"That's it, this time I'm quitting for good!"

If it's cigarettes you are talking about, I have good news for you. For Canadians, January is the most popular month for smoking cessation and also the time you are most likely to make it. If you've tried quitting before, your odds of success go up every time, so plan to succeed. But before you begin, let's review a few proven ways to butt out for good.

The Canadian Guidelines for smoking cessation makes the following evidence-based recommendations for smoking cessation:

  • Doctors trained in smoking cessation providing brief counselling help their patients get higher quit rates.
  • Nicotine replacements (gum, patch, lozenge, inhaler), bupropion (Zyban®), and varenicline (Champix®) increase remission rates.
  • Pregnancy offers an ideal time for smoking cessation.
  • Although modest weight gain is common during quitting, it can be kept to a minimum and later lost. Drastic dieting during smoking cessation interferes with quit rates.
  • Exercise helps with both quit rates and weight.
  • Depression is associated with more severe nicotine addiction and poorer rates of cessation. So if depression is present, it should be treated at the same time. Depression occurring during early abstinence is associated with relapse.
  • Alcohol dependence is associated with more treatment-resistant nicotine dependence.
  • Treat nicotine dependence like other chronic illnesses.

First of all you must be motivated, committed to quitting, and prepared to practice new routines and behaviours until they become habits. To check this out, review your list of benefits from smoking compared to your list of its costs or consequences. Be really honest. Only when you are convinced the costs outweigh the benefits will you become motivated enough to form the necessary resolve to quit and then follow through. Rate your readiness to quit on a scale of 1 to 10. Next, list those situations where you will have the toughest times saying no, and prepare plans for handling or avoiding those situations. Think of all the ways you might change your routine, especially for the first few weeks, to avoid the cues that start you craving, like that cup of coffee, chatting on the phone, driving to work in your car, or having a beer after work.

Make yourself accountable. As you approach your quit date tell your family and friends about your plans. This also makes it easier when you have to apologize later for being grumpy on your second or third smoke-free day. Discuss your options or treatment plan with your family doctor. Many find it a good idea to have a buddy to quit with or a group for mutual support during the early stages of quitting. Helping somebody else through their discomfort somehow makes your own more bearable. Strong evidence supports combining approaches. Nicotine replacement using the patch or gum significantly improves quitting rates. Getting some counselling on quitting also improves your chances. The very best results in seriously addicted smokers has been achieved by combining adequate preparation; counselling; medications including nicotine replacement, bupropion (Zyban®), or varenicline (Champix®); and by continuing these treatments for at least 3 months.

Finally, remember to reward yourself. After all, one of the reasons you got addicted to nicotine and stayed addicted was because it provided reward or pleasure by activating the part of your brain responsible for helping you feel good. So be sure to schedule other ways to feel good or to comfort yourself, such as through regular exercise, a special purchase with the money you've saved, or a trip to the opera. Be careful about rewarding yourself with food. Food as a reward is very effective because it activates the same part of the brain as other addictive substances so it is easy to replace the nicotine with high calorie foods and merely replace one type of addictive behaviour with another that is both unhealthy and hard on your self-esteem. (We call that "changing seats on the Titanic.")

OK, are you ready? Choose a date that works for you, such as National Non-Smoking Week in January (usually the third week of January each year) or Weedless Wednesday (usually the Wednesday of National Non-Smoking Week) and get yourself prepared to kick butt!

For further support, visit the smoking channel, read A Clean Start, No Ifs, ands or butts, or call the Canadian Cancer Society Smokers' Helpline, toll-free, at 1-877-513-5333. Other resources include Health Canada tobacco reduction and the Canadian Network of Smokers' Helplines (CNSH). You can also talk to your doctor or pharmacist for more information on medications and smoking cessation programs in the area to help you quit smoking.

If you are now a smoker, there is no single investment you could make that is more valuable to your health.

Dr. Ray Baker, MD 
in association with the MediResource Clinical Team