“Psychology Works” Fact Sheet: Quitting Smoking

According to the most recent Canadian Tobacco, Alcohol and Drugs Survey, about 4.2 million people in Canada over the age of 15 smoke tobacco. This is the lowest national smoking rate ever recorded, but is still about 15% of the adult population, with provincial rates ranging from 11% in B.C. to 20% in New Brunswick. Smoking is a leading cause of illness and early death in Canada, reinforcing the need to bring this national smoking rate down even further to allow all Canadians to live longer, healthier lives.

Quitting smoking reduces your chances of developing many physical conditions (e.g., cancers, heart disease, respiratory diseases). Quitting smoking also has a lot of mental health benefits. Compared with those who continue to smoke, people who quit smoking experience the following benefits for many years after quitting: less stress and anxiety; fewer symptoms of depression; more frequent positive emotions; higher overall quality of life; and feeling healthier in general.

Why is Smoking So Addictive?

Nicotine is the major addictive chemical in cigarette smoke and acts very quickly in your body, reaching your brain in about 10-20 seconds. Within about 2 hours of finishing your cigarette, nicotine levels in your body drop by 50%. This leads to cravings, feeling anxious or irritable, and generally feeling ‘down.’

Nicotine affects a number of important chemicals in your brain and body, which can boost your mood, reduce stress, make you feel energized, and even reduce pain. However, these effects are short-lived and most common in new or occasional smokers. This is because your body adapts to these changes over time, resulting in a need to smoke more over time in order to feel any of these effects – or just feel ‘normal.’

Although nicotine is very addictive, it’s not the only reason why people have trouble quitting. For regular smokers, lighting up a cigarette is often part of a routine. Whether you smoke after dinner, on work breaks, or when socializing, smoking in response to daily triggers can make it more difficult to quit.

What Treatments Are Available?

Quitting smoking involves managing the physical symptoms and breaking the links between smoking and how you feel, what you do, with whom who you spend time, and how you see yourself. As a result, it often takes many attempts, and many treatment types, before you’re able to quit successfully.

Quitting “cold turkey” is one of the most common approaches, but it’s also one of the least effective. A number of treatments are proven to help make your quit attempt a success:

  1. Behavioural Therapy: These treatments target the beliefs, attitudes, and behaviours that support an addiction. Common therapies include cognitive behavioural therapy, acceptance and commitment therapy, and functional analytic therapy.
  2. Nicotine Replacement Therapy (NRT): NRT comes in two forms: slow release (e.g., nicotine patch) and rapid-delivery (e.g., nicotine gum, inhalers). NRTs help to reduce cravings and withdrawal symptoms by releasing small amounts of nicotine into your body, but are not addictive.
  3. Prescription Medication: In Canada, two major prescription drugs are used to help people quit smoking: varenicline and bupropion. These drugs affect nicotine receptors in your brain and help to reduce cravings and withdrawal symptoms. Varenicline also helps to make smoking less pleasurable.

Note: You should always consult a doctor for information on the risk of side-effects or interactions before using NRTs or prescription medications.

What Works?

Varenicline is the most effective on its own, but all three types of treatment work. While using at least one of these treatments can boost your odds of successfully quitting by as much as 80%, research shows that the best way to quit is by combining treatments. The two most successful combinations are:

  • Combined NRTs, which involve using a combination of a slow-release NRT (e.g., nicotine patch) and a rapid-delivery form (e.g., nicotine inhaler).
  • Combined Pharmacotherapy and Behavioural Therapy. You can boost your chances of quitting by using pharmacotherapy (i.e., NRT or prescription drugs) while getting help to quit from a licensed mental health professional (e.g., registered psychologist).

Quit-lines and online help, whether on their own or combined with other treatments, can also increase your likelihood of staying smoke-free.

What Doesn’t Work?

Aversion therapies (e.g., smoking until you feel sick), alternative tobacco products (e.g., chewing tobacco, snuff, e-cigarettes, and alternative therapies (e.g., hypnotherapy, acupuncture, and natural herbs and remedies) don’t improve your odds of quitting.

How Can I Help Myself Quit?

Whatever route you choose, keep in mind that it can be incredibly difficult to quit smoking. Even if it takes you many tries, you can eventually succeed.

Whether it’s your first attempt or your fifth, psychological research shows that there is much you can do to make your quit attempt a success:

  • Set concrete and realistic goals (e.g., set a specific ‘quit date’).
  • Start using treatments before you quit.
  • Tell your friends and family that you’re quitting and let them know how they can help.
  • Embrace change in your daily routine, social circle, and motivations.
  • Find a buddy who is also trying to quit.
  • Gradually reduce your smoking before you quit.
  • Start by reducing the amount you smoke.
  • Reward yourself, even for small gains.
  • Make a plan to deal with withdrawal symptoms (e.g., headaches, sadness, irritability, anxiety) in the first 1-4 weeks after quitting. These are signs that your body is recovering.
  • Follow the 4 Ds to help deal with cravings: Distract yourself, Drink water, take Deep breaths, and Delay smoking for as long as possible.
  • Get active.
  • Keep your focus on what you don’t enjoy about smoking rather than what you enjoy.
  • Forgive yourself if you have the occasional cigarette.
  • Keep yourself busy.
  • Understand your triggers and learn how to manage them.
  • Replace cigarettes with other things, activities, and people that you enjoy.
  • Re-identify yourself as a “non-smoker” or “former smoker” to your friends, family, co-workers, and yourself.
  • Accept that this will be difficult for a while, but the rewards will last a lifetime.

Where Can I Go For Help?

Your family doctor can help you to develop a plan for quitting, figure out which treatments might be most effective, and refer you to other health care professionals who can also help you quit smoking. Doctors can also advise you on the safety of NRTs and medications (e.g., side-effects, interactions).

Registered psychologists can help you develop a plan for quitting and provide therapy that will help you quit. Psychologists can offer a variety of effective therapies and will work with you to figure out which one is likely to work best for you. Check with your provincial or territorial psychological association at https://cpa.ca/public/whatisapsychologist/ptassociations/ to find a psychologist in your area who can help you quit smoking.

Health Canada and the Canadian Cancer Society offer a free, confidential ‘quitline’ at 1-866-366-3667. Their telephone counsellors are trained to provide support and help you create a plan for quitting.

You can also seek online help at http://breakitoff.ca/, which includes support forums, information on treatments, self-help resources, and a mobile app.

This fact sheet has been prepared for the Canadian Psychological Association by Matthew Murdoch, Canadian Psychological Association.

Date: August 2016

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