About 40% of America's 50 million smokers will try to kick the habit at least once this year, according to the federal Centers for Disease Control and Prevention. On each attempt, fewer than one in 10 will succeed. As discouraging as those numbers may seem, nicotine addiction researchers offer the offsetting news that those very failures pave the road for breaking dependence on tobacco--something that about half of smokers ultimately achieve, according to federal treatment guidelines.
"Most people have to try to quit probably five to seven times before they succeed," said John Hughes, professor of psychiatry at the University of Vermont. "It's just like swimming--it's important to keep jumping in the water to learn."
And as experts like to note, there has never been a better time to quit--or so many different scientifically validated options to help smokers reduce the pangs of nicotine withdrawal and the craving for cigarettes, both of which make quitting smoking harder than making most other behavioral changes.
Ten years ago, "all we had to offer was going cold turkey or nicotine gum," says Michael C. Fiore, chairman of a federal panel that issued treatment guidelines two years ago calling for nearly every smoker who wanted to quit to use medications to support their efforts. Today, there are seven drug-treatment choices, as well as many organized smoking-cessation programs and individual counseling services that also boost chances that smokers will manage to quit.
Four safe and proven nicotine replacement methods--gum, a patch that delivers nicotine through the skin, an inhaler that mimics the effect of smoking and a spray that provides a quick burst of nicotine to nasal passages--can deliver gradually declining doses to take the edge off cravings and withdrawal. They have only minimal side effects, a very low risk of addiction and are free of the nearly 4,000 harmful substances that cigarette smoke delivers.
The treatments don't end there. An antidepressant medication--bupropion, marketed for depression under the brand name Wellbutrin and for smoking cessation as Zyban-- can also help break cigarette addiction, though the scientific process by which this occurs is still not understood. There have been many reports of serious adverse effects, including some deaths, from Zyban in Europe. For now, "it's unclear if the events are related to the medication," says Hughes.
Two other options for especially difficult cases of smoking addiction are the blood pressure medication clonidine and the antidepressant nortriptyline. While the evidence of their value is not as extensive as that for nicotine replacement drugs, a government panel advised recently that these medications be tried if other drugs have failed. (Neither, however, is approved for this use by the Food and Drug Administration.)
"The good news for smokers," Fiore says, "is that people now have a choice. There's never been a better time to quit."
Trouble is, a lot of smokers do it the wrong way and increase their odds of failure. Since smoking is often viewed as a weakness or character flaw, many smokers tend to tough it out and go cold turkey.
Or they mistakenly use minimal amounts of the nicotine replacement drugs and other medications that are proven scientifically to help assuage the strong physiological symptoms of withdrawal.
"That is why there is such a high relapse rate," explains David Sachs, clinical associate professor of pulmonary and critical-care medicine at Stanford University School of Medicine. "It's like killing all four engines on a Boeing 747 where you're 2,000 feet above the runway. You crash and burn and then people start beating up on themselves. They say, 'I am a failure,' when they are really dealing with something that has a striking rationale as far as pharmacology and physiology are concerned."
"Well, I am back again. They say that the third time's a charm. Hope they are right. This is the third time this year that I am quitting. The last time I went back to smoking, I got so depressed that I didn't want to talk to anyone for a long time. Can't say I will make it, can't say I won't. I'm just going to take this one minute, hour and day at a time."
--Quitnet.com posting from a smoker planning to give up cigarettes on Feb. 13
No one suggests that quitting is easy, even with nicotine replacement medications. Adult smokers go through an average of a pack of cigarettes each day. At 20 cigarettes per pack and 10 puffs per cigarette, that's 200 nicotine hits a day right to the brain, making smoking "one of the world's most intense habits," says Hughes.