Smoking is an addiction. Careful studies have shown that it is at least as powerful an addiction as heroin or crack cocaine. Drug addicts go through terrible withdrawals when they stop. Cigarette smokers face the same symptoms when they try to kick their habit. Two major differences exist between these addictions. First, heroin and crack cocaine use are illegal in this country. Cigarette smoking isn’t. Secondly, heroin and crack cocaine users know they’re hooked on drugs. Most cigarette smokers believe each cigarette is a free choice.

Cigarette smoking increases the risk of hardening of the arteries, such as heart attack, stroke and leg amputations 3-5 times that present in the non-smoking population. Likewise, people with diabetes have 3-5 times the risk of hardening of the arteries (those same complications) compared to the non-diabetic population. But, if you both have diabetes and you smoke, those risk factors do not add up, they multiply each other. That means you have 9-25 times the risk of having such complications as a heart attack or an amputation compared to someone who neither has diabetes nor smokes. These odds are so bad that you are virtually guaranteeing yourself of developing one of those complications if nothing changes. So far we can’t cure diabetes. But you can make a very big difference in your life, and markedly reduce your risk of such problems. Quit smoking now!

I’m stating the obvious. Cigarette smoking is entirely up to you. All I can tell you as a physician is that the compounds and carcinogens in the products you’re smoking are harmful, toxic, poisonous, and surely shortening your lifespan. I can explain to you that those chemicals are robbing your blood of the ability to carry oxygen to your heart and tissues, increasing the work load of your heart, accelerating the deposits of cholesterol and fats on the insides of your blood vessels (atherosclerosis), dulling some of your senses, damaging your genes, and constricting your blood vessels. If you’re lucky enough to avoid death by heart disease or cancer, you’ll probably ultimately develop emphysema and die slowly by suffocation. These chemicals are doing things that age your body prematurely and will hasten your death in a variety of different ways. Cigarette smoking is entirely up to you. If, how, and when you are going to quit is your decision.

How do you go about quitting? My recommendations are as follows. First, cut down on the number of cigarettes you smoke daily. Taper your consumption down to ˝ pack of cigarettes/day and keep it there for at least 1 month. Use that month to pull together the resources you’ll need to quit and stay free of cigarettes permanently. The more resources you gather together to help you, the more likely you will be to succeed. The more you plan and practice how to deal with cravings and urges, the more likely you will be to succeed. Here are some resources you may find helpful:

-    First and most importantly, enlist the help of your spouse and/or loved ones. Tell them how they can help you, what to do and what not to do.
-    Take advantage of smoking cessation groups. Most will have free introductory meetings. Nicotine Anonymous meetings are totally free. You can call The American Lung Association (800) 548-8252, The American Cancer Association (800) ACS-2345, The National Cancer Institute (877) 44U-QUIT, Nicotine Anonymous national line (800) 642-0666 or local chapter number (408) 236-2196, or Community Hospital of the Monterey Peninsula smoking cessation program 625-4708. You can go online for the American Lung Association free Freedom From Smoking program by typing “Freedom From Smoking” into your browser.
-    I think a very good website to look at is It has a wealth of most interesting and helpful material.
-    Nicotine patches or nicotine gum can be helpful in the first month after quitting to reduce some of the cravings. I recommend first transitioning to ˝ pack of cigarettes per day for 1 month, then when you stop, use the lowest dose nicotine delivery system for 1 month, and then stop it as well. Using the nicotine systems for longer than this will simply substitute one route of nicotine addiction for another. Nicotine in any form can have side effects such as headaches, dizziness, upset stomach, weakness, blurred vision, vivid dreams, mild itching and burning on the skin, and diarrhea.
-    Bupropion (Zyban) is a prescription medication that has been shown to improve the success rates of people who want to quit cigarettes. It is also known as the antidepressant Wellbutrin. It’s an oral medication you take daily to help reduce the urge to smoke. It’s begun a week before a person quits and then continued for 1-2 months longer, at which point it can be stopped.
-    Varenicline (Chantix) is a new prescription drug that in initial studies has been more effective at helping smokers quit than Zyban. It is a partial nicotine receptor stimulator and both blocks withdrawal symptoms when quitting smoking and blocks cigarettes’ effects when smoked. It is given as 1 mg twice daily for 12 weeks. For those who are successful and stop smoking in this period of time, it typically is extended for 12 more weeks and then stopped.  In clinical studies, this drug has the HIGHEST success rate for helping smokers quit compared to all other agents.

Remember, quitting cigarettes is stopping an addiction. Most people do not succeed on their first try. You need to look back on your prior efforts and identify what went wrong, what help you needed and didn’t get, and what you could have done to prevent the relapse. If you truly want to quit, you will eventually succeed, but surely only through significant effort.

Revised 9/08



©Ted A. Tobey, M.D., Inc. ~ All Rights Reserved