Mark Twain once quipped "Quitting smoking is easy. I've done it at least a hundred times!" Unfortunately, nicotine is a highly addictive drug and quitting smoking is not an easy task for most people. However, quitting is not impossible and you can be successful!!! Hopefully, the information contained in this pamphlet will guide you to a longer, healthier smoke-free life.

• Decide positively that you want to quit and avoid negative thoughts about how difficult it might be.
• Begin to condition yourself physically: start a modest exercise program; drink more fluids; get plenty of rest
• set a target date
• remember... you have 2 major hurdles to overcome: the addiction of nicotine and the habit of smoking

Nicotine is a drug and quitting smoking leads to withdrawal symptoms including intense food cravings, jittery nerves, anxiety, short temper, depression and sleeplessness. These symptoms are usually the worst during the first week after quitting and are essentially gone after the first month. Several drugs are available to help you reduce the symptoms of nicotine withdrawal. These products include:

• NICOTINE: available as a gum, skin patch or nasal spray. The dose is tapered as you are breaking the habit of smoking.
• BUPROPION: this drug was originally marketed as an anti-depressant but it seems to block many of the symptoms of nicotine withdrawal.
• CLONIDINE: this drug is primarily used for high blood pressure but it also can block some of the withdrawal symptoms of nicotine. It is available as either a pill or a patch.

Not only is there a strong addictive component to smoking, but the habit of grabbing for a cigarette in specific situations also needs to be broken. In order to break yourself of these habits, you need to make a conscious effort to become aware of why you are smoking. Are you upset? Are you in an environment where you usually smoke? Once you become aware of the reasons you smoke, you will have better control of these situations. Realize that most successful ex-smokers quit for good only after several attempts. If you don't quit the first time you try, don't give up. Try again.

• Involve a friend: friends and family can be an important source of support and encouragement both before and after you quit.
• Switch brands: switch to a brand that you find distasteful.
• Cut down on the number of cigarettes you smoke: for example, decide that you will only smoke during the even hours of the day. CAUTION: Don't let this cutting down phase go on too long....when you are down to 7 cigarettes per day, it's time to set a quit date and quit for good. Remember, don't focus on never smoking again, just think of quitting in terms of one day at a time.
• Make smoking inconvenient: don't buy cigarettes by the carton. Don't carry cigarettes with you at home or at work
• Make smoking unpleasant: collect all your cigarette butts in a glass container as a visual reminder of the filth made by smoking.
• Get your teeth cleaned on the day you quit and resolve to keep them that way.
• Keep busy, especially on your quit date and the first week after quitting when the withdrawal symptoms are the worst. Spend time where smoking is not allowed.
• Drink plenty of water or juice: avoid caffeine
• Avoid temptation: after a meal, get up from the table immediately and brush your teeth. Avoid situations that you associate with the pleasurable aspects of smoking.
• Anticipate triggers for your smoking and prepare in advance how to avoid them. For example, if you always associate drinking coffee with smoking, try switching to tea.
• Avoid alcohol not only because you will link this activity to smoking, but also because it lowers your willpower to resist smoking.

• Keep oral substitutes handy: try carrot sticks, celery, sugarless gum or sunflower seeds.
• Relaxation breathing: inhale through your nose, hold breath for a count of six and slowly exhale. Repeat 4-5 times as often as necessary.
• Take a shower or bath if possible
• Light incense or a candle instead of a cigarette.

Remember, cravings usually pass fairly quickly.

Gaining weight after quitting smoking is not inevitable. Being aware of some of the pitfalls that lead to weight gain is the first step to avoiding them. Because many smokers enjoy a cigarette after a meal, they generally eat faster than non-smokers. After quitting, instead of reaching for a cigarette, the now former smoker goes for a second helping or a rich dessert. You can avoid this problem by:

• eating slower,
• letting your spouse portion your food for you, and
• leaving the table immediately after your first helping and going to the bathroom to brush your teeth.

Another cause of the weight gain is using high calorie foods to satisfy the craving for something to be in your mouth. Instead, use low calorie foods or gum to satisfy this urge.

Exercise.

Your health care team at Dubuque Internal Medicine is a great resource to help you kick the cigarette habit. Many people benefit from drugs to help with the withdrawal symptoms from nicotine. The drug companies that manufacture these products have many resources (patient education materials, videos, support hotlines) available to help you. In addition, some people find it useful to get support in a group setting from other people who either have been already successful in quitting or who are trying to quit right now, just like you. You can find out more about the resources available in Dubuque by contacting Finley Hospital at 589-2352, Mercy Hospital at 589-9600 or the American Cancer Society at 583-8249.