Stop smoking How to quit for a healthy heart
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Stop smoking How to quit for a healthy heart
Stopping smoking. It may not be easy – but it is possible! People who plan and prepare to stop smoking are much more likely to be successful. The information, practical tips and questions in this guide will help you understand more about why you smoke and how you can stop smoking for good. At the British Heart Foundation (BHF) we understand that changing a long-standing habit may not be easy and have produced this interactive guide to help you succeed in stopping smoking for good. Fill in the sections as you go along. If you’re a smoker, stopping smoking is the single most important step you can take to protect the health of your heart. In this guide we talk mostly about cigarettes, but the same advice applies to all forms of tobacco and smoking – roll-ups, chewing tobacco, pipes or cigars, or shisha smoking (also known as hookahs, narghiles, hubble-bubble pipes or water pipes). This guide does not replace the advice your health professionals may give you based on their knowledge of your condition.
Contents Ten top tips 3 What makes smoking so dangerous? 5 Why it is worth stopping smoking 9 Understanding why you smoke 13 Decision time. Are you ready to stop? 16 Stop-smoking services – helping you to quit 20 Preparing to become smoke-free 23 Methods people use to stop smoking 41 Preparing for your quit date 51 Tips on managing the first week 59 What if I get tempted to smoke? 63 Achieving lasting success 71 How the British Heart Foundation can help you 74 Index 79 Contents 1
Ten top tips
● Think positive. Tell yourself – you can stop smoking.
● Contact your local NHS Stop Smoking Service for
practical help and advice from trained specialists.
● Using nicotine replacement therapy (NRT), or
a medication such as bupropion (Zyban) or
varenicline (Champix), can more than double your
chance of stopping smoking successfully. If you
take medication or NRT and also get professional
support, you are four times more likely to stay
smoke-free. (We explain more about all these
things on pages 41–49.)
● Pick a quit date that will be stress-free and stick to it.
● Avoid situations and people that might tempt you
to smoke.
● Avoid temptation. There’s no such thing as having
‘just one’ cigarette.
● Plan ahead to help you cope with stressful situations.
● Pair up with someone else who wants to stop
smoking, and support each other.
● Spend some of the money you’re saving on a well
deserved treat.
● Take it one day at a time and congratulate yourself
every day.
Ten top tips 3
What makes smoking so dangerous? Tobacco smoke contains tar, carbon monoxide, nicotine and over 4,000 chemicals. Every time you inhale, this deadly cocktail enters your lungs and goes straight into your bloodstream and body tissues. What makes smoking so dangerous? 5
Chemicals The chemicals in tobacco smoke are known to damage the lining of the coronary arteries (the arteries that supply the heart muscle with oxygen-rich blood). This damage leads to atheroma – the build-up of fatty material within the arteries, which in turn causes coronary heart disease. Tobacco smoke also makes the small particles in the blood – called platelets – more sticky, which means that the blood is more likely to form clots. Cigarette smoke contains over 60 chemicals that are known to cause various cancers. Shisha smoking (a custom of some South Asian people) is also harmful. Recent research has shown that shisha smoke contains large quantities of the chemicals that can lead to heart disease, cancer, and addiction in cigarette smokers. A shisha smoker may typically inhale as much smoke during one session as a cigarette smoker would inhale by smoking 100 or more cigarettes. Even after it has been passed through water, the smoke from a water pipe contains high levels of toxic compounds including carbon monoxide, heavy metals, and cancer-causing chemicals. Carbon monoxide Carbon monoxide is a poisonous gas and is fatal in high concentrations. It binds onto the red blood cells, reducing their ability to carry oxygen around the body and depriving the heart and body tissues of vital oxygen. Having carbon monoxide in your blood greatly increases the risk of heart disease. The good news is that, as soon as you quit smoking, your carbon monoxide level should drop dramatically. If you see an NHS Stop Smoking adviser to help you stop smoking, they will probably measure your carbon monoxide level both before and after you stop smoking, so you’ll be able to see the benefits of stopping smoking. (To find out how to contact an adviser, see pages 20 and 21.)
Tar The tar in cigarette smoke can cause cancer (most commonly lung cancer), and other serious diseases related to the lungs and airways. When you inhale, about 70 per cent of the tar stays in your lungs. Low-tar cigarettes are not safer. People who smoke ‘light’ or ‘mild’ brands are likely to inhale as much tar as smokers of regular brands. Misleading descriptions like these are now banned on cigarette packaging across Europe. There is no such thing as a ‘safe cigarette’. Nicotine Most people who smoke become dependent on the nicotine they get from cigarettes. Nicotine can raise the heart rate and blood pressure and speed up the smoker’s metabolism. Second-hand smoke Second-hand smoke – or ‘passive smoking’ – is when someone inhales other people’s smoke. Medical research shows that people who are exposed to second-hand smoke can experience: ● irritation of the eyes, nose and throat ● headaches, dizziness and sickness, and ● worsening of their asthma and allergies. Long-term exposure to second-hand smoke can also increase the risk of getting lung cancer, coronary heart disease, and problems with the lungs and airways. If you want to live a longer and healthier life, stopping smoking is the single most important thing you can do. What makes smoking so dangerous? 7
Why it is worth
stopping smoking
Facts
● Smoking is one of the major risk factors for coronary heart
disease. (A risk factor is something that increases your risk
of getting a disease.)
● 30,000 smokers die from coronary heart disease each year
in the UK.
● Smokers who have coronary heart disease have nearly twice
the risk of having a heart attack compared with people who
have never smoked.
● Stopping smoking after a heart attack reduces the risk of having
another heart attack and improves the chances of surviving
a heart attack.
● Stopping smoking before surgery, especially before heart surgery,
reduces the risk of serious complications.
● More than eight in every ten cases of lung cancer and more than
50 different serious diseases and disorders are caused by smoking.
● Smokers die, on average, about ten years younger than
non-smokers.
● Among women who take the contraceptive pill, those who smoke
are more at risk of getting diseases of the heart and circulation
than those who don’t smoke.
● Pregnant women who smoke are more likely to have underweight
or premature babies, or stillbirths. Their children are also more
likely to suffer mental and physical developmental delays up to
the age of 11.
● Smoking has been associated with increased sperm abnormalities
and is a cause of impotence.
● Smokers are more likely to develop facial wrinkles at a younger
age and to have dental hygiene problems.
Why it is worth stopping smoking 9The heart attack really scared me. It was my kids who really gave me the motivation to quit, especially as we’d had another baby after I thought the medication I was on had made me infertile. My wife Nicola and I both realised it was really important not to set the kids a bad example by smoking, so she stopped too. I feel so much better now – I can taste food and smell things properly. It’s not always been easy, but I owe it to my kids to be around to see them grow up. We’ll never go back.
The health benefits of
stopping smoking
Good news. The box below shows how your body
will benefit from stopping smoking, even if some
damage has already been done.
Time stopped Benefits
8 hours Nicotine and carbon monoxide
levels in the blood reduce by half
and oxygen levels return to normal.
The circulation improves.
24 hours Carbon monoxide and
nicotine leave the body.
48 hours The ability to taste and smell improves.
3 to 9 months Coughing and wheezing decline.
1 year The risk of having a heart attack reduces
by half compared to that of a smoker.
10 years The risk of lung cancer falls to
about half that of a smoker.
15 years The risk of having a heart attack falls
to the same as someone who has
never smoked.
Why it is worth stopping smoking 11Understanding why
you smoke
Think about why you first started smoking.
Fill in the box below.
Tick the Tick those
reasons reasons that
why you still apply
first started
smoking
Peer pressure
To look ‘cool’ or sophisticated
To rebel
To be accepted
To show my independence
It made me feel confident
Curiosity
Family or friends all smoke
Other reasons
Understanding why you smoke 13List any times when the need to smoke has been inconvenient for you. For example: when having a meal out, or at the cinema, or when visiting non-smokers. Next, find out how much you have spent supporting your smoking habit. You might be in for a big surprise. How much does one week’s supply of tobacco cost? £ Multiply this weekly amount by 52 to get the cost for a year. In a year I will spend this amount on tobacco: £ The total amount of money I’ve spent on tobacco in my lifetime is probably £ If you stop smoking now, what else could you spend this money on? For example: a family holiday, a car, or the mortgage. Understanding why you smoke 15
Decision time. Are you ready to stop? Think about the advantages and disadvantages of stopping smoking. Fill in your answers on pages 17 and 19.
What I enjoy about smoking
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Why I want to stop smoking
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Read through your answers.
Are you ready to make a serious attempt to stop smoking?
Yes No Maybe
Understanding why you smoke 17I started smoking in my teens, when no-one knew it was bad for your health. When I tried to quit, nothing seemed to work, even though I felt guilty about exposing my family to my smoke and being a bad role model to the youngsters I worked with. About a year ago I signed up for NHS Smokefree, and with the support of my family and fellow quitters, I finally succeeded. I’m a changed man – and I’ve put the money I’ve saved towards founding an orphanage in Bangladesh. A lot of our community have died from smoking. I chose not to be one of them.
If your answer is ‘Yes’ Congratulations and good luck! If your answer is ‘No’ Try to answer this question honestly: What would have to happen, to make me want to stop smoking? For example: having a heart attack, cancer, no money saved, clothes smelling. If your answer is ‘Maybe’ It would be a good idea to talk through your specific situation with a professional stop-smoking adviser. See pages 20 and 21 for how to contact one. Understanding why you smoke 19
Stop-smoking services – helping you to quit NHS Stop Smoking Services Stop-smoking groups and one-to-one support Research shows that getting professional help (for example, in a stop-smoking group or one-to-one with a stop-smoking adviser) doubles your chance of quitting. There is a comprehensive network of free NHS Stop Smoking Services providing counselling and support to anyone who wants to quit smoking. To find your nearest service, call the free NHS Smoking Helpline on 0800 022 4 332 or visit www.smokefree.nhs.uk You can go to group support sessions or, in some areas of the UK, you can have one-to-one support. Going to a group can help you to feel less alone in your attempt to quit. Being with other people who are also stopping can provide you with all-important support, a sense of being understood, and some friendly competition! Groups are usually run over a period of about six weeks and take you through the different stages of stopping. To find out more, call 0800 022 4 332 or visit www.smokefree.nhs.uk National stop-smoking helplines and websites Calls to these helplines are free from a land line, but not from a mobile phone. England 0800 022 4 332 Lines are open daily, from 7am to 11pm, with specialist advisers available from 10am to 1pm. www.smokefree.nhs.uk Northern Ireland 0800 85 85 85 Lines are open daily, from 12 midday to 7pm. www.spacetobreathe.org.uk Scotland 0800 84 84 84 Lines are open daily, from 12 midday to 12 midnight. www.canstopsmoking.com Wales 0800 085 2219 Lines are open daily, from 12 midday to 12 midnight. www.stopsmokingwales.com
Other helplines and websites The following helplines can offer information and advice on stopping smoking, and support for people who are finding it hard to stop. Calls to these helplines are free from a land line, but not from a mobile phone. BHF Smoking Helpline 0800 169 1900 Lines are open daily, from 7am to 11pm. bhf.org.uk/smoking Quitline® 0800 00 22 00 Lines are open daily, from 9am to 9pm. www.quit.org.uk QUIT also offers the following language helplines: Arabic 0800 16 91 300 Saturdays 1pm to 9pm Bengali 0800 00 22 44 Mondays 1pm to 9pm Gujarati 0800 00 22 55 Tuesdays 1pm to 9pm Hindi 0800 00 22 66 Wednesdays 1pm to 9pm Punjabi 0800 00 22 77 Thursdays 1pm to 9pm Urdu 0800 00 22 88 Sundays 1pm to 9pm Action on Smoking and Health (ASH) www.ash.org.uk No Smoking Day No Smoking Day is the UK’s leading health campaign for smokers who want to stop. Their website has information and resources to help you stop smoking. www.nosmokingday.org.uk Stop-smoking services – helping you to quit 21
Preparing to become smoke-free If you have been smoking for a long time, by now you will have many daily routines and habits associated with using tobacco. It’s a good idea to become aware of these patterns before you stop smoking, so they don’t catch you unawares after you have stopped. You may find you smoke at certain times each day due to ‘habit’ rather than a craving. Stopping will be easier if you have taken the time to work out some different ways to cope with these triggers. Here we help you analyse the different times when, and the reasons why, you smoke. Preparing to become smoke-free 23
Below are some common prompts to lighting up. Tick which ones apply to you. When I wake up in the morning At work breaks While watching television After finishing a meal While talking on the phone At social events, parties or meals out During arguments At times of personal crisis When working under pressure When I’m with people who smoke When I’m having a drink Others
Now decide on some different things you could do at these times. And try to practise them before your quit date. Possible replacements for lighting up Go for a short walk. Do a word search or a dot-to-dot puzzle. Call a friend for a chat. Take a few long, slow, deep breaths. Sip some water. Use a strong mouthwash. Your ideas Preparing to become smoke-free 25
Smoking patterns. Keep a record Keep a record, below, of each cigarette you smoke over the next few days. Understanding when, where, and why you smoke will help you plan what you need to do differently during your first smoke-free week. Write down each time you smoke and the reason why. Think about what you can do instead when you stop smoking. List all your ideas in the last column. When you’ve finished filling in your smoking record, you will have lots of information about your personal smoking habits and preferences. You’ll be able to see which cigarettes you’ll miss and, more importantly, which cigarettes you can do without. Perhaps you can start to cut out the ones which are least important to you. This will get you off to a great start. (Remember that you are more likely to succeed if you use nicotine replacement therapy – see pages 44-47.) Does anything in your smoking record surprise you?
My smoking record
The times when Instead of smoking
on a scale of 1-5?
is this cigarette
How important
I smoke I could:
1 = Not very important > 5 = Essential
Preparing to become smoke-free 27Learning from past experiences Lots of people make five to six attempts to stop smoking before they eventually succeed. If you have tried to stop before, don’t let this put you off trying again. This exercise helps you remember what worked or didn’t work last time, and will help you learn from and build on your experiences.
Times I’ve given up How long I stayed stopped smoking before 1. 2. 3. 4. 5. Thinking about the times you stopped in the past, how did you do it? Which strategies were the most successful? List your answers below. What helped me to What things got in my way? stay stopped? Preparing to become smoke-free 29
How did you cope physically during the time that you were off tobacco? Does anything from your past experience of stopping smoking concern you about your next quit attempt? If so, what is it? Is stress one of your concerns? Yes No If your answer is ‘Yes’. Lots of people think tobacco helps them relax and cope with stress, but in fact this is not true. Most smokers are caught in a trap. Nicotine is highly addictive. When they inhale they get a ‘hit’ from the nicotine and feel a rush of adrenaline which makes them ‘feel good’. Unfortunately the ‘positive’ effects of nicotine only last a short while. When they wear off, the smoker can start to feel ‘withdrawal symptoms’ – such as irritation, and tension building up in their body – and they interpret these as stress. To reduce the build-up of these stressful feelings, a smoker will light up another cigarette. So round and round it goes, becoming a vicious circle. Trying to make time and find places to smoke – especially now that public places in the UK are all smoke-free – can also cause stressful feelings. Stop and think about just how much of your time has been taken up by the need to have a nicotine fix. Preparing to become smoke-free 31
My current thoughts about stopping You can adapt these questions if you smoke a pipe or cigars rather than cigarettes. I started smoking when I was years old. I’ve now been smoking for years. Currently I smoke cigarettes a day. I have probably smoked cigarettes in my life. I spend up to £ a week on cigarettes. My reason for being a smoker is: I’d like to quit smoking because: I am thinking of stopping on: (add date) When I have stopped, I hope to feel: One thing I will no longer have to worry about is: The people who will be really pleased with me are: I will be proud with myself because: It will be worth the effort because: Preparing to become smoke-free 33
Preparing yourself for possible withdrawal symptoms Many smokers experience problems when trying to quit. One of the main reasons why stopping smoking is difficult is because the body craves the nicotine it used to get from cigarettes. These strong feelings make people feel irritable and anxious. When you are trying something for the first time, any unexpected symptoms can be frightening. It’s important to be prepared for the withdrawal symptoms and understand how to manage them. Otherwise, you may fall into the trap of thinking that returning to smoking is the only way to ‘fix’ the problem. Using a stop-smoking treatment will greatly reduce the withdrawal symptoms and double your chance of successfully stopping smoking. (For information on these treatments, see pages 41–49.) When you stop smoking, it is likely that you will experience some strong physical, emotional and psychological changes. These symptoms are caused by nicotine leaving the body and are different for each person. They are positive signals that your body is starting to repair itself and that the recovery process has begun. Preparing to become smoke-free 35
We describe and explain some of these below, and
suggest some ways of coping with them.
Withdrawal How it feels and Ways to cope –
symptom what causes it try these simple
practical tips.
Craving An intense desire Take a few long,
to smoke, which slow, deep breaths.
becomes less frequent Drink a glass of water.
over the first four Glucose tablets
weeks. The craving is can help too.
mainly caused by the
withdrawal of nicotine.
Coughing This is often worse in A warm drink can
the beginning. It is ease the cough.
caused by the body Remind yourself that
clearing out the tar a cough is a good
from your lungs. sign, as it shows your
lungs are recovering.
Hunger You may feel extremely Keep a ‘survival kit’ of
hungry. This is due fruit, healthy snacks or
to changes in your chewing gum with you.
metabolism, and the Drink extra water.
fact that food tastes
better once you have
stopped smoking.
Changes in You may get Drink more clear fluids.
bowel constipation or Take more physical
movement diarrhoea. activity.
If you get constipated,
change your diet to
include more fruit
and fibre.
See your GP if you’re
concerned.Disturbed You may find that Doing more physical
sleep your normal sleeping activity may help
pattern is disturbed. you to sleep better.
It should get back to Try to get some exercise
normal within a month. in the fresh air.
The sleep disturbance Cut down on stimulants
is caused by the such as coffee, tea
nicotine leaving your or cola drinks.
body. However, some
people find that they
sleep much better after
stopping smoking.
Dizziness You may occasionally If you have a dizzy
feel dizzy in the spell, sit down and
first few days after drink some water.
stopping smoking. This
happens when more
oxygen starts getting
to your brain instead
of carbon monoxide.
This is a positive
sign. Your body will
soon adjust and the
dizziness usually
passes after a few days.
Mood These are emotional Try to figure out some
swings, signs of nicotine coping mechanisms
inability to withdrawal, and show that work for you.
concentrate, that your body is Warn your family and
or feeling missing the chemicals friends that you might
irritable and stimulation get these withdrawal
of smoking. symptoms, and ask
for their support – but
don’t let them persuade
you to have a cigarette!
Preparing to become smoke-free 37Diet and physical activity
Will I put on weight?
Many people who want to stop smoking are concerned about the
possibility of putting on weight. Most smokers will put on some
weight when they quit smoking. However, compared with the risk of
continuing to smoke, putting on some extra weight is a very minor
health risk.
Some people put off the decision to quit smoking because they
worry about gaining weight. But the single biggest danger to your
future health comes undoubtedly from carrying on smoking.
Why people can put on weight when they stop smoking
● Nicotine use has suppressed their natural appetite and
increased their metabolism.
● They find that food tastes better after they quit smoking,
and so they eat more.
● They replace cigarettes with snacks and sweets, or eat more
than they used to.
To avoid putting on weight after you stop smoking, try to keep to
your normal diet and avoid high-calorie or fried foods. You are less
likely to put on weight if you eat a balanced diet from the beginning
and avoid starting new habits.
Tip
To avoid putting on extra weight, imagine yourself at your
ideal weight. Each time you are choosing what to eat, ask
yourself “Will eating this help or hinder me in keeping
to my current weight?” Keep a range of healthy snacks
within reach so that, when the desire to eat strikes, you
can grab something tasty that won’t cause weight gain.The hard facts A small amount of weight gain is a minor health risk compared with the risks of continuing smoking. If you eat healthily and keep physically active, you are unlikely to put on too much extra weight. Once you have stopped smoking for a while, hopefully you will find it easier to lose any extra weight. Can physical activity help? Stopping smoking can slow down your body’s metabolism, so it’s very important to do some form of regular physical activity. Physical activity has also been shown to reduce the body’s cravings for nicotine and has the additional benefits of reducing stress and low moods and improving your fitness. Thirty minutes’ moderate-intensity activity a day will help to keep the extra pounds off and improve your fitness level. (Moderate-intensity activity means working hard enough to make you breathe more heavily than normal and become slightly warmer than usual.) If you’re not used to doing much physical activity, phase it in slowly – for example, by having two 15-minute walks. You don’t have to join a gym to get the benefits. Building physical activity into your everyday life, such as walking, will be as effective. Add variety to your route and, as you get used to this level of activity, try to walk more. Walking will clear your mind and help you feel more positive. If you have a heart condition or high blood pressure, or if you are taking medication for these conditions, check with your doctor before you start any new activity. Preparing to become smoke-free 39
Methods people use to stop smoking If you have tried to stop smoking before and have started smoking again, it is vital to keep trying. Many people are not successful the first time. Fortunately there are many things you can do to increase your chances of becoming an ex-smoker. Methods people use to stop smoking 41
People use a variety of methods to quit smoking. Some people stop smoking completely. Others try to cut down gradually and then stop. There is now a wide variety of medical products available to help people stop. And across the country there are stop-smoking services offering one-to-one or group sessions, as well as free telephone helplines and websites (see pages 20 and 21). Research shows that the people who are most likely to stop smoking successfully are those who use a stop-smoking treatment and also get professional support. Professional support includes, for example, using one-to-one support from a stop-smoking adviser, or going to a stop-smoking group. We explain more about these in this section.
Cold turkey The phrase ‘going cold turkey’ means abruptly stopping smoking. In other words, if you smoke a pack of cigarettes today, you are ‘going cold turkey’ if, from tomorrow, you smoke none at all. If you have tried this method but are still smoking, don’t let this put you off trying again. Try stopping smoking again, but this time ask your doctor or pharmacist about medical products that can help you as well as getting some professional support. (See Licensed medical products on pages 44–49.) Cutting down This means reducing the number of cigarettes you smoke over a period of time. If you want to try cutting down, it is important that, each week, you set yourself a definite goal for the number of cigarettes you will cut down to. It’s also important to set an eventual quit date, after which you will not smoke at all. If you plan to stop smoking by cutting down, you are much more likely to be successful in stopping smoking if you use a nicotine replacement product while you are cutting down, to help you manage the cravings and reduce the withdrawal symptoms. We explain more about these products on pages 44–47. Methods people use to stop smoking 43
Licensed medical products There are two types of licensed medical products which can help people stop smoking: Nicotine replacement therapy, or NRT for short. There are several forms of nicotine replacement available – gum, patches, microtabs, lozenges, nasal spray and inhalator. These products are all available on prescription. You can also buy them over the counter from pharmacists, and many types are available from supermarkets and retail outlets. Non-nicotine treatments. These are medicines that do not contain nicotine. They include bupropion (trade name Zyban) and varenicline (trade name Champix). These are only available on prescription. These products have been proven to greatly reduce the symptoms of withdrawal. Ask your doctor, pharmacist or local stop-smoking service for information on which type will best suit you and your medical condition. Nicotine replacement therapy (NRT) How does nicotine replacement therapy (NRT) work? Nicotine replacement therapy acts by providing a ‘clean’ alternative source of nicotine that the smoker would otherwise have received from tobacco. NRT provides nicotine in a slower and less satisfying – but safer and less addictive – way than cigarettes. It has been shown to double a person’s chance of successfully stopping smoking. Unlike tobacco smoke, NRT does not contain tar or carbon monoxide. Most people, including those who have a history of heart disease, can normally use NRT products safely. However, if you have had a heart attack or stroke within the past few weeks, or if you have unstable angina, or if you are taking medication for a problem with your heart or circulation, you must ask your GP or cardiologist (heart specialist) about when you can start using NRT. Pregnant women can also use NRT, but you should check with your GP or pharmacist before starting it. All forms of NRT are equally effective as each other, so you can make a personal choice of which one to use. It is important to follow the manufacturer’s recommendations. For your best chance of success, make sure you take the full course, and don’t try to under-dose yourself.
Nicotine gum Comes in 2mg and 4mg doses. Nicotine is absorbed through the lining of your mouth when you chew the gum. A chew-rest-chew technique is best, because any nicotine you swallow is wasted. Leave the gum in your cheek between chews. People who smoke more than 20 cigarettes a day should start on the 4mg dose. People who smoke less than 10 cigarettes a day should start on the 2mg dose. You can use up to 15 pieces of gum a day. Nicotine patches Comes in 16-hour and 24-hour patches. A 12-week course. Nicotine patches give you a constant supply of nicotine while you wear them. Apply one new patch each day to any non-hairy part of the body. To help prevent any skin irritation, put the patch on a different place each day. Patches are suitable for people who smoke more than 10 cigarettes a day. People who smoke within half an hour of waking up should use the 24-hour patches. The patches come in several strengths – from 25mg to 5mg – so that you can gradually reduce the dose over the 12-week course. Microtabs 2mg nicotine-based sub-lingual tablet (‘Sub-lingual’ means under the tongue.) You place the microtab under your tongue, where it slowly dissolves, and the nicotine is absorbed through the lining of your mouth. You should not suck, chew or swallow the microtab, as this will reduce the amount of nicotine you get from it. You can use up to one microtab per hour. (However, if your craving to smoke is very strong, you can use two tablets at a time to start with, and reduce this to one tablet as the craving becomes less strong). You should use no more than 20 tablets in any one day. Nicotine lozenges The nicotine lozenge is like a sweet that you suck slowly. As it dissolves, it releases nicotine. You must not crunch or chew it, but instead allow it to dissolve slowly in your mouth. Any nicotine that you swallow is wasted and can cause some indigestion. You should use no more than 15 lozenges in any one day. Methods people use to stop smoking 45
Nicotine nasal spray A 12-week course Nicotine nasal spray is the strongest form of NRT available. Nicotine taken in this way gets absorbed fast, so the nasal spray is especially suitable for people who are heavy smokers. It also helps people who get severe withdrawal symptoms. The spray can irritate the nose at first, but this passes after a day or two. For this reason, don’t use the spray while you’re driving or operating heavy machinery. You can use up to two doses an hour. (One spray is one dose.) The amount used is normally reduced over the 12-week course. Nicotine inhalator The nicotine inhalator is a plastic device, shaped like a cigarette holder, into which a nicotine cartridge is fitted. Sucking on the mouthpiece releases a nicotine vapour, which gets absorbed through your mouth and throat. Inhalators are preferred by people who miss the hand-to-mouth action of smoking. You should suck on the inhalator for 20 minutes each hour. After three 20-minute sessions, the cartridge will need to be changed. An average smoker uses three to six cartridges a day. Nicotine replacement therapy – questions and answers Aren’t NRT products as dangerous as smoking cigarettes? Compared with smoking, NRT products are very safe. They don’t cause cancer or heart disease. Damage to the health of a smoker is caused by the tar, carbon monoxide, and chemical compounds found in cigarette smoke, and you get none of these if you use NRT. There is no evidence that NRT increases the risk of heart attacks. Ask your GP for advice on which is the best nicotine replacement product for you to use. Can I use NRT to cut down on smoking rather than to stop altogether? Smokers who are not ready to stop completely can use nicotine gum, microtabs, lozenges, nasal spray, or the inhalator (but not nicotine patches) to help them cut down their cigarette consumption. The evidence shows that using NRT in this way can increase people’s confidence to stop smoking altogether.
Won’t using NRT just keep me craving nicotine? No. The amount of nicotine that you get from NRT is just enough to beat the craving to smoke, but not enough to keep you addicted. By following the step-down plan that the manufacturers recommend, your body learns to reduce your nicotine intake until you no longer need it. NRT is not a replacement for will power, but it helps you manage the physical changes that are going on in your body. The best way to use NRT is to combine it with structured support – the sort that you can get from your local NHS Stop Smoking Service (see page 20). I have coronary heart disease and I get angina. I’ve been told it’s OK to use NRT. Is that true? If you are taking medicines for any condition, but particularly if you have heart disease, you should always speak to your doctor, pharmacist or a trained stop-smoking adviser before taking NRT. Although it is usually safe to take NRT with other medicines, NRT itself can cause your heart rate to increase. However, taking NRT is better for you than smoking cigarettes, because of all the other harmful chemicals they contain. Getting expert advice means you will be given the NRT that is most suited to your condition. I have recently had a heart attack. Can I use NRT? It is advisable not to use NRT for the first month after a heart attack unless your doctor specifically prescribes it for you. You can use it after the first month, but you should check with your GP or cardiologist (heart specialist) before you start using it. Is it OK to use two NRT products together? Yes. You can use more than one form of NRT at the same time. For example, you might want to wear a nicotine patch to provide a steady delivery of nicotine, and combine this with an oral product, such as the nicotine gum, microtab, lozenge or inhalator. Using a combination of two NRT products in this way can give relief from any breakthrough urges or cravings that may arise during the day. I’m worried about putting on weight. Will NRT help? People can put on weight when they stop smoking, because nicotine suppresses your natural appetite and makes your body burn calories faster. NRT products provide you with some nicotine, so this will help you to keep your weight under control while you’re taking the NRT. For more on controlling your weight, see pages 38 and 39. Methods people use to stop smoking 47
Non-nicotine treatments There are two medicines which do not contain nicotine and which have been licensed to help people stop smoking. They are: ● bupropion – trade name Zyban, and ● varenicline – trade name Champix. Using one of these medications can more than double your chance of stopping smoking. Bupropion (Zyban) A two month course Bupropion is a non-nicotine treatment licensed to help smokers who are motivated to quit. Bupropion works directly on the brain to help reduce the cravings for cigarettes and the withdrawal symptoms associated with quitting. Bupropion is only available on prescription. It comes in tablet form and a full course lasts two months. Smokers should start taking bupropion while they are still smoking, and set a date for quitting during the second week of treatment – for example, on day 8 of taking the tablets. Tablets are usually taken once a day for the first six days, and then twice a day – one in the morning and one in the evening – for the rest of the two-month treatment course. As with any medicine, some people may get side effects while taking bupropion. The most common ones are difficulty sleeping, a dry mouth and headache. These side effects are usually mild and generally disappear within the first few weeks. Many of these effects can also be due to your body adjusting to being without nicotine. Bupropion is not suitable for some people. You should not take it if you suffer or have ever suffered from seizures (fits) or eating disorders. Before starting on bupropion, your doctor will need to check your full medical history. Bupropion is a safe medication when it is prescribed appropriately.
Varenicline (Champix) Usually taken as a 12-week course Varenicline is a prescription-only tablet, specifically developed as a stop-smoking medication. People usually take it as a 12-week treatment course, but if you feel vulnerable to relapse you can take it for longer. The most common side effect is mild or moderate nausea, which subsides over time. If you are taking varenicline, you should not drive until you are sure that it does not affect your driving ability. You can’t use varenicline if you are pregnant or if you are under 18. If you have suffered from mental illness in the past, you should discuss with your GP whether you should start taking this medication. Varenicline use has been linked to depression and suicidal thoughts. You should stop taking varenicline immediately if you or your family notice that you become agitated or depressed, or if there are changes in behaviour that are of concern to you or your family. Alternative therapies Some people claim to be helped by alternative therapies. However, the effectiveness of alternative therapies remains unproven. The two most popular forms are hypnotherapy and acupuncture. If you decide to try alternative therapy, it is important to find a registered practitioner. Contact one of the organisations below. They can both offer information on the services available and details of local practitioners. Institute for Complementary The British Complementary and Natural Medicine Medicine Association Can-Mezzanine PO Box 5122 32-36 Loman Street Bournemouth BH8 0WG London SE1 0EH Phone: 0845 345 5977 Phone: 0207 922 7980 www.bcma.co.uk www.i-c-m.org.uk The British Heart Foundation will not accept responsibility for referrals or advice offered by either of these organisations. You are strongly advised to satisfy yourself about the competence, registration, insurance and background of any complementary therapists. Methods people use to stop smoking 49
Preparing for your quit date When you stop smoking, it is really important to have a clear plan of action. If you know what you are going to do from the beginning, you are less likely to get caught out. Preparing for your quit date 51
Fill in this page using the information on pages 23–39 and record your ideas and plans. My quit date is: I have chosen it because: The people who are going to support me are: My emergency ‘phone a friend’ numbers are: I am going to tackle my withdrawal symptoms by: (See pages 35–37.) If I get tempted to smoke I will distract myself by: (See page 25.) Preparing for your quit date 53
It was one of the biggest decisions of my life, especially because two years after I’d stopped I was allowed to have a gastric bypass which would have been too risky if I was still smoking. I’ve lost eight stone and feeling healthier has helped me to exercise properly and lose more weight. I do more walking and climb hills I would never have managed before. We’ve even saved money on our home and life insurance now I’m a non-smoker!
These are the rewards or treats I will give myself After 1 day After 1 week After 1 month After 3 months At my 1 year anniversary Tip for success Saying NO to cigarettes During the first week you will be aware of your decision to stop smoking on almost an hour-by-hour basis. You may also have to battle against any ‘little ideas’ that pop into your head about how nice it might be to smoke again and how just one couldn’t hurt. This takes will power. It is really important to recognise that, even if you have ‘just one’ cigarette, this feeds the nicotine addiction and within a few hours you will be back in the same place, except that this time you will be smoking. You have set a goal to stop smoking. You can do it. In the days ahead it will get easier, but if you give in at this stage, you will have to go right back to the beginning and start again. I will respond to the urge to smoke by telling myself: Preparing for your quit date 55
The stop-smoking contract You can adapt this contract if you use a different form of smoking to cigarettes. I (add name) have decided to stop smoking. I am going to commit myself to the following actions I will stop smoking on (add your quit date) After this date, I will never accept another cigarette. I will tell my family, friends and work colleagues of my decision. After stopping, I will never buy another cigarette. Signed Witnessed by Witnessed by Witnessed by 57
Tips on managing the first week When you stop using tobacco, be prepared to make changes in both the way you think and the way you act. Tick those changes that you will be able to make. Tips on managing the first week 59
Remove as many Coping with the urge to smoke:
temptations as possible: Remember that each craving
Plan to keep your quit day to smoke will pass in a few
as stress-free as you can minutes.
make it. Try to sit still for a few
Don’t keep any cigarettes, moments and take slow
chewing tobacco or loose breaths in and out.
tobacco near you. Talk about these feelings
Get rid of all ‘smoke with someone you trust.
reminders’ such as ashtrays Change the way you
and lighters. think about smoking:
Enlist support from Recognise that smoking ‘just
people around you: one’ cigarette will undo all
Talk to an ex-smoker. Find your work.
out how they stopped. If they Take the process one day at
did, so can you. a time. Don’t worry about
Talk to a friend or family tomorrow or next week.
member about stopping. Today is happening now.
Explain how important it Remind yourself why you
is to you. decided to stop and the
Find a friend or relative amazing benefits.
who also wants to quit and Remember that you are
support each other. choosing not to smoke.
Change your usual routine: No-one is making you do
Keep yourself busy. Begin a anything.
project, or finish something Develop healthy habits:
you have been putting off. Limit or avoid coffee and
Avoid standing in areas other caffeinated drinks.
where smokers meet to have Reduce or avoid
a smoke, either at work or alcoholic drinks.
when you are out socially.
Drink lots of water each day,
Get outside and take a walk to help remove the toxins
in the fresh air as often as from your system.
you can.
Avoid sugary sweets or
snacks. Choose fruit or
sugarless gum instead.
Tips on managing the first week 61What if I get tempted to smoke? Some people find it difficult to be successful in stopping smoking for good. Even with all the expert help and support on offer, there may be times when you feel really tempted to use tobacco again. What if I get tempted to smoke? 63
Here are some of the most common reasons
people have given for their relapse:
● They were not aware of their ‘triggers’ for
smoking and got caught out.
● They didn’t have an alternative strategy when
they got tempted.
● They didn’t seek professional advice to help
them stop.
● They didn’t find an alternative means of
handling pressure.
● They thought they could have ‘just one’ cigarette.
● They went through a ‘bad patch’ and smoking
seemed the answer.
● They found it difficult to cope with weight gain.
● They still thought of themselves as smokers.You may have already learnt a great deal from your past attempts
to stop smoking. If so, this will make it easier to spot situations which
could make you relapse. There are some obvious ‘danger’ situations.
You know yourself better than anyone else. So think ahead about
which situations are likely to tempt you. Fill in the chart below,
and be realistic about your answers.
Situations that are What I will do immediately
likely to tempt me if I light up or if I am
tempted to light up:
My main reason for stopping smoking is:
Remember that stopping smoking will:
● reduce your chances of developing cancer and coronary
heart disease
● increase the oxygen supply to your heart and help you breathe
more easily
● help you cope better with sudden exertion, like running for a bus
● increase your chances of living a longer and healthier life.
What if I get tempted to smoke? 65Prevention strategies Most smokers are well aware of their tobacco ‘hot spots’ – the times when they feel most tempted to smoke. Sometimes, people look for an excuse to start again, especially if staying stopped is becoming difficult. People who smoke are famous for ‘setting up’ a situation to give them a ‘good excuse’ to light up. The next exercise will help you assess your chances of relapse and help you avoid any self-sabotaging thoughts.
Answer the following questions honestly. What would I gain from starting smoking again? If I’m honest, the things I need to be concerned about are: I plan to manage these concerns by: I can ask the following people to help me by: My strategy to avoid getting caught out is: What I need to say to myself if I ever consider smoking again What if I get tempted to smoke? 67
Slipped up? Getting back on track
Life isn’t always fair and may not respect the fact
that you are in the process of doing something really
important for yourself. Due to past conditioning, you
may accidentally respond to a situation with an old
instinct and have an urge to smoke. If you follow this
‘gut reaction’ and give in, the ‘urge to smoke’ will
come back within a couple of hours.
Learning any new skill can take practice. If you do
light up and smoke, try following these steps:
1. Remind yourself why you wanted to stop.
● Speak to someone you trust, to help you get back
on track.
● Change your surroundings to leave the situation.
● Go outside for a brisk walk.
● Throw away any remaining tobacco or cigarettes.
2. Think about the experience.
● What happened that led up to this lapse?
● Where were you?
● Who were you with?
● What were you doing/feeling/thinking?
3. Think about how you felt when you lapsed.
● What was it like when you smoked again?
● Did it match your expectations?
● Did you feel better, or worse?
● Did it make the problem go away?
● Can you now find another way to cope?4. Decide! Think of all your reasons for not smoking and imagine yourself handling this situation again, but this time without a cigarette. If the same situation arises again, how will you handle the problem? 5. Don’t feel guilty! Learn from the lapse and let it go. People make mistakes. Don’t let a mistake lead you to give up trying. Remember that you haven’t failed. You just need more time to succeed. You can do it! 6. Contact your stop-smoking adviser. Finally, think of three or more qualities about yourself that you expect to improve by stopping smoking. (For example, you will be able to see yourself as smoke-free, healthier and more in control of your life.) Focus on how good you will feel to have managed the change. What if I get tempted to smoke? 69
Achieving lasting success As time passes it’s possible to forget the effort you put into stopping the smoking habit. Breaking an addiction is something to be proud of. You really deserve lots of support and congratulations. If you can do this, doesn’t it make you wonder what else you can achieve? Achieving lasting success 71
This exercise is designed to help you take stock of where you are now and build on your learning and success. My effort to stop smoking was worthwhile because: Since I stopped smoking my life has changed in the following ways: I can now look forward to: What does successfully stopping smoking say about me? The qualities and strengths that have helped me stop smoking are: If I can stop smoking, I should also be able to: Achieving lasting success 73
How the British Heart Foundation can help you We are the nation’s heart charity, dedicated to saving lives through pioneering research, patient care, campaigning for change, and providing vital information. You might find some of the following resources helpful: Booklets Our heart health catalogue For you, for family and friends, for health professionals Get active, stay active Enjoy being active and keep your heart healthy Be active for life Over 50? Keep your heart healthy with physical activity Physical activity and your heart For people who have a heart condition or are at risk of developing heart disease Put your heart into walking It’s easy, it’s free, it’s great for your heart Coping with stress How to manage stress and help your heart Take control of your weight Safe ways to lose weight for heart health Eating well How to keep food fun and good for your heart Cut down on salt It’s easy to do and good for your heart
DVD
Risking it
This DVD follows five ordinary people, all of whom have one or more
risk factors for coronary heart disease. They have decided to start
taking responsibility for their health and take positive action.
For information on other BHF booklets and DVDs ask for a copy
of Our heart health catalogue.
How to order our resources
To order any of our booklets or DVDs:
● call the BHF Orderline on 0870 600 6566
● email orderline@bhf.org.uk
● visit bhf.org.uk/publications
You can also download many of our publications from our website.
Our booklets are free of charge, but we would welcome a donation
so we can continue our vital work. (Turn the page to see how you can
make a donation.)
Heart Matters
Heart Matters is our free, personalised service to help you live
with a healthy heart. Join Heart Matters today to access benefits
including heart matters magazine, a HelpLine and an online
members’ area with recipes, articles and lifestyle tools. Register
online at bhf.org.uk/heartmatters or call 0300 330 3300
(calls are charged at a similar cost to 01 or 02 numbers).
How the British Heart Foundation can help you 75We need your help…
to continue our life-saving work
As a charity we rely on the generosity of people like
you to fund our vital work. Thousands of people with
heart disease turn to us for help every year and even
more will need us in the future. We want to be there
for them.
Please donate today and together we can beat
heart disease for good.
If you would like to make a donation:
● please call our donation hotline on 0300 330 3322,
● contact us through our website at bhf.org.uk/donate
● or fill in the form on the next page and post it to us at the
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Other ways you can help
There are many other ways you can play a crucial role
in our efforts to beat heart disease:
● Become a volunteer and help run our shops, events or
services for local communities. To find out more, call
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● Have fun on a sponsored run, bike ride or walk. For more
on this, call 0844 477 1181 or visit bhf.org.uk/events
● Join our Heartstart initiative and learn to save lives with the
skills of emergency life support. Over 2.3 million people already
have. For more information contact heartstart@bhf.org.uk
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Index
activity ............................................ 39 hypnotherapy .................................. 49
acupuncture . ................................... 49 inhalator .......................................... 46
advisers . ..................................... 20–21 irritability ......................................... 37
alternative therapies ......................... 49 lozenges .......................................... 45
benefits of stopping smoking . .......... 11 microtabs . ....................................... 45
bupropion . ...................................... 48 mood swings . .................................. 37
carbon monoxide ............................... 6 nasal spray ....................................... 46
Champix .......................................... 49 nicotine . ............................................ 7
chemicals ........................................... 6 passive smoking ................................. 7
constipation ..................................... 36 patches ............................................ 45
contract: stop smoking contract ........ 57 physical activity . .............................. 39
cost of smoking ................................ 15 quit date ..................................... 51–57
coughing ......................................... 36 record: smoking record ..................... 27
counsellor ................................... 20–21 relapse ....................................... 63–69
craving . ........................................... 36 second-hand smoke ........................... 7
cutting down . .................................. 43 tar . .................................................... 7
diarrhoea ......................................... 36 varenicline ....................................... 49
diet .................................................. 38 weight ....................................... 38–39
gum . ............................................... 45 withdrawal symptoms ................. 35–37
helplines ..................................... 20–21 Zyban .............................................. 48
Have your say
hunger . ........................................... 36
Index 79You can also read
