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How to quit smoking

by John R. Polito

How to quit smoking? Trust your natural instincts! If doubting them, take your own poll of all ex-smokers you know who have quit for at least one full year. What you'll find, as did a July 2013 Gallup Poll, is that cold turkey generates more long-term ex-smokers each year than all other quit smoking methods combined.[1]

In fact, the 2013 Gallup Poll found that only a tiny fraction of all successful quitters used approved products, just 8 percent. Imagine after 40 years and billions spent marketing nicotine gum (Nicorette), only 1% of successful ex-smokers crediting it, and only 2% crediting all prescription quitting products combined (nicotine nasal spray + nicotine inhaler + Zyban + Chantix = 2%). As I stated in a November 19, 2013 letter published in the British Medical Journal, "How much closer to consumer fraud can approved products get?"

The short video playing to the right is entitled "How to quit smoking." It was created by Joel Spitzer, my nicotine cessation mentor since January 20, 2000. In it, Joel shares his top 16 tips on how to quit.

The question of how to quit smoking is really two questions: (1) what method to use and (2) tips on how to succeed at that method. The first tip shared in Joel's video is to "quit cold turkey." The next 15 are tips on how to succeed going cold. The balance of this article is devoted to presenting evidence as to why quitting cold is an extremely wise decision.

Listen closely to quitting product commercials. Most either directly or indirectly bash and trash cold turkey quitting. Why? Because they must. They know that the quitter's instincts are to stop smoking by going cold. They need to diminish confidence in those natural instincts. They must if they are to have any hope of convincing you to purchase their almost worthless magic cure, their nicotine gum, patch, lozenge, Zyban, Chantix, Champix or e-cigarette.

They also know that the natural confidence of smokers who previously went cold turkey and failed has already been seriously shaken. Instead of teaching them why their prior attempt failed and the cold turkey insights needed to succeed, they use and play upon that failure to help sell their product.

But then, is it fair to expect anyone with a direct or indirect interest in selling quitting products to tell smokers the truth, that it's how the vast majority succeed?

Although undisputed, you won't find reference to this simple truth on any quitting product website.[2] Table 3 from American Cancer Society's Cancer Facts and Figures 2003 report indicating that 91.4% of smokers quit smoking entirely on their own.Instead, most will try to convince you that quitting without buying and using their product is nearly impossible.[3]

Nor will it be mentioned by any major health organization that accepts pharmaceutical industry contributions,[4] nor on any government health site with ongoing industry partnerships.[5]

But answering the question of how to quit smoking is broader than simply recognizing cold turkey as being the most productive quitting method. Which quitting method has the highest success rate?

The correct answer to the highest success rate question depends on how success is measured. More than 200 quitting product clinical trials measured success against users of placebo look-a-like products. Real cold-turkey quitters were never involved. There, quitting product users generally did 1.5 to 2 times better than participants given placebo products.[6]

But out here in the real world, placebo isn't a real quitting method. Although this may come as a shock, those using approved quitting products have failed to prevail over those quitting cold turkey in nearly every real-world population level quitting method survey conducted to date.[7]

Click image for free full-text copy of this 2002 Journal of the American Medical Association paper - JAMA -  concluding that NRT appears no longer effective in increasing long-term successful cessation in California smokers.

For example, a 2006 study followed the smoking patients of 1,000 Australian family practice physicians. Not only did cold turkey quitters double the success rates seen among nicotine gum, nicotine patch, nicotine inhaler and Zyban quitters, cold turkey accounted for 1,942 of 2,207 of all successful quitters, a whopping 88% of all success stories.

Click image for study summary.  Quitting methods chart prepared by WhyQuit.com using data from a May 2006 study in Addictive Behaviors, Volume 31, at page 764

So how does the newest yet rather frightening magic cure, Pfizer's varenicline, compare? Varenicline is marketed as Chantix in the U.S. and Champix in the rest of the world. Although real-world performance data is treated as top secret, a 2008 Pfizer clinical study found "no significant differences" in the number of successful quitters when comparing varenicline to nicotine patch at 6 months or 1 year. That finding was echoed by a second 2010 patch versus Chantix study which found "no significant difference in abstinence rates was observed between the 2 groups over weeks 9-12 and weeks 9-24."

If no more effective than nicotine replacement therapy (NRT) products, does it make sense to risk experiencing the long list of Chantix/Champix serious injury side effects, that include risk of death?

Smokers must either find a way to succeed at quitting, or expect diminishing health as smoke's 81 known cancer causing chemicals and hundreds of toxins gradually destroy and kill them. Ask yourself, are the few who succeed while using these products doing so because of having used them, or in spite of having done so?

UK NHS one year program quit smoking ratesSo why do quitting products prevail inside formal clinical trials yet fall flat on their face in real-world use? The primary reason (and there are many) is that most study participants were teased into joining clinical trials by dangling free quitting products in front of them. Most had lengthy quitting histories and hoped the product would diminish the intensity of withdrawal. The problem is that those 200 placebo-controlled clinical trials were not blind as claimed,[8] as experienced quitters had become experts at recognizing their withdrawal syndrome.[9]

Would you have become frustrated if you'd joined hoping to receive three months worth of free nicotine lozenges and realized within 48 hours of quitting that you'd been given inert placebo lozenges instead? So did many of them, handing the product being tested an unearned frustrations victory.

As I suggested in a November 2008 letter published in the Canadian Medical Association Journal, testing quitting products against placebo is a licence to steal, as "chemical dependency may be the only known research area in which blinding is impossible."

But what about the big picture consequences of millions of smokers deeply believing in 3 decades of headlines generated by hundreds of placebo-controlled clinical trials? I wrote about two victims of sham placebo studies in November 2011, Neil age 53 and Helen age 50, members of Freedom and Turkeyville, WhyQuit's online support groups.

As I asked in a February 2012 letter published in the British Medical Journal, "If NRT is less effective long term than quitting without it, are quitters paying with their lives?" If so, should those who insist on generating additional sham science, or who grossly distort real-world survey findings, be held accountable for hundreds of thousands of needless deaths?

Table 1 from Pierce JP, Cummins SE, White MM, Humphrey A, Messer K, Quitlines and Nicotine Replacement for Smoking Cessation: Do We Need to Change Policy?, Annu. Rev. Public Health 2012. 33:12.1a 12.16

Can you sense my outrage? Sorry, I'm doing my best to hide it. Please forgive me. Back to cold turkey. Answering "cold turkey" to the question of "how to quit smoking" does not tell us the key or secret to successful cold turkey quitting.

The common thread among all successful cold turkey quitters is that they didn't allow any nicotine back into their bloodstream. The common thread among all who relapsed to smoking is that they did. My mentor Joel Spitzer refers to this as the "Law of Addiction."[10]

Nicotinic receptor saturation

Research shows that just one puff and up to half of the brain's nicotinic-type receptors become occupied by nicotine.[11] Like alcoholism, nicotine addiction is a permanent disease, a brain wanting disorder.[12] While roughly half of quitters who try to cheat and smoke just once walk away thinking that they've gotten away with it, they soon find their brain wanting or even begging for more.

The wanting and desire felt following lapse is not a matter of a lack of willpower or weakness. It reflects the design, purpose and function of brain dopamine pathways, the mind's priorities teacher. It's their job to make activities which activate this circuitry nearly impossible, in the short term, to forget or ignore. It's why ending use of food or water is almost unthinkable.

We will never be stronger than nicotine's influence upon our mind's priorities teacher. But then, we don't need to be as nicotine is only a chemical with an I.Q. of zero. It cannot plot, plan or conspire against us, and is not some monster or demon that dwells within.

How to quit smoking?  Go cold turkey!Attempting to quit without first learning how can be frightening. Our greatest weapon is our superior intelligence but only if put to work. Key to dramatically enhancing our odds of success is in becoming more nicotine dependency recovery savvy than our addiction is strong.

That being said, it may be best to learn as you go. Why? Two studies have found that unplanned quitting attempts are twice as likely to be successful as planned ones.[13] Why worry about some future quitting date and allow time to gradually erode your resolve before ever starting? Jump in the recovery pool! The water is great and roughly half find the going vastly easier than their chemically dependent brain kept telling them.[14]

As for learning, the Internet is loaded with wonderful free resources that transform cold turkeys into smart turkeys. For example, Joel's Library is home to more than 100 original articles on every stop smoking topic imaginable, to Joel Spitzer's free e-book "Never Take Another Puff," and to more than 160 free video quitting lessons. Why quit afraid and alone in ignorance and darkness when we can turn on the lights?

If seeking support, give Turkeyville and Freedom a visit. Turkeyville is a cold turkey Facebook group where the primary objective is to educate and support new quitters in getting off to a solid start.

Freedom is the Internet's only 100% nicotine-free support site. Membership is limited to cold turkey quitters who have not used any nicotine for at least 72 hours, thus becoming 100% nicotine-free.

One final quitting method warning. While gradual weaning, tapering and other cut-down schemes are highly tempting, they are also highly ineffective. A 2007 study found that cold turkey roughly doubles your odds over cut-down schemes. Even there, the doubling that occurred was generally among uneducated and unsupported cold turkey quitters.

But whether educated, supported or not, there's just one rule which if followed provides a 100 percent guarantee of success to all. It's just three simple words: no nicotine today! The next few minutes are all any of us can control and each is entirely do-able.

Yes you can!





References:
  1. Gallup. Most US smokers want to quit, have tried multiple times, 2013; also see, Chapman S and MacKenzie R The Global Research Neglect of Unassisted Smoking Cessation: Causes and Consequences, PLOS Medicine, 2010; also see Doran CM et al, Smoking status of Australian general practice patients and their attempts to quit, Addictive Behaviors, May 2006, Volume 31(5), Pages 758-766; also see Cheong Y, et al, Does how you quit affect success? A comparison between abrupt and gradual methods using data from the International Tobacco Control Policy Evaluation Study. Nicotine and Tobacco Research, August 2007, Volume 9(8), Pages 801-810.
  2. Chantix, www.Chantix.com; Nicorette, www.Nicorette.com, Nicoderm CQ, www.nicodermcq.com
  3. Polito JR Flawed research equates placebo to cold turkey, WhyQuit, 2007
  4. Helliker, K NICOTINE FIX - Behind Antismoking Policy, Influence of Drug Industry, Wall Street Journal, 2007; also see Polito JR, Great American Smokeout Hijacked, 2003
  5. Polito JR, Smokefree.gov really Buymeds.now, 2010
  6. U.S. Clinical Practice Guideline for Treating Tobacco Use and Dependence, June 2000
  7. see, Polito JR, GlaxoSmithKline Continues Defrauding Smokers, 2010
  8. Mooney M, The blind spot in the nicotine replacement therapy literature: Assessment of the double-blind in clinical trials, Addictive Behaviors, 2004, Volume 29, Pages 673-684, also see, Polito JR Smoking cessation trials, Canadian Medical Association Journal, 2008; also see Polito JR, Widespread Blinding Failures Put Validity of Nicotine Replacement Studies in Serious Question, 2004
  9. Perkins, K. A., et al, Nicotine discrimination in male and female smokers, Psychopharmacology (Berl), 1994, Volume 116(4), Pages 407-413; also see, Perkins, K. A. et al, Influence of training dose on nicotine discrimination in humans, Psychopharmacology, 1996, Volume 126(2), Pages 132-139; also see, Perkins, K. A., et al, Nicotine discrimination and self-administration in humans as a function of smoking status, 1997, Psychopharmacology (Berl), Volume 131(4), Pages 361-370.
  10. Spitzer, J, The Law of Addiction, 1988
  11. Brody AL et al, Cigarette smoking saturates brain alpha 4 beta 2 nicotinic acetylcholine receptors, Archives of General Psychiatry, August 2006, Volume 63(8), Pages 907-915.
  12. Polito JR, Addiction to smoking nicotine a mental illness and disease, 2010
  13. Ferguson SG, et al, Unplanned quit attempts--results from a U.S. sample of smokers and ex-smokers, Nicotine & Tobacco Research, July 2009, Volume 11(7), Pages 827-832, and West R and Sohal T., "Catastrophic" pathways to smoking cessation: findings from national survey, British Medical Journal, February 2006, Volume 25;332(7539), Pages 458-460.
  14. Chapman S and MacKenzie R The Global Research Neglect of Unassisted Smoking Cessation: Causes and Consequences, PLOS Medicine, 2010



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Learn More About Smart Turkey Quitting

  • WhyQuit.com's coffin bannerWhyQuit.com - WhyQuit is the Internet's oldest forum devoted to the art, science and psychology of cold turkey quitting, the stop smoking method used by the vast majority of all successful long-term ex-smokers. Left to right, WhyQuit is organized under three headings: (1) Motivation, (2) Education and (3) Support.
  • "Never Take Another Puff" - Imagine a free 149 page stop smoking ebook that's registered more than 4 million downloads and was written by a man who has devoted 40 years, full-time to helping smokers quit. Never Take Another Puff (NTAP) was authored by Joel Spitzer, the Internet's leading authority on how to stop smoking cold turkey. It is an insightful collection of almost 100 articles on every cessation topic imaginable.
  • "Freedom from Nicotine - The Journey Home" - Written by John R. Polito, a former 30-year heavy smoker and WhyQuit's 1999 founder, Freedom from Nicotine (FFN) is a free nicotine dependency recovery book that documents the science underlying nicotine dependency and successful cessation. Visit Turkeyville, Facebook's most popular quit smoking support group!Whether hooked on cigarettes, e-cigarettes (e-cigs), bidis, kreteks, a pipe, hookah or cigars, on dip, chew, snuff or snus, or on the nicotine gum, lozenge, spray, inhaler or patch, FFN provides a comprehensive yet easy to follow road-map to freedom from nicotine.
  • Turkeyville - Visit Turkeyville, Facebook's most popular quit smoking support group. The group's primary focus is the first few days and helping new quitters get started. Yes you can!
  • Joel's Library - Joel's Library is home to Joel Spitzer's "Daily Quitting Lesson Guide." The Guide walks new quitters through the first two weeks of smoking cessation, recommending daily videos to watch and articles to read. Joel's Library is also home to more than 100 original short stop smoking articles, to his free ebook Never Take Another Puff, and to his collection of more than 200 video stop smoking lessons.
  • Nicotine Addiction 101 - WhyQuit's guide to understanding nicotine dependency.
  • Freedom's small link banner Freedom - Looking for a deadly serious and highly focused education oriented support group? Home to Joel Spitzer, Freedom is the Internet's only 100% nicotine-free peer messageboard support forum. Explore Freedom's hundreds of thousands of archived member posts on how to quit smoking.
  • Nicotine Cessation Topic Index - An alphabetical subject matter index to hundreds of nicotine cessation support group discussions, article and videos.
  • 40 Quitting Tips - Key cold turkey nicotine cessation tips on how to stop smoking, vaping, chewing or sucking nicotine into your body and bloodstream.


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Article written December 18, 2010 and page last updated December 4, 2013 by John R. Polito