Christiane Fux studied journalism and psychology in Hamburg, Germany. Since 2001, the experienced medical editor has been writing magazine articles, news and non-fiction texts on all conceivable health topics. In addition to her work for NetDoktor, Christiane Fux is also a prose writer. In 2012, she published her first mystery novel; she also writes, designs and publishes her own mystery novels.
Quitting smoking is usually enormously difficult. The reason is that nicotine is highly addictive – both physically and psychologically. A combination of elements of behavioral therapy and medications that assist with physical withdrawal therefore promises the greatest success. Read here what strategies there are and how effective they are.
Nicotine is a powerful addictive substance. Those who stop smoking have to cope with both physical and psychological withdrawal symptoms from nicotine.
Nicotine withdrawal: course
Physical nicotine withdrawal is usually completed after 72 hours. For very heavy smokers, however, the nicotine withdrawal period can last up to 30 days. Those who know the withdrawal symptoms and arm themselves against them have significantly higher chances of becoming permanently smoke-free.
Physical withdrawal symptoms
When smoking is stopped, withdrawal symptoms occur on a physical level, such as:
- Sleep disorders
- Lack of concentration
Psychological withdrawal symptoms
The psychological dependence manifests itself in
- violent desire to smoke
- Inability to refrain from smoking in certain situations
Quitting smoking spontaneously
A large proportion of smokers try to become smoke-free spontaneously, at least at the first attempt. However, the chances of success with this abrupt method of quitting smoking are low.
Because a key difficulty in quitting smoking is "the power of habit". Means behavior patterns, special situations, stress compensation or group dynamics that one associates with smoking. This makes quitting particularly difficult. For critical situations I should quit smoking ideally already before the smoking stop – or at least parallel to it – a whole arsenal of counter-strategies and alternative behaviors to work out.
Evaluation: The resolution "Quit smoking – immediately!"Only one to five percent of smokers achieve long-term abstinence. If the decision is based on medical advice, smoking cessation is successful in as many as five percent of smokers – they can remain non-smokers without much preparation and therapy.
Smoking cessation with behavioral therapy
Behavioral therapies are the most comprehensive and effective methods for smoking cessation. They are usually carried out in groups, but sometimes also individually. Basically, this therapy for smoking cessation is divided into three phases:
Here, one’s own smoking behavior in everyday life is put under the microscope. Many moments are automated (z.B. the cigarette with the morning coffee or at the end of the day) and have an uncontrollable effect on the individual. Those who are prepared for difficult situations can cope with them more easily in the acute withdrawal phase and are also more secure in relapse-critical life situations.
Self-observation and thus the acquisition of knowledge about one’s own behavioral patterns are therefore the be-all and end-all before the start.
Some try to quit smoking immediately (point-close method), others gradually limit cigarette consumption. Those who prefer the latter method definitely need partial goals and rules for self-control. The point-close method is simpler.
Parallel to cessation, counter strategies are very important. What alternative behavior is possible? How to cope with stressful situations differently? What other ritual can be used to replace the morning cigarette??
Reward for quitting smoking
Equally important is the reward for quitting smoking. Also the circle of friends and the working environment should be initiated, so that nobody offers a cigarette any more. Sometimes it also helps to make a bet: "I will persevere".
Stabilization and relapse prevention
But those who have made it this far are far from cured. Relapses are possible at any time. Therefore, stabilization of cessation success and relapse prophylaxis are urgently needed.
Every ex-smoker must be on guard against critical situations (e.g., when the smoker is in a bad mood).B. pub night with friends). Therapists therefore train participants specifically to cope with critical situations. In group therapies, this is often done in the form of role plays.
Assessment: Smoking cessation by means of behavioral therapy is significantly more effective than quitting on your own. Combined with nicotine replacement therapy, the chances of success increase even further – especially for highly dependent smokers.
There are also self-help books that follow behavioral therapy methods. They can be helpful as a supportive measure. Modern mobile variants to support smoking cessation are apps for the smartphone.
However, behavioral therapy smoking cessation programs under individual professional guidance offer greater chances of quitting smoking. Books and apps can supplement this.
Nicotine replacement therapy
The principle of nicotine replacement therapy is to give the body the dose it needs – nicotine. This alleviates withdrawal symptoms and the desire to smoke – the cessation process is facilitated.
There are nicotine gums, patches, inhalers and nasal sprays. With chewing gum, inhalers and sprays, nicotine can be supplied quickly when the desire to smoke overcomes you. The substance is continuously supplied via the patch. This means that the absorption of the active ingredient (in contrast to chewing gum, inhalers and nasal spray) is decoupled from the previous addictive behavior.
Assessment: The effectiveness of nicotine replacement therapy (NET) has been confirmed in numerous clinical studies. According to this, nicotine patches& Co. roughly doubles the chances of successful tobacco cessation. Nicotine replacement therapy in combination with behavioral therapy is especially promising.
Smoking cessation without nicotine replacement – this is what the active ingredients amfebutamone (bupropion) and nortriptyline promise. They have long been used as antidepressants. At some point it was discovered that these substances in low doses also help smokers to quit. And this is how to proceed:
In the first days of therapy, when the smoker is already receiving the anti-smoking medication, he may continue to smoke. Weaning begins after six to nine days, when the drug’s active ingredient level in the blood is high enough.
Another anti-smoking tablet contains the active ingredient varenicline. It docks in the brain at the sites to which nicotine also binds. This is to curb the craving for a cigarette
Evaluation: The Tobacco Cessation Guideline estimates that the effectiveness of bupropion is similar to that of nicotine substitutes. However, because of frequent and also severe side effects, bupropion is considered a second-choice withdrawal drug – just like clonidine, which was originally used to treat high blood pressure.
Compared to placebos, varenicline tripled smoking cessation rates; compared to bupropion, it is expected to double smoking cessation success rates. However, side effects such as headaches, fatigue, nausea and indigestion are possible.
Quitting smoking – alternative methods
Many people also rely on alternative methods to stop smoking, the effectiveness of which is usually not proven. For those who believe in it, at least the placebo effect may well help under certain circumstances.
Quitting smoking with acupuncture
Acupuncture against smoking is widely used by people who want to stop smoking. However, the mechanisms of action of this method have not yet been clarified.
As a rule, acupuncturists insert three needles into the addiction points of the ear, where they remain for several days. This is supposed to curb addictive cravings. On average, it takes five acupuncture sessions before an effect is seen. But there are also people for whom acupuncture does not help.
Evaluation: Different acupuncture techniques do not differ in terms of effectiveness, according to the tobacco cessation guideline. No acupuncture procedure has yet been shown to be more effective than placebos.
Injection against smoking
A so-called non-smoking injection is also frequently advertised. This involves injecting a mixture of different substances into the muscles or even into acupuncture points in the ear. There are different mixtures for it, whose exact compositions remain under lock and key. They are supposed to contain, among other things, vitamins, trace elements, homeopathic remedies, and sometimes nicotine.
Evaluation: There is no proof of effectiveness. The fact that it is not disclosed which substances are contained in a non-smoking injection is a strong factor of uncertainty. An assessment of effect and side effects is not possible.
Quitting smoking with hypnosis
Quitting smoking should become easier with hypnosis. The therapist puts the future non-smoker under hypnosis and then acts on his subconscious: smoking is perceived as an unpleasant experience à la "ashes in my mouth" experienced. These negative messages are contrasted with positive ones that represent the new non-smoking life. There are also therapists who only work with positive messages with hypnosis patients.
EvaluationFor the most significant form of all suggestive methods, the same applies as for acupuncture. A long-term efficiency, that one can stop smoking more easily, could not be proven so far. The disadvantage of both methods: They do not give the smoker any tools to cope with crises and temptation situations on his own.
Autogenic training, progressive muscle relaxation according to Jacobson and breathing exercises are useful as building blocks of a combined smoking cessation program. However, taken on their own, they are usually not sufficient to really become a non-smoker.
Stop smoking help from the healer?
Other methods such as laying on of hands, the use of natural products and the like are to be regarded rather critically. Often, only the suggestive influence of the therapist comes into play.
It is true that the therapist can achieve high success rates in the short term through skilful psychological support. Many smokers, however, soon relapse after such injections because they have not learned to deal with situations that tempt them to smoke, and to cope with stress, boredom and nervousness even without cigarettes.
Smoking cessation for risk groups
Certain risk groups are even more endangered by daily smoking than others. These include patients with vascular disease, smokers with particularly severe physical dependence, or pregnant women. For these groups, successful smoking cessation is particularly important.
Special features for women
In women, there are three main risk groups from smoking:
Women who are pregnant. Recent studies show: Only about 50 percent of all pregnant women succeed in giving up smoking during pregnancy. Around 25 percent at least reduce their cigarette consumption, and a good quarter of women continue to smoke unchanged.
Women with an unfulfilled desire to have children on the other hand, should at least rule out smoking as a possible cause of reduced receptivity.
Women taking the pill, thus increase the risk of thrombosis.
The women of all three groups are strongly recommended to give up smoking. Scientists have designed special treatment programs for women who belong to one of the risk groups. In these programs, the usual standard behavioral treatment is enriched with additional information, motivational aids, greater consideration of social supports, information on diet and exercise balance, and components to stabilize abstinence.
As a study by the University of Tubingen shows, more intensive care can significantly increase the success rate. Women with the above-mentioned special factors benefit most from individual treatment. With a specific program for pregnant smokers, a long-term chance of success is 20 to 30 percent.
If a pregnant, motivated smoker is still unable to quit completely, a nicotine replacement product should be considered. In any case, they should consult their physician. Bupropion and other antidepressants are not suitable for smoking cessation during pregnancy.
Heavily dependent smokers
Heavily dependent smokers benefit less from exclusively psychotherapeutic approaches to smoking cessation. They are generally more physically dependent and therefore need larger amounts of nicotine replacement products. This makes it easier for them to kick the habit. The effectiveness of nicotine replacement therapy has been proven in many studies.
In a study at the University of Tubingen, highly dependent smokers received nicotine replacement therapy using nicotine patches as part of a six-week behavioral therapy treatment program. In addition, they should still use a nicotine nasal spray, as needed. 60 smokers took part in the study. After half a year, 48 percent of the participants were still abstinent. Thus, giving greater consideration to nicotine dependence may lead to significantly higher medium-term abstinence rates.
For heavy smokers, long-term, sustained or combination nicotine replacement therapy (nicotine patch combined with nicotine gum or nasal spray) is warranted to prevent relapse.
The tobacco cessation guideline estimates the effectiveness of bupropion to be similar to that of nicotine replacement products. Because of frequent side effects, bupropion is considered a second-choice cessation drug. The same applies to clonidine, which was originally used for high blood pressure.
Compared to placebo, varenicline tripled cessation rates; compared to bupropion, initial study results suggest success rates doubled. Studies to date suggest that effective drug support with few side effects is possible*.
Smokers with cardiovascular diseases
Despite the proven link between cigarette smoking and atherosclerosis and heart attack, not all heart attack patients succeed in quitting smoking after the life-threatening event.
The most important element of smoking cessation after a heart attack is an adequate supply of background information and behavioral therapy. Nicotine replacement is only recommended if there has been no cardiovascular event (such as heart attack, stroke, acute heart attack or arterial occlusion) in the four weeks prior to starting with nicotine patches, sprays or gum. Because of possible side effects, a close medical examination and controls are necessary during a withdrawal treatment with bupropion.
Stop smoking – tips
Motivation, small rewards, relaxing: The following non-smoking tips will help you keep the craving for cigarettes at bay. Click through the image gallery: