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Puff, Puff, Poof!

Quitting smoking is easier said than done, but it’s an essential key to good health. Here’s a look at the latest technology and techniques aimed to help puffers curb the nicotine habit

The addictive power of nicotine can have such a grip on smokers, it takes an average of 14 attempts to quit for good.

Smokers serious about stopping have a better chance at success when combining the patch, which provides a small but steady dose of nicotine, with immediate-delivery nicotine lozenges or gum to fight urges after eating or in social settings, according to smoker cessation experts.

While researchers continue to test various treatment methods for kicking the habit, the biggest breakthrough in recent years has come in the way of studies supporting two types of nicotine replacement are better than one.

“There’s not much new with medicine, but using two forms of nicotine replacement – like the patch and gum – is most effective,” said Dr. Daniel Seidman, a member of the Columbia University Behavioral Medicine Faculty and author of “Smoke-Free in 30 Days” and contributing author of “Helping the Hard-Core Smoker: A Clinician’s Guide.”

Nicotine replacement therapies like the patch work by giving smokers a small amount of nicotine, but without the dangerous effects of inhaling tobacco smoke. The nicotine lozenge comes in the form of a small, candy-like tablet that dissolves over the course of 20 to 30 minutes and delivers nicotine to the bloodstream, relieving short-term cravings to smoke.

Proven medications such as the antidepressant bupropion and varenicline work for many, but in slightly different ways. Numerous studies show that bupropion substantially reduces the severity of nicotine cravings and withdrawal symptoms.

Varenicline has fairly high cessation rates. It binds at nicotine receptor sites in the brain, reducing cravings for cigarettes and making people less likely to smoke, says Paul Cinciripini, cancer prevention expert at the MD Anderson Cancer Center and director of its Tobacco Treatment Program.

The University of Texas MD Anderson Cancer Center is home to one of the largest tobacco research programs in the nation, and Cinciripini also encourages people to consider participating in tobacco research studies and clinical trials if available in their area.

Cinciripini says people should be leery of unregulated products and claims on the internet, including nicotine water, herbal supplements, home remedies, eye movement desensitization and reprocessing (EMDR) and hypnosis. On the other hand, he says, studies support mindfulness meditation can help when combined with medication.

The experts agree a good smoking cessation treatment plan includes medication and behavioral and psychological therapy, including support groups, cessation classes or specific behavioral change techniques.

Another newer treatment option, the prescription nicotine inhaler, delivers nicotine vapor to the mouth and upper airways, but not as much of it reaches the lungs. Other methods that deliver medicine to the lungs – metered dose sprays, dry powder inhalers or nebulizers that create a fine mist – do not replicate the natural inhalation used by smokers when drawing on a cigarette.

The good news is current pharmacological methods approved by the Food and Drug Administration have been successful for many, Seidman says.

“A lot of people who could quit easily, have quit,” he says. “It used to be about half the population smoked. Now, it’s about 19 percent and half of those people have other problems that make it difficult [to quit].”

Seidman’s research interests include developing innovative approaches to assist underserved and highly addicted smokers. He says rates of smoking among depressed people are twice as high and they have a much harder time quitting.

Seidman believes social media and new smartphone applications could help provide support and encouragement to smokers throughout the day.

“You can download it and work on it on your phone to help with the behavior of smoking,” he says. “With something like the patch, you’re not really dealing with the person’s overall adjustment or emotional dependency on smoking.”

Seidman, also a practicing psychotherapist and clinical professor at Columbia, says it is important to set a specific date to quit and prepare for it – from how to handle being around other smokers to dealing with stressful situations and triggers.

Cinciripini reminds smokers who want to quit not to beat themselves up over a failed attempt or to get discouraged. Rather, they should try to learn from it – what worked and what didn’t – and take time to learn about themselves. He also says there is no set time to win the battle over cigarettes.

Long-term cessation requires dedication and a plan, rather than relying on willpower alone, because nicotine is a psychoactive drug and quitting is about a permanent lifestyle change.

“If someone is serious about quitting, always start with a patch and use lozenges to manage breakthrough cravings,” Cinciripini says. “All the data shows that is takes multiple times for people to quit. It’s not about the next magic pill; it’s about what you need to do to maintain your motivation.”

Neither Seidman or Cinciripini recommend the e-cigarette as a way to give up smoking. Both say more research is needed to understand the potential role of e-cigarettes in smoking cessation. They actually could be a hook for future smokers or keep smokers puffing.

“It’s all about intention,” Cinciripini says. “Nicotine replacement products are marketed with the intention to get people to quit. It’s a very different story with the e-cigarette.”

A product of Big Tobacco companies, e-cigarettes are battery-powered devices that provide inhaled doses of nicotine vapors and flavorings. Their ingredients are not regulated or approved by the FDA.

“Most people who use the e-cigarettes continue to use cigarettes,” Seidman says. “They’re very addictive because they are very pulmonary. They’re not in the business of getting people to quit, but help them deal with the times they can’t smoke.”

Does quitting smoking seem daunting or overwhelming? Not sure where to start?

Smokers have more options than ever to help them free themselves of cigarettes, including a federally funded website and hotline that provides telephone access to a specially trained counselor. Smokers can explore ways to quit, find tips to prepare to quit and receive ongoing help through the process.

The hotline – 1-800-QUIT NOW (784-8669) – connects smokers who want to quit to their own state’s smoking-cessation program and local resources. The website, smokefree.gov/talk-to-an-expert, also offers instant messaging support from a National Cancer Institute smoking cessation counselor via LiveHelp 8 a.m.-11 p.m. weekdays.

Also available through the site, SmokefreeTXT is a mobile text messaging service designed for adults and young adults across the United States who are trying to quit smoking. The program was created to provide 24/7 encouragement, advice, and tips to help smokers quit and stay smoke free.

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