Stop smoking (smoking cessation)

What is it about ?

Most smokers have some form of tobacco addiction. This dependence is at the same time physical, psychological and behavioral. It is therefore not always easy to quit smoking. The physical dependence is due to nicotine and acts on two levels: on the one hand, the fact of smoking provides a feeling of well-being, which encourages the smoker to continue smoking (positive reinforcement) and, on the other hand, quitting is accompanied by unpleasant sensations, which causes the smoker to continue smoking (negative reinforcement). The establishment of habits reinforces smoking behavior. It is estimated that around seven in ten smokers would like to quit. To do this, 3 to 4 attempts are usually necessary.

Some numbers

Each year, smoking is the cause of around 20,000 premature deaths in Belgium. The survey carried out in 2004 by the CRIOC (Center for Research and Information of Consumer Organizations) shows that 27 Belgians out of 100 smoke every day (30 men out of 100 and 25 women out of 100) and that 6 out of 100 smokers are occasional smokers. For every 100 deaths, 14 are caused by smoking-related illnesses; For every 100 smokers who die, 50 have died from the consequences of smoking. Studies show in black and white that quitting smoking dramatically decreases the mortality and risks associated with smoking. The health benefits of this stop are felt even in heavy smokers and long-term smokers (people over 65). The younger you quit, the greater the benefits. Smoking cessation is really an all-or-nothing thing: the risks of smoking are hardly reduced if you reduce the number of cigarettes per day or if you choose lighter cigarettes.

Why stop smoking ?

The benefits of smoking cessation are numerous:

• the carbon monoxide (CO) in your body disappears after one day and the nicotine after two days;
• cough and phlegm production decrease within 1 to 2 months and lung function improves within 2 to 3 months after smoking cessation;
• the feeling of stress decreases, while sleep improves (in quantity and quality);
• in the year following smoking cessation, the risk myocardial infarction is divided by two;
• mortality by ischemic heart disease (due to lack of oxygen) decreases by more than 30%.
• Within 5 to 15 years, the risk of cerebral infarction (stroke or stroke) drops back to the same level as in non-smokers;
• the risk of lung cancer is also halved within ten years;
• in case of chronic obstructive pulmonary disease (COPD), smoking cessation has a positive effect on the prognosis regardless of when you stop smoking.

Why is it so hard to quit?

Withdrawal symptoms
A nicotine dependent smoker who wishes to quit smoking after prolonged daily use may experience withdrawal symptoms: craving for nicotine, irritation, frustration, aggressiveness, anger, depressed mood, anxiety, difficulty concentrating, impatience, insomnia, constipation , decreased heart rate, increased appetite and weight gain.

Most of these events occur during the first week of quitting, especially within 48 hours of quitting, but decrease by the third / fourth week. However, some withdrawal symptoms, especially irritation and the urge to smoke, may last for up to six months.
The duration of withdrawal symptoms varies from person to person. This duration cannot be predicted based on the number of cigarettes smoked or the results of a nicotine addiction test.

Coffee can make withdrawal symptoms worse.

Weight gain
The body weight of smokers is lower than that of non-smokers (on average 3 to 5 kg). Normal weight is usually regained when you quit smoking. During the 6 to 12 months following smoking cessation, men gain an average of 2.8 kg and women 3.8 kg; this weight gain is even greater in 10 out of 100 men and 13 out of 100 women. Combining smoking cessation with individual support in terms of dietary measures and physical activity can help control weight gain. Nicotine replacement therapy or bupropion may also be helpful.

What can your doctor do?

The doctor will ask you questions about your smoking behavior; he will ask you in particular if you have ever tried to quit smoking and how it happened. It will help you quit smoking. He may also refer you to a Smoking Assistance Center (CAF®) or to a tobacco specialist.
The doctor will also encourage you to participate in physical activity. Exercise should be an integral part of treatment.
Sometimes it may be helpful to take medication, under the supervision of your doctor, to help you quit smoking. There are several different treatments.

Nicotine replacement therapy
Nicotine replacement therapy relieves withdrawal symptoms and is well tolerated. They are the first choice drugs for smoking cessation. All forms (chewing gum, patch, spray, inhaler and lozenges) are effective. These substitutes increase the chances of successful smoking cessation and are recommended for people who smoke more than 10 cigarettes per day. The duration of treatment is 3 to 6 months. The choice of product depends on your degree of dependence as well as your state of health and preferences. Eventually, in some cases, your doctor may suggest that you combine several forms of nicotine replacement therapy.

Nicotine substitutes are less dangerous for health than tobacco, including in case of prolonged use. When used with caution, they are also safe for people with heart disease. Nicotine substitutes offer a better alternative than tobacco if you are pregnant or breastfeeding. By smoking during pregnancy, you increase the risk of premature birth and low birth weight of your child.
If you are using nicotine replacement chewing gum, you should stop it gradually or replace it with patches, as it is addictive in some smokers who are quitting. This addiction does not develop with the patches.

Others
If nicotine replacement therapy has failed, the bupropion can be considered. This medication is used for 7 to 9 weeks and started 1 to 2 weeks before the expected date of smoking cessation. This medication is not suitable for people with epilepsy, alcohol dependence or who have suffered severe head trauma in the past.
The varenicline can also support smoking cessation. This treatment is started 1 to 2 weeks before smoking cessation. The dose is increased to a maximum of 1 mg, twice a day. In total, the treatment lasts 12 weeks. It is sometimes accompanied by nausea. The combination of varenicline and nicotine replacement therapy is not helpful and may enhance the negative effects of nicotine.
The nortriptyline is an antidepressant that could be used to make quitting smoking easier because it decreases the symptoms of withdrawal. However, the drug is not recognized as a treatment for smoking cessation.

Want to know more?

• Stop smoking. It’s possible – Tabacstop – Foundation against cancer
• Tobacco: preparing the stop – mongeneraliste.be – SSMG – Scientific Society of General Medicine
• Smoking a little: not a good idea – mongeneraliste.be – SSMG – Société Scientifique de Médecine Générale

• Being parents and smoking here Where to find on this page of the Erasme ULB hospital
• Health, passive smoking (video) – Family look – ONE – Office for Birth and Childhood

• Eat Move – Health Question

• Drugs used in smoking – CBIP – Belgian Center for Pharmacotherapeutic Information
• e-cigarette – Tabacstop

Are you looking for more specialized help?

• Smoking Assistance Center (CAF®) – FARES – Respiratory Affections Fund
• Tobacco specialists – FARES – Respiratory Affections Fund

Sources

• Belgian practice guide ‘Stop smoking’ (2005) – SSMG – Scientific Society of General Medicine
• Drugs used in smoking – CBIP – Belgian Center for Pharmacotherapeutic Information