Quitting smoking: how to become a non-smoker!

and Christiane Fux, medical editor

Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.

More posts by Christiane Fux All content is checked by medical journalists.

Quitting smoking is usually extremely difficult. The reason is that nicotine is highly addictive - both physically and mentally. A combination of elements of behavior therapy and medication that support physical withdrawal therefore promises the greatest success. Read here what strategies are available and how effective they are.

Withdrawal symptoms

Nicotine is a highly addictive substance. Those who quit smoking have to cope with both physical and psychological withdrawal symptoms from nicotine.

Nicotine withdrawal: course

The physical withdrawal from nicotine is usually done after 72 hours. For very heavy smokers, however, the nicotine withdrawal period can last up to 30 days. Those who know the withdrawal symptoms and arm themselves against them have a significantly higher chance of becoming permanently smoke-free.

Physical withdrawal symptoms

On a physical level, withdrawal symptoms such as:

• sleep disorders
• fatigue
• Lack of concentration
• nervousness
• Restlessness
• constipation
• Cravings

Mental withdrawal symptoms

The psychological dependence manifests itself in

• nervousness
• violent desire to smoke
• Inability to quit smoking in certain situations

Quit smoking spontaneously

The majority of smokers try to spontaneously become smoke-free, at least in the first attempt. However, the chances of success with this abrupt method of quitting smoking are slim.

Because a central difficulty in quitting smoking is "the power of habit". This refers to behavior patterns, special situations, stress compensation or group dynamics that are associated with smoking. this makes it particularly difficult to do without. For critical situations, I should ideally develop a whole arsenal of counter-strategies and alternative behaviors for those willing to quit before they quit smoking - or at least in parallel.

Evaluation: The decision to “quit smoking - immediately!” Only leads to long-term abstinence in one to five percent of smokers. If the decision is based on medical advice, quitting smoking is successful for at least five percent of smokers - they can remain non-smokers without much preparation and therapy.

Smoking cessation with behavior therapy

Behavioral therapies are the most comprehensive and effective methods of smoking cessation. They are usually carried out in groups, but sometimes also individually. Basically, this therapy for smoking cessation is divided into three phases:

Introspection

Here your own smoking behavior in everyday life is scrutinized. Many moments are automated (e.g. the cigarette with morning coffee or after work) and have an uncontrollable effect on the individual. Those who are prepared for difficult situations can cope with them more easily in the acute weaning phase and are also safer in life situations where relapse is critical.

Self-observation and thus the acquisition of knowledge about one's own behavioral patterns are therefore the be-all and end-all before starting.

Acute weaning

Some try to quit smoking immediately (point-to-point method), others gradually restrict cigarette consumption. Those who prefer the last method absolutely need sub-goals and rules for self-control. The point-to-point method is simpler.

Develop counter-strategies

In parallel to weaning, counter-strategies are very important. What alternative behavior is possible? How can stressful situations be dealt with differently? What other ritual can be used to replace the morning cigarette?

Reward for smoking cessation

Equally important is the reward for quitting smoking. The circle of friends and the work environment should also be inaugurated so that no one offers a cigarette anymore. Sometimes it also helps to place a bet: "I will hold out".

Stabilization and relapse prevention

Anyone who has made it this far is still far from cured. Relapses are possible at any time. Therefore, the stabilization of the weaning success and the relapse prophylaxis are urgently needed.

Every ex-smoker must be on the lookout for critical situations (e.g. pub evening with friends). Therapists therefore specifically train the participants to cope with critical situations.In group therapy this is often done in the form of role play.

Evaluation: Smoking cessation using behavioral therapy is significantly more effective than smoking cessation on your own. Combined with nicotine replacement therapy, the chances of success also increase - especially for heavily dependent smokers.

There are also self-help books that use behavioral methods. They can be helpful and supportive. Modern mobile variants to support people quitting smoking are apps for smartphones.

However, behavioral smoking cessation programs under individual professional guidance offer greater chances of quitting smoking. Books and apps can complement these.

Nicotine replacement therapy

The principle of nicotine replacement therapy is to give the body what it needs in doses - nicotine. This alleviates the withdrawal symptoms and the desire to smoke - the weaning process is made easier.

There are nicotine chewing gums, patches, inhalers and nasal sprays. With chewing gum, inhalers and sprays, nicotine can be added quickly when you feel the urge to smoke. The substance is fed continuously through the plaster. This decouples the absorption of the active ingredient (in contrast to chewing gum, inhaler and nasal spray) from previous addictive behavior.

Evaluation: The effectiveness of nicotine replacement therapy (NET) has been confirmed in numerous clinical studies. Accordingly, nicotine patches and the like can roughly double the chances of successfully quitting smoking. Nicotine replacement therapy in combination with behavior therapy is particularly promising.

Anti-smoking drugs

Smoking cessation without nicotine replacement - this is what the active ingredients amfebutamone (bupropion) and nortriptyline promise. They have long been used as antidepressants. At some point it was discovered that these active ingredients in low doses also help smokers to quit. And this is how you do it:

In the first days of therapy, when the smoker is already receiving the anti-smoking medication, he is allowed to continue smoking. Weaning begins after six to nine days, when the level of the drug in the blood is high enough.

Another anti-smoking tablet contains the active ingredient varenicline. It docks in the brain where the nicotine also binds. This is supposed to dampen the desire for a cigarette

Assessment: The guideline on smoking cessation rates the effectiveness of bupropion as similar to that of nicotine substitutes. Because of its frequent and severe side effects, bupropion is considered to be the second choice drug for withdrawal - just like clonidine, which was originally used for high blood pressure.

Compared to sham drugs (placebos), varenicline tripled the quitting rates, compared to bupropion one reckons with a doubling of the success rates when quitting smoking. However, side effects such as headache, fatigue, nausea, and indigestion are possible.

Quitting Smoking - Alternative Methods

Many also rely on alternative methods to quit smoking, the effectiveness of which has usually not been proven. If you believe in it, the placebo effect may at least help you.

Quit smoking with acupuncture

Anti-smoking acupuncture is widespread among those who wish to quit. However, the mechanisms of action of this method have not yet been clarified.

Typically, acupuncturists stick three needles into the ear's addiction points, where they remain for several days. This is supposed to curb the craving for addiction. On average, it takes five acupuncture sessions to show an effect. But there are also people for whom acupuncture does not help.

Evaluation: Different acupuncture techniques do not differ in terms of effectiveness, according to the guideline on smoking cessation. So far, no acupuncture procedure has been shown to be more effective than sham drugs (placebos).

Syringe against smoking

A so-called non-smoking syringe is also often advertised. A mixture of different substances is injected into the muscles or into the acupuncture points in the ear. There are various mixtures for this, the exact compositions of which remain under lock and key. They should contain vitamins, trace elements, homeopathic remedies, and sometimes nicotine, among other things.

Evaluation: There is no proof of effectiveness. The fact that it is not disclosed which substances are contained in a non-smoking syringe is a major factor of uncertainty. An assessment of the effect and side effects is not possible.

Quit smoking with hypnosis

Quitting smoking is said to be easier with hypnosis. The therapist puts the future non-smoker into hypnosis and then acts on his subconscious: Smoking is experienced as an unpleasant experience à la "ashes in my mouth". These negative messages are contrasted with positive ones that stand for the new non-smoking life. There are also therapists who work with hypnosis patients only with positive messages.

Evaluation: The same applies to the most significant form of all suggestive procedures as to acupuncture. A long-term efficiency that makes it easier to quit smoking has not yet been proven. The disadvantage of both procedures: They do not give the smoker any tools to cope with crises and temptation situations on their own.

Relaxation methods

Autogenic training, progressive muscle relaxation according to Jacobson and breathing exercises are useful as components of a combined smoking cessation. On their own, however, they are usually not enough to really become a non-smoker.

Smoking help from the healer?

Other processes such as the laying on of hands, the use of natural products and the like should be viewed more critically. Often only the suggestive influence of the therapist comes into play.

It is true that the therapist can achieve high short-term success rates through skillful psychological support. However, many smokers soon relapse again after these because they have not learned how to cope with situations that tempt people to smoke and how to cope with stress, boredom and nervousness without cigarettes.

Smoking cessation for risk groups

Certain risk groups are even more at risk from daily smoking than others. These include patients with vascular problems, smokers with particularly pronounced physical dependence or pregnant women. Successful smoking cessation is particularly important for these groups.

Special features in women

There are three main groups of risks from smoking in women:

Women who are pregnant. Recent studies show: only about 50 percent of all pregnant women manage to give up smoking during pregnancy. Around 25 percent reduce at least their cigarette consumption and a good quarter of women continue to smoke.

Women who do not want to have children, on the other hand, should at least rule out smoking as a possible cause of a reduced willingness to conceive.

Women who take the pill increase the risk of thrombosis.

The women of all three groups are strongly advised to say goodbye to the Glimmstängel. Scientists have designed special treatment programs for women belonging to one of the risk groups. The usual behavioral standard treatment in these programs is enriched with additional information, motivational aids, greater consideration of social support, information on nutrition and exercise, as well as components for stabilizing abstinence.

As a study by the University of Tübingen shows, more intensive care can significantly increase the success rate. The women with the aforementioned special factors benefit above all from individual treatment. With a specific program for pregnant smokers, a long-term chance of success is 20 to 30 percent.

If a pregnant, motivated smoker is still unable to quit completely, a nicotine replacement product should be considered. But you should definitely talk to your doctor. Bupropion and other antidepressants are not suitable for smoking cessation during pregnancy.

Heavily dependent smokers

Heavily dependent smokers benefit less from exclusively psychotherapeutic approaches to smoking cessation. They are generally more physically dependent and therefore need larger quantities of nicotine replacement products. This makes the way out of addiction easier for them. The effectiveness of nicotine replacement therapy has been proven in many studies.

In a study at the University of Tübingen, heavily dependent smokers received nicotine replacement therapy using nicotine patches as part of a six-week behavioral therapy treatment. You should also use a nicotine nasal spray as needed. 60 smokers took part in the study. After six months, 48 ​​percent of the participants were still abstinent. The greater consideration of nicotine dependence can therefore lead to significantly higher medium-term abstinence rates.

In the case of heavy smokers, long-term, prolonged or combined nicotine replacement therapy (nicotine patches in conjunction with nicotine chewing gum or a nasal spray) is justified in order to prevent relapse.

The guideline on smoking cessation rates the effectiveness of bupropion as similar to that of nicotine substitutes. Because of its common side effects, bupropion is considered the second choice drug for withdrawal. The same applies to clonidine, which was originally used against high blood pressure.

Compared to placebo, varenicline tripled the weaning rates, compared to bupropion, according to initial study results, a doubling of the success rates could be achieved. The current study situation suggests effective drug support with few side effects *.

Cardiovascular disease smokers

Despite the proven link between cigarette smoke and arteriosclerosis and heart attack, not all heart attack patients succeed in quitting smoking after the life-threatening event.

The most important element of smoking cessation after a heart attack is a sufficient range of background information and behavioral therapy. Nicotine replacement products are only recommended if there has been no cardiovascular event (such as heart attack, stroke, acute constriction of the heart or arterial obstruction) in the four weeks prior to starting the nicotine patch, spray or chewing gum. Because of possible side effects, careful medical examinations and controls are required during withdrawal treatment with bupropion.

Quit Smoking Tips

Motivation, little rewards, relaxation: the following tips for non-smokers will help you keep the cigarette craving at bay. Click through the picture gallery:

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