You knew it was only a matter of time: Your hospital just implemented a new policy that makes taking a smoke break a major hassle. Now you have to find someone to cover your patient assignment and then leave the unit and drive off the property to smoke.

So you’ve decided to quit smoking. But if you’re like many smokers, you’ve tried to quit many times—only to relapse. Mark Twain summed it up best when he said, “Quitting smoking is easy. I’ve done it 100 times.” Read on to learn how to make your 101st attempt a lasting success.

Choosing a quitting method
You can take one of two basic approaches to smoking cessation:

• quitting “cold turkey”—smoking your regular amount of cigarettes today and then smoking none tomorrow
• quitting gradually, either by tapering or “postponing.” The gradual approach beats going cold turkey if you’re especially anxious about quitting or lack confidence in your ability to quit.

With the tapering method, set your quit date, count the number of cigarettes you typically smoke daily, and then smoke fewer cigarettes each day. If you typically smoke, say, 30 cigarettes daily, resolve to smoke 5 fewer cigarettes each day, so you’ll have quit completely in 6 days. Unless you’re a light smoker to begin with, cut back by more than just one cigarette daily; your total tapering time should be a few days, not a few weeks. Dragging it out too long could turn into a procrastination tactic.

With the “postponing” method, delay your first cigarette of the day by 2 hours every day. Here’s a sample schedule: On day 1, smoke your first cigarette at 8:00 A.M.; on day 2, at 10 A.M.; on day 3, at noon—and so on. If you go this route, make sure to consider your work schedule; it could limit your ability to delay your first cigarette.

Prescription and over-the counter therapies
Nicotine replacement therapies (NRTs) are drugs that contain nicotine but lack the harmful chemicals in cigarettes, such as cyanide, arsenic, acetone, formaldehyde, carbon monoxide, and ammonia. They include over-the-counter nicotine patches, gum, and lozenges as well as prescription drugs, such as nicotine nasal sprays and inhalers.

NRTs ease cravings and withdrawal symptoms, helping you focus on and deal with the psychological reasons behind your smoking. If you decide to use an NRT, be aware that you must quit smoking cold turkey, because mixing cigarettes with an NRT can cause dangerous arrhythmias, myocardial infarction, or both.

Nonnicotine medications used to aid smoking cessation include bupropion (Zyban) and the new drug varenicline (Chantix). They work by stimulating nicotine receptors in the brain, which helps reduce nicotine withdrawal symptoms. Varenicline also blocks nicotine from binding to these receptors, eliminating the desire to smoke.

Finding the best approach
You can boost your chance of quitting by using a combination of methods. To help find the best approach for you, visit the American Cancer Society website at www.cancer.org and follow the links to “Quiz: What’s the best way for you to quit?”. This website also can point you toward a smoking cessation program near you; visit the “Find a Quitline or Other Support” page, or call 1-800-227-2345.

Dealing with withdrawal symptoms
Withdrawal symptoms reflect your body’s attempt to recover from your cigarette addiction. They may include irritability, poor concentration, light-headedness, increased coughing, increased appetite and weight, trouble sleeping, headache, and depression. These symptoms are transient—but you need to make a plan for dealing with them so they won’t derail your effort to quit. Your plan should include:

• drinking plenty of water throughout the day
• gradually increasing your physical activity, such as by taking brisk walks
• using relaxation techniques, such as deep, slow breathing, progressive muscle relaxation, or visual imagery.

Preventing weight gain
Your plan also should include ways to help prevent weight gain. About 80% of people who quit smoking gain 5 to 10 lb. But don’t let that discourage you, because 56% of people who continue to smoke also gain weight.

To help prevent weight gain, eat a healthy diet and stay active. Be aware that food can become a replacement for smoking, so buy low-fat snacks and foods. Watch portion sizes and choose low-fat foods. If you need to have something in your mouth to quell your cigarette cravings, chew sugar-free gum or mints or chew on a straw or cinnamon stick.

Don’t let weight gain—or fear of it—distract you from quitting smoking. Although gaining weight may be a real concern, health risks from smoking far outweigh the risks of the average weight gain.

Avoiding trigger situations
In the first few weeks after you stop smoking, scramble your routines to avoid the places, people, and situations that trigger your urge to smoke.

• If watching TV is a trigger, plan substitute activities, such as reading a book or taking a walk.
• If drinking alcohol triggers the urge to smoke, avoid alcohol for the first few days or change to a different alcoholic beverage to reduce the association between alcohol and smoking.
• If driving is a trigger, take a different route to work.
• If you’re accustomed to having a cigarette first thing in the morning, drink a glass of orange juice.
• If a post-meal smoke was part of your routine, brush your teeth immediately after eating.
• If talking on the phone makes you crave a smoke, stand instead of sitting during phone calls. (For more advice on resisting cigarette cravings, see Tips to help you stop smoking for good.)

Getting back on track after a relapse
If you relapse, don’t let this undo all your hard work. Forgive yourself and immediately get back on track by throwing away any cigarettes you have. Tell yourself that this was the past and you don’t need to smoke another cigarette. Remember how far you’ve come, and go back to the strategies that helped you quit smoking. Assess the situation, time of day, or mood you were in when you slipped, and figure out how to do it differently the next time.

Rewarding your success
Congratulate yourself on becoming a nonsmoker! You’ll notice that with time, your energy will continue to increase, your smoker’s cough (if you had one) will fade, your lung capacity will improve, and your risk of heart disease, respiratory disease, and cancer will drop. You’ll be healthier and more active. Chances are, you’ll also be more assertive and confident in dealing with stressful situations.

Each year, celebrate the anniversary of your quit date. And go on that cruise. You deserve it!

Selected references
American Cancer Society. Guide to quitting smoking. Available at: www.cancer.org. Accessed February 19, 2007.

American Cancer Society. Workplace Solutions: Freshstart® training. Available at: www.acsworkplacesolutions.com/FreshStartFacilitator.asp. Accessed February 19, 2007.

American Lung Association. Freedom from Smoking® Online. Available at: www.lungusa.org. Accessed February 19, 2007.

National Center for Chronic Disease Prevention and Health Promotion. Tobacco Information and Prevention Source (TIPS). Available at: www.cdc.gov/tobacco. Accessed February 19, 2007.
Tobacco Free Nurses. QuitNet. Available at: www.tobaccofreenurses.org/quit.php. Accessed February 21, 2007.

Karen Willis, BSN, RN, is Manager of the Cardiac Health and Fitness Center at CaroMont Health in Gastonia, N.C., and an instructor for Freshstart®, the smoking cessation program of the American Cancer Society.