Trying to Quit

January 12, 1993|By JEAN MARBELLA

First, the bad news: Every year, about 17 million Americans try to quit smoking. A year later, almost 16 million of them have started smoking again.

But when you consider that smoking is responsible for about 430,000 deaths a year, even if just a small percentage of smokers can quit every year, you're saving a lot of lives," said Dr. Donald Jasinski, director of the Center for Chemical Dependence at Francis Scott Key Medical Center and a nicotine-addiction researcher.

"To quit smoking" is always one of the more popular New Year's resolutions, but this year, smokers should be even more motivated: The Environmental Protection Agency has classified second-hand smoke as a carcinogen responsible for the deaths of some 3,000 non-smokers a year, by conservative estimate. The ruling, criticized by tobacco companies as scientifically unsubstantiated, is expected to result in a host of laws that further restrict the already dwindling number of places where smoking is allowed. Even Oriole Park at Camden Yards has banned smoking in the seats.

But, as always, the dilemma remains: How to quit? It's not easy, otherwise why would 50 million Americans, in the face of documented medical risks, expanding non-smoking zones, increased cigarette taxes and intense social pressure, still smoke?

It's not for lack of programs, books, patches, support groups, tapes, hypnotists and other devices and methods purporting to help them quit, for a price, usually. But which works?

"Different things work for different people," said Dana Shelton, an epidemiologist with the Centers for Disease Control who has surveyed the literature on the efficacy of various smoking-cessation strategies.

Ironically, for all the methods out there, the vast majority of successful quitters did it on their own, usually cold turkey, Ms. Shelton discovered. But that doesn't mean other methods are worthless -- those ex-smokers may have tried other methods and benefited from them in previous attempts to stop smoking before finally quitting on their own, she said.

Ms. Shelton offers these tips for smokers trying to choose among the myriad of programs available to help them off cigarettes:

* Ask for information from the American Lung Association and the American Cancer Society. While they will promote their own programs, they do have a lot of good, sound information they can send you, she said. "They have done a lot of research and their programs contain a lot of what that research has found," Ms. Shelton said.

* Find out if the program includes a specific date for quitting. "Smoking cessation programs are more effective if there is a target date for quitting," she said.

* Ask what happens after that date. "Relapse prevention should be part of the program. They have to let smokers know what to expect down the road," she said.

* Ask the program's success rate, and be wary of programs claiming near 100 percent. "You see ones that say, 'We have a 97 percent quit rate.' Ask when they surveyed the quitters -- if you survey them a day or two after the program, of course it will be high," she said. The standard measure of success is one year of abstinence, she said.

* Don't despair if you aren't successful the first -- or second, third, etc. -- time around. Keep trying different methods until one sticks because you never know which one will work for you

personally, she said.

"People on the average make five or six separate attempts to quit before they're successful," said Dr. Neil Grunberg, a professor of psychology at the Uniformed Services University of the Health Sciences in Bethesda with expertise in smoking behavior.

Smokers need to individualize their approaches, even if they're joining a group or following a particular method, because people smoke for so many different reasons and under so many different situations, he said.

"Some people, if they go into a bar, they have to smoke," Dr. Grunberg said. "Whatever these triggering stimuli are, they work the way the Pavlovian mechanism works."

Still, there is perhaps one thing that characterizes the ones who manage to quit for good, he said.

"The individual who successfully quits," he said, "is highly motivated."

NICOTINE PATCH

Susan Davis' children used to squirt out her cigarettes with water pistols or throw entire packs under a horse's hoof at the stable trying to get her off her two-pack-a-day habit. Her doctors warned her of a pre-emphysema condition and off-the-charts high blood pressure.

But it wasn't until her employer, Francis Scott Key Medical Center, began offering a wellness program involving nicotine patches and a support group that Ms. Davis finally gave up her more than 20-year addiction to cigarettes. She recently ended a two-month regimen of wearing the patch -- which slowly releases nicotine into the bloodstream to satisfy the smoker's craving -- and has been off cigarettes ever since.

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