Quit smoking

Once you have started smoking, it soon becomes a habit, developing into an addiction, which at some point you want to get rid of. Something to be encouraged. For some it is easy, for others it is difficult or very difficult and for others it seems (almost) impossible. Whichever group you are in, you have already taken an important step in deciding to stop smoking.

Smoking is inhaling the smoke of smouldering tobacco in cigarettes, cigars, pipes, etc...*. When smoking, the smoke can either be inhaled, ie sucked into the lungs, or not inhaled, ie remain in the mouth. Tobacco contains the addictive substance nicotine. In addition to nicotine other substances are added to make and keep cigarette or cigar even more attractive. However, a lot of these substances are carcinogenic when burned. Some common harmful substances are:

• Ammonia: nicotine reaches the brain even faster through ammonia and thus strengthens the addiction.
• Tar: this substance is released during combustion of the added substances and is carcinogenic. Tar also accumulates in a lot of organs.
• Flavourings (menthol, sugars, cocoa, aniseed, etc.): they are added to give a pleasant taste to the cigarette, but when burned they are carcinogenic.

In addition, carbon monoxide, although not contained in a cigarette, is released when the cigarette is burned. Carbon monoxide attaches to the red blood cells in the body, hence preventing oxygen from doing so. Also, carbon monoxide is harmful to the environment (passive smoking).

Smoking is harmful to health. It causes a lot of diseases, such as lung and other types of cancer. Other diseases and conditions that can be caused by smoking are chronic respiratory and pulmonary diseases (COPD), cardiovascular diseases, hypertension, cerebral infarction and haemorrhage, eye diseases, metabolic diseases, diabetes, rheumatism and Crohn's disease. In addition, smokers often suffer from smoker's cough and a hoarse voice, poor skin that can become pale, yellow and grey, more likely to have wrinkles. There are risks of bad breath, decaying teeth (turning yellow or even brown), reduced smell and taste, etc… Women who smoke may have problems getting pregnant. Moreover, it may affect the health of the foetus, resulting in smaller babies, more frequent miscarriages and premature birth. Men are more likely to suffer from erectile dysfunction and loss of sperm quality.

There are many reasons why people start to smoke. The reasons are:

• Curiosity about the product. Others seem to enjoy it, which can stimulate curiosity.
• A contagious effect, almost everyone in your environment smokes.
• Group pressure: this is a familiar phenomenon among young people. Not wanting to be inferior to others, wanting to belong.
• Wanting to stand up to the rules of adults.
• Advertising. Although there has been a complete ban on tobacco advertising in the Netherlands since 2002 for example, there is still a lot of smoking in TV series and films. The smoking characters can be seen as a role model.
• Smoking used to be socially accepted. In the past, people smoked on television; even doctors smoked; smoking was still a socially accepted phenomenon at that time.

Smoking is triggered by a situation or an action. This makes it so hard to stop. We see the following mechanisms associated with smoking:

• Psychological effect: there is a slight intoxication that can last several minutes. This intoxication is sought after time after time.
• Habituation: you need more and more to achieve the same effect.
• Physical dependence: the body asks for more and protests when no nicotine is supplied.
• Ritual behaviour: the cigarette when you get up, with your coffee, after dinner, with a drink, etc. Smoking is triggered by certain situations.
• Reward or consolation: you feel that you have earned a cigarette after a certain task and/or you first take a cigarette to relax or unwind. In this way, smoking is triggered by emotions.
• Concentration: you need the cigarette to concentrate. Here, too, smoking is triggered by a particular situation.
• Withdrawal symptoms when you stop: you really do not feel well. When you light a cigarette, that nasty feeling stops.
• Denial: everyone knows the story of 'the one family member who was a chain smoker and who turned 80' to 'I can stop whenever I want' and 'I will be okay, I do a lot of sport and eat healthily'.

Your doctor can advise you which treatment or a combination of treatments suits you best. Counselling together with nicotine substitutes or medications has the greatest chance of success. There are different types of support.

• Telephone coaching: the coach will give you on-the-phone advice on how to stop.
• Personal coaching: your coach (sometimes your GP) will advise you in person, sometimes followed up by e-mails or phone calls. Some of the calls can also be made by e-mail or by telephone.
• Group training: here the idea is that after a number of group meetings all participants stop smoking together. The participants can help to support each other.
• Lifestyle training: this is the last resort when all other treatments have failed. The training is more intensive than the other forms of support and can take place individually or in a group.

There are various types of medicines that can help to stop smoking. They can be used in combination with a non-medical treatment.

• Before starting medication, read the leaflet.
• Remember that during pregnancy nicotine may affect the health of the foetus.
• When breastfeeding, take the nicotine medication just after breastfeeding and do not breastfeed until 2 to 3 hours after taking it.
• If you are on insulin, make sure to consult your doctor, as giving up smoking may require an adjustment of the insulin dose

The following medications are possible:

• Nicotine substitutes (NVM), which come as mouth spray, patches, medicines that dissolve under the tongue, sugar-free chewing gum and lozenges. A combination is possible. If you use nicotine substitutes, you must refrain from smoking otherwise you may consume too much nicotine.

The following medications may help to reduce withdrawal symptoms and reduce your need to smoke. They can be prescribed in combination with nicotine.

• Bupropion: this medicine only works after a week, so it is best to start this medicine one week before you stop smoking.
• Nortriptyline: only works after a week, so it is best to start this medicine a week before you stop smoking.
• Cytisin: this medicine must be started at least 5 days you stop smoking.
• Varenicline: this blocks the nicotine activity in the brain and can therefore not be used with nicotine substitutes. The medication must be started 1 to 2 weeks before you stop smoking. And it must be continued for 12 weeks.

• Acupuncture, homeopathy, hypnotherapy and laser therapy: although there is insufficient proof of the positive effect of these therapies, some patients are known to have benefited from them. The search for the right method to quit smoking is the responsibility of each individual.
• Apps: there are several apps on the market that can help you quit smoking. They will give you tips on how to stop smoking and how to persevere. Some allow you to set up schemes. They indicate how long you have not smoked for and what the benefits of not smoking are.
• Other online help: there are also games and online courses that provide support. There are also programs to stop on your own, independent of others.
• E-cigarette: there is no scientific evidence yet as to whether the e-cigarette is good or bad for your health. The e-cigarette is electronic and mimics a real cigarette; it also contains nicotine. The advantage is that you can slowly reduce the amount of nicotine; the disadvantage may be that with the e-cigarette you keep the habits associated with smoking.

A change in lifestyle for people who decide to quit smoking or have stopped entirely, is very personal and depends on the patterns you have developed over time while smoking. These patterns need to be broken through maintaining a healthy lifestyle, ie eating a varied diet and drinking enough water. Get enough sleep, avoid stress and exercise regularly. Moderate the consumption of alcohol and coffee. Get sufficient relaxation.

When you stop smoking, you may experience the following withdrawal symptoms:

• Tension
• Unrest
• Irritation
• Insomnia
• Concentration problems
• Sweating
• Mood swings
• Depression
• Headache
• Coughing fits
• Stomach complaints
• Delayed bowel movements
• Increase in appetite, possibly with weight gain

Do not be discouraged by these phenomena. They are transient. If you worry, discuss them with your doctor, he or she may prescribe medication or adjust it. After a few weeks, the symptoms should gradually become less and you should start to reap the benefits of having stopped smoking.

Giving up smoking has a significant positive effect on all diseases and conditions that may be caused or aggravated by smoking. Some of the advantages of giving up smoking are:

Physical effects:

• Better breathing
• More energy
• Better smell and taste
• Whiter, healthier teeth and fresher breath
• Helathier skin and hair
• Increased fertility

Less chance of illness:

• Reduced risk of lung and other smoking-related cancers
• Reduced risk of heart disease, cerebral haemorrhage and heart attack. After 4 years of non-smoking, you are as likely to suffer from these diseases as a non-smoker.
• Fewer colds due to improved resistance.
• Reduced risk of miscarraige and premature birth.

Other benefits:

• You are an example to others.
• You have more money left.
• And you can and should be proud of yourself.

Do not be tempted by the reasons why people start smoking and think about the benefits of not smoking.

Rokeninfo.nl. (z.d.). Operation & risks / operation / addiction. Consulted on 5 May 2019 at https://www.rokeninfo.nl/publiek

Jellinek.nl. (September 2018). Substances in tobacco. Consulted on 5 May 2019 at https://www.jellinek.nl/vraag-antwoord/welke-stoffen-zitten-er-naast-teer-en-nicotine-in-tabaksrook/

Prostop.nl. (z.d.). Why are we smoking, anyway? Consulted on 5 May 2019 at https://www.prostop.nl/waarom-roken-mensen-eigenlijk/

Stichtingstopbewust.nl. (z.d.). Diseases. Consulted on 5 May 2019 at https://www.stichtingstopbewust.nl/informatie/stoppen-met-roken-gezondheid/

ikstopnu.nl. (z.d.). What is the best way to quit smoking? Consulted on 5 May 2019 at https://www.ikstopnu.nl/vraag-en-antwoord/wat-is-de-beste-manier-om-te-stoppen-met-roken/

ikstopnu.nl. (z.d.). Apps for stopping. Consulted on 5 May 2019 at https://www.ikstopnu.nl/vraag-en-antwoord/online-hulp/de-5-beste-stoppen-met-roken-apps/

farmacotherapeutischkompas.nl. (z.d.). Medication. Consulted on 5 May 2019 at .https://www.farmacotherapeutischkompas.nl/bladeren/indicatieteksten/stoppen_met_roken

van der Putten.N. (09-02-2017). Alternative treatments. Consulted on 5 May 2019 at https://www.rokeninfo.nl/publiek/blog/post/?bericht=13

Brijder.nl. (z.d.). Smoking addiction / Stopping smoking / Withdrawal symptoms. Consulted on 5 May 2019 at https://www.brijder.nl/probleem/rookverslaving

* Whenever cigarette is used in this text, it includes cigarette tobacco and pipe tobacco.