For years, smoking was referred to as a habit. A ??ofilthy??? one, but a habit nonetheless. But we now know that smoking is more than that. It??Ts an addiction to nicotine ??" one of the most stubborn addictions we know.


More and more Canadians are trying to quit smoking cigarettes, but it??Ts not easy. Addiction Research Foundation research shows that nicotine can be as tough to kick as other drugs. More than half of 1,000 ARF clients surveyed in 1986-88 said they thought cigarettes would be harder to give up than their main problem substance ??" whether heroin, cocaine or alcohol.


Research has also shown that the proportion of people who relapse after quitting smoking is remarkably similar to the proportion who relapse after treatment for cocaine or heroin abuse.


WORTH A TRY


Quitting smoking takes effort, perseverance and, often, some kind of help. But it??Ts worth the effort for a number of reasons. Nearly 40,000 Canadians die prematurely each year from tobacco-related causes such as cancer, emphysema or heart disease. That makes smoking the single largest preventable cause of death in the country.


There are social consequences too. Smokers are often treated as outcasts by society. Many are forced outside, even in the coldest weather, by workplace regulations and other by-laws that protect the health of non-smokers.


For those who think smoking is glamorous and sophisticated, there??Ts another reason to quit. In an ARF survey, the majority of respondents viewed pack-a-day smokers in the same light as heavy drinkers. And in the business world, the researchers noted, smoking is no longer associated with competence, intelligence, confidence and other positive qualities.


There??Ts also the health of a smoker??Ts friends and family to consider. Second-hand smoke is known to cause a variety of illnesses among non-smokers. Spouses of smokers, for instance, have higher rates of cancer and heart disease than spouses of non-smokers.


Young children of smokers develop more respiratory illnesses (such as bronchitis and laryngitis), ear infections and other health problems than the children of non-smokers. And smoking by pregnant women may harm an unborn child.


And there??Ts the soaring expense of smoking. A pack of 25 costs approximately $6.00, and virtually every government budget bumps the price higher. A pack a day, 365 days a year ??" that??Ts nearly $2,200 that could be spent on a vacation... a new stereo... home renovations... on many things other than smoking.


WAYS TO QUIT


Quitting is often hard, but people are doing it, and in record numbers. In fact, half of all living North Americans who ever smoked have now quit.


For those who decide to quit smoking ??" whether for health, social or other reasons ??" the question is: how?


Many people are able to quit on their own. For those who want help, there are many options available, some of them free, some modestly priced and some quite expensive.


They include self-help materials, such as books or videotapes; nicotine patches (available by prescription only); nicotine chewing gum (2 mg gum is available over-the-counter at drug stores, 4 mg is available by prescription only); group programs, which may last anywhere from one night to many weeks or months; hypnotism, acupuncture or laser therapy; and aversion therapies, which make smoking extremely unpleasant.


No one can say which works best for each individual. Different people will respond to different strategies. But just signing up for a program ??" committing time and money and setting a date ??" is an excellent first step.


WHERE TO START


Someone who wants to quit smoking may want to survey the full range of techniques and tools available. The more you know about it, the better able you will be to choose the program, or combination of programs, that??Ts right for you. And ARF researchers say that people are more likely to break an addiction when given choices of ways to do it.


If it??Ts not your first time quitting ??" and four of five smokers need more than one try before quitting for good ??" review past attempts to see not only what went wrong... but what went right.


Your physician can help. He or she can prescribe nicotine patches or 4 mg nicotine gum, the only pharmaceutical products that have been clinically shown to help people quit. Both the patch and gum help maintain nicotine levels in the blood while you wean yourself from cigarettes, easing withdrawal symptoms (such as irritability and impaired concentration).


You should beware of continuing to smoke while using the patch or gum because your body may get too much nicotine.


ARF experts point out that the patch and gum work best when combined with a behavioural support program.


Your physician can also help by reviewing the health hazards of smoking. Not just the latest research and numbers, but the hazards as they relate to you in particular (your family history of cancer or heart disease or a desire to become pregnant, etc.). Physicians may also be a good source of information about programs in your area.


You can get information on quit-smoking programs from a variety of other sources. The Heart and Stroke Foundation, Lung Association, the Canadian Cancer Society, hospitals and public health departments offer programs, or can refer you to someone who does.


There are also a number of private (for-profit) companies that offer stop-smoking programs. These are usually more expensive than courses such as Countdown, offered by the Lung Association.


COMPARING PROGRAMS


It??Ts easier to compare programs??T prices than their effectiveness, since very few use the same evaluation techniques. Some programs claim success rates as high as 90 per cent. These should be taken with a grain of salt. Most are not based on solid research evidence and can often be misleading.


For one thing, advertisers don??Tt always mean the same thing when they talk about success rates: Were their clients still off cigarettes after 12 months or did they merely complete the course? Are the rates based on solid data or anecdotal evidence and impressions?


These questions point out the difficulty of rating or comparing programs and their success rates. No treatment such as laser, acupuncture or hypnosis has been scientifically proven to be better than placebos. The only methods shown to be superior are combinations of behavioral treatment and nicotine patches or nicotine gum.


But it??Ts important to add that in most cases these therapies won??Tt hurt either. Sometimes, if a smoker thinks they help, they will. It may be suggestion; or it may be that the person really is ready to quit, and the treatment is just the last push he or she needs.


As long as a treatment is not prohibitively expensive or hazardous, it may be worth a try. Even if you decide to quit on your own, you might pick up some useful hints about things that can help, and pitfalls to avoid. If you do choose to enrol in a program, commit to it as fully as you can.


TIMING IS EVERYTHING


Most people who successfully quit smoking do so abruptly (??ocold turkey???), while others prefer to set a target date and taper off. Again, no one strategy can be said to be better.


If you do choose to set a date and work towards it, consider the timing ??" it can be critical. Pick a time when you??Tll be under the least amount of stress. If a major work commitment is looming, or if there??Ts a family crisis brewing, you may want to re-think your plans.


There are ways to work towards a quit date, experts say. Change brands to break any association with a particular brand. Put cigarettes in hard-to-reach places. Establish non-smoking areas, such as your car, office or certain rooms in your house.


Soliciting support from family, friends and co-workers is also important.


If you do change to a lighter brand, or cut down, try to avoid drawing harder and longer on a cigarette to compensate. That will only increase your inhalation of tar, carbon monoxide and other harmful substances.


REWARD YOURSELF


Many smokers also help themselves by rewarding non-smoking behavior. They try to see quitting as a positive thing ??" something to gain, whether it??Ts health, hygiene, respect, money ??" rather than something they are losing or giving up. Some people start putting the price of a pack in a jar every day, to see how much they spend on their addiction, and to see how much they can save if they quit.


You might also want to embark on an exercise program. The improvements you see in your physical fitness can help your resolve to quit. Exercise also keeps you out of smoking areas and can help prevent weight gain. The average weight gain after quitting is about five pounds. A number of strategies ??" like keeping low-calorie snacks such as carrot and celery sticks handy ??" can minimize any gain.


Some people also benefit by keeping a diary of their attempt to quit. Recording urges, and how you handle them, may teach you strategies that will help this time ... or next time.


KEEP TRYING


If you try and fail, don??Tt give up. Focus on the time you went without cigarettes, rather than on the fact that you gave in.


As mentioned above, many smokers fail to quit on their first try. The important thing is to keep making serious efforts. Each attempt adds to your repertoire of skills and increases your motivation. Each relapse can teach you situations to avoid next time. And even a short time without cigarettes leads to an improvement in your health ??" no matter what your age.


Within hours, the carbon monoxide level in your bloodstream will go down. Within just three days, your lung capacity will show signs of improvement.


With dedication, support and the program that is right for you, those days could stretch into weeks... months... and years.