to break the cycle and finally quit.
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CARR: And once they realize there's nothing to give up, they'll not only be healthier - they know that - but they'll be better able to concentrate, better able to cope with stress. Then, instead of, oh, I mustn't, I'm not allowed to - and then it's forbidden fruit. You're fighting it all the time. You're having to use willpower. Once you realize it's like being released from a prison, you're like the count of Monte Cristo. You put out that last cigarette - no, no. Why, isn't it great? I've finally escaped from this prison. I don't need to smoke anymore.
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KENNEDY: So let's break down how to escape from this prison. Our first takeaway is that you need a plan. We'll talk about what the research says about what should probably be in that plan in a minute. But one thing to keep in mind is that it's probably going to be pretty personal. We heard from hundreds of former smokers about how they quit. Stacey Moore (ph) from Georgia had a serious health scare.
STACEY MOORE: Just a couple weeks ago, I woke up with what I thought was this cancerous lump in my throat. And it turned out to just be tonsillitis. But it scared me enough that I knew I just had to stop. I just can't play this roulette game anymore.
KENNEDY: Others, like Greg Moulton (ph) from South Carolina, spent months, or even years, preparing to quit, slowly reducing the amount of nicotine they were taking in every day.
GREG MOULTON: You slay the beast slowly and let it bleed to death on its own.
KENNEDY: Ursula Glover (ph) from Michigan enlisted the help of her family.
URSULA GLOVER: I ended up calling my dad. He was like the smoke god, like, 'cause my dad smoked for so many years, and he quit. And I said, Dad, you have to get me through this. You have to be my smoke god guru.
KENNEDY: The truth is that no one method will work for everyone, but there are some that are probably going to help you more than others. We asked Dorothy Hatsukami, a scientist from the University of Minnesota who's published literally hundreds of research papers on tobacco and nicotine, about what is most likely to work. And the good news is it's pretty straightforward. It comes down to two main tactics.
DOROTHY HATSUKAMI: To really enhance the success for quitting, you can use both medications and psychosocial or behavioral treatments. The combination of both is what leads to greater success.
KENNEDY: So medication and counseling - these are pretty much the central tenants of years of research on quitting smoking. And they can greatly enhance the chances that a quit attempt succeeds. I know these might sound a little mundane. I wish I had a totally new fix to tell you about that was guaranteed to work. And we have some more surprising research to tell you about later. But there's good reason to take these methods seriously.
HATSUKAMI: I think it's really important for the smoker to know that you want to give the best shot possible in order to help yourself quitting.
KENNEDY: Because the stakes are high here. Addiction counselors like Gary Tedeschi from the California Smokers' Helpline talk about needing a battle plan to slay a four-headed dragon.
TEDESCHI: Quitting smoking has a lot of parts to it. And I've seen it called the two-headed dragon, the three-headed dragon. But we've kind of settled on the four-headed dragon, and that is the things that make it difficult to quit that you have to be prepared for.
KENNEDY: You need to be prepared for more than just the physical withdrawals from nicotine. That's the first head of the dragon.
TEDESCHI: So that's the body's dependence on nicotine.
KENNEDY: Another head is your behavioral dependence on smoking.
TEDESCHI: And that's the habit. That's where the cigarette smoking is ingrained in your daily routine.
KENNEDY: There's also the psychological side of quitting.
TEDESCHI: You know, feeling mixed feelings about quitting. I know I should do this, but, you know, I'd really rather not have to do this.
KENNEDY: And the final head of that dragon has to do with your social environment.
TEDESCHI: Expectations or pressures from the community or family or friends to continue smoking.
KENNEDY: We're going to give you some tips about tackling each of these parts of the dragon as you make your plan. And this is one thing that counseling could help with. If you call your state quitline, you can talk to a specialist like Tedeschi, and they'll help you develop a plan tailored to your needs for free. And then they'll probably follow up with you around the day you're planning to quit if you feel ready to set a date. In any state in the country, you can call 1-800-QUIT-NOW.
And I know counseling can sound intimidating or really intimate. You can pour your heart out if you want, but you can also just call for tips and think of it as a coaching session. Some of them offer text-based counseling if you'd prefer to type than talk. The research shows that getting this kind of support, especially paired with medications, is the most likely to lead to quitting for good. And some of these quitlines even provide free samples of medications. Our second takeaway is this. It's a good idea to get help. That could mean counseling or medications or, ideally, both.
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KENNEDY: Here's what happens to your brain when you light up. Nicotine is targeting receptors in your brain, which then release chemicals that make you feel good. These are also chemicals that could motivate you to repeat the behavior. Hatsukami says that's why cigarettes are addictive.
HATSUKAMI: So what happens when people are in withdrawal is that they have more urges to smoke because they want to get that nicotine into their brains. They also might experience irritation or anger.
KENNEDY: The idea behind the seven medications approved by the U.S. Food and Drug Administration to help people quit is to ease these withdrawal symptoms so you can focus on battling other tough things about quitting smoking, like getting into new routines.
OK. This is going to be a lot of information coming at you. We're not saying that you have to take any of these medications. They're not going to be right for everyone, and you should talk to your doctor about what would be best for you. But we want you to understand your options and what they do.
Five of the medications are known as nicotine replacement therapies. They give you nicotine, but not through a cigarette. It's in a gum, a lozenge, a nasal spray, an inhaler or a patch. Here's Julie Higgins (ph) from California, who sent us this voice memo.
JULIE HIGGINS: At about a quarter to midnight, I was smoking like a chimney. And at midnight, I quit. Lots of patches for (laughter) a very long time, but I finally quit after 30-plus years of smoking.
KENNEDY: You've probably seen these medications at the pharmacy - some you can buy over-the-counter and some you need a prescription for. So how do you choose between the five different kinds? Well, the patch gives you a steady dose of nicotine throughout the day.
HATSUKAMI: That would be really beneficial in order to reduce the withdrawal symptoms. So, you know, you have enough nicotine in your system so it doesn't create this really strong urge to smoke or withdrawal symptoms.
KENNEDY: Other kinds of nicotine replacement, like the gum or a lozenge, can be used as needed to combat specific cravings. These can help at trigger moments when you might have smoked before. And actually, Hatsukami says that some of the latest research suggests that people should try a combination of two types - say, both a slower-acting patch and then a fast-acting gum to combat specific cravings.
HATSUKAMI: And the reason why is you can sustain a certain level of nicotine in your body but then use these other products, like the gum and lozenge or the nicotine inhaler and spray, during those times when you have a strong urge to smoke.
KENNEDY: I know what you might be thinking. Am I going to get addicted to these?
HATSUKAMI: The probability of becoming addicted to a nicotine replacement product is far less than the addictiveness of cigarettes.
KENNEDY: That's because the nicotine is delivered to the body in a different way. And you should know that nicotine is what will get you hooked on cigarettes, but it's not what causes their worst health effects.
HATSUKAMI: I think it's really important for the smoker to know that nicotine does not cause cancer.
KENNEDY: Just to be clear, there are at least 69 other chemicals in tobacco smoke linked to cancer, but not nicotine.
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KENNEDY: Now let's talk about a couple of other medications. The next one that's proven to help is called varenicline. It's marketed as Chantix in the U.S. You would need a prescription for it. And it doesn't give the body nicotine. Instead, it interacts with your brain chemistry by targeting the nicotine receptors in the brain to block the drug's effects.
HATSUKAMI: If you block the effects of nicotine, then it takes the pleasure away from smoking.
KENNEDY: And it also reduces withdrawal symptoms. Another prescription medication called bupropion, which is sometimes marketed as Zyban, has also been shown to ease some of the withdrawal symptoms. They all do have side effects, like any medication, though those pale in comparison to the side effects of smoking. We should mention that after new clinical trials, the FDA removed a prominent warning from the Chantix label in 2016 about reported serious mental health side effects.
HATSUKAMI: You know, there isn't really any strong evidence to support the fact that Chantix may lead to some of these negative behavioral or mood symptoms.
KENNEDY: It also removed a similar warning from the Zyban label.
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KENNEDY: This is probably a good time to bring up another product that contains nicotine that some people use on the path to quitting, but it's not approved by the FDA as a smoking cessation medication, and it's the field's most divisive topic in decades. Yup, I'm talking about vaping. There were many people who told us that switching to an e-cigarette was really helpful when they were trying to quit. Here's Anna Garrett (ph) from Texas.
ANNA GARRETT: I had bought my first vape from a local store. The day I picked that up was the day I quit cigarettes for good. And I don't think I could've done it otherwise.
KENNEDY: Hatsukami says research shows e-cigarettes have fewer toxic chemicals compared to cigarettes. And they might have fewer immediate health consequences.
HATSUKAMI: However, we don't know what the long-term consequences are of the electronic cigarettes.
KENNEDY: Given the recent outbreak of lung injuries and deaths linked to vaping, she considers it a last resort for smoking cessation after people have tried other methods. She says smokers who switch to vaping should consider eventually quitting vaping, too. And they should make sure to purchase the products through reputable sources and not illegal markets. At this point, Hatsukami notes that there's limited research about how to quit vaping nicotine. But in principle, the methods that help smokers quit should likely be helpful for vapers.
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KENNEDY: All right. Let's talk about cravings, something you'll probably deal with as soon as you quit. You might feel them even if you're taking medication. And that brings us to our third takeaway; meds aren't the only way to go. There are other things you can do to help you navigate all of the other tough things about quitting smoking.
Cravings for a cigarette might be linked to your daily routine - times when you used to smoke. For me, it was when I had a coffee, when I woke up, when I was writing - basically, all the time. You should try to plan for a substitute or an alternative behavior. This battle is with another head of the dragon, the behavioral head. Tedeschi says cravings tend to follow a pattern.
TEDESCHI: Usually, they last three to seven minutes, maybe 10 minutes for very strong ones.
KENNEDY: Remember the craving will pass. And it's probably going to be easier to do something than to just stare at the wall and think about smoking.
TEDESCHI: If you get busy and you really do something that you've planned ahead of time that you're going to do instead of smoke when you get a craving, that three to seven minutes will pass. And then you can move on with your day - until the next craving hits.
KENNEDY: Try to distract yourself. Do something fun. Or maybe one of the things you liked about smoking was going for a walk or just taking a break. You can still do that. Munching on crunchy things like carrot sticks might be helpful. Or use a toothpick. Or maybe you get physical, like Miyoshi Juergensen (ph) from Alabama.
MIYOSHI JUERGENSEN: I started doing pushups every time I wanted a cigarette. And that really just changed my whole outlook. And I also lost 70 pounds in the process.
KENNEDY: Just to state the obvious, a carrot or a pushup is not very much like smoking. But just remember that it is a finite time that you have to get through. And here is another way to think about it. These cravings are just a sign that you're freeing yourself from a horrible addiction. And that, of course, is a thing to celebrate.
Tedeschi says you should also prepare yourself by thinking about your social environment - there's another dragon head - and where you might feel tempted to smoke. Like if someone in your home smokes or if your friend doesn't want to lose their smoking buddy, try to think through how you're going to handle those situations when they come up. And that could mean just knowing what you're going to say when you're offered a cigarette, even if it's a simple, no thanks. Tedeschi says you can try to get ahead of this by asking your friends and family to help you.
TEDESCHI: You really have to think about how to negotiate with others and maybe talk about, I'm quitting. It's really important to me. I really need your support. I'm not asking you to quit, but if you can not give me cigarettes or offer cigarettes to me, that would be really helpful.
KENNEDY: You may want to consider avoiding certain trigger situations until you feel steady, like being around a certain chain-smoking friend or going to bars. If you associate cigarettes with alcohol, you might also want to consider cutting back for a while. And so much of navigating quitting smoking is psychological. Some smokers are going to have to reckon with the fact that being a smoker has become a big part of their identity. Here's Rinat Greenberg (ph) from Los Angeles.
RINAT GREENBERG: I was one of those people who loved smoking. I loved everything about it. I loved the ritual. I had a very cool lighter with my name engraved in it. I was always that person who'd whip out the lighter and light other people's cigarettes. I loved everything about it.
KENNEDY: It can take time and work to shift your self-image from smoker to nonsmoker.
TEDESCHI: That is, smoking is not an option in any situation. So if things are too stressful, I think I had a really good meal or I'm feeling really bored, a nonsmoker doesn't even consider a cigarette as an option. It's just not a choice.
KENNEDY: And someone who still thinks of themself as a smoker might be leaving the door open a little, he says, which could increase the chances of a relapse. One way to make this shift is to remind yourself that you've probably changed your self-identity before. Tedeschi says it might be helpful to think about other times in your life that you've made a big transition, like going to college or starting a new job or becoming a parent.
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KENNEDY: Or maybe take it in a totally different direction. What if you changed your self-image from smoker to painter or soccer player? That's our fourth takeaway; embracing other things in your life could help you quit. Becoming a master basket weaver probably won't single-handedly make you want to stop lighting up.
This is a newish idea, but there's some evidence that new and exciting life events are linked to dropping the habit for good. Psychologist Mona Xu from Idaho State University studies the link between quitting smoking and engaging in things that are novel, exciting or challenging. She calls these self-expanding events.
MONA XU: It's anything that makes you feel like your self-concept is changing and growing. So who you are as a person is expanding to include a new identity, a new skill, new knowledge, new perspective. And so it is individual for every person.
KENNEDY: Xu and her colleagues did a study of current and former smokers. They asked the former smokers to list the self-expanding events they experienced in the two months before they quit. For the current smokers, they asked them to list those events in the lead-up to their most successful quit attempt.
XU: And what we found was that compared to people who are current smokers - so people who returned to smoking - former smokers just had more of these self-expanding events going on in their life in that lead-up time.
KENNEDY: The people who quit had about doubled the number of these new and novel experiences than the ones who went back to smoking. We're not necessarily talking about super adrenaline-pumping activities like skydiving. It could be getting a promotion or even making a new friend. It could be picking up a new hobby, like running, that becomes a big part of your identity. That's what happened to Walter Ostrander (ph) from Wisconsin.
WALTER OSTRANDER: As I started making sacrifices to get faster, such as eating healthier, sleeping longer and taking on harder workouts, it dawned on me one day that by eliminating smoking, I'd likely see even more improvement. Eventually, enough time went by where the thought of inhaling tobacco smoke just seemed gross.
KENNEDY: And it could even be a change of scenery. We heard from listeners who were finally able to quit after they moved or changed jobs. Xu's research looks at how both addictive behaviors and these new and novel events show up in our reward system in the brain. This is linked back to why smoking is addictive.
XU: And it's a particularly powerful system because it not only is implicated in feeling good about things, but also wanting things and being motivated to do things.
KENNEDY: Do things like light up a cigarette.
XU: And so if we are able to find other things that also activate those areas, maybe there can be a bit of a substitution.
KENNEDY: By the way, these are also the areas of the brain that are especially active in studies of people who are intensely and passionately in love.
XU: You know, we don't want to one-on-one say love is a drug, but in terms of how the brain is responding, there are similarities.
KENNEDY: So what does this mean? Xu says it doesn't necessarily mean you should try to pick up a new hobby to quit or try to fall in love, but it might provide a hint about when to try a quit attempt.
XU: What some of this research suggests is that when you have other forms of reward and motivation, when you have things that are interesting to you happening in your life besides smoking, that might be a good time to think about quitting.
KENNEDY: And while timing it to an exciting, active time could help, we should say that there isn't a bad time to think about stopping smoking. In fact, experts told us about recent research focused on smokers who said they weren't ready to quit. The researchers asked these smokers to use some of the quit-smoking medications anyway. And they found that this actually worked to increase the odds that the smoker who wasn't ready to quit would make a quit attempt in the future. So even if you're not prepared to set a quit date, there are things you can do to move yourself in that direction, like smoking one less cigarette than you did yesterday. Maybe just see how it feels.
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KENNEDY: And once you do quit, there are a lot of former smokers out there who want to tell you about how much better you'll feel and how much better life is. Remember Rinat Greenberg, who had a really cool lighter and loved being a smoker? Here's how she felt after she quit.
GREENBERG: I am so immensely proud of myself. And it actually made me realize that I was so much stronger than I ever gave myself credit for. And it actually inspired me to tackle other big challenges like that, because I thought, you know what? If I can quit cigarettes, I can do almost anything - within reason.
KENNEDY: We also heard from Jodi Wilkie (ph) from Georgia. And just listen to how happy she is.
JODI WILKIE: You'll feel so much better. You'll have pinker skin. Your eyesight will improve. Your lungs will clear. Food tastes amazing. And that's a lot less money to spend. I have never regretted it in any way, shape or form.
KENNEDY: Hatsukami says the sooner you quit, the more health benefits you'll see.
HATSUKAMI: But the other thing for smokers to remember is even if they quit when they're older - 70, you know, 80 - it still has beneficial effects. And so quitting at any stage of life is important.
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KENNEDY: Let's recap. Remember, quitting is a process, and any amount of time without a cigarette is a win. First, you should make a plan and know when you want to start it. Second, don't hesitate to get help. This is hard. And medication and counseling can help. Ideally, do both. Third, there are strategies that you can use to combat the parts of smoking that are part of your routine, social life and self-image. And finally, embracing other things in your life could help you quit.
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KENNEDY: For more NPR LIFE KIT, check out our other episodes at npr.org/lifekit. We cover all sorts of topics, like how to have a meaningful experience when you travel. So make sure to subscribe and listen to LIFE KIT: All Guides. And here, as always, a completely random tip, this time from NPR's Anne Li.
ANNE LI, BYLINE: A lot of people think that every plant requires a lot of light and a lot of water. But in reality, every plant has its own care requirements. For example, a tropical plant might do well in a humid bathroom with low light because that bathroom kind of mimics a rainforest. But a desert plant would struggle, probably, in a humid, dark bathroom. My tip for you is if you're thinking about buying a specific plant, do some research and make sure that your home can provide the right environment for that plant.
KENNEDY: If you've got a good tip or want to suggest a topic, email us at email@example.com. This episode was produced by Chloee Weiner. Meghan Keane is the managing producer. Beth Donovan is the senior editor. Our digital editor is Beck Harlan, and our project coordinator is Clare Schneider. Music by Nick DePrey and Bryan Gerhart. I'm Merrit Kennedy, and thanks for listening.
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