Congratulations on taking the first step to becoming a non-smoker !
Congratulations on taking the first step to becoming a non-smoker ! This Quit Kit has been developed to show why your decision to quit smoking is the best choice for you and for those around you. The kit will also provide you with plenty of ideas on how to quit and to stay a non-smoker. The Quit Kit contains: • ‘Quit because you can’ booklet, which includes a step-by-step guide to quitting. • ‘Products to help you Quit smoking’ brochure which outlines products known to be effective in aiding quitting. This brochure includes information on Nicotine Replacement Therapies and prescribed medications. • ‘You can Quit’ pocket guide, which you can carry with you, and which contains simple messages and hints on how you can stay a non-smoker. • ‘Quitline’ brochure – an information brochure about the Quitline service, explaining how the friendly, expert Quit advisors can provide you with information and advice about quitting smoking for yourself or your family or friends, and how the Quitline is now able to provide ongoing support during your quit attempt. • ‘Choosing the best way to Quit’ booklet to guide you through the maze of assistance and medications available to help you quit and find what works for you. Please do not hesitate to call one of the advisors on the Quitline (13 7848) any time of the day for further support and advice on becoming and staying a non-smoker. This service is available to help you through this period of becoming smoke free. We wish you every success in your decision to stop smoking. Yours sincerely, Prof Jim Bishop Chief Cancer Officer Cancer Institute NSW Dr Denise Robinson Chief Health Officer NSW Department of Health Cancer Institute NSW Level 1, Biomedical Building, Australian Technology Park Eveleigh NSW 2015 PO Box 41, Alexandria NSW 1435 tel (02) 8374 5600 fax (02) 8374 5700 www.cancerinstitute.org.au NSW Health 73 Miller Street, North Sydney NSW 2060 Locked Mail Bag 961 North Sydney NSW 2059 tel (02) 9391 9000 fax (02) 9391 9101 www.health.nsw.gov.au Quit because you can YES – you can quit smoking Over the years we’ve learned a lot about how to quit smoking from the people who know – Australians who have stopped smoking for good. What we have learned is here in your Quit because you can book. It’s got the facts that show quitting is the right choice. It also has plenty of ideas about how you can quit. Keep this book handy, so you can refer to it as you go through the different stages of quitting. Like all good things, it’s going to take some time and effort for you to quit smoking, but millions of smokers in Australia have already stopped. You can too. Make the book work for you. Write in it. Underline the parts that really mean something to you. Flick to the Checklist pages to jog your memory on important points. You need to know Chemicals in cigarettes change the way some medications work. See your doctor before quitting if you are taking medication. We know that stopping smoking can be stressful. If you have suffered from depression, anxiety or another mental illness, ask your doctor’s advice before quitting. CONTENTS Step 1 Deciding to quit Smokingkills Cigarettesarefullofpoisons Smokingcausesdisease Moregoodreasonstoquit Decidingtoquitchecklist Step 2 Getting ready to quit 4 4 4 7 9 11 12 Understandyournicotineaddiction12 Knowwhyyousmoke 15 Planwaystodealwithquitting 15 Setadatetoquit 17 Managingyourweight 18 MyQuittingPlan 19 Step 3 Quitting 20 Youareready 20 Chooseanapproachthatwillwork 20 Understandwithdrawalsymptoms 20 Copingwithcravings 23 Quittingchecklist 27 Step 4 Becoming a non-smoker Yournew,smokefreelifestyle Doingsomethingaboutstress Tipsforthetoughtimes Becominganon-smokerchecklist Coping with setbacks 28 28 31 33 35 36 Warningsigns 36 Ifyouhaveacigarette 38 Ifyougobacktoregularsmoking 38 Quitting support and services 39 STEP 1 Deciding to quit Cigarettes are full of poisons Do you know why you want to stop smoking? You know smoking is bad for you – but do you know how bad? Tobaccosmokecontainsover4000 chemicals.Aswellastarandnicotine, thereisalsothegascarbonmonoxide (foundincarexhaustfumes),ammonia (foundinfloorcleaner)andarsenic (foundinratpoison). People who have quit say it’s important to be clear about your reasons. Work out what reasons are important for you. Cancer Smoking kills Atleast69ofthechemicalsintobacco smokeareknowntocausecancer. Cancerscausedbytobaccoincludeof thelung,mouth,throat,oesophagus, stomach,pancreas,kidneys,bladder, cervixandbonemarrow(myeloid leukaemia). Everyyear,about19,000Australians diefromdiseasescausedbysmoking. Aboutone-thirdofthesedeathsoccur inmiddleage.Oneintwolifetime smokerswilldiefromtheiraddiction. Your lungs Toxicgasesdamagecilia,thetinyhairs thatarepartofyourlungcleaning system.Tar,thesolidparticlesin tobaccosmoke,coatsyourlungslike sootinachimney.Smokeirritatesyour lungs,sotheyincreasetheamount ofmucustheymake.Overtime,your smallairwaysswellupandletlessair intoyourlungs. FACT 1 Twelve hours after stopping, almost all nicotine is out of your system. In about five days, most nicotine by-products have gone. 4 Deciding to quit 1 My kids made faces every time they saw the pack. They thought the diseases on the pack would happen to me. It made me think about it too. M A r K , 4 2 Y E A r S . Your blood All cigarettes are toxic Manychemicalsfromtobaccosmoke passthroughyourlungsintoyour bloodstream.Theygoeverywhereyour bloodflows.Carbonmonoxiderobs yourmuscles,brainandbody ofoxygen. Itdoesn’thelpifyousmokeweaker tastingcigarettessuchasthose labelled‘fine’,‘smooth’or‘refined’.These cigaretteshaveholesinthefilterthat letinairtodilutethesmoke.Butyou stillendupinhalingthesameamount ofchemicalsasyouwouldfrom strongertastingcigarettes.Soyoudo thesameamountofdamage. Everycigaretteyousmoketemporarily increasesyourheartrateandblood pressure,andnarrowsthesmallblood vesselsunderyourskin.Itslowsyour bloodflow,reducingoxygentoyour feetandhands.Yourfingersandtoes becomecolder. Your heart and brain Chemicalsfromsmokemakeyour bloodcellsandbloodvesselwalls sticky,allowingdangerousfatty depositstobuildup.Thisslowly blocksyourbloodvessels,starving yourtissuesofoxygen.Blockedblood vesselsinyourheartorbraincan disableorkill. FACT 2 Quitting smoking at any age will result in major and immediate health benefits. This applies to people with and without diseases caused by smoking. 6 Deciding to quit 1 Smoking causes disease – a good reason to quit Lung canceriscausedbychemicals intar.Mostlungcancersarecaused bysmoking.Smokingdamagesa genecalledp53,andstopsitfrom protectingyourcells,allowinglung cancertodevelop. Smokingharmsalmosteveryorgan inyourbodybutbecauseithappens gradually,youprobablydon’t notice.Thestrainputonyourbody bysmokingoftencausesyearsof suffering. Heart diseaseandstrokesarealso morecommonamongsmokersthan non-smokers.Oneinthreedeathsfrom heartdiseaseinpeopleunder65are causedbysmoking. Emphysemaisanillnessthat slowlyrotsyourlungs.Peoplewith emphysemaoftengetbronchitisagain andagain,andsufferlungandheart failure. Peripheral vascular disease (PVD) occurswhenbloodvesselsinyourlegs orarmsbecomeblocked.Itcausespain andsomesmokersenduphavingtheir limbsamputated. Tobaccosmokecanleadtodisabilities suchasblindness,hipfracturesand painfulstomachulcers. Thesearejustafewoftheharmful effectsofsmoking. C a n C E r i n a Lu n g s ta i n E D by ta r . This lung, removed from a smoker, shows a lung cancer (white tissue) blocking the main air passage to the right lung. The tumour extends to the outside of the lung. Picture courtesy of the Prince Charles Hospital, Departments of Pathology and Medical Photography. 7 A cross-section of a healthy blood vessel. Fat deposits have reduced the space inside the blood vessel by three-quarters. FACT 3 Within a day of quitting, the level of carbon monoxide in your blood has dropped dramatically. Your body can take up and use oxygen more easily. 8 The vessel is blocked by a clot. Pictures courtesy Boehringer Ingelheim GmbH photo Lennart Nilsson/Albert Bonniers Förlag AB Deciding to quit 1 More good reasons to quit Fertility. Menwhosmokearemore likelytohaveproblemsgettingor maintaininganerection,duetothe effectsofsmokingontheblood vesselsinthepenis.Smokingmay affectspermquality. your body’s self defence.Smoking suppressesyourimmunesystem,so youarelessprotectedagainstthe fluandotherillnesses.Evenyoung smokershavemorecoughs,phlegm, wheezingandchestinfectionsthan non-smokers.Smokersalsotendto havemoreseveresymptoms. Womenwhosmokearemorelikelyto missperiodsandhavemorepainful periods.Theymaytakelongerto conceiveandaremorelikelytohave amiscarriage. babiesborntomotherswhosmoked inpregnancyaremorelikelytobe premature,stillbornordieshortly afterbirth.Ababyexposedtotobacco smokehasahigherriskofdyingfrom SIDS(suddeninfantdeathsyndrome). Money.Inaway,givingupsmoking islikegettingapayrise,morethan $3000*ayearifyousmoke20 cigarettesaday. Fitness. Smokingmakesitharderto getenoughoxygentoyourmuscles duringexercise,soyoutiremore quickly. Childrenofparentswhosmokeare morelikelytogetpneumoniaand bronchitisintheirfirstyearoflife. Theyaremorelikelytosufferfrom meningococcaldisease,asthmaand middleearinfection(acommoncause ofdeafness).Theyarealsomorelikely tobecomeregularsmokersthemselves. your appearance.Wrinklesaroundthe eyesandmouthdevelopearlier,and tarstainsyourfingersandteeth. Confidence.Onceyousucceed,you willhavemoreconfidencetotakeon otherchallenges. * At the time of publication. 9 try tHis Evennowyoumightstillbewonderingwhetheryoureallydowanttoquit.Take yourtimeinthinkingaboutyourreasonsforwantingtosmoke,andyourreasons forwantingtostop. Listallyourreasonsonbothsidesandcirclethethreemostimportantitemson eachlist.Thenputastarnexttotheonereasonthatismostimportanttoyou– justonestar,notoneforeachlist. Why I want to smoke Why I want to quit Yourdecisionmightbeaveryclose one,oronesidemaywinbya landslide.Theimportantthingisto decidewhichyoumostwanttodoand actonthatdecision. FACT 4 Itiscommontosetouttoquitwith apartofyoustillwantingtosmoke. Youneedtoacceptthis,andcommit yourselftoquitting.Workouthow youcangetthethingsyougotfrom smokinginotherways. Quitting reduces your risk of stroke and heart attack. This is especially important for women who smoke and take the contraceptive pill: their risk of death from heart attack increases dramatically with age. 10 Deciding to quit 1 Deciding to quit checklist g I will reduce my risk of heart attack. g I will reduce my risk of cancer. g I will feel fitter and my skin will look better. g Within 12 hours, my body will be free of nicotine. g I will set a great example for the children around me. g My lungs will start to recover and be able to clean themselves properly. g I will have more money to spend any way I choose. g I will give myself a confidence boost by quitting cigarettes. try tHis From the following list, tick the things you are looking forward to when you are a nonsmoker. Add your own ideas in the space provided. c Having more energy to play sport or keep up with the kids. c Knowing I’m back in control and no longer addicted. c Freedom from the hassle of always checking that I have enough cigarettes. c Reducing the risk of getting sick from cancer or heart disease. c c c c c 11 STEP 2 Getting ready to quit 1. Understand your nicotine addiction Most people are not 100% sure about quitting and many are worried about how they might cope without cigarettes. This is normal. Don’t put off quitting because you feel this way – there is lots of help to get you through. Nicotineistheaddictivedrugin tobacco.Afteryou’vebeensmoking forawhile,yourbodygetsusedto nicotineandreliesonittofeelnormal. Doyouhaveanyofthesesignsof nicotineaddiction? Planningcanhelpyouunderstandwhy yousmokeandsetupsomequitting strategies. Ifyou’vetriedtoquitbefore,remember thethingsthatworkedforyouand thethingsthatdidn’t.Youcanuse whatyoulearnedtomakeyourplan stronger. g Yousmokeyourfirstcigarette within30minutesofwakingup. g Yousmokemorethanten cigarettesperday. g Youhavecravingsandwithdrawal symptomswhenyoutrytoquit. 4.Setadatetoquit Nicotineaffectsthechemicalsinyour brain,andafterapuff,youmayfeel goodforamomentortwo.Itproduces differenteffectsonthebodyatthe sametime.Itmaymakeyoufeel relaxedormorealertbutthisdoesn’t lastlong. FACT 5 Whensmokersstop,mostgetcravings. It’snormaltofeelanxious,hungry andirritable,andfindithardtofocus onwhatyouaredoing.Evenafter successfullygivingupsmoking,most smokerswhotrytojusthavean occasionalcigarettequicklyreturnto regularsmoking. Therearefourthingsyouneedtodo: 1.Understandyournicotineaddiction 2.Knowwhyyousmoke 3.Planwaystodealwithquitting After quitting, your sense of taste and smell begin to improve. Your breath, hair and clothes will smell fresher. 12 Getting ready to quit 2 I really wanted to travel but smoking cost too much. A friend quit too and saved up with me. V I C K Y, 2 4 Y E A r S . try tHis Smoking Record g You can learn about your habit while you prepare to quit. g Make a Smoking Record sheet like the one below and carry it with you everywhere. Each time you have a cigarette, or feel a craving, fill in the date, time, occasion or activity, what you are feeling and how much you feel the need for a cigarette, using the point system below. 1 = I could do without it 2 = I feel like it 3 = I need it 4 = I really need it 5 = I’m desperate for it g Even after a couple of days, you’ll have a good idea about what makes you want to smoke, the times you smoke and the importance of each cigarette. These are your smoking ‘triggers’. g You can also use the Smoking Record after you have quit to learn more about your cravings. The more you know, the better you can plan for staying stopped. Example of Smoking Record 14 3. Plan ways to deal with quitting Allsmokershavetheirownsmoking habits.Thesehabitsareusuallytied tocertainmoods,activities,events, placesorpeople.Theymaybequite strongbonds. Somepeopleseequittingasaprivate battlebetweenthemselvesand cigarettes.Butgettinghelpisnota signofweaknessorlackofwillpower –it’sasmartwaytoquit. Someofthemostcommonreasons whypeoplesmokeare: g addiction:tosatisfythecravingfor nicotineoracigarette g emotions:feelingstressed,upset, angry,frustrated,boredorhappy g pleasure:toenjoysomethingeven moreortorewardyourself g social pressure:feelingpartofthe crowd,bondingwithothersmokers g habit:feelinglikesmokingwhile doingthingsortakingabreak. Therearetwotypesofhelptoinclude inyourplan: g getsomecoaching g usequittingmedications. Get some coaching Acoachgivesyoustructure, motivation,support,newskillsand confidence.Itismuchhardertoget thesethingswhenyoutrytoquiton yourown.Gettingacoachwillgiveyou amuchgreaterchanceoflong-term success. Beinginthesesituationsafteryou havequitwillusuallytriggercravings. Knowingwhatmakesyouwantto smokecanhelpyouplanhowtocope intriggersituations. Themoretimesyouhavetriedtoquit andthelessconfidentyouare,the morecoachingyouarelikelytoneed. FACT 6 After four weeks without smoking, exercising will be easier because more air is getting into your lungs. 15 2 Getting ready to quit 2. Know why you smoke Here are some good coaches: Ifyouhaveasthma,diabetesorother healthproblems,itcanbeuseful todiscussquittingwithahealth professional. Call the Quitline on 13 7848 (13 QUIT) TheQuitlineisaconfidential telephonequittinginformation andadviceservice.Professional telephoneadvisors,whounderstand thechallengesofquitting,provide strategiesandsupporttohelpyouquit. Thisisforthecostofalocalcall(except mobiles). Use quitting medications Theseproductsaresuitablefornicotine addictedsmokers. Quittingmedicationsreduce withdrawalsymptomssuchascravings, irritability,moodswingsandanxiety. Theyusuallydonotstopwithdrawal symptomsaltogether.Mostpeople’s smokingislinkedtohabitsand emotions.Soyouarelikelytostillget somecravingsinsituationswhere youusedtosmoke.rememberthat coachingcanhelpyouhandlethese timesandadjusttolifewithout cigarettes. Go online with the QuitCoach ThisisavailableontheInternetat www.QuitCoach.org.au.Youanswer questionsandtheQuitCoachgivesyou theideasandsuggestionsthatwillbe mostusefultoyou.TheQuitCoachcan helpyoubeforeandafteryouquit. Therearetwokindsofmedication: Talk to your doctor, pharmacist or other health professional Doctorsandpharmacistsaregood sourcesofadviceaboutquitting, especiallyforadviceonquitsmoking medications.Youneedtoseeadoctor ifyouwanttouseprescriptionquitting medications. g nicotinereplacementproducts g prescriptionmedications. Nicotinereplacementproducts,such asthepatch,gum,lozenge,tablet andinhaler,workbyreplacingsome ofthenicotineyouusuallygetfrom cigarettes.Nicotinebyitselfhasnot beenshowntocausecancer.Because nicotineproductsremovealltheother dangerouschemicals,theyaremuch saferthansmoking. Ifyouhavesufferedfromamental illnessoraretakingmedicationfor one,itisimportanttoseeyourdoctor beforequitting. 16 4. Set a date to quit Prescriptionmedications,suchas bupropionandvarenicline(Champix), mustbediscussedwithyourdoctoras theyarenotsuitableforeveryone. Unlessthereisaverygoodreason, makethedatewithintwoweeksfrom now.Chooseaneasydaytostop,one whenyouwillnotbeundermuch pressure,butwillhaveplentyto occupyyourself. Gather information Practise quitting Talktootherpeoplewhohavequit abouthowtheydidit.Therearesome usefulwebsites(seeinsidebackcover). remember,differentthingsworkfor differentpeople. Onceyouhavepickedadatetoquit, sticktoit.Beforeyouquit,youmight setyourselfsomesmallergoalstosee howyouwouldgo.Tryquittingfor onlyoneday.Oryoucouldexperiment bynotsmokingattimeswhenyou normallywould,suchaswhenyou’re outwithfriendsorhavingabreakwith othersmokersatwork.Thiswillhelp youworkouthowmuchyouneedto prepareforthesesituationswhenyou quitcompletely. Get help from friends and family Thesupportandencouragementof friendsandfamilyisimportant,but sometimesotherscanhinderyour efforts. Ifyoudotalktoyourfriendsandfamily aboutyourquitting,explainhowthey canhelp–forexample,bynotoffering youcigarettesiftheysmoke,orby beingpatientifyouareabitirritable atfirst. try tHis Throw away all cigarettes, lighters and ashtrays in your home and car. If your partner smokes, suggest that he or she stops too, or only smokes outside the house. Quittingwithafriendcanbeusefulas youcanhelpeachotherthroughthe hardtimes. FACT 7 Most smokers want to quit. Research shows that more than 75% of smokers have made at least one attempt to quit. 17 2 Getting ready to quit Yourdoctororpharmacistcanexplain toyouhowtousetheseproducts. Managing your weight Tips to help manage your weight Thebestapproachistofocusonhow youlookandfeelphysically,rather thanyourweight. Differentpeoplegaindifferent amountsofweightduetostopping smoking. Butyoucantakeactiontohelpkeep weightgainlow,startingwith: g Exercise.Doingsomemoreexercise canhelpkeepyourweightdown andhelpyoubeatcravings. g Cookingwithandeatinglittle fat. g Limithowmuchalcoholyoudrink. Alcoholicdrinkscancontainalotof energy. Makingsmallchangeseveryweekcan beeasierandlongerlastingthantrying tomakealotofchangesatonce. Ifworryingaboutweightgainis stoppingyoufromquitting,talktoa healthprofessionalwhocanhelpyou: g getadvicefortheissuesthatare importanttoyou g makeahealthyeatingandexercise planthatsuitsyourlifestyle. Seeyourdoctor,whocanalsorefer youtoadietitianorotherspecialist. Youcanalsofindadietitianatthe DietitiansAssociationofAustralia websiteatwww.daa.asn.au. 18 g Usethetimeandmoneyyou’ve savedfromnotsmokingtoplan andcooktasty,healthymeals. g Don’ttrytosticktostrictdiets. Constantboutsofhungerwill undermineyoursuccessatquitting. g Trynottomissmeals,especially breakfast. g Limitsugarytreats,suchassweet drinks,lollies,biscuitsandcakes. g Preparesomehealthysnacks– celeryandcarrotsticksorvegetable strips,wholefruits(notfruitjuice) andnuts. g Berealistic–allowyourselfsome treatsoccasionally. g Ifyouusefoodtohelpyoudeal withfeelings,suchasdepressionor loneliness,tryotheractivitiesthat makeyoufeelbetter. g Emotionaleatingand‘binge’eating cansometimesbedifficulttodeal withbyyourself.Forhelpand support,considerseeingahealth workerwhospecialisesinpeople’s relationshipswithfood,suchasa psychologist. g Ifyouarefemale,tryquitting smokinginthefirstweekafteryour periodhasstopped,asyoumay havelesswithdrawalsymptoms andeatlessatthattime. My Quitting Plan g My main reasons to quit: g My three main triggers to smoke: g My main strategies to avoid smoking: g The coaching I will get: g The quitting medication I will use: g My quit date is: ____/____/_______ Keep a copy of your plan with you as a reminder. Add to it if you find you need new strategies to deal with difficult times. 19 2 Getting ready to quit Write out your Quitting Plan. Use your Smoking Record to help you. STEP 3 Quitting Understand withdrawal symptoms Now it’s time to put all your work into practice and quit. You are ready g You’vemadeyourdecisiontoquit. g Youhaveanyextrainformationor supportyoufeelyouneed. Withdrawalsymptomsaretheway yourbodyreactswhenitstopsgetting nicotineandalltheotherchemicals intobaccosmoke.Thinkofthemas recoverysymptoms. g You’vedoneyourplanning. g You’vesetyourquitdate. Commonrecoverysymptomsinclude: g Cravings.Eachonelastsashort time,butmaybestrong.Overtime, cravingswillhappenlessoften. g Feelingsofirritability,frustration, depressionoranxiety. g Feelingsofrestlessnessand/or difficultyconcentrating. g Changedsleepingpatterns. g Increaseinappetiteandweight gain. Stick to your decision You’redoingtherightthing. Choose an approach that will work for you Ifyouarequittingbyyourself,thebest approachistostopcompletelyand suddenlyonyourquitdate. Somepeoplealsoreport: g Coughing,sneezingorsorethroat. Considergettingsupportfroma quittingcoach,suchastheQuitline, andusingaquittingproduct,suchas nicotinegum. g Mouthulcers. g Upsetdigestionanddisturbed bowel. g Headache,earache,deafnessor feelingoff-colour. FACT 8 Usually,youwon’thaveallofthese symptoms,andthosethatdoaffect youwillrarelylastmorethanafew weeks. Even though withdrawal symptoms can be hard to go through, remember they are actually a good sign. They show your body is adjusting to being free from the chemicals in tobacco smoke. 20 Quitting 3 Mates at work thought I couldn’t do it, but I used patches and that made it easier than last time. D AV I D, 3 1 Y E A r S . Quitting and stress Somerecoverysymptomswillcome andgooverthefirstweek.Most aregonewithintwotofourweeks; heavysmokersmayhavesymptoms forlonger.Theemotionalsymptoms –suchasirritabilityorfrustration– fadeasyourbodyadjuststobeing nicotinefree. Somepeoplefeelmorestressedin thefirstmonthorsoaftertheyquit. Thismaybepartlyduetocoping withrecoverysymptoms.Also,it takestimetosettleintonewroutines andbecomecomfortablewithnew waysofmanagingwithoutcigarettes. However,otherpeoplehaveamore positiveexperienceofstopping smoking,andfeelmoresatisfied. Youmaygetoccasionalcravings(the urgeordesiretosmoke)longafter otherrecoverysymptomshavegone. Thesecravingsaretriggeredbybeing insituationswhereyouusedtosmoke (seeStep4:Becoming a non-smoker). Afewmonthsafterquitting,most peopletendtofeelasgoodas,or betterthan,whentheyweresmoking. Ifyouhavetroublewithcertain withdrawalsymptoms,planhowyou couldcopeorworkaroundthem.For example,warnyourfamilyyoumight becrankyforafewweeksandaskfor theirpatience. Themorewithdrawalsymptomsyou have,themoreyouwillbenefitfrom usingquittingproducts. FACT 9 Within four to six days of quitting, your cilia (the hair-like cleaning system in your lungs) begin to recover and remove the mucus in your lungs so that you can cough it up. The mucus may be brown from tar. 22 Coping with cravings Trythesetips: Fewsmokerscanquitwithoutfeeling theurgeordesiretosmoke.Thefirst weekafteryouquitcanbethehardest, ascravingscanbemorefrequent andintense. Therearefourmainwaystodealwith cravings. Makeyourhomeandcar smokefree.Ifthat’snotpossible, haveatleastonesmokefreearea foryourself. g Makeitharderforyourselftoget cigarettes. g Askothersnottosmokearoundyou. g Useplaceswhereyouarenot allowedtosmokeas‘protection’ untilthecravingpasses. g Avoidsituationsthatwillbetough whilecravingsarestillintenseand frequent. 2. Changingyourenvironment. 3. Usingcopingthoughts. 4. Changingwhatyoudo. 1. Using quitting products t r y t H E 4 D s: Nicotinereplacementproductsand prescriptionmedicationsworkby makingcravingslessstrong.Theywork bestwhenyoucarefullyfollowthe instructions.Makesureyoudon’tstop themtooearly. g Delayactingontheurgeto smoke.Don’topenapackorlight acigarette.Afterafewminutes, theurgetosmokewillweaken, especiallyifyoudothefollowing: g Deep breathe.Takealongslow breathin,andslowlyoutagain. repeatthreetimes. Cravingsoccurmostcommonlyin situationsthatremindyouofsmoking. g Youcanreducehowoftenandhow stronglycravingsoccurbymaking yourenvironment‘quittingfriendly’. Drink water.Sipitslowly,holding itinyourmouthalittlelongerto savourthetaste. g Do something else.Takeyourmind offsmokingbytakingaction–put onsomemusic,goforawalkor ringafriend. 2. Changing your environment 23 3 Quitting 1. Usingquittingproducts. g 3. Using coping thoughts g Thinkabouthowgooditwillfeel toshowpeoplewhodoubted you,thatyouhavesucceededat quitting. g Setshort-termgoalssuchastaking onedayatatime. g Talktosomeoneabouthowyou’re feeling. g Challengenegativethoughts.Ifyou thinkacigarettewouldbenice,tell yourself‘No,I’mnotgoingtobe suckeredback.’ Thewayyouthinkaboutquittingcan helpyouresisttemptingsituations. Trythesetips: g Usepositive‘self-talk’.Tellyourself ‘Icanquit’or‘Idon’tneedcigarettes’ or‘Icanfindbetterwaystocope’. g Breakyoursmokingthought patterns.Stopthoughtsthatlead youtowanttosmokeandchange themtosomethingelse. g remindyourselfofyourmain reasonstoquit.Carrysomething withyouthatwillhelpyoustay motivated,suchasanoteor picture.Thinkofthingsyouwant todoasanon-smoker.Usethe Deciding to quit checklistonpage11. g Thinkofthebenefitsofquitting andthepositivechangesinyour lifesinceyoustopped. g Focusyourmindonsomething else–trydistraction,meditation, thinkingofimagesorfantasies. 4. Changing what you do Toquit,youneedtolearnnewwaysto copewiththingsthatusedtotrigger yoursmoking.(referbacktopage15: Know why you smoke).Asyoubecome betteratdoingthingsinsteadof smoking,yourcravingswilltendnotto happenasoftenorbeasstrong. FACT 10 Quitting reduces your risk of lung cancer if you do not already have the disease. After ten years, the risk is halved. 24 g g Congratulateyourselfeverytimeyou beattheurgetosmoke.remember totreatyourselfoccasionallywiththe moneyyou’vesaved,suchaswitha movie,anewCD,flowersoramealout. Refuse offers of cigarettes Youhavetherighttorefuseacigarette andcandosowithoutupsetting others.Practisesaying‘Nothanks, Idon’tsmoke’toprepareyourselfin casesomeoneoffersyouacigarette. Useotherthingstokeepyour handsormouthbusy.Tryfiddling withkeys,beads,astressball, mobilephoneorjewellery.Try chewingsugarfreegum,eatinga healthysnackordrinkingwater. Stay on track Ifyouareunsureofwhattodoin somesituations,askorwatchwhat non-smokersdo. Don’tletotherpeopletalkyouinto havingacigarette.It’syourdecision –don’tletotherspressureyou.Tell them‘No’likeyoumeanit. Just one WILL hurt Caffeine Having‘justone’isthewaythatmost peoplegobacktoregularsmoking. Quittingmeansresistingtheurgeto smokeevenonecigarette,despitethe cravings,thehabit,thepressureand yourownemotionalreasons. Tea,coffee,coladrinksandchocolate allcontaincaffeine.Caffeinemaymake yourestless,irritableandsleeplessfor awhile.Withoutnicotine,yourbody retainsmorecaffeine.Tryandreduce theseproductsandhavenon-caffeine drinks. 25 3 Quitting g Reward yourself Inthefirstfewweeks,changeyour routinesthatarestronglylinked tosmoking.Takeallyournormal breaksbutwithacupofherbal teaorotherdrinkinsteadofa cigarette,orholdyourcupinyour otherhand.Trycleaningyourteeth straightafterameal,sittingina differentchairtowatchTV,and havingashowerassoonasyou getup. Smoking and alcohol try tHis Manypeoplefindithardtoresist smokingwhendrinking.Cravingsare oftenstrongerwhenyouaredrinking andsocialising.Alcoholmayweaken yourresolveaboutgivingupsmoking. Youneedtoplanforsocialoccasions. Go back to your Smoking Record and Quitting Plan for ideas to deal with cravings. During the first week, make changes to your plan if you need to. Did you use the ideas you wrote down? How are they working? Do they need changing? Are there any triggers you hadn’t thought of? Are there any new situations that you hadn’t planned for? Somestrategieswhengoingoutwith friendsare: g Gotoasmokefreevenue. g resolvebeforeyougooutnot tosmoke. g Haveaquittingbuddyornonsmokingfriendwithyouassupport. g Avoidalcoholforafewweeksafter youquit,especiallyinsituations whereyouwouldhavesmoked. g Ifyoudodrink,cutdownonhow muchyoudrinkbyalternating alcoholicdrinkswithglassesof water.Also,changeyourdrinkto somethingyoudon’tusuallyhave toremindyourselfthatthingsare different. g Tellyourselfit’sokaytogohome earlyifthecravingsbecometoo hard.Youcanaffordataxiwiththe moneyyou’vesavedbyquitting. FACT 11 All States and Territories have legislated for restaurants and cafés to be smokefree. In many States and Territories there are smokefree areas in licensed premises as well. Remember to ask. 26 Quitting checklist g I am aware that withdrawal symptoms are a good sign and show that my body is getting rid of the poisons and chemicals in my system. g I have planned how to handle the places and events that I know make me want to smoke. g I will congratulate myself every time I beat the urge for a cigarette. g I know I have the right to refuse a cigarette and can do so without upsetting others. g I will keep my hands busy by doing something, or by fiddling with a pen, phone cord, mobile phone or some beads. g Even if I decide to have alcohol, I will stick to my decision to quit. g I know it’s okay to avoid situations that will be tough while cravings are still intense and frequent. g I am telling myself ‘I can deal with this craving’ and I am talking myself out of smoking by thinking of the good things about being a non-smoker. 27 3 Quitting g I will remind myself of my reasons to quit to make it easier to refuse cigarettes. STEP 4 Becoming a non-smoker Once you have beaten your urges to smoke and you are getting them less often, you are ready for Step 4. Find new habits to take the place of smoking Smokersusecigarettesformany things.Forexample,toconcentrate, socialise,relax,fillintime,when hungry,asarewardandtocopewith feelingssuchasstress,angerorgrief. Quittingisn’toverjustyet.Thenext stageislearningtoenjoyandvalue yournewsmokefreelifestyleand startingtothinkofyourselfasanonsmoker. remember,it’snormaltogetcravings insituationswhereyouusedtosmoke. resistingcravingsisanecessarystepin makingthemgoaway. g Whatdidyouthinkcigarettesgave you?Lookatyourlistonpage10. g Canyoudoeachofthesethingsas wellaswhenyouusedtosmoke? Ifyouansweryes,thisprovesthat smokingwasn’treallyusefulinthis situationandthatyouhaven’tlostout byquitting. Your new, smokefree lifestyle Ifyouanswerno,it’sreallyimportant totryoutnewwaystoreplacethose thingsyoufeltsmokinggaveyou.Try funandrelaxingactivitieswiththe timeandmoneyyou’vesavedfrom quitting.CalltheQuitlineifyouneed ideas.Once you find things that work, make them a part of your regular routine. Gettingridofsmokingisabigchange inyourlife.Learningtoenjoyandvalue lifewithoutcigarettesisthenextstep. Forsomepeoplethiscomesnaturally, whileothersfinditharder. Thissectiondescribeswhatmight happenaftercravingsdiedownand howtobecomesomeonewhono longerneedscigarettes. FACT 12 There are now more Australians who have quit smoking than there are Australians who smoke. 28 Becoming a non-smoker 4 My skin has improved, my cough has gone and I’m feeling great. C H r I S T I N E , 3 4 Y E A r S . Coping with stress try tHis Ifyouusedsmokingtodealwithstress (asmostsmokersdo),thenyouare likelytogetcravingstosmokenext timeyou’restressedout.Takeyour timebeforereacting.remember, havingacigaretteisnotgoingtomake theproblemgoaway. Think about a sudden crisis that happened in your past when you were smoking. Imagine going through it now, but without smoking. What strategies could you use? resistingcravingsandusingother strategiestocopewillmakeyouless likelytohavestrongcravingsinfuture stressfulsituations. Stopping quitting medication Ifyouusednicotinereplacement productsandcravingsbecometoo strongafteryoustopusingthem,start usingthemagainforawhilelonger. Asanon-smoker,you’velearned newskillsandhaveshowngreat determination.Howelsecanyouget thesupportyouneedinsteadoffalling backonacigarette?Istheresomeone youtrustwhoyoucouldtalkto?Do youhavenew,relaxingactivitiesthat helptaketheedgeoffthings? The quitting blues Somepeoplefeelsadaboutstopping smoking.Eventhoughpeoplewant tostop,theymayfeeltheyarelosing somethingthathasbeenpartoftheir life,sometimesabigpart.Thisisa normalreaction.Itusuallypasses,but itmaytakesomework. Ifyouarefindingittough,trytostop yourselffromdwellingtoomuchon missingsmoking,asthiscanbringon cravings.Focusinsteadonthebenefits quittinghasbroughtyou. Ifthesefeelingscontinueandyou’re havingdifficultycoping,speaktoyour doctor. FACT 13 Within two months of quitting, the blood flow to your hands and feet improves. 30 Doing something about stress List below the main sources of stress in your life. Now think about how much control you have or want to have over these sources of stress. Next to each of these, write the number 1, 2 or 3 depending on whether you believe it is possible for you to: 1. Get rid of the source of stress altogether. 2. Make changes to reduce the stress. 3. Learn to cope with the situation as it is. For example, you might decide to try to accept and learn to cope with the peak hour traffic. This means you will continue to drive in peak hour and you will find ways of dealing with the stress. SOURCES OF STRESS 1, 2, or 3 31 IDEAS, PLANS, STRATEGIES 4 Becoming a non-smoker There are no right or wrong answers. Another person may make different choices for the same situation. Confront old smoking situations Thishappensbecauseyoureturn toasituationthatislinkedtoyour pastsmokinghabit,evenifyoudon’t recogniseitatfirst.Forexample,you mightstartcravingacigarettewhen visitingaplacewhereyouusedtolive whenyouwereasmoker,orwhenyou meetupwitholdfriendswithwhom youusedtosmoke. Whileyouwerequittingyoumayhave avoidedriskysituationssuchaspeople orplaceswhereyouusedtosmoke. Whenyou’reready,preparefor andfacethesesituationswithout smoking.Themoretimeyouspend inoldsmokingsituationswithoutthe cigarette,thelesslikelyyouwillbeto getcravings.Intime,you’llfeelmore andmorelikeanon-smoker. Drawonthestrategiesyouused whenyoufirstquittodealwiththese situations. Ifyouusedaquittingproductto helpyouquit,youalsoneedtoprove toyourselfthatyoucancopeinold smokingsituationswithoutthis extrasupport. Social pressure Ifyourfriendsorfamilyaremaking quittingharderforyou,explainto themhowyoufeel.Spendtime relaxingwithpeoplewhoaregladto seeyoulookingafteryourhealth. Sudden strong cravings Occasionally,youmightgetacraving ‘outoftheblue’,evenyearsafter quitting.Thisisnormalanddoesn’t meanyouarefailingatquitting. FACT 14 After eight weeks without smoking, your immune system improves. 32 Tips for the tough times try tHis g 1. BREATHE DEEPLY AND SLOWLY 4. MANAGE YOUR WORKLOAD AND TIME g Set achievable goals. g Don’t take on more than you can handle. g Ask for help if you need it. g Keep some distractions on hand for boring times e.g. music or a stress ball when stuck in traffic or queues. 5. TAKE CARE OF YOUR FEELINGS g Talk to others about your problems – don’t keep your feelings bottled up. g Try to be around people who support you. 6. DO THINGS YOU ENJOY g Write in a journal or draw. g Do nice things for yourself occasionally. g Do something you enjoy every day. 7. EXERCISE This can be as simple as getting off the bus one stop early and walking the extra distance or using stairs instead of lifts. 33 4 Becoming a non-smoker 2. RELAX YOUR BODY AND YOUR MIND LIKE THIS: g Lie down or sit in a comfortable position. g Close your eyes and take a few deep breaths. g Tighten your feet and toes, hold them tight for three seconds, then relax them. Repeat this exercise with your leg muscles, your stomach and your arms and shoulders. g Think about something relaxing, perhaps lying in the shade of a tree on a hot day … a gentle breeze brushes your skin … the leaves rustle quietly … nothing to do just now except close your eyes and let your mind drift … g When you are relaxed and ready, open your eyes and bring the good feelings with you. 3. LOOK AFTER YOUR BODY g Get enough sleep. g Eat sensibly and well. g Do some gentle stretches to relieve muscle tension. Ask a friend for a neck and shoulder massage. What if you do gain weight? try tHis Ifyouputonafewkilos,trynottobe toohardonyourself.Concentrateon yourresolvetogiveupsmokingand thentackletheweightgain.Butdo trytoeathealthyfoodsandgetsome extraexercise. Think about your plans at work and home for the next few weeks. Can you make one or two changes to reduce the pressure? Talk about problems openly with those involved. Ifyouthinkweightgainisaproblem, discussitwithyourdoctorordietitian. remember,startingtosmokeagain maynothelpyoulosetheweightyou havegained. refertopage18formoretipstohelp youmanageyourweight. The new you Youmaystillseeyourselfasasmoker who’squit.Starttothinkofyourself asanon-smoker–thatis,someone whoseesnorealuseforcigarettes. Themorenon-smokingexperiences youhave,themoreyou’llfeellikea non-smokeroraproudex-smoker. Congratulations! FACT 15 In the long term, the average weight of ex-smokers is similar to people who have never smoked. 34 Becoming a non-smoker checklist g I have changed my routine to suit my new smokefree life, with new hobbies, new rewards or comforts, and new ways to enjoy life. g I am exploring new ways to manage stress, such as discussing problems or feelings with others, not taking on too much work, and looking after my body. g I am finding new ways to relax, such as massage, deep breathing, and making time to relax my mind and body. g I will cope with cravings that happen ‘out of the blue’, and know that I am still succeeding at quitting. g I am planning how to cope with stressful situations. If I get stressed, I will take time to think before I react, and remind myself of other ways to cope. I will ring the Quitline if I think I need more support or ideas. g I will take action if weight gain is really a problem. I will be kind to myself if I put on a few kilos. g I will appreciate the benefits of being a non-smoker and give myself credit for what I’ve achieved. g I am a non-smoker now! 35 4 Becoming a non-smoker g I will prepare myself carefully before I return to risky places, people or activities. Coping with setbacks Quitting can be hard. You might be going along OK, but suddenly … Watchoutforwarningsignsandget helpfromtheQuitlineiftheystartto builduporthingsgowrong. Warning signs try tHis g you keep on thinking ‘Just one would be OK’ or ‘it’d be great to smoke just one a month or one a week’. Butwhyweren’tyousmokingjust oneamonthorjustoneaweek beforeyouquit?Theansweris becausetobaccoisextremely addictive.That’swhyyou’vehad toworksohardtoquit.Don’tlet nicotinecontrolyouagain! g you’re really missing smoking and question whether quitting is worth the effort. Sometimesquittingcanbereally tough,butyoucangetthroughit. Findotherwaystotreatyourself andkeepdoingthingsthatyou enjoyeveryday. g you take puffs of other people’s cigarettes but excuse it as ‘not really smoking’. Youknowit’sonlyamatteroftime beforeyoufindyourselfbuyinga pack.Askyourfriendsnottogive youcigarettes,nomatterwhat. g Remember, every craving only lasts a few minutes. You can fight it off: delay, deep breathe, drink water or do something else. g Remind yourself of how far you have come. Do you really want to have to start all over again? g List your reasons for quitting on a card that you can carry with you. Read the reasons whenever you feel the urge to smoke. g Reward yourself for staying stopped. Do things you enjoy. g Have you found replacements for all the things you used cigarettes for? Think of what you can do to enjoy life without cigarettes. FACT 16 Smoking rates among both men and women are going down. Rates for men have almost halved in 50 years; 79% of adults aged 14 years and older do not smoke. 36 TO N Y, 4 9 Y E A r S . Coping with setbacks I had a big night and ended up having a few smokes. I didn’t even enjoy them. It felt like I’d failed but I haven’t lit up again. So I guess that’s success. If you have a cigarette try tHis Don’tletonecigaretteleadyouback tofull-timesmoking.Thinkofhowlong youhavegonewithoutacigaretteand saytoyourself:‘I’mdeterminedtogive up.Afterall,Ihaveonlyslippedup once.Inthepast,Iwouldhavesmoked 20aday.Iamdeterminedtoquit.’ If you are smoking again: reviewyourQuittingPlanandrevise ifnecessary.Formorehelp,callthe Quitlineon137848(13QUIT). If you go back to regular smoking Don’tdespair.Begintoplanforyour nextattempt. Mostpeoplewhohavesuccessfully quitsmokingforgoodhavemade severalseriousattempts.Itmaytake youawhiletolearntobeanonsmoker. Althoughyoumaybefeeling disappointed,youshouldtakepride inwhatyouhaveachieved.Everyday thatyouspentsmokefreemadeyour bodyhealthierandhelpedtobreak yourhabitandweakenyouraddiction. g Plan another date to give up as soon as possible. If you have lost the urge to quit, go back to your reasons for quitting in the first section of this book. g Make a note of what you learned from your recent quit attempt. What situations did you need to prepare for? What strategies worked best? g If you have made your home and car smokefree, keep them that way. g Call the advisors at the Quitline. They understand that quitting for good can take a few tries. They won’t judge you, but will discuss your experiences of quitting with you and offer help with what you decide to do next. FACT 17 After 12 months of not smoking, your increased risk of heart disease is down to almost half that of a smoker’s. Fifteen years after stopping, this risk is almost the same as for a non-smoker. 38 30 Quitting support and services Quitline 13 7848 (13 QUIT) Advice on use of nicotine replacement products TheQuitlineisaconfidentialtelephone informationandadviceservice, availablethroughoutAustralia.Forthe costofalocalcall(exceptmobiles), professionaltelephoneadvisors provideencouragementandsupport tohelpyouquit.Theyarefriendly, helpfulandnon-judgmental. Advisorshavebeentrainedinhealth, educationorpsychologyandsmoking cessation.Theyknowthehealth effectsofsmokingandunderstand thequittingprocessandhowdifficult quittingsmokingcanbe.Quitlinecan provideadviceonappropriateuseof nicotinereplacementproductstohelp youbeattheaddiction.Properuse ofproductscanoftenbethekeyto successfullyquittingforgood. Quitline services Free callback service Language services - NSW only Thecallbackserviceisavailablefor smokerswhowouldlikeongoing supportwiththeireffortstoquit smoking.Uptosixfollow-upphone callscanbescheduledthroughout themostdifficultperiodofquittingat timesthatsuityoubest.Thisservice canhelptokeepyoumotivatedandon trackandcandoubleyourchancesof successfullyquittingforgood. InadditiontotheEnglish-speaking Quitline(137848),therearenowseven dedicatedlinestoassistpeoplewho speakthefollowinglanguages: Arabic:1300784803 Chinese(CantoneseandMandarin): 1300784836 Italian:1300784861 Vietnamese:1300784865 Korean:1300784823 Greek:1300784859 Spanish:1300784825 Help with planning ForinformationabouttheMulticultural HealthCommunicationServiceplease seethewebsite:www.mhcs.health.nsw. gov.au 39 Support and services Ifyouwanttoquitsmoking,aQuitline advisorwillaskquestionsaboutyour smokinginordertoassistyoutotailor apersonalquitplanthatsuitsyour needs.Anadvisorcandetermineyour levelofnicotinedependencyand lookatwhatstrategiesarelikelytobe effectivetosuityourlifestyle. 4 WAYS to avoid a cigarette even when you’re desperate 1 2 3 4 Call the Quitline on 13 7848 (13 QUIT) Remember how far you have come Do some light exercise Remember the 4Ds: Delay Deep breathe Drink water Do something else NSW Department of Health Locked Mail Bag 961, North Sydney NSW 2059 Telephone (02) 9391 9000 SHPN: (CHA) 100519 ISBN 978-1-74187-600-0 NSW Department of Health Revised November 2010 ® The Quit, Quitline and QuitCoach logos are registered trademarks of the Cancer Council Victoria Printed by a carbon neutral process using world’s best practice ISO14001 Environment Management Systems. © Quit Victoria 2010 They are friendly, helpful, non-judgmental Once you have nominated a Quit date, and able to assist you at whatever stage you a Quitline advisor can call you on the are at in the quitting process. following days to help you through the The advisors can: process of quitting: n give you advice about quitting smoking n the day before your Quit date n help you assess your level of nicotine n within the first two days after your Quit date dependence n provide strategies on preparing to quit, preventing relapse and staying a non-smoker n provide information on products and services to help you quit. The free and confidential callback service is available for smokers who would like further help with their efforts to quit smoking. Up to six follow-up phone calls can be scheduled throughout the most difficult period of quitting. This service has proven to be very popular as it can help to keep you motivated and on track. n within the first week of your Quit date n twice within the following three weeks. The callback service can double your chances of quitting for good and can be tailored to meet your individual needs. You elect how many callback phone calls you wish to receive. You will also be offered a follow-up call three months after your Quit date just to check on your progress. Remember, even if you have nominated to participate in the callback service, you are always welcome to ring the Quitline 13 7848 and talk to an advisor at any time. CALL SHPN (TH) 070227 © NSW Department of Health February 2008 More help is available to you Quit smoking 13 7848 The Quitline on is available 24 hours a day, seven days a week, every single day of the year to receive a free Quit Kit. There are now seven dedicated lines to assist people who speak the following languages: n Arabic 1300 7848 03 n Chinese (Cantonese and Mandarin) 1300 7848 36 n Italian 1300 7848 61 When you first call you will be offered a Quit Kit The Quit Kit has been developed to show why your decision to quit smoking is the best choice for you and for those around you. The kit also provides you with plenty of ideas on how to quit and stay a non-smoker. The Quit Kit contains: n The Quitline 13 7848 telephone advice n n n n Monday to Friday 7am–10.30pm n n Saturday, Sunday and Public 9am–5pm If you wish to speak to an advisor but call outside the hours of the advice and information service, you can leave your contact details and a Quitline advisor will return your call the next day The Quitline 13 7848 is a free, confidential telephone based service primarily designed to help smokers quit. The Quitline 13 7848 n brochure which outlines products known 1300 7848 23 to be effective in aiding quitting. This brochure includes information on Greek bupropion tablets (Zyban), varenicline tablets (Champix) and nicotine replacement therapies (NRT) such as patches, gum, Spanish lozenges, tablets and inhalers. 1300 7848 25 By calling the Quitline 13 7848 you can: n be sent a free Quit Kit n take advantage of talking to the specially trained Quitline telephone advisors n A ‘Products to help you Quit smoking’ Korean 1300 7848 59 Holidays A ‘Quit because you can’ booklet, which includes a step-by-step guide to quitting. 1300 7848 65 and information service operates seven days a week during the following hours: Vietnamese take part in the callback and follow-up service. n A ‘You can Quit’ pocket guide that contains simple messages and hints on how you can stay a non-smoker. n A ‘Choosing the best way to Quit’ booklet to guide you through the maze of assistance and medications available to help you quit and find out what works for you. The Quitline advisors are specialists who have can also provide assistance to the family and By calling the Quitline 13 7848 you are friends of smokers and others requesting taking the best step available to help you and smoking cessation. They know the health information about smoking. A telephone succeed in quitting for good. Getting expert effects of smoking, understand the quitting interpreter service is available to assist those help to quit doubles your chances of remaining process and are aware of the difficulties many who are not fluent in English. a non-smoker. smokers face in quitting. been trained in health/education/psychology 010062 ProductsQuit 4/3/08 3:25 PM Page 1 Other strategies What type of products? Medical products shown to be successful are.1 ■ ■ Other strategies that may help you when you decide to quit are: ■ Counselling. ■ Developing a quit plan which includes: Nicotine replacement therapies (patch, gum, lozenge, sublingual tablet and inhaler). All nicotine replacement therapies are available over the counter in your local pharmacy and can be bought without a prescription. Some products may be more widely available in supermarkets etc. Bupropion (Zyban) or varenecline (Champix) tablets. These need to be prescribed by a doctor and are listed on the Pharmaceutical Benefits Scheme, which makes them cheaper. Correct usage of any of the above products has been shown to double the chances of stopping smoking among heavy smokers. If you have recently had a heart attack, are pregnant, or you are breastfeeding, talk to your doctor before using these products. 1 Setting a date to quit. 2 Reviewing past experience to determine what worked and what did not work. 3 Identifying potential problems and ways to deal with them. 4 Enlisting the support of family and friends. 5 Quitting with a friend. 6 Reducing alcohol and caffeine use in the first two weeks. 7 Avoiding other people’s smoke. ■ Being mindful of stressful or negative events. ■ Call the Quitline 13 7848. ■ Visit www.quitnow.info.au or www.13quit.org.au Products to help you ® smoking Things to remember How does nicotine replacement therapy (NRT) work? It is the 4000+ toxic chemicals in tobacco smoke that are harmful. The most harmful thing about the nicotine in cigarettes is that it keeps you addicted to smoking. NRT works by replacing the nicotine obtained from cigarettes with nicotine delivered by the patch, gum, lozenge, sublingual tablet or inhaler. ■ The gum, lozenge and sublingual tablet slowly deliver the nicotine through the lining of the mouth. ■ The patch slowly delivers the nicotine through the skin. ■ The inhaler delivers the nicotine a little faster through the mouth. Because these products deliver a constant low dose of nicotine compared to cigarettes they: ■ ■ reduce your body’s addiction to the nicotine in cigarettes reduce symptoms of withdrawal, eg cravings, sleeplessness, poor concentration and anxiety. ■ The first two weeks in quitting smoking can be difficult. During this time most of the physical symptoms of withdrawal occur, after which they diminish over time. At about three months most quitters have become established non-smokers. ■ Many ex-smokers have made several attempts before they quit for good. ■ Planning will improve your chances of success. ■ The health benefits of quitting start within two hours of giving up. Quitting may not be easy. Tobacco products are addictive and it is easier to quit smoking References 1 Silagy C, Lancaster T, Stead L, Mant D, Fowler G 2004, Nicotine replacement therapy for smoking cessation (Cochrane Review), In: The Cochrane Library, Issue 1, Chichester, UK: John Wiley & Sons, Ltd. 2 Fiore MC, Smith SS, Jorenby DE et al 1994, The effectiveness of the nicotine patch for smoking cessation: a meta-analysis. JAMA; 271(24):1940–1947. 3 Fiore MC, Bailey WC, Cohen SJ, et al 2000, Treating Tobacco Use and Dependence, Clinical Practice Guideline, Rockville, MD: US Department of Health and Human Services, Public Health Service. SHPN (HP) 010062 © NSW Department of Health 2001 Reprint April 2004, January 2006, Updated February 2008 The Quit logo is a registered trademark of The Cancer Council Victoria. For more information talk to your doctor or pharmacist. medical products available that Call the of success.1 for free, ongoing advice and support while you quit. with help. There is a range of can double your chances 010062 ProductsQuit 4/3/08 3:25 PM Page 4 How to use NRT Lozenge The program recommended by the manufacturers is: The following information is not intended to replace the Consumer Medicine Information that accompanies the NRT. Remember to read the Consumer Medicine Information issued in the NRT packaging before using the products. This product works in the same way as nicotine gum; the nicotine is absorbed into the bloodstream through the lining of the mouth. Because the lozenge is sucked until it dissolves completely, up to 25 per cent more nicotine may be absorbed into the blood than with similar dosages of gum. This means that it may be more effective in reducing nicotine withdrawal symptoms. ■ 6–12 cartridges per day for 12 weeks ■ 3–6 per day for 2 weeks ■ 1–3 per day for 2 weeks ■ Some ex-smokers may need longer treatment with NRT to avoid returning to smoking, however, regular use of the NRT inhaler beyond 12 months is not recommended. Patch The nicotine patch is an adhesive patch that you wear on your skin. It slowly releases nicotine, which you absorb through your skin. The patch works by replacing some of the nicotine you normally inhale from cigarettes. ■ If you smoke more than 10 cigarettes a day, start on the highest strength patch – either the 15mg/16 hour patch, or the 21mg/24 hour patch. 1 Use one lozenge at a time. 2 Do not exceed 15 lozenges per day. 3 The lozenge should be moved around the mouth from time to time and sucked until it dissolves (takes 20–30 minutes). 4 Do not eat or drink while sucking the lozenge. ■ If you smoke less than 10 cigarettes a day or weigh less than 45kg, start on either the 14mg/24 patch or 10mg/16hrs. 5 For about six weeks, use one lozenge about every 1–2 hours. 6 For the next 3 weeks, use one lozenge every 2–4 hours. ■ Wearing a patch for 16 hours per day is as effective as wearing one for 24 hours per day.1 7 ■ Using the patch for 8 weeks is as effective as longer courses and there is no evidence that gradually reducing the dose is better than simply stopping use of the patch.1,2 If necessary, continue using 1 lozenge every 4–8 hours for 3 weeks and then use a lozenge if strongly tempted to smoke for up to 12 weeks. ■ Some ex-smokers may need longer treatment with NRT to avoid returning to smoking, however, regular use of NRT patch beyond 9 months is not recommended. Withdrawal symptoms and side effects Remember to read and adhere to the information on the pack ■ The lozenge comes in two strengths. It is easy to decide which one is suitable for you. If you usually reach for your first cigarette of the day: ■ see your doctor or pharmacist for more information. Some smokers confuse symptoms of withdrawal from tobacco with the side effects of NRT. They may become tense, agitated, depressed, have disturbed sleep or crave cigarettes when using NRT. These can be symptoms of nicotine withdrawal. This can happen when the nicotine from the NRT has not properly replaced the nicotine from cigarettes. Different types of NRT can be combined to enhance the success, for example patch plus one of the following: 1 gum 2 lozenge One patch is used per day. 3 sublingual tablet 2 Apply to clean, dry, smooth skin on arm or upper body, in the morning. Sublingual tablet (Microtab) 4 inhaler. 3 Choose a different site each day to avoid skin rash. Similar to the lozenge, nicotine is released and absorbed through the lining of the mouth as the tablet dissolves. The levels of nicotine attained are similar to those of the 2mg gum. Sublingual tablets may be useful in situations where chewing gum is inappropriate. Some people do experience side effects, but these are usually mild. Side effects can include: ■ You must use nicotine patches correctly for them to be effective in helping you quit. 1 Gum ■ Within 30 minutes of waking – use the 4mg. Longer than that – use the 2mg. ■ a rash on the skin where the nicotine patch is worn. Moving the patch to a new area of skin each day will help reduce skin irritation, and there are also medicated skin creams available Drinking is permitted while tablet dissolves. ■ hiccups, indigestion and mouth irritation. 4 Those who smoke less than 20 cigarettes per day should use one tablet per hour (8–12 tablets per day will be adequate). If you are concerned, talk to your doctor. 5 Those who smoke greater than this amount, or who have not succeeded using one tablet should use two tablets per hour (16–24 tablets per day) the recommended maximum number of tablets in one day is 40. 6 Full dose of tablets should be used for 3 months, then gradually reduced to zero. 7 Some ex-smokers may need longer treatment with NRT to avoid returning to smoking, however, regular use of NRT sublingual tablet beyond 6 months is not recommended. Nicotine gum is available in 2mg and 4mg strengths. Usually the 4mg strength is recommended if you smoke 20 or more cigarettes in a day or are a smoker who has not been able to quit smoking using the 2mg strength. 1 Tablet is placed under the tongue where it releases nicotine as it dissolves. 2 Tablet should not be swallowed, sucked or chewed. 3 ■ Nicotine gum is NOT to be chewed like regular gum, but used as an oral patch. ■ Use gum regularly, for example, 1 piece per hour, as follows: ■ 1 Chew 3–4 times, until you feel a tingling sensation or a ‘peppery’ taste. 2 Flatten it and place it between your cheek and gum. 3 Occasionally move the gum around your mouth and chew two or three times to release more nicotine as needed. 4 Eating or drinking anything except water should be avoided for 15 minutes before and during chewing.3 5 ■ ■ ■ Discard after 30 minutes. Medical guidelines recommend you use the gum every 1–2 hours during the day, for a period of 1–3 months.3 It is recommended that you do not chew more than 20 of the 2mg or 10 of the 4mg pieces in one day. Some ex-smokers may need longer treatment with NRT to avoid returning to smoking, however, regular use of NRT gum beyond 12 months is not recommended. Inhaler This device consists of a plastic mouthpiece and cartridge containing a dose equivalent to 2mg of nicotine. It may be useful for those who miss the hand to mouth action of smoking. ■ The inhaler resembles a cigarette and the nicotine is inhaled through the mouth. ■ After 20 minutes of intense use with deep inhalations for continuous puffing you will have used all the available nicotine in a cartridge. Note. Some NRT products are safe to use in pregnancy and lactation or following a heart attack or stroke. Call the Quitline 13 7848 for more information. Varenicline (Champix) and bupropion (Zyban) There are two non-nicotine medications available in Australia that help people stop smoking. Both bupropion (Zyban) and varenicline (Champix) are only available on prescription from a doctor and are available through the Pharmaceutical Benefits Scheme, therefore the cost is subsidised. Talk to your doctor about the suitability of these medications for you, as they each work in different ways and may be unsuitable for some people. Use of these medications can increase your chances of quitting smoking successfully. This pocket guide is to: - remind you about the reasons why you are quitting Quit ! - encourage you you CAN quit for Life. - inform you about cravings and other withdrawal symptoms - remind you about calling the Quitting is a good idea Smoking cigarettes can lead to many health problems and early death. Smoking causes heart disease, cancers, stroke and respiratory illness, reduces fitness and can aggravate asthma and allergies. Besides your health, there are plenty of other reasons to stop smoking... A pack a day smoker can save around $3,600 in one year of quitting. Other reasons for you to quit... - Concern for the health of your children/others close to you. - Trying to have a baby or you or your partner are pregnant. Other reasons you have: Now is a good time to quit Quitting at any age brings major and immediate benefits to your health. Your body begins cleaning itself within hours of your last cigarette and you will soon look better and have more energy, because your blood oxygen levels are higher. A year after quitting, your risk of dying from heart disease has halved. In 10 years, your risk of lung cancer is more than halved and continues to decline over time. It’s important that you want to quit... and feel confident you can succeed The following tips may help: - As soon as you quit, call yourself a non-smoker. - Get rid of your ashtrays, lighters and anything else that reminds you of smoking. - Think about when and why you have smoked, and plan ahead for difficult situations. Beating cravings When you stop smoking, your body’s cravings for nicotine will be strongest the first two days after quitting, then decrease over the next two weeks. If you get through the first two weeks you have a good chance of quitting for good. Medications to help control cravings are: Nicotine replacement therapies (gum, patches, lozenges, sublingual tablets and inhaler). These can be bought from a chemist, who can explain how to use them. Bupropion (Zyban™) is a non-nicotine medication (tablet) that needs to be prescribed by your doctor. Even the worst cravings will last only a few minutes – if you can resist them for this period, they will pass. Other symptoms of withdrawal Most smokers will suffer from some withdrawal symptoms. These can include restlessness, mood changes, trouble concentrating, irritability or anger, anxiety, dizziness or headaches, tingling sensations, muscle aches and sweating, digestive upsets and coughing. Some of these occur because your body is adapting to the absence of nicotine; some are signs that your body is cleaning itself, eg coughing helps clear the lungs of tar and mucus. Things to remember - Research shows that drinking alcohol within the first two weeks of quitting may reduce your chance of success. - Try to cut down on coffee and cola for a few weeks after quitting as, without nicotine, your body absorbs twice as much caffeine, which can make you feel anxious. - Successful quitting usually takes a number of attempts. A slip-up does not mean that you have failed. Don’t be hard on yourself – work out how you will manage that situation differently next time. Practice saying “No thanks, I don’t smoke” and remind yourself of your reasons for quitting. Quitline is a confidential telephone service providing information, support and advice for quitting. You can call for the cost of a local call from anywhere in Australia.
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