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Excerpts from PUTTING OUT THE FLAME
SMOKERS WHO WANT TO QUIT HAVE MORE WEAPONS THAN EVER BEFORE

By Barbara Isaacs HERALD-LEADER [07/07/98]

If you're a cigarette smoker -- and about 28 percent of adult Kentuckians are -- chances are, you'd love to quit. Surveys show that about 75 percent of adult smokers want to kick the habit for good. But you've probably also heard that the odds are stacked against you: Fewer than 5 percent of smokers quit successfully in any given year. "People wish they knew how -- and they wish it wasn't so hard," said Janet Brigham, a California research psychologist who has studied tobacco use and dependence.

"Nicotine is a very strong addiction," said Veltkamp, a registered nurse and unit manager for St. Joseph Hospital's Behavioral Health Services, which helps people recover from problems including substance abuse. "We frequently hear from people who are detoxing off alcohol, cocaine and prescription drugs. They say that's a piece of cake compared to getting off nicotine." Still, for smokers who want to quit, there's an array of options to help increase the chances of becoming non-smokers. Cold turkey, once the only option, is now considered one of the least effective. "If you quit cold turkey, you have only a 4 percent chance of being a non-smoker a year later," said Craig Congleton, a licensed clinical social worker who helps lead the Cooper-Clayton smoking cessation program. Odds are better using nicotine replacement therapy -- either nicotine gum or transdermal nicotine patches. Both have been available over the counter since 1996. And a new pill, Zyban, on the market for the last year, also seems to boost success rates. Another way to give yourself an edge: Commit to quitting, and answer to someone about it. Surveys have shown that people who are accountable to someone for their progress -- whether it's in a support group, a doctor or other support person -- have better chances of kicking smoking for good.

Some people still use the cold turkey method -- abruptly quitting smoking. That's the way most people traditionally have quit smoking. Until the mid-1980s, it was practically the only way to do it. But it isn't easy -- and some experts say it's not the best approach. Studies have shown that nearly half the people who go cold turkey resume smoking within 48 hours.

For those who have tried cold turkey without success or don't want to try it, nicotine replacement is another option. "To optimize the chances of success, it's better to use a nicotine replacement -- either nicotine gum or the nicotine patch," Brigham said. "It doubles your chances of success on any individual quitting attempt." That means, instead of a 4 percent to 5 percent chance of being a non-smoker a year later, the odds are more like 10 percent with nicotine replacement.

The newest option is Zyban, generically known as bupropion, the same medication used in the anti-depressant Wellbutrin. It's available by prescription only. The drug acts in the brain, reducing the craving for cigarettes. It shouldn't be used by people with a history of seizures or who are taking Wellbutrin.

One study found that about 23 percent of people who tried Zyban were still smoke-free a year later.

"The average smoker has about 200 association bonds with smoking," Congleton said. That means that smokers relate smoking to dozens of tasks: They do it while driving, on the phone, after a meal, when they first get up in the morning. "Smoking becomes very intertwined with their lives," Brigham said. "It's not a simple thing -- even when the addiction to nicotine is broken."

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