4 ways to quit smoking

From Harvard Medical School Overcoming Addiction: Paths toward recovery The hallmarks of addiction are the “3 C’s”: Craving for the object of addiction, which can be mild to intense, loss of control over the use of the object of addiction, and continued engagement with the object of addiction despite adverse consequences. This report describes a number of effective treatments for addiction, including self-help strategies, psychotherapy, medications, and rehabilitation programs. It also includes targeted advice on specific types of addiction, as well as information about coping with a loved one’s addiction. [READ MORE]

4 ways to quit smoking
If you smoke, you probably are quite aware that smoking is bad for your health — very bad, in fact. If you’ve been thinking about quitting, there is good news. There are more ways to kick the habit than ever before. Why bother? Even if you’ve smoked for years, you’ll greatly improve your health. Within days, your blood vessels will regain much of the normal function that is damaged by smoking. Within weeks, you’ll be able to taste food better, and your sense of smell will recover from tobacco’s assault. Within months, symptoms of chronic bronchitis ease up, and lung function improves within a year. Quitting reduces the risk of heart attack and stroke within two to five years. And the risk of lung cancer begins to drop substantially within five to nine years of quitting. How to quit There are four basic strategies for quitting. Most smokers start by trying to quit on their own, but many end up needing several methods and making several attempts before they kick the habit. Strategy 1: Do it yourself Cutting back slowly rarely works; nearly everyone who tries slides back up to their usual dose of nicotine. Cold turkey is the way to go, but it takes preparation. And even without professional help, cooperation from family and friends can be important. Here are some tips: Pick a quitting date and stick to it. In choosing a date, steer clear of stressful periods, and avoid holidays if you are likely to be invited to smoke-filled parties. Try to get other smokers in your household or circle of friends to join you in quitting—the mutual support can help you succeed. As your quit date approaches, throw out your ashtrays, clean your house, car, and clothes, and have your teeth cleaned. Once you’re away from it, you’ll see that smoking stinks. Anticipate withdrawal symptoms such as grumpiness, restlessness, irritability, hunger, headache, anxiety, and drowsiness or insomnia. The discomfort usually peaks one to three weeks after you quit, and then it gradually diminishes. To get through the rough patches, stock up on low-calorie snacks and sugarless gum or candy to keep your mouth busy. Plan enjoyable diversions to keep your mind busy. Think of ways to keep your hands busy. Begin an exercise program. It will relieve tension, promote good sleep, and help control weight gain. Walking for 30 minutes a day can really help. Stay away from secondhand smoke. Don’t even think about smoking “just one” — even a single puff will set you back. Think positively — you can quit. Take it one day at a time. And if you slip, try, try again — either on your own or with one or more of the other strategies for quitting. Strategy 2: Behavioral support Quitting may be hard, but it doesn’t have to be lonely. Many employers, health plans, and hospitals offer individual or group counseling. Your doctor or your local chapter of the American Lung Association or American Cancer Society can refer you to a program in your area. Telephone support can also help; you can try it for yourself by calling the National Smoking Cessation Hotline at 800-QUIT-NOW. Hypnosis is another alternative that has helped some smokers break free. Strategy 3: Nicotine-replacemen t therapy Nicotine replacement is safe. You’ll get less nicotine than from cigarettes, and you won’t get any of the tar, carbon monoxide, and other damaging substances in tobacco. Plan to start nicotine-replacemen t therapy—nicotine patches, gum, lozenges, inhalers, or nasal sprays—on the day you quit smoking. If you are a heavy smoker, you’ll need higher doses. Estimate how much nicotine you need based on an average of 1 to 2 milligrams (mg) of nicotine per cigarette. Start with the full dose, then gradually taper down over several months. Under-dosing is more common than overdosing, but you should not smoke while using nicotine-replacemen t therapy. Strategy 4: Prescription drugs Bupropion (Wellbutrin, Zyban) was initially approved to treat depression and was then approved for smoking cessation. It does not contain nicotine and can be used in combination with nicotine-replacemen t therapy. Typically, quitters start taking bupropion one to two weeks before their quit date. The usual dose is 150 mg once a day for the first three days, then 150 mg twice a day for 8 to 12 weeks, or longer if needed. Bupropion can reduce weight gain after quitting. Possible side effects may include dry mouth and insomnia; seizures are very rare. Varenicline (Chantix) is the newest drug approved for smoking cessation; although experience is still limited, it also promises to be the most effective. It blocks nicotine receptors in the brain while also partially stimulating these receptors to reduce nicotine withdrawal symptoms. The usual dose is 0.5 mg once a day for the first three days, then 0.5 mg twice a day for four days, followed by the full dose of 1 mg twice a day for 12 weeks or longer. The dose should be lowered in patients with severe kidney disease. Nausea is common, and bad dreams may occur. Mood disturbances and behavioral problems have developed, particularly in smokers with psychiatric problems, but it’s not clear that these are caused by the medication. Reports of accidents and visual abnormalities are also being investigated by the FDA. More research is needed. For more information on treating addiction, order our Special Health Report, Overcoming Addiction: Paths toward recovery at www.health.harvard. edu/ADD.

Notable from Harvard Medical School
** Overcoming Addiction: Paths toward recovery
The hallmarks of addiction are the “3 C’s”: Craving for the object of addiction, which can be mild to intense, loss of control over the use of the object of addiction, and continued engagement with the object of addiction despite adverse consequences. This report describes a number of effective treatments for addiction, including self-help strategies, psychotherapy, medications, and rehabilitation programs. It also includes targeted advice on specific types of addiction, as well as information about coping with a loved one’s addiction.
[CLICK TO READ MORE or BUY]
** Viruses and Infectious Diseases: Protecting yourself from the invisible enemy
Have you ever wondered whether you are truly protected from infectious diseases ranging from the common cold to more deadly threats like rabies or bird flu? When you travel, are you protected from the many infections abroad, from malaria to yellow fever? Are you up-to-date on the new adult vaccines and do you know what to do should a bioterrorist try to spread deadly smallpox or anthrax? This report describes the most up-to-date information on infectious disease and how to protect yourself from everything from stomach flu to HIV/AIDS.
[CLICK TO READ MORE or BUY]

What to do about a “superbug”
Q: Every time I pick up my newspaper, I seem to read about a “superbug” called MRSA. I don’t want to be an alarmist, but I want to know how to protect my family. A. Staph. aureus (where the “SA” in MRSA comes from) does not live on animals or in nature. Unfortunately, though, it lives very happily in the human nose. At any one time, in fact, up to 30% of perfectly healthy people carry these germs. In the vast majority of cases, the bugs are harmless. But following a bout of influenza, they can slide down into the lungs to cause pneumonia. They can also spread from nose to hand to skin, where they may cause boils, abscesses, or serious infections of the skin and underlying tissues. Even more ominously, Staph. aureus can invade the bloodstream to cause life-threatening infections. Fortunately, these major infections are much, much less common than simple boils or simple nasal colonization. Staph. aureus is a very hardy critter that can survive on inanimate objects. The germ’s toughness also explains why it can spread from person-to-person by hand contact and from contaminated objects, even in hospitals. When penicillin was discovered in the 1940s, virtually all strains of Staph. aureus were vulnerable to this new antibiotic. But within a decade, bacterial mutants that could resist penicillin began to emerge. In 1959, scientists developed methicillin, an antibiotic that was able to kill penicillin-resistan t Staph. aureus. A large family of similar antibiotics soon followed and gained widespread use. Unfortunately, staph learned how to resist methicillin and similar drugs. Methicillin- resistant Staph. aureus, MRSA, was here. Community threat At first, MRSA was found mostly in hospitals. But in the past few years, it has exploded into the community. In both settings, it behaves much like other staph, usually existing in the nose or on the skin without causing disease, sometimes producing boils and other mild infections, but occasionally causing life-threatening infections. Tough as it is, MRSA is vulnerable to special antibiotics. Doctors usually rely on vancomycin to treat hospitalized patients, but linezolid, daptomycin, and other drugs are useful alternatives. However, only one of these medications is effective in tablet form, and it is extremely expensive. Fortunately, many community-acquired strains of MRSA are susceptible to older oral antibiotics like clindamycin and trimethoprim- sulfamethoxazole, which are not helpful against hospital strains of MRSA. MRSA is a tough problem, and it shows signs of getting tougher. You can protect yourself and your family by washing your hands regularly; alcohol-based rubs are best. Don’t share personal items like razors or towels. Avoid direct contact with infected patients. And notify your doctor if you develop a skin infection or another problem that could signal MRSA. — Harvey B. Simon, M.D. Editor, Harvard Men’s Health Watch This Question and Answer first appeared in the November 2008 Harvard Men’s Health, available at www.health.harvard. edu/men.

Harvard Medical School publishes authoritative Special Health Reports on a wide range of topics. Each report delivers practical information on diagnosis, treatment, and prevention of major health concerns in clear, easy-to-understand language. For more information on a specific topic, click the appropriate link below: Alzheimer’s, Arthritis, Bladder, Cholesterol, Depression, Diabetes, Digestion, Energy, Exercise, Eye Disease, Headache, Heart Disease, High Blood Pressure, Memory, Menopause, Prostate, Sexuality, Sleep, Stroke, Vitamins
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