(this is mostly USA-based info, sorry!)
So. You smoke. Or you vape. Or you use pouches or chew. And maybe you've realized doing that isn't serving you.
Maybe it's the money. Cigs are expensive. Maybe it's that you can't go anywhere without having to plan around when you can get outside to vape or smoke. Maybe it's the risks of lung or oral cancer or COPD. Maybe it's the heavy metals in disposable vapes.
Whatever it is, it can be a really tall order to make the next leap to quitting.
This post is here to help with that.
What Nicotine and Tobacco Are Doing For You:
Nicotine is the substance in tobacco products that makes it hard to quit. A lot of people talk about withdrawals from nicotine, and those are definitely a thing that need to be managed and I'll talk about that in a second. But something not often talked about is that nicotine, as a stimulant, does something for people who use it.
Maybe it's keeping you going to get through another shift. Maybe it's curbing some anxiety. Maybe the use of tobacco products provides a social benefit (all your friends vape) or let you take breaks at work without having to do too much explaining. If you use nicotine, think about what nicotine is doing for you.
Then, think about if there is anything else you can do or use to meet that need that will hurt you less than tobacco products. This can be a really tall order (we do live in a society that rewards stimulant use). Some options include talking to a doctor about starting medication for anxiety or ADHD if you have one of those conditions. It might mean starting an exercise regimen that you like. It might mean structuring rewards or reasons for breaks into your day that aren't tobacco products. It might be drinking more coffee. It might be just learning to deal with the problem nicotine was solving without having another coping strategy. Not everything is going to be 100% brilliant for you, you're just looking for things that are better.
You don't 100% have to have this figured out to quit, either. It's a process.
A mainstay of tobacco cessation is nicotine replacement. This basically says: hey, nicotine withdrawal sucks and tapering (reducing it slowly over time) makes it bearable, but it's hard to taper off of cigarettes or vapes in a controlled way. So get your nicotine in carefully measured amounts so you can incrementally reduce that over time in an easy-to-control way. If it is prescribed by a medical professional, sometimes insurance will cover nicotine replacement, but patches and gum can be purchased over the counter too.
You've probably heard of patches, gums, and lozenges. If you smoke (or vape, or chew) every day, you're probably going to want to take both patches and either gum or lozenges at the same time. The patches deal with the physical withdrawal symptoms. They may not do this perfectly, but they're a start. The gum or lozenge gives you that extra boost when you need it for withdrawal and cravings.
Patches: Patches come in 21mg, 14mg, and 7mg doses. If you consume the equivalent of 10 cigarettes or more per day, start with a 21-mg patch. If you consume less than that, try the 14-mg patch. Put one new patch on clean skin on the upper part of your body every morning, and throw the old one away. Put it on a different place each day. Eight to twelve weeks later, move down to the next lowest dose.
Gum: Gum comes in 2mg and 4mg doses. You do not use it like normal chewing gum. To use, place a piece of gum in your mouth and bite down until you feel a tingling. Then "park" the gum in your cheek for about a minute to let the nicotine absorb, and repeat the chew-park-chew-park until the tingling stops, about 30 minutes. If you aren't using a patch, use 1 piece of gum every 1-2 hours while awake and gradually decrease from there. If using the patch with the gum, use the gum any time you get or expect to get a craving.
Lozenge: Lozenges also come in 2mg and 4mg doses. To use a lozenge, hold it between your cheek and gum, moving it around occasionally until it dissolves. If you aren't using a patch, use 1 lozenge every 1-2 hours while awake and gradually decrease from there. If using the patch with the lozenges, use a lozenge any time you get or expect to get a craving.
There are other forms of nicotine replacement therapy, including oral inhalers and nasal sprays.
Non-Nicotine Medications:
Some people choose to use other medications to help them quit nicotine. There are 2 that have been approved by the US FDA: bupropion and varenicline. Neither of these contain nicotine, but they can help with withdrawal and cravings.
Varenicline works by sitting on nicotine receptors, partially activating them (so withdrawal and cravings are minimized) but making it so nicotine itself can't work (so you don't get a pleasurable feeling when using a tobacco product). Generally, you start taking this about a week before a planned "quit date". Typically 12 weeks (or a little longer) is all you take this medication for.
Bupropion works similarly to varenicline, but it also further reduces withdrawal and cravings by increasing dopamine and norepinephrine in the brain. This can also treat anxiety and depression, which can help if the reason someone was smoking was due to one of these problems. You can take this medication for 12 weeks, or if you are treating anxiety or depression or ADHD with it, you can take it indefinitely.
Using nicotine replacement can help manage cravings, but you want as many options as possible for when cravings hit. Here are some options:
Distraction- nicotine urges are strong but often brief. Sometimes just knowing this is enough to allow you to do something else for a few minutes when they strike. Practice this before quitting- get an urge and ride it out while you're still smoking, so you know it's possible.
Do something with your mouth, like eating a piece of candy or chewing on something- a lot of nicotine products are inhaled or absorbed in the mouth. This means there's often something that feels "missing" when you quit. Replace this. Consider something edible or even a piece of chew jewelry.
Physical activity- it doesn't have to be a whole workout. Even a few squats can give you a small energy boost that can help decrease the immediate need for nicotine.
Expression- remind yourself by writing down or saying reasons you are quitting.
It's important to understand that cravings will lessen after several weeks. Getting through the worst of it can be tough, but it's worth it for all the benefits, health and financial, that you will achieve.
Quitlines- 1-800-QUIT-NOW can connect you to a quit smoking coach for 1:1 support. These are 100% free and people who use them are more likely to quit. In my state you can also text "READY" to 200-400 (not sure if this works outside of Washington).
2Morrow Health- a free, self-guided app.
Freedom From Smoking- this is a 7-week class. There is a paid online option, but many hospitals and health departments offer it for free.
Nicotine Anonymous- It's a 12-step program. Which works for some people and not others. Also tends to be Christian. YMMV.
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