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Smokers looking to quit have options

The “best” way to quit smoking depends on the smoker, Tom Klingemann says.

“If I had 1,000 ex-smokers and I had to go ask them all what's the best way to quit smoking,” he said, “I'd get 500 different answers.”

Klingemann is a pharmacist and former smoker who runs the smoking-cessation program at the Nebraska Medical Center. He doesn't recommend quitting cold turkey, the way he did. He said he didn't have other options: He couldn't afford nicotine gum or patches at the time.

Smokers today have a number of options for assistance if they're looking to quit. And depending on the method and their insurance policy, the assistance can be fully paid for.

Quitting smoking also will save them money on their health insurance rates, as insurers soon will be allowed to charge smokers a surcharge of up to 50 percent more than what they charge nonsmokers.

Klingemann splits up the cigarette addiction into the physical and the psychological aspects. “We have medications that help with nicotine,” he said. “But there isn't a medicine that helps with the behavioral part.”

He has smokers keep a diary of their cigarette use for three or four days, noting the time they smoked, where they smoked, why they think they picked up a cigarette and what they were doing at the time. If they write all that on separate pieces of paper and review the days' results side by side, he said, patterns will become clear. The smokers then can work to alter their habits.

Laura Krajicek, who leads smoking-cessation classes at Methodist Hospital's Estabrook Cancer Center, said breaking a smoking addiction requires lifestyle changes.

Smokers, she said, “plan their daily activities around smoking. Some of those activities have to be changed or dropped until they're over the hump of quitting smoking.”

Many smokers smoke to help relieve stress, she said: “Frustration, anger, any kind of emotional stressor. What we try to tell them is, unfortunately, we're all going to have stress in our life. We have to learn how to deal with that. There are other ways besides smoking.”

Class participants are taught proper breathing techniques and given a relaxation CD and a fake cigarette that Krajicek said helps them “with the hand-and-mouth thing” smokers deal with.

Holding a cigarette in her mouth or her hand wasn't what Mary Ellen Hughes missed after she quit in February 2012. She simply craved a cigarette.

“I still get those cravings,” said Hughes, an Omahan who smoked a pack of Tareytons every day for 40 years. “It's not been an easy road, let me tell you, for the last year and a half. But I have heart disease. So I know that if I would continue to smoke or if I would start again, I might as well just go pick out my coffin. I finally realized that. And I have two wonderful grandchildren now that I don't want to leave.”

What helped her quit after half a dozen previous attempts failed, Hughes said, was simply talking with Krajicek. “Telling her what my frustrations were. She was a previous smoker, so she understood.”

Hughes said she also used nicotine patches to help her quit.

Assistance with the physical addictions can make a big difference for some people, said Lisa Fuchs, a tobacco treatment specialist with Alegent Creighton Health.

“The nicotine patch gives the most consistent release of nicotine over a 24-hour period,” she said. And Chantix, a prescription medication that targets nicotine receptors in the brain and blocks nicotine from reaching them, “has worked really, really well for people who have no underlying depression issues,” she said.

Klingemann also speaks highly of that drug's effects. “People aren't getting any more pleasure from their cigarettes. They start telling me it starts to taste gross.”

But medications don't work for everybody, said Jeff Soukup, program manager for Tobacco Free Nebraska, the state's smoking-cessation program. And different people, he said, need to focus on different aspects of their addiction. “The body's craving for (nicotine) goes away after a certain point,” he said. “Most of those withdrawal symptoms are gone in less than a week. It's that psychological addiction that continues on.”

Fuchs said she tailors the treatment approach to the person but notes it's a tough addiction to beat: “It takes an average of five to seven times for someone to finally quit.”

Smoking-cessation treatments
Self-Help
Quit rate: 9% to 12%
Counseling
Quit rate: 13% to 17%
Bupropion SR (Zyban)
Quit rate: 24%
Nicotine replacement therapy
Quit rate: 19% to 26%
Varenicline (Chantix)
Quit rate: 33%
Medication combinations
Quit rate: 26% to 36%
Counseling and medication combinations
Quit rate: 26% to 32%
Source: Smoking Cessation Leadership Center




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