Question: I took my first cigarette in 9th grade. I have been smoking steadily for the past 15 years. If I am honest I realize that it is a big health risk but that doesn’t seem to motivate me to stop. I guess I kind of “want to want” to stop. It certainly would make my wife and parents happy.  My question is 1. Do you have any suggestions as to how to become more motivated to quit? 2. Are there any specific methods that you recommend more or less for quitting i.e. cold turkey vs slowing down vs switching to an e-cigarette, hypnosis, medication, psychotherapy etc... I would appreciate your input. Thanks. 

Thank you for raising this important question. As the research on the dangers of smoking continues to pour in, leading Poskim are increasingly forbidding it. It is now documented that smoking is the number one cause of preventable death, causing cancer, breathing problems, heart attacks, and strokes. Secondhand smoke causes asthma and breathing problems.  Due to space limitations, I will focus on your second question. My only comments on your first question is to search for a therapist who specializes in Motivational Interviewing and continually remind yourself of the benefits of quitting. These benefits include things like feeling better, getting healthier, saving others from secondhand smoke, and saving money.

Regarding methods of quitting, I will share with you my understanding of the research. There is no one method that will work for everyone so the best way is to take on something that you can stick with. I will summarize some of the approaches that people use as well as the pros and cons.

  1. Do it yourself. This is the most common approach utilized by 90% of people who try to quit. They do it without therapy, medicine, or other aids. This doesn’t have strong results: only about 4-7 percent succeed by doing it alone.
  2. Behavior therapy. This involves working together with a therapist (or some other self-help organized method) to find triggers (emotions or situations that make you want to smoke) and developing a plan to get through the cravings. More on this soon.
  3. Nicotine replacement therapy. These are items that work by giving you nicotine without using tobacco and include nicotine patches, gum, inhalers, and nasal sprays. These work best when combined with behavior therapy and support from others. Keep in mind also that the end goal is to end the nicotine addiction, not just to not use tobacco.
  4. Medication. Prescription medications (such as Zyban and Chantix) can help decrease cravings and withdrawal symptoms.

The best way to increase the likelihood of success is to use a combination of treatment methods such as combining behavior therapy with nicotine replacement therapy, two type of nicotine replacement therapy, or using medication together with a nicotine replacement patch.  

There are also treatments that do not yet have sufficient evidence that they work such as hypnosis or acupuncture. Regarding e-cigarettes, these are not FDA-approved for smoking cessation. More studies are needed to determine their effectiveness as well as their long-term safety. Experts recommend that for smokers unwilling or unable to attempt to quit, they are almost certainly safer than continuing to smoke cigarettes. However, anyone switching from cigarettes to e-cigarettes must do so completely and they should not be used together.

 

As a behavior therapist, I would like to elaborate a bit on the various behavioral strategies involved.

  1. Awareness of triggers. Urges for smoking will be strongest in situations where you smoked most often, such as when with certain people, at certain places, or when feeling stressed. Write down these triggers and try to avoid these situations or find other ways to get through them without smoking.
  2. Prepare for a tough beginning. During the first few days, you will probably feel depressed, slow, tired, and irritable. Try to have a support system to give you chizuk. Once you get past these first days, you’ll feel more normal (though you still may crave cigarettes).
  3. Change habits. Keep your mouth busy with healthier satisfying things like chewing gum or munching on carrots. Also consider taking on a hobby that keeps your hands active like lifting weights or other physical activity that can distract you such as running up and down the stairs, vacuuming, or other mind consuming chores.  
  4. Don’t give in to cravings. When you get the urge, remember that it will probably pass in 5-10 minutes. In addition, each time you resist the craving, your chances of quitting up go up.
  5. Reward yourself. When you hit milestones (like 30 or 100 days) treat yourself to something that will provide a worthwhile incentive.