Smoking Cessation: Snuffing Out the Habit

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After completion of this course you will receive 2 Continuing Education Units
Is this course for me? This course is for RNs, LVNs, Psych Techs, Administrators & Workers for Adult Residential Facilities, Residential Facilities for the Elderly & Group Homes
Course Synopsis:

  Isn’t it interesting how, within the span of forty years, cigarettes have gone from being considered a fairly harmless habit to having a reputation as being one of the most harmful things a person can inflict on their body? By now almost every American has heard the message through a megaphone that smoking is unequivocally bad and a terrible habit to have. For those who do still smoke, and would like to quit, the message they receive from society can sometimes lack compassion. Usually people say, “How can you possibly still smoke? Don’t you know they’re terrible for you and everyone around you, and will kill you if you keep it up? Just quit already!” Have you heard people say that or have you yourself said that. But as millions who’ve become addicted to smoking know, it’s never that easy. Quitting smoking is a difficult and discouraging road for many people, and anyone who wants to quit needs the support and encouragement of friends and society, not finger-shaking and lectures. If getting the message out that cigarettes are bad for you were all it took, we wouldn’t have anyone with a smoking problem left anymore. Instead, people who are trying to quit smoking need caring support and specific strategies in place to help them overcome their addiction.

   As health and human services professionals, we’re on the front lines of people’s choices and habits, and the effects they have on people’s health. The information we’re able to share, and the attitude with which we convey it, can make the difference to a patient or client struggling with a health issue. No matter what area of health and human services realm we work in, we’ll almost certainly have patients or clients who smoke and many who may be trying to quit smoking. What an impact we can have, and what an encouragement we can be, if we’re prepared with an understanding attitude and specific, helpful advice, instead of an eye roll and a warning about how bad cigarettes are for you. This also applies if you’re the one struggling with a smoking addiction. You may be trying not to think about the harm that cigarettes are causing you because you don’t feel like you’ll ever succeed at quitting. For your own healthier life, or for the lives of those you serve, let’s learn about some real, practical steps that people can take to quit smoking for good!

Sample CEU Certificate for ClickPlayCEU

Sample CEU Certificate

Course Objectives: 

Upon completion of this course you will be able to:

  • Understand the harmful effects of smoking on the body
  • Gain knowledge about the various methods of tobacco consumption and their effects
  • Learn about the psychological & physical components of an addiction to smoking
  • Comprehend tobacco use addiction rates & characteristics
  • Incorporate helpful strategies for smoking cessation
  • Comprehend success rates for various methods of smoking cessation
  • Apply effective methods of smoking cessation to help support patients & clients
  • Understand & apply smoking cessation strategies for the health & human services worker

Course Instructor Profile:

 Donn Kropp founded CLiCKPLAY Continuing Education University out of a desire to bring others to greater levels of health and wellness. With over ten years of emergency and trauma room experience, Donn brings a seasoned, yet fresh approach to continuing education.

Course Approvals

This course is approved by the following governing boards & organizations:

  • CA Board of Registered Nursing: CA Provider # CEP 15849
  • District of Columbia Board of Nursing: CE Provider #50-14108
  • California Board of Vocational Nursing Provider # V10810
  • Psychiatric Technicians Provider # V10806
  • DSS/CCL Division for Adult Residential Facilities (ARF) Vendor Approval # 2000149-735-2: Course Approval #149-0212-25834
  • DSS/CCL Division for Residential Facilities for the Elderly (RCFE) Vendor Approval # 2000149-740-2: Course Approval #149-0212-25845
  • DSS/CCL Division for Group Homes (GH) Vendor Approval # 2000149-730-2: Course Approval #149-0212-25844
  • Far Northern Regional Center


Smoking Cessation: Snuffing Out the Habit

Hi there. I’m Donn Kropp. How are you doing? Good I hope.Well, we’re here today to talk about smoking cigarettes… actually, to be a bit more specific, we’re here to talk about quitting smoking cigarettes. This course focuses on how to help a patient, a client, a friend- or even yourself- quit smoking. Isn’t it funny how, within the span of forty years, cigarettes have gone from being considered a fairly harmless habit to having a reputation as being one of the most harmful things a person can inflict on their body? By now almost every American has heard the message through a megaphone- that smoking is unequivocally bad and a terrible habit to have. For those who do still smoke, and would like to quit, the message they receive from society can sometimes lack compassion. Usually people say- “How can you possibly still smoke? Don’t you know they’re terrible for you and everyone around you, and will kill you if you keep it up? Just quit already!” Have you heard people say that or have you yourself said that. But as millions who’ve become addicted to smoking know, it’s never that easy. Quitting smoking is a difficult and discouraging road for many people, and anyone who wants to quit needs the support and encouragement of friends and society, not finger-shaking and lectures. If getting the message out that cigarettes are bad for you were all it took, we wouldn’t have anyone with a smoking problem left anymore would we. Instead, people who are trying to quit smoking need caring support and specific strategies in place to help them overcome their addiction. As health and human services professionals, we’re on the front lines of people’s choices and habits, and the effects they have on people’s health. The information we’re able to share, and the attitude with which we convey it, can make the difference to a patient or client struggling with a health issue. No matter what area of health and human services realm we work in, we’ll almost certainly have patients or clients who smoke and many who may be trying to quit smoking. What an impact we can have, and what an encouragement we can be, if we’re prepared with an understanding attitude and specific, helpful advice, instead of an eye roll and a warning about how bad cigarettes are for you. This also applies if you’re the one struggling with a smoking addiction- you may be trying not to think about the harm that cigarettes are causing you because you don’t feel like you’ll ever succeed at quitting. For your own healthier life, or for the lives of those you serve, let’s learn about some real, practical steps that people can take to quit smoking for good!

During this course, you will learn:

About the harmful effects of smoking on the body
Various methods of tobacco consumption and their effects
Psychological and physical components of an addiction to smoking
Addiction rates and characteristics
Helpful strategies for smoking cessation
You will also learn about success rates for various methods and how to combine them most effectively in order to quit smoking permanently
We will take a look at the most effective methods for supporting patients or clients who are struggling to quit smoking
And finally we will delve into cessation strategies for those of you who may be fighting your own battle against smoking
So we have a lot to cover in this course…. Let’s get started!

Now, we’re not going to spend the majority of this course going over what people already know- that cigarettes are a bundle of bad news for your health. However, many smokers who have successfully quit said that purposely thinking about the negative health consequences of cigarettes helped them resist a craving for one when they were in the process of quitting. So here’s just a quick refresher on cigarettes’ effects on the body, beyond the tired old saying, “It’s bad for your lungs!” You may even learn a few facts you didn’t know before, which could help motivate you or one of your patients or clients to last through a craving and avoid the next cigarette. Here’s one for starters- did you know that smoking’s most devastating effect on the body is its harm to the cardiovascular system, not the lungs? While lung cancer is the disease that everyone associates with smoking, the increased risk for heart attacks and strokes that comes with smoking ultimately kills more people than cigarette-related cancer. How can smoking give you a heart attack or a stroke?, someone may ask… Isn’t it just a person’s lungs that are affected by cigarette smoke? Sadly, it isn’t. Smoking can exacerbate or worsen blockages in arteries that can lead to heart attacks, loss of circulation, and strokes. The nicotine in cigarettes constricts blood vessels and increases the likelihood of blood clot formation, both of which can lead to blocked arteries. Clots can sometimes also form in a person’s arms or legs, leading to tissue death and possible circulation problems or even amputation. Cigarette smoke also contains carbon monoxide, which takes the place of oxygen in the blood and reduces the blood’s ability to deliver an adequate oxygen supply to the body. A side effect of poorly-oxygenated blood is an increased rate of fat build-up on artery walls, which also increases the risk of poor circulation or blockages. For people with heart disease, diabetes, or risk of strokes, smoking adds another burden to an already struggling body. Now, smoking’s effects on the respiratory system are the most well-known of all a smoker’s problems. The tar and particles contained in cigarette smoke greatly increase the risk of lung cancer and breathing problems. Cigarette smoke is more than just nicotine, tar, and carbon monoxide- some other nasty elements in smoke include formaldehyde–yes, the same stuff that preserved the animals you dissected in high school biology class, and the same substance used to embalm dead bodies, benzene- a poison, and hydrogen cyanide-another poison. The low levels of cyanide in cigarette smoke aren’t enough to kill a person, of course, but they can still cause nerve damage and numbness in fingers and toes, and damage to the cells that line the lungs. Other nasty substances in smoke include acetic acid, ammonia, arsenic, and butane, which are as bad for the body as they sound.

How does this lead to cancer? Well, cancer starts from a single cell that mutates in harmful ways, usually by changes in its mechanism controlling cell division. The cell begins dividing uncontrollably, forming masses and pushing aside healthy tissue. These mutations can be random- that’s why cancer can appear in someone who has no risk of unhealthy habits or dangerous exposures- but they are far more likely to happen in the presence of substances that irritate and damage cells. Guess what severely irritates and damages lung cells? Yes, that would be tobacco smoke. The thousands of chemicals contained in smoke, in addition to particulates from the burning cigarette itself, travel deep into the lung and become trapped. The presence of these foreign chemicals and particulates causes cells to be at a higher risk of a deadly mutation that turns it into a cancer cell. What’s also insidious about lung cancer is that it’s hard to detect until it’s in an advanced stage and has often spread to surrounding lymph nodes or other organs. This gives lung cancer one of the highest mortality rates of any type of cancer, because in many cases, it’s not detected when it’s still possible to give effective treatment. Once cancer cells begin to metastasize, or spread throughout other organs, treatment becomes much more problematic and has a much smaller chance of success. Despite the fact that smoking greatly increases a person’s risk of lung cancer, however, it’s not a guaranteed result of smoking. Some people who smoke heavily their whole life may not develop lung cancer, while others who smoke for less time, or quit at some point, may still go on to develop the disease. Many smokers use this to rationalize their smoking-you may have heard someone use the reasoning of “My Uncle Bill smoked 12 pack a day till he was 92 and never had a problem!”

Uncle Bill. I love that guy. Smoking is like playing Russian Roulette in regards to cancer. Cancer’s invisible growth and unpredictability means that every smoker is at a higher risk for developing this deadly lung disease. Smoking also causes other serious lung problems such as emphysema and chronic bronchitis which fall under the title of chronic obstructive pulmonary disease, or COPD. Emphysema is caused by the damage that cigarette smoke does to the tiny air sacs, called alveoli, in the lungs which help oxygenate blood; when these air sacs are damaged, the body does not get enough oxygen and this can lead to poor circulation and tissue death in various parts of the body. COPD doesn’t strike fear in people’s hearts like the mention of cancer, but it can be just as deadly and can also lead to a reduced quality of life in the years preceding death. People with COPD have a chronic cough, can’t catch their breath easily, and become winded or exhausted from ordinary activities such as walking or talking. Many people who suffer from emphysema or COPD end up dependent on supplemental oxygen, a wheelchair, or other medical interventions that lessen a person’s independence and quality of life. Damage to the lungs can also lead to asthma and an

Most people know of smoking’s direct connection to lung cancer, but many don’t realize that smoking also has a correlation to higher rates of all kinds of other cancers. The tar and other contaminants in cigarette smoke can harm other parts of the bronchial system and lead to mouth, throat, larynx, or esophageal cancer. The harmful particulates in smoke also migrate even further into the body, leading to an increased risk of stomach, kidney, and pancreatic cancer. Given that most people would do just about anything to avoid the pain and fear that comes with cancer diagnosis and treatment, thinking of these increased risks can be one tool to help people battle against the craving for another cigarette. Besides the myriad harmful effects that smoking causes to the body of the person doing the smoking, it can also have tremendous negative effects on people around the smoker. Awareness has greatly increased in the last 20-30 years as to the harmfulness of secondhand smoke, especially to children. Pregnant mothers who smoke put their unborn child at risk for a number of serious conditions, including preterm delivery, low birth weight, and sudden infant death syndrome (SIDS). Secondhand smoke can also cause asthma or other breathing problems in both children and adults who are exposed to it, and prolonged exposure (such as for someone who lives with a smoker) can result in a risk of cancer, just as if the person themselves smoked. Many people who have successfully quit smoking have stated that even when their willpower was not strong enough to quit smoking for the sake of their own health, they were motivated by their concern for the health of their children or other family members enough to be able to quit.

So why do people continue to pursue a destructive habit, despite all these negative health consequences? It’s because of nicotine’s effect on the brain- the pleasure kick that makes nicotine, consumed in any form, an addictive drug. Nicotine is absorbed very quickly through smoking and begins to affect the brain and our dopamine levels within seconds. This natural brain function controls sensations of pleasure; dopamine is naturally produced by the brain and levels rise in reaction to exercise, sex, food, and other positive stimuli. Nicotine not only temporarily raises dopamine levels, leading to a feeling of reward or pleasure, but when its effects wear off, dopamine levels temporarily drop below normal, leaving users feeling “down” and craving another uptick in dopamine. This is the basis for people’s addiction to smoking, and the reason why it’s so hard to stay away from that next cigarette. The brain’s pleasure system is a powerful force, as we can clearly see from the millions of people who struggle with addictions not only to nicotine, but to unhealthy eating, unsafe sexual practices, or drug use.

Now it’s worth mentioning again that most of this isn’t news to anyone in this day and age, when the negative effects of smoking have been verified and publicized time and again. Most smokers know all this negative information but still either don’t want to quit or feel like they can’t, even for the sake of their health. It’s important that we as health and human services care workers, when interacting with patients who smoke, don’t use statistics and negative information to guilt or shame the individual, because that causes most people to become defensive or withdraw. Hardly anyone has ever been browbeaten into quitting smoking. However, when a person wants to quit and is searching desperately for motivation, these health risks, and the accompanying benefits of quitting smoking, as we’ll discuss later, can help them get over the mental hurdle of avoiding that next cigarette. For this reason, it’s important to keep an updated knowledge of the health consequences of smoking.

Now, before we get to the cessation part of this course- and we are getting there, I promise!- we quickly need to touch on the fact that there are some other methods of tobacco consumption which generally fall under the category of smoking but don’t actually involve cigarettes. People are sometimes under the mistaken impression that some of these methods, unlike smoking, are not harmful to their health, but this is a dangerous false belief. Some of these methods of tobacco consumption don’t carry the same health risks as smoking, but all of them carry their own type of risks. Any type of tobacco consumption introduces nicotine into the body, and as we’ve already discussed, nicotine carries certain health risks no matter how it’s ingested. Let’s quickly look at a few of these alternative methods to tobacco consumption and their risks. First, cigars. Many people believe that cigar smoking isn’t dangerous because users typically don’t inhale the smoke into their lungs, but rather hold it in their mouth. But cigars not only introduce nicotine into the body, they also carry carcinogens in their smoke which can affect the mouth, tongue, and throat. People don’t develop cancer or circulation problems because of cigar smoking as often as they do with cigarette smoking, but cigars still raise a person’s risk for these conditions. The nicotine that’s absorbed through the mouth, however, has the same negative effects on a person’s entire system as any other method of nicotine intake, as well as the same addictive properties that can cause someone to become dependent on the drug.

Another form of tobacco harmful to the mouth is chewing tobacco, which is designed to be wedged between a person’s cheek and gums. This causes excessive salivation, which is why spitting is so necessary for those who use chewing tobacco, and causes nicotine to slowly be absorbed by the bloodstream. Chewing tobacco, like cigars, is associated with high rates of mouth, tongue, and throat cancer, and carries all the same dangers of nicotine consumption that we’ve already learned. Another tobacco product is dip. Dipping tobacco, traditionally referred to as moist snuff, is a type of finely ground or shredded, moistened smokeless tobacco product. It’s commonly known by various terms – most often as dip and sometimes rub. It’s used by being placed between the lip and gum. The nicotine and other chemicals are quickly absorbed through the oral mucous membranes and from their enters the vascular system. As you can imagine dipping can leave an individual at risk for developing lip and oral cancers. Some people choose electronic cigarettes, which are not smoked at all, but are used to form a vapor containing aerosolized nicotine which is then inhaled. E-cigarettes have risen in popularity in recent years because of claims that they aren’t as harmful as real cigarettes. People who smoke electronic cigarettes maintain that these bypass many of the negative health effects of smoking. In a sense, they’re correct, because without the burned byproducts of tobacco, tar and many other secondary chemicals aren’t introduced into the body. But electronic cigarettes, like all other methods of nicotine consumption, still carry the dangers of nicotine itself, from its addictive nature to its negative effects on the vascular system and other bodily functions. So regardless of the method, tobacco consumption, and even distilled nicotine consumption, is detrimental to a number of the body’s systems and carries a heavy risk of addiction. If someone is justifying their tobacco use through one of these alternatives, saying “At least it’s not as bad as smoking”, it’s worth noting that nicotine itself has many negative health effects, no matter how it’s consumed.

Let’s talk a little about the addictive aspect of tobacco. Just how often do people become addicted to nicotine, anyway? Obviously pretty often, since millions of people continue to smoke, despite adverse health effects, and struggle to quit, a lot of times without success. As we in the health-care and human services profession strive to support our patients and clients in a positive way, and even walk our own battle against smoking, it’s worth noting the addictive power of nicotine in order to understand people’s struggles to stop smoking and why it’s so hard, in the words of many a non-smoker, to “just quit already!”. The more we can respond to clients who want to quit smoking with compassion and practical help, rather than lectures, the more successful we’ll be in helping them break their addiction. A good starting point is to recognize how common smoking is. While rates have fallen significantly in the past thirty to forty years, and smoking has been pushed out of the public eye in many states by various bans on in public places, over seventy million Americans still use tobacco on a regular basis, according to a survey done by the U.S. National Survey on Drug Use and Health. That’s about one-fourth of the U.S. population! Wow, can you believe that. As we’ve mentioned, the messages about smoking’s terrible health consequences have been broadcasted loud and clear, so for such a large segment of the population to still use tobacco speaks to its highly addictive power. And how many people manage to quit successfully? It’s difficult to measure success and failure rates regarding smoking cessation, since many people relapse after an attempt to quit smoking and may have to try a number of different methods before quitting smoking for good. However, most major studies estimate that only around ten percent of people are still smoke-free at their six-month milestone. A ninety percent relapse rate again shows the highly addictive nature of nicotine, and the fierce internal battle that most people wage in order to stop smoking.

Let’s listen for a moment from Mark, who’s been smoking for over twenty years and hasn’t been able to permanently quit. He describes what his addiction feels like, physically and emotionally. Mark’s words really demonstrate that addiction is a multi-faceted issue. In recent years, more and more studies have been done to find the core causes of addiction. As you may have heard, some studies have found that a tendency towards addiction has a genetic basis. Alcoholism and other addictions often run in families, and those with relatives who struggle with addiction may be more likely to become addicts themselves. Studies of twins have shown that if one twin has a problem with addiction, the other twin is much more likely to also struggle with addiction than two unrelated people are. Does this mean that someone with a particular genetic code is destined to become an addict in some form, and there’s nothing they can do to prevent this? No- we can clearly see from the world around us that will power and people’s personal choices also influence whether or not they will become addicts. Just as someone whose genes give them a predisposition towards obesity can avoid it with diet and exercise, someone whose genetics give them a tendency towards addiction can stay away from addictive substances, and never develop an addiction, or they can overcome their addiction through struggle. Many scientists like to say that genetics “loads the gun”, while people’s environment and personal choices “pull the trigger”.

Genetics can even help determine the physical reaction that a person has to an addictive substance. This means that when two people try alcohol, or cocaine, or cigarettes, they may actually experience the effects of the drug in different ways. People who have genetic predispositions towards addiction sometimes have stronger physio-chemical reactions to drugs, getting more of a “high” and then more of a “crash” in the course of using it. This means that the lure, appeal, and “addictive-ness” of a drug is physically more pronounced in someone whose genes give them a tendency towards addiction. Why is this relevant to our responses to patients and clients who are struggling with a smoking addiction? It helps us understand that because of genetics, some people truly do struggle more with substance abuse than others. It helps explain why two people can try cigarettes in high school, and one easily quits a couple years later while the other battles for a lifetime with trying to quit. It helps us see why one person can quit cold turkey, and never look back, while another struggles with a cycle of quitting and relapsing for years and years. Most importantly, knowledge about the genetic component to addiction helps us understand that there can be no “one size fits all” solution to quitting smoking, and that stories of how so-and-so quit so easily can be deeply discouraging to someone who struggles mightily with addiction due to genetic factors. So as we can see, smoking is a far more complex problem than other so-called habits. This isn’t the same as biting your nails or tapping your pencil when you think; an addiction to smoking, like addictions to other drugs, alcohol, or food, has physical, psychological, and emotional dimensions that must be addressed in order for any smoking-cessation program to be effective. You can also see why an awareness of the health problems brought on by smoking aren’t always enough motivation for someone to quit, because of the other factors of addiction; so browbeating patients and clients with the negative health effects, instead of approaching the problem holistically, can cause them to tune out or react angrily. We’ll look at some more positive and holistic approaches in a bit.

In addition to the difficulties in dealing with ending an addiction, the act of quitting smoking also leads to physical withdrawal symptoms. This stacks the deck even higher against someone who is trying to quit, because they’re dealing with unpleasant physical sensations and cravings while trying to break daily habits and patterns and also deal with psychological elements of addiction. The more we learn about these various roadblocks to quitting, the more I hope you are seeing why it’s ineffective at best, and cold-hearted at worst, to tell someone to “just quit” and that if it isn’t easy, they’re just “not trying hard enough”. The multiple obstacles involved in the process of quitting smoking makes this a difficult road for anyone to walk, which is why people who are trying to quit need encouragement and support, not put-downs or sneers. Now, the physical withdrawal symptoms of nicotine addiction are not as severe as, say, withdrawal from heroin or cocaine. Harder drugs have more of an immediate, severe effect on the human body, and withdrawal can bring extremely painful and even life-threatening symptoms. Nicotine withdrawal, thankfully, isn’t that severe. However, its withdrawal symptoms are still highly unpleasant, and someone who is quitting smoking needs to know what’s ahead and prepare for ways to make it through the hardest period. Nicotine withdrawal symptoms will vary in intensity depending on the person’s rate of smoking and former daily nicotine intake- obviously someone who smokes two packs a day has a higher nicotine consumption rate than someone who only smokes a pack a week, and the heavier smoker is going to probably have more severe withdrawal symptoms as a result. These symptoms often begin within a couple hours of a person’s last cigarette, and often reach their most severe level within two to three days of quitting. Then the feelings will gradually get better and the majority of physical withdrawal symptoms will be markedly better by two weeks after quitting. Now, two weeks doesn’t sound like a long time— anyone can get through something unpleasant for two weeks, right? Well, as we look at descriptions of these withdrawal symptoms, imagine having to deal with each of them for fourteen days. I think you’ll see that it’s a highly unpleasant two weeks for most people. Let’s take a look at some of the things people have reported sensing and feeling when going through nicotine withdrawal. The first symptom we’ll talk about is Anxiety- People going through nicotine withdrawal often report an oppressive sense of anxiety or worry, without any proximate cause. You know the feeling you’d have if you were suddenly called on without warning to give a speech to a crowd of five thousand people? That stomach-churning, cold-sweat, trembling nervousness? If you’ve ever felt this, you know it isn’t fun. Someone going through nicotine withdrawal will get this nervous feeling and be unwilling to shake it. As we already heard Mark say, smoking can be an effective distraction from stressful life situations, and when someone quits smoking, that distraction is no longer available. This means that on top of the generic anxious feeling that nicotine withdrawal brings, stress from life situations may seem worse than usual. This combination, as you can imagine, makes for a very unpleasant experience.

People withdrawing also complain of headaches- If you’ve ever found yourself drinking too much coffee, and then had to go a day without any, you’ll recognize and be quite familiar with the throbbing headache symptom. Irritability is another common withdrawal symptom- As you can guess, someone who feels anxious and has a bad headache is also going to feel quite irritable. This can be frustrating to both the person experiencing withdrawal and to their friends and family, as the person can become very grouchy and irritable during the withdrawal period. The fourth common withdrawal symptom associated with tobacco use is hunger- As we’ve already learned, nicotine suppresses appetite, so once the nicotine has left a person’s system, those feelings of hunger come back. This gives many people an added burden of anxiety when quitting smoking, because weight gain is a common side effect of quitting smoking and many people want to avoid that. We’ll talk more in a bit about healthy ways to snack in order to minimize weight gain during smoking cessation. Another withdrawal symptom is restlessness and sleeplessness- As the brain adjusts to a lack of nicotine, other chemicals may be temporarily thrown out of whack, especially neurotransmitters such as serotonin and dopamine. These chemicals help regulate sleeping patterns, among many other things, and when a person quits smoking, they may experience difficulty sleeping. During nicotine withdrawal, the sleep a person does get may have more nightmares or restlessness than usual. Like other symptoms, this gets better within one to two weeks for most people, but in the meantime, feeling exhausted from lack of sleep makes the other symptoms of withdrawal that much harder to tolerate.

The last withdrawal symptom we’ll mention today is Cravings for nicotine- A “craving”, as we’ll hear more about in a bit, is a sudden, intense sensation that the person needs a cigarette, must have a cigarette, can’t stand not having a cigarette. This is different than the previous symptoms we’ve just looked at, because rather than being an ongoing sensation, a craving comes on quickly and generally lasts just five minutes or so. Someone who wants to succeed at quitting smoking will need to have plans in place to fight against cravings, because most smokers who relapse after quitting say that they gave in to a craving. Since the smoker’s brain has become accustomed to the effects of nicotine, a craving is part of the brain’s attempt to regulate itself when nicotine is no longer present. All these withdrawal symptoms can vary from person to person. Each person’s level of physical discomfort, and the duration of the symptoms, will depend on their levels of exposure to nicotine and their body’s unique chemical processes. Almost all ex-smokers agree, however, that the first one to two weeks are the hardest, and that it’s a critical time in the quitting process that’s best faced with proactive strategies to avoid relapsing. That’s what we’re going to discuss next: Effective strategies for quitting smoking.

Now we arrive at the heart of the matter: what strategies are most effective at helping people end their addiction to smoking? Countless books, programs, and products are marketed towards those who want to quit smoking. There are also several drugs designed to block the effects of nicotine on the body. The best answer, however, is that there’s no one solution that fits every person. Each person’s combination of motivations to quit, temptations to start again, habits, level of addiction, and personality will need a different blend of smoking-cessation methods in order to be successful. It’s also vital to note that the majority of people who quit smoking try several times and fail before they are ultimately successful. Anyone who has tried to quit, and failed, needs to keep in mind that almost no one quits smoking the first time they try. If a particular strategy or method doesn’t work for a person, they can try again, or try a combination of different methods, in order to quit smoking for good. Let’s look at some of the various methods for quitting smoking. Method one. Going cold turkey, or stopping smoking abruptly and never starting again, is incredibly difficult and only a tiny fraction of people are able to pull this off. Individuals who attempt the cold turkey method have to get rid of all their cigarettes and refuse to buy more, deal with the unpleasant physical and mental sensations of nicotine withdrawal, and make a massive change of habit and lifestyle overnight. Those who have successfully gone cold turkey often credit mental motivations as their primary support through withdrawal, such as the thought of a loved one’s health and well-being, or the money saved through not buying cigarettes. Lisa, age 32, quit nearly ten years ago, cold-turkey, because the guy she wanted to date refused to go out with someone who smoked. Listen to what she says,

Let’s note that Lisa was a light smoker. Someone who smokes a pack a day, rather than a pack a week, will have seven times the nicotine levels to withdraw from. Because cold turkey is so hard to do, it’s very important to note that if you want to be supportive of someone who is trying to quit should not hold up a cold-turkey example as a motivation. -“So-and-so just quit cold turkey… why can’t you?” Don’t say that to people. Everyone’s needs are different, and cold-turkey doesn’t work for many. As we’ve just learned, addiction can be more than an issue of mere will power, and sometimes will power alone is not enough to enable a person to quit smoking. The second method utilized to stop smoking is by Method 2:Tapering Off. This is a much more common method, which also meets with more success. Tapering off is essentially a form of self-administered gradual withdrawal, and just means that the smoker incrementally increases the time between smokes. Someone who smokes ten cigarettes a day might cut down to nine a day… then eight, seven, six…you get the picture. This gradually lessens the body’s dependence on nicotine and eases the physical feelings of withdrawal. But, just like cold turkey, this method takes a huge amount of self-discipline and doesn’t address the emotional or psychological aspects to the person’s addiction. Often people who are successful at using the “taper-off” method combine it with other sources of support, as we’ll discuss in a bit.

Another method to help with quitting tobacco is by utilizing Method 3: Nicotine Replacements.For some people, instead of trying to taper off cigarettes themselves, it’s more effective to stop smoking immediately and use a form of nicotine replacement therapy to help with withdrawal. The most common forms of nicotine replacement are nicotine gum and nicotine patches, both of which are self-administered. Some people find that the gum is most helpful because the chewing helps replace the physical sensation of smoking, while others prefer the patch because it only needs to be applied once a day. It’s important to note, however, that nicotine gum isn’t meant to be chewed like regular gum; it’s chewed only at intervals, and then held in the mouth like chewing tobacco, then chewed again. If a person chews it quickly, like regular gum, they won’t absorb the nicotine as intended and it won’t be as effective. There are also nicotine lozenges, inhalers, and nasal sprays that serve the same purpose of nicotine replacement for the sake of easing withdrawal symptoms. These products are designed to be tapered off gradually, usually over a period of six months, and can be harmful if used longer than that.

Let’s talk a little bit about the use of Method 4: Nicotine Blockers. This can be a powerful and effective strategy to incorporate to help stop the smoking addiction. A newer medication, Varenicline, was released in 2006 and is sold under the brand name of Chantix. This prescription medication, a pill taken twice a day, doesn’t contain any nicotine but rather attaches and stimulates the nicotine receptors in the brain, so that any cigarette smoked doesn’t give the smoker any high or physiological reaction. A smoker who used Chantix described the attempt to smoke a cigarette as “just sucking in hot air”; and since varenicline doesn’t stimulate the brain to the extent that real nicotine does, going off the drug isn’t as difficult as going off actual cigarettes. As helpful as this can be for many smokers in their attempt to quit, this isn’t a magic bullet that’s appropriate for everyone. Varenicline causes severe nausea in some people, and since 2009 it’t carried a strong FDA warning that some people may experience suicidal tendencies and depression. Therefore, varenicline must be used with caution and may not work for every person. However, the use of either nicotine-replacement therapies or varenicline can help double a person’s chances for success in quitting smoking, so people trying to quit should give them serious consideration, as long as they can closely monitor any adverse side effects.

Implementing Habit-Breaking Strategies is another way to aid with the smoking cessation process. As we’ve already learned, nicotine withdrawal isn’t the only hurdle to overcome when trying to quit smoking. Many smokers have developed entrenched habits surrounding the act of smoking, and it may also fill emotional or psychological needs in their life. For the best chance of permanently quitting smoking, people need to have proactive strategies in place to help avoid situations that may trigger a craving and a network of support to help fight an emotional battle. We will delve into seven specific habit breaking strategies later on in this course so hold on. Our sixth and final strategy we can implement to help stop ourselves or others from smoking is by utilizing support support and the avoidance of temptation. There are a few smokers who prefer to fight their war alone, but many people find that their most important weapon in their battle to quit smoking is a support network. It’s difficult to overstate how vital this is to a person’s success; having people to turn to for support can really make the difference between a long-term success and a failed attempt to quit. When your willpower seems exhausted, hearing the encouragement of someone supporting you can give you the extra reserve of strength to make it past a craving. Sometimes people find this support from non-smoking friends and family, but many times the best support comes from others who are also working through quitting, or who have quit successfully. One of the best ways to find this type of support is online; there are thousands of websites, support groups, and forums to support people in their fight to quit smoking. In addition to finding a support group and accountability partners, websites can also provide reams of success stories, data on health problems caused by smoking, health benefits gained by stopping, and personalized tools like trackers or daily email reminders to motivate people to hold out against cravings.Facebook has quit-smoking groups to join; Twitter users can tweet their struggle and get positive support. There’s also many useful apps for smartphones, which can give a personalized “taper-off” countdown, update with progress and health benefits, and deliver stats on how much money and time have been saved by quitting. So if you find yourself surrounded by non-smokers, who want to be encouraging but don’t understand the severity of the stress you’re going through to quit, like-minded support is incredibly easy to find online.

I wanna to spend a little bit of time talking about the actual habit of smoking. Smoking is interesting because you don’t just have a chemical and biological addiction. You have a habitual or emotional addiction as well. The very act of smoking becomes a routine, a ritual and strongly entrenched habit. The very nature of a routine or ritual is that it gives us comfort and brings a sense of calm and security. This emotional response is extremely difficult to break because it makes us feel so snuggly inside. Did I just say snuggly! I do that every time. Why did you put in all those outtakes. You guys are mean. Let’s get serious now. Are we serious now. Ok. Let’s hear from John about the habitual aspect of smoking. In the previous section we talked about six strategies you can incorporate to quit smoking or helping someone to quit smoking. Do you remember what those six were. Let’s just quickly review them shall we? Strategy number one go cold turkey. Number two- Taper off. Number three utilize nicotine replacements. Number four incorporate the use of nicotine blockers. Number five implement habit breaking strategies. And number six utilizing support from others. In this section of the course I want to highlight strategy number five; “Habit Breaking Strategies” and give you seven activities you can perform that will help stop the “emotional-habit” aspect of smoking.

Nicotine consumption aside, many people have had smoking as part of their daily ritual for so long that just trying to break a pattern of normal routines can be extremely difficult. The absence of a habit is almost always easier to deal with when it’s replaced with a different action or habit, rather than just removed from a person’s life all together. So what are some of these replacement habits that people can use to avoid a craving? These will be different for every person, depending on the specific role that smoking has played in their life, but here are seven common strategies that many smokers find useful: Strategy 1: Chewing gum or eating a snack to replace the feeling of a cigarette in the mouth. When you keep your mouth busy with something else, it can help fight off the intense craving for a cigarette. Pretzels, sunflower seeds, veggie sticks, or popcorn can make a good snack choice. Many smokers are naturally drawn to eating in order to replace the physical craving for a smoke, but calories can add up fast, so low-fat snacks are important in order to keep from replacing a smoking problem with a weight problem. Nicotine suppresses a person’s appetite, so many smokers find themselves to be more hungry when they quit and many struggle with weight gain. Having healthy snacks prepared and close by can help people minimize the weight gain they may experience as they quit.

Our second habit breaking strategy is to: Find and perform an alternative activity to replace a smoke break. For instance, let’s say that a person always smoked as they had their morning coffee and checked their email. When trying to quit, sitting down at the computer with a cup of coffee can trigger a powerful craving to smoke, in keeping with their habit. They may need to change up their whole routine- drink their coffee instead while walking the dog, and check their email at a different time while squeezing a stress ball or chewing a piece of gum. By breaking up the old routine, it’s easier to deal with the lack of a cigarette than if it were the only thing removed from the old habit. Sometimes this can be very difficult, since many people smoke during activities, such as watching TV, these sedentary type activities and the routines associated with them can be very hard to break. Some former smokers find that activities to do with their hands can be helpful when watching TV, such as folding laundry, knitting, or squeezing a stress ball. As long as an activity is helping a former smoker to resist that craving, it’s not a wasted effort! Others have found that even rearranging the furniture can help, since they’re not sitting in their ‘usual’ spot to watch TV and missing the cigarette that they usually had in hand before. Another common pitfall is smoking while driving– knitting or folding laundry aren’t viable replacements for a craving then! In addition to gum-chewing or snacks, some people have found that listening to an engaging talk-radio program, calling a friend with a hands-free phone, or even singing loudly along with the Top 40 station can help them get past the craving for a cigarette.

Oddly enough, sometimes changing one’s route to work can help too, because it can help get the person out of the “autopilot” mindset that many of us fall into while driving a familiar road. If someone’s version of “autopilot” used to include smoking, it’s important to shake that up whenever possible to help distract from cravings. Here’s what Ryan, had to say about his struggle to quit. Here’s another great strategy to break smoking habits. Roll your own cigarettes. This may seem like a strange way to quit smoking. Smokers who have used this technique have said that self-rolling cigarettes instead of buying packs from the store can be a helpful first step in the journey towards quitting altogether. People who have incorporated this “trick-of-the-trade” have stated that it allowed them to save quite a bit of money, which lead them to think of how much they would save by quitting altogether. These money saving thought processes came about all because rolling cigarettes takes more time and effort than just flipping open a pack. The extra hassle that it adds to smoking routines makes it easier to stop altogether a few months later, isn’t that interesting? For someone who has struggled to quit and been unsuccessful, this might be an unconventional but helpful method to try. Another good way to help stop smoking is just taking a real hard and direct look at how the habit is effecting your wallet. Here’s a little secret–Quitting smoking is a huge money-saver! Let’s do some math to illustrate this point. That’s a lot of money saved, isn’t it. Some smokers have motivated themselves to quit by setting aside that money that they would have spent on cigarettes and saving it for something they really want- a special trip, a luxury handbag, tickets to a championship game. This obviously won’t stop anyone’s cravings, but it is one more mental motivation that can give a person the boost that they need to fight that craving. Our fifth strategy to help break the habit of smoking is to: List reasons to stop. Many smokers find it helpful to write down all the reasons they are quitting, as specifically as possible. Not just “better health”, but “fewer asthma attacks” or “better endurance for golfing”. Not just “my family”, but each person by name. Keep this list with you at all times, and pull it out during a craving. Mentally picture each person or each activity on the list for another mental boost to fight against that craving. Another helpful list to make is one of all the health benefits gained by quitting smoking, as they will happen over time. These lists are easy to find online (search “benefits of quitting smoking” or “smoking recovery timeline”) and detail the recovery a person’s body makes by the number of hours or days since their last cigarette. When someone is faced with a craving, being reminded that at two months post-smoke their heart-attack risk has dropped and lung function has improved can help provide the motivation to fight a craving and make it to that two month mark.

Our sixth strategy or technique to break the habit of smoking is to: Remember others who will benefit from your smoking cessation. As we mentioned earlier, one of the most powerful motivations for a person to quit smoking is the health or well-being of someone they care about. Whether it’s a child you don’t want to expose to secondhand smoke, a friend or relative who has asthma irritated by smoke, or a friend or family member who doesn’t want to be around smoke, calling to mind the person or even carrying a picture of them to look at can be a source of motivation to fight a craving. Remember how Lisa, said that she quit her social smoking habit cold turkey when the guy she really liked refused to date her? They’ve been married nearly ten years, and she hasn’t relapsed. Love is a powerful motivation for many people! Our last Strategy to break a smoking habit is to:“Take a walk”. That’s right, Walk. Many smokers have found going for a walk to be a simple and effective way to fight a craving. Walking not only releases tensions and endorphins, it gets the person out of the situation and location where they were experiencing the craving, and gives them something physical to do. As we’ve learned, each person’s specific habits and patterns will dictate which of these habit-breaking strategies will be effective in their situation.

Now that you’re armed with all this new awesome information about methods of quitting, strategies, techniques and available support, how do you communicate this to your patients or clients? From what we’ve learned in this course and from what we’ve heard from current and former smokers, one thing is clear: you can’t browbeat your patients into quitting smoking. If someone is determined to keep smoking, and they know the risks, you can’t pressure, guilt, or force them to stop. Let’s hear some more from Mark, who has tried to quit in the past but is currently smoking again: It’s pretty clear that Mark will have to initiate another attempt to quit on his own. So do we stand idly by and say nothing as patients and clients make a dangerous health choice? No; our job, as health and human services professionals, is to offer people the tools they need to maintain their best health, and to be ready with information and support when someone is ready to receive it. If you personally don’t smoke, hopefully this course has helped you learn about how fiendishly difficult it can be to quit, and you’ll be prepared to offer help and advice from a sympathetic, caring perspective instead of the common “You’re so stupid for smoking” perspective that so many patients are used to hearing, which only raises their defenses. What are some specific steps you can take to be supportive to patients and clients? Try this activity: Make a question about smoking habits part of every checkup, assessment or evaluation, but don’t be accusatory or linger on the subject. Here’s another step you can take- When your client brings up the topic of quitting, even if only to say “I’ve tried and I just can’t!”, keep a positive and upbeat manner and an open mind, and be ready to listen with sympathy, not condemnation. Ask questions about specific struggles, such as “What triggers you to smoke?” or “What happened when you tried to quit before?”. This might open the door to a discussion in which you can share strategies that they might not have tried before, or suggest resources for them to seek out.Go easy on advice that masquerades as a question, like “Have you tried chewing gum? Have you tried a nicotine patch?” Couple questions like this with other open-ended questions, like the ones we just mentioned, which will help the people you serve become more at ease, talk about their specific struggles, and allow you to learn more about their specific concerns.

Suggest that patients and clients set a goal of cutting back if quitting seems out of the question. Clearly state the health effects that you observe in them as a result of smoking, but only if it is a natural part of the interaction. (For instance if a patient or client, comes to pick up a prescription smells of smoke, don’t launch into a lecture on the evils of smoking out of the blue! That would be a sure-fire way to make them feel defensive or guilty, not motivated.Know the resources that your workplace or community offers. If you work in a hospital setting, have a general knowledge of the classes, counseling support, or other aids that might be offered for smoking cessation. This doesn’t mean that you have to memorize the schedule and phone number of every department in the hospital, but it’s helpful to be able to point people towards where they should go or who they should contact. If you work in an office, residential, or home care setting, it might be well worth your time to find out some local support programs for smoking cessation and keep the information with you. If you are in charge of a work area or waiting rooms, keep them stocked with information on websites and support groups for smoking cessation. Provide information about computer access and help for those who aren’t computer-savvy, so they can take advantage of online support. Check your local library to see if it offers computers for internet use or computer classes. Let patients and clients know that you will always be happy to talk about strategies for quitting, but that you won’t give them a finger-shaking lecture every time they see you. If you can present patients and clients of yours with a caring and concerned attitude, free of lectures and condemnation but straightforward with the facts and ready with information on ways to quit, you’ll be a breath of fresh air–pun intended!- for patients who are used to being treated as dumb and/or irresponsible people. And this in turn may persuade them that you’re a safe place in which to broach their fears and their struggles to quit smoking.

Now, we began this course by stating that it was designed to help health-care and human services professionals learn to better support their patients through smoking cessation. But what if you work in the health field, and you’re the one with the smoking habit? You may be reminded, more than most smokers, of the health consequences of your choice and may be more pressured than most smokers to quit by co-workers and patients or clients alike. However, don’t let people make you feel guilty about your struggle just because of your profession. Plenty of doctors out there smoke! We workers in the health and human services field have the same personal struggles as the rest of the population, and we’ve already seen clearly that nicotine addiction is not just something that you can educate yourself out of. A smoking addiction is a complex tangle of physical, mental, and emotional issues, and working in our profession doesn’t give anyone an easier time dealing with it. Yes, you do want to be a good example for the people you take care of, but for those who smoke, think how powerful it could be if you are open about your struggles and your attempts to quit. Instead of hearing the same old “Just quit now!” message of condemnation that they’re used to receiving from health-care professionals, your willingness to share your discouragements, your quitting strategies, and your refusal to give up the fight to quit could give them a new sense of hope or let them know that a failed attempt doesn’t mean you have to stop trying. Hopefully this course has given you a reminder of the many various aids for quitting smoking that are available to you, and you can end this course prepared to map out a new strategy for quitting that will work for your personality and your specific needs.

Whew! We’ve really covered a lot of ground in our course today. As we come to the end of this course, we hope you’ve been encouraged about how you can help your patients or clients live healthier lives, and how you can be a support to them in their journey towards becoming a non-smoker. And what’s most important in acting as that support? To be a caring and understanding presence who walks with them through this difficult battle instead of watching from the sidelines, who encourages them instead of making them feel guilty and depressed. Anyone who is addicted to nicotine has a grueling battle ahead in order to quit; let’s be the best support we can be for that battle and help many people claim victory. If you your self are struggling to stop smoking I just want to let you know that I understand because I was once there. The ability to stop is in you. A lot of times we think we’re powerless to change. This negative thinking pattern holds us in our present circumstance and we feel as if we are a slave to our habits and patterns of behavior. I encourage you right now to stop and say to yourself- I can change and I will change. From this very moment you can commit to taking your health and the health of those around you to a new level. You’ll feel so good about yourself when you start making healthy life sustaining decisions. I want to end with this. In 1941 during the height of WWII the Prime Minister of England, Winston Churchill gave a rousing speech. Interestingly history has credited him with saying during that speech, “Never give up, Never give up, Never, Never ever, Never give up.” Those are good words and they’re encouraging to hear especially if you are thinking of giving up on something. It’s funny though because Churchill never said those words- but I think his actual words are even more powerful and appropriate in regards to the battle to fight the addiction of smoking. He said Never give in, never given in, never ever ever give in. Let those words speak to you and never give in to the temptation of cigarettes, never ever ever. And also never give up. Thanks so much for joining I hope you’ve learned a lot. We’ll see you next time.

Writers and References

Writer(s): Donn Kropp, RN, BSN & Margaret Petry


  • Cancer Research UK. “Survival statistics for common cancers”. <> Updated September 2009. Accessed January 2013.
  • Carr, Allen and Francesca Cesati. The Easy Way for Women to Stop Smoking. New York: Sterling Press, 2010.
  • Centers for Disease Control and Prevention. “Health Effects of Cigarette Smoking”. <> Updated January 2012. Accessed January 2013.
  • (Pennsylvania Dept. of Health). “Nicotine Replacement Therapies”. <> Accessed January 2013.
  • DiPlacido, Leah, Ph.D. “Components of Cigarette Smoke” <> Updated March 2010. Accessed February 2013.
  • Gammon, Christina. “Here’s How I Stopped Smoking”. <> Accessed January 2013.
  • Mukherjee, Siddhartha. The Emperor of All Maladies: A Biography of Cancer. New York: Scribner, 2010.
  • National Institute on Drug Abuse. “Tobacco Addiction (Nicotine)”. <> Updated July 2012. Accessed July 2013.
  • Psychology Today. “Nicotine”. <> Updated May 2010. Accessed January 2013.
  • U.S. National Library of Medicine, “Nicotine Addiction and Withdrawal” <> Updated November 2011. Accessed February 2013.
  • Wallis, Claudia. “The Genetics of Addiction”. News. Written October 2009. Accessed February 2013. <>



Withdrawal Symptoms

Length: 10 minutes

This lesson explores tobacco withdrawal and the accompanying symptoms.

Strategies For Quitting

Length: 10 minutes

In this lesson we’ll explore the various strategies for quitting tobacco addiction once and for all.

The Habit of Smoking

Length: 18 minutes

Smoking is a habit that can be hard to break. In this lesson we’ll take a look at the habitual aspect of smoking.

Providing Support

Length: 6 minutes

Those addicted to tobacco need support. Learn how to aid and support someone who is on their journey to quitting tobacco.

You the Smoker

Length: 2 minutes

Do you as a healthcare worker struggle with tobacco abuse. Learn how to combat smoking addiction so that you can provide the best care possible to your patients.

Conclusion & Final Quiz

Length: 20 minutes

This lesson concludes our course on smoking cessation. Once you watch the lesson take the final quiz and get your certificate instantly!