What should I know going into a conversation about nicotine addiction?

August 25, 2008 4:32 PM

I am seeing my doctor tomorrow about quitting smoking. I have tried quitting so many times I can no longer keep count. But nicotine has this tremendous hold on me. I have smoked for almost four years and would like to see my 29th birthday as a turning point. What questions should I be asking my doctor and what questions should I be prepared to answer?
posted by parmanparman to health & fitness (23 comments total)

They have a drug now to help you quit: Chantix
I would ask about that.
posted by phunniemee at 4:41 PM on August 25, 2008 [2 favorites]

i would be sure to document, honestly, all of your previous attempts. what helped? what didn't? what triggered relapses? (stress, peer pressure, anxiety, a strong association between smoking and other things like coffee or beer, etc.)

be honest, and be open. my grandmother quit after 50 years. it took her a long, long time, but she did.

although you didn't ask, here's what i did: i took almost a year to quit. i spent a couple of weeks charting when and how i smoked. then i spent a couple of weeks establishing a routine. then, every couple of weeks, i would cut one cigarette out of that routine (always the same one). it took a really long time, but it has worked over the past few years. now i just smoke occasionally, but the addiction is gone.
posted by thinkingwoman at 4:44 PM on August 25, 2008

Honestly, in my experience you may or may not get a ton of help from your doctor. I think that you'll be better off researching this on the web and going in knowing what prescription you want.

With that said, Chantix was a tremendous help for me (smoker for 10 years, with some off time/ now have been quit since Nov 07).
posted by designmartini at 4:46 PM on August 25, 2008

I tried hypnotherapy, personally. I smoked for almost 15 years. I got up to 2.5 packs a day. One visit to the hypnotherapist cut it down to nihil. As a bonus, most hypnotherapy packages let you "relapse". For instance, my hypnotherapist gave me the option for up to 10 sessions, should i need them.

I'll admit, I've relapsed here and there in times of deep stress - but to cloves. Normal cigarettes still taste like absolute shit (though they used to be my delicious friends). This isn't to say I think cloves are "healthier" by any means, but I don't have the tendency to get addicted to them, cause they tend to taste terrible if smoked at any regularity.

Anyway - good luck, man. That's a tough nut to crack.
posted by revmitcz at 5:03 PM on August 25, 2008

Yeah, I can't say that doctors have much to offer for quitting smoking besides a prescription pad.

The one time I sought help from an MD I went in asking for (1) a prescription for the then Rx-only nicotine patch, (2) tranquilizers for the rough patches. That plus herbal cigarettes worked for about two weeks. I would try that combination again if I needed it, though.

I quit a couple of years ago and have nothing better to offer than that lifestyle changes with gradual tapering rather than cold turkey was what did it for me. If you smoke with your morning coffee, you might nix the morning coffee for a while, etc.
posted by kmennie at 5:09 PM on August 25, 2008

This isn't related to the doctor specifically but I know people who've found a lot of help through the book "The Easy Way to Stop Smoking" by Allen Carr. Good luck.
posted by puffl at 5:25 PM on August 25, 2008 [1 favorite]

Try reading "The Easy Way to Quit Smoking"
posted by xammerboy at 5:32 PM on August 25, 2008

I agree with xammerboy. Check out "The Easy Way To Stop Smoking" by Allen Carr. I tried all kinds of methods and this book was all it took. The great thing about his method is that he doesn't address the health aspect of smoking at all, he figures that the health concerns are pretty much common knowledge by now. What he does address are the mental crutches that smokers develop to rationalize why they need to smoke. For myself, this has ALWAYS been the biggest obstacle to quitting. I highly recommend giving this a try before spending money on expensive drugs or patches.
posted by ISeemToBeAVerb at 5:59 PM on August 25, 2008 [1 favorite]

a) When your doctors asks if you really want to quit, be completely honest with yourself. It's easy to say you want to stop for your health, or your partner, or your finances. It's easy to look for external reason to make you quit. But you really need to decide deep down that you do not want to smoke ever again, and that is smoking in no way necessary to living your life the way you want to live.
b) Nothing is going to make you not want to smoke (even hypnotherapy only emphasizes what you have already decided), but there are a lot of treatments to help take the edge off of quitting. For me acupuncture was incredibly helpful in that regard. I've heard good things about hypnotherapy as well. You'll want a good support group (tell everyone you know that you are quitting). Meds can sometimes help, but many of them have their own withdrawal process.
c) Identify your smoking habits and try to intentionally disrupt them. Consider temporarily quitting coffee and alcohol, don't over-eat, whatever normally makes you want to smoke. But be careful not to start smoking again just so you can start drinking again.
d) Exercise more, especially a couple months after quitting when you start to get your lung capacity back. Running, biking and swimming are good. Sports are good. I've never been much into any of those myself, but I took up rock climbing and hacky sack and it helped. Whatever gets your heart rate up that you enjoy doing.
posted by tweaqslug at 6:04 PM on August 25, 2008

I'd tried the gum before to no avail. But I'm going on 1 month and 1 day without a cigarette using the patches. YMMV
posted by drleary at 6:10 PM on August 25, 2008

"Do you know of any smoking cessation support groups in the area?"

I didn't go for this when I quit, but I did see the research and people who attend groups are much likelier to quit and stay quit.

(And here's my unsolicited advice: I went for the nicotine patches and gum. But the big thing that helped me quit was realising that smoking a cigarette didn't mean that I'd failed. The only real failure was if I stopped trying to quit. So there were a few very stressful days over Christmas where I was smoking a single cigarette every day and it was totally OK for me to do that. But it didn't mean my quitting attempt was over and once that stress was gone I was able to go back to zero cigarettes.)
posted by xchmp at 6:14 PM on August 25, 2008

Nicotrol Inhaler. It sits in your hand like a cigarette, you suck on it like a cigarette, it contains nicotine, but it's not a cigarette. It's the most obvious way to quit I've found because you don't have to change your behavior drastically.
posted by merocet at 6:30 PM on August 25, 2008

Can't answer the exact question, but I will offer this:

Nicotine addiction is easy to beat. The psychological addiction of smoking- the stress/reward thing, the habit thing, the cigarette-as-metronome-of-your-day thing- those are the hard part.

Here's how to quit:

1- Decide to never smoke cigarettes again, for any reason.

1b- Decide that smelling smoke and seeing other people smoking isn't a problem for you, because you don't smoke any more.

2- Use the patches. (I used the Walgreens ones to great success.)

3- While you are on the patches, you will not have any nicotine addiction to deal with. They are supplying the nicotine you are physically addicted to.

4- Huh? I still want to smoke.

5- That's all that other psychological addiction stuff.

6- That's what you deal with while you are on the patches.

7- Take as long as you need on the patches to excise all that other stuff from your life. This is hard. Every time you want to smoke, sit down and think about what triggered that craving and remember or even write it down. Next time you do that trigger thing, think about what that thing and cigarettes have to do with each other.

8- Realize that the patches may not work for exactly 24 hours as advertised, especially when you get down to the lower doses. I found that they only lasted 18 hours for me, and I adjusted my timing to account for that.

9- Not the best advice in the world, but it worked for me: when I was ready to stop with the patches, I got good and drunk and tore the patch off right before I went to bed. Woke up the next day with a hangover, but no nicotine jitters. The half-life of nicotine is so short that all the nicotine in my system was effectively gone by morning.

I don't think the gum or the inhaler are helpful, because they just substitute another thing to do when you want to smoke and continue to reinforce the stress/reward nicotine thing. To really quit smoking, you have to self-analyze yourself and, to a certain degree, rebuild your life without cigarattes in it.

(I personally had a bit of anxiety that I was self-medicating with smoking. The mere idea of not *having* cigarettes drove me nuts. So I kept a pack in a drawer. That was comforting. As was throwing them away when I didn't need them any more. And helpful because there was nothing stopping me from smoking one, except the will to quit. And the notion of my heart exploding from smoking while also on the patch.)
posted by gjc at 6:47 PM on August 25, 2008 [1 favorite]

Training now includes smoking cessation therapy which looks at triggers, what you get out of smoking, what makes you want to quit, what situations make a relapse more likely, etc. You should think hard about these: what position makes in inevitable that you must have the cigarette? Can you control/prevent them? Can you identify them as they develop and do something else? Conversely what positions can you put yourself into that make it impossible to smoke? Can you use the latter to defeat the former? If you can put a barrier which takes away the instant fix aspect, that helps. Some people who've tried and failed need to learn that a cigarette doesn't make you a smoker again; you can toss the rest of the pack and be back on the wagon. Learn from the mistake and move on.

Lots of MDs don't have/want to spend the time on this, but they should know someone who does. They also have bupropion, which helps.
posted by a robot made out of meat at 6:58 PM on August 25, 2008

I smoked for nearly 40 years.. at that point I just decided to quit... I was tired of the cost, the cough, the smell, the impact on my health and abilities..

For a week it was a pain in the ass, primarily because of the habit nature of smoking... after that, there was nothing that could have moved me to smoke again...you can do it!

Ask your doctor to help you deal with the physiological withdrawal, but draw on your own determination to just, fucking, quit...

After being free of it for nearly five years, I would never go back..!
posted by HuronBob at 8:12 PM on August 25, 2008

I quit by using a combo of Chantix and Lexapro (mild antidepressant).

The Chantix works like calomine lotion for the persistent "itch" of nicotine addiction. I took it for a full six months, along with Lexapro.

The Lexapro took just enough of the edge off so that I didn't bite the heads off of my loved ones, and didn't completely dissembowel those that I had no emotional attachment to.

Neither of these meds work on the psychological addiction. You'll have to use behavior mod techniques to substitute new healthy habits for cigs. It takes time, and discipline. Chantix and Lexapro buy you the time.

Word of caution: You will gain weight. Oh yeah.

STRONG WORD OF CAUTION: Chantix has some very unpleasant side effects for a small number of people. Check out the info carefully. I didn't have any side effects at all.

ANOTHER WORD OF CAUTION: Don't do what I did and stop taking the Lexapro cold turkey. Bad idea. Talk to your doctor and taper off very slowly.
posted by Corky at 8:28 PM on August 25, 2008

(Oh, I smoked for 40+ years...)
posted by Corky at 8:29 PM on August 25, 2008

!. (ONE) Number ONE Avoid that FIRST smoke, experience here talking. I quit for three years. i will leave out the long story. i know many people who fall for that 'one' smoke.
posted by raildr at 10:33 PM on August 25, 2008

nthing Chantix, Zyban, Wellbutrin, etc.
posted by eclectist at 1:19 AM on August 26, 2008

Chantix worked well for many people I know who said exactly what you said regarding the hold of nicotine. I tried it, but found that it interfered badly with zoloft, so I went off chantix immediately thereafter. Others have told me it interferes with medication they were taking also, so take care. However it works very well for many people so YMMV.
posted by waraw at 5:11 AM on August 26, 2008

Best advice I ever got was "NEVER quit quitting." About 30 attempts (some of them pretty feeble, I'll admit) later, I am smoke free 2 years.
posted by Spyder's Game at 1:27 PM on August 26, 2008

Late to the game, but 2nd-ing asking about support groups which can help. I quit pre-Chantix, so used nicotine patches + Wellbutrin/Zyban + nicotine gum. but, CAUTION! Check with your doc first about your patch and gum dosage, because you don't want to overdose the nicotine, esp if you have high blood pressure issues.

Also, if you're not already physically active, ask your doc if/how you can start up a workout routine. Keeps you busy, and helps offset some slowing of your metabolism/weight gain.
posted by NikitaNikita at 6:10 PM on August 26, 2008

UPDATE:

I went to see my doctor yesterday. I have gotten a year's prescription to Chantix and will pick up my starter kit and first month's dosage today. I am looking forward to this so much.
posted by parmanparman at 12:21 PM on August 27, 2008