The Doctor is In

Q. I want to quit smoking once and for all in 2014. I’ve tried going cold turkey several times, and the nicotine patch didn’t work. What can I do to stop? 

Dr. Raskin: I am so glad you asked about stopping smoking as it is the number-one cause of preventable death in the United States. You are not alone in trying to quit and failing.

Nicotine is one of the most addictive substances known to man (even more addictive than heroin and cocaine!), and most successful quitters tried numerous times before they actually quit for good. Mark Twain said, “Quitting smoking is easy. I’ve done it a thousand times!”

The most important thing is to mentally come to the conclusion that it really is time to quit. I am sure I don’t have to get into the grisly details of all of the medical complications of cigarette smoking that can happen, but as a physician, I always try to scare patients a little bit without turning them off too much.

I have found that with younger people, talking about lung cancer and emphysema have little impact, whereas the cost of cigarettes, bad breath and erectile dysfunction can be better motivators to quit.

The next step is setting a quit date so you can really have a little time to mentally prepare, and then making a plan as to how you are going to quit. I encourage all my smoking patients to discuss and formulate the plan with me together to customize what might work best for the individual.

What about “cold turkey” i.e. just quitting? Studies show that only 4-7 percent of people are able to quit smoking on any given attempt without medicine or other help. So, it is obviously better to make a plan!

Here are the options as I see them. Some of them can be mixed and matched together for even better success.

First, there is a big mental component to the addiction, and getting as much support in quitting is very helpful. This could mean leaning on friends or family members or getting more formal support from smoking cessation counselors in person, on the phone or on-line. Being able to discuss cravings and learning tips from ex-smokers who have succeeded can be extremely helpful. These tips offer behavioral changes you can make, such as learning how to disconnect common smoking links with food, drinking alcohol, and sex.

Then, there are the nicotine replacement products that can help relieve the physical withdrawal symptoms from stopping smoking. These include over-the-counter options like patches, gum and lozenges as well as prescription nicotine nasal spray and inhalers. These have varying degrees of success, but all work much better when combined with a behavioral support program.

For those patients who want the convenience of a once daily product, the patch may be best. However, people who miss the act of putting something in their mouth throughout the day may do better with the nicotine inhaler.

Also, there are two FDA approved medications that can help with quitting smoking. Bupropion (Zyban) and varenicline (Chantix) can work very well by working in the brain to help with cravings. Chantix, which interferes with the nicotine receptor in the brain, has some scientific evidence showing that it helps more people succeed with smoking cessation than other available treatments.

I have had a lot of success with these products with my patients. Be aware however that these prescription products may not be right for everyone and both of them have potential side effects. On the Internet, you may come across rumors and anecdotal stories about the side effects of these medications, but I urge you not to rely on the Internet for all of your medical information. I encourage you to speak with your doctor about the pros and cons of these medications.

Finally, there are some alternative therapies that aren’t backed by a lot of scientific data, but which can still help some people. These include hypnosis, acupuncture and laser treatments. It is hard for me to endorse any of these methods without hard evidence that they work.

The other big rage these days is the “electronic cigarette,” which comes in many flavors. The jury is still out whether this can help people stop smoking, and it is still too early to know if the other ingredients in the e-cigarette are actually safe. For now, I still encourage my patients to try one of the other options with good science behind it.

I wish you all the success in this effort this year, and let’s make it a healthy 2014!

Dr. Damon Raskin is a board-certified internist who offers preventative medicine, concierge services and addiction medicine to patients in and around the Palisades. Contact: (310) 459-4333. To submit your medical questions, like or follow us on Facebook.com/PalisadianPost or Twitter.com/PalisadianPost or email editor@palipost.com with “The Doctor Is In” in the subject line.