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    What are the different ways to quit?

     Last reviewed December 2014

    Contents

    Quitting smoking is different for each person, and sometimes even different from the last time you tried. Your personal experience will help you determine your quitting decisions. 

    Have you tried to quit smoking before?

    Think about the different ways you have tried to quit in the past.

    What worked for you?  What didn't work for you?

    Some people quit without help, others feel they need some sort of medication to help them through. Here are some ways of quitting:

    If one strategy does not work out, then maybe another will.

    Calling Quitline 13 7848 doubles your chances of successfully quitting. Quitline counsellors can help you work out your best way of quitting – and plan what will work best for you.

    Nicotine replacement therapy (NRT) 

    The aim of Nicotine Replacement Therapy (NRT) is to reduce the withdrawal symptoms associated with nicotine addiction by replacing some of the nicotine obtained from cigarettes.  the nicotine, as it is not associated with the harmful constituents found in tobacco smoke. Treating nicotine addiction with NRT enables people who smoke to focus on the two other aspects of smoking - the habits or behaviours associated with smoking and the emotional aspects, such as stress and boredom

    For many people, quitting is a major life change that often involves making serval attempts over time before quitting for good.  NRT assists with the physical addiction to nicotine while quit smoking counselling from a service such as Quitline helps with the behavioural and emotional aspects. Research has shown that the best outcomes are achieved when NRT or other medications such as Champix are combined with ongoing counselling ad support.

    Will I still experience cravings when using NRT?

    Blood nicotine levels are lower in people using NRT when compared with people who smoke. This means that for those people who are heavy smokers, the standard doses of NRT may not be enough to manage nicotine cravings and withdrawal symptoms.

    Cigarettes provide significantly more nicotine than any form of NRT so heavy smokers may still experience nicotine cravings. In these situations, the use of more than one form of NRT such as patches and gum (combination therapy) may be necessary. People who smoke tend to be very self aware about the amount of nicotine they need to manage withdrawal symptoms and are usually best able to determine what level of NRT is right for them.

    Can anyone use NRT?

    NRT can be used by most people who smoke. The key recommendations are:

    • Combination therapy: patches can be used in combination with gum or other intermittent forms of NRT (gum, inhalator, lozenge, mouth spray and oral srips) to reduce
    • Cut Down To Stop: patches or other forms of NRT can be used to help reduce the number of cigarettes smoked prior to quitting
    • Young people (12 and older), pregnant women and some people with cardiovascular disease can safely use some forms of NRT
    • ‘Stepping down’ or ‘weaning’ from higher to lower strength patches is no longer considered necessary: using the 21 mg or 25 mg patch and then stopping abruptly is just as effective
    • Using NRT to quit is always safer than continuing to smoke
    • For further information call Quitline 13 7848 or speak with your doctor.

    What NRT products are there?

    There are 2 types of NRT products: patches and oral or intermittent forms (gum, inhalator, lozenge, mouth spray and oral strips). All oral forms of NRT provide nicotine by absorption through the lining of the mouth. Oral forms of NRT can be used as a cigarette substitute and are very effective in cutting down the number of cigarettes smoked prior to quitting. The choice of an oral form of NRT will depend on personal preferences and many people try different forms of NRT before working out what suits them best.

    Obtaining nicotine from NRT is very safe compared to smoking. If nausea or any other adverse effects from NRT are experienced, then you should reduce the amount you are using or stop using it, and speak to your pharmacist or doctor. The experience of nausea may occur, but nicotine toxicity is unlikely to occur from the correct use of NRT products. While NRT is a safe form of medication for adults who smoke, it is a poison and therefore caution needs to be exercised around small children. Caution is particularly needed with products such as the gum and lozenges that could be mistaken for lollies.

    Patches

    The nicotine patch is designed to continuously deliver nicotine to the bloodstream via the skin.  Blood plasma levels of nicotine slowly rise during the first few hours after application with the maximum level being reached after 6-10hours.  The 21 mg/24 hour patch is recommended for those smoking more that 15 cigarettes per day and have their first cigarette within 30 minutes of waking.  Using this patch for 24 hours, however, may lead to vivid dreams and/or disturbed sleep.  If this is experienced then it is advisable to remove the patch overnight.  After patch removal, nicotine already in the skin continues to be absorbed for up to two hours.

    If vivid dreams and/or disturbed sleep are experienced, then the 25mg/16 hour patch may be a better alternative.  However, when the patch is not worn overnight strong nicotine cravings may be experienced in the mornings after waking.  This is more likely in the early stages of quitting or cutting down when nicotine dependence is higher.

    Intermittent forms of NRT such as lozenges, inhalators and gum can be used to provide a more immediate dosage of nicotine while waiting for the nicotine from the patch to be delivered.

    Cut Down To Stop:  The patched marketed as 'Pre-quit' patches are actually 21 mg patches that can be used to cut down the number of cigarettes smoked prior to quitting.  Recent research has found that using patches or intermittent forms of NRT to cut down the number of cigarettes smoked prior to quitting, doubles the success rate compared to using patches for abrupt quitting.

    Clear patches provide the same therapeutic benefits as flesh-coloured patches and may be preferred as they are less obvious when the skin area is visible.

    The patches should be applied to a clean, dry, hairless area of the skin above the waist such as the upper arm with the location changed daily to avoid skin irritation.  Adverse effects of the patch may include itching and tingling of the skin at the applicaiton site, redness of the skin and sleep disturbances.

    Nicotine patches on the PBS 

    From February 2011, nicotine patches became available on the Pharmaceutical Benefits Scheme (PBS). With this PBS subsidy, smokers who obtain a doctor’s prescription for patches can receive a four-week course with up to two repeats at approximately $36.90 or $6.00 (CPI adjusted yearly) if they hold a Centrelink health care card.

    Nicotine mouth spray

    The nicotine mouth spray was introduced in 2012 and is another oral or intermittent product like the gum, lozenge and inhalator. When used as directed it provides a spray or mist of nicotine into the lining of the mouth and/or under the tongue. The nicotine is absorbed here and then travels to the brain via the blood circulation.

    The mouth spray has a child resistant feature that needs to be mastered before use. If the spray is new or hasn’t been used for several days it needs to be primed. The spray is released onto the inside of the cheek or under the tongue. Try to avoid the lips or the back of the throat as this can lead to a burning sensation. Avoid inhaling the spray or swallowing for a few seconds as the spray is most effective when held in the mouth. One or two sprays can be used each time a craving for a cigarette is felt. It is recommended no more than 4 sprays an hour or 64 sprays a day. There are approximately 150 sprays in each dispenser.

    Side effects from excess usage can include nausea, salivation, abdominal pain, sweating, diarrhoea, headache, dizziness and hearing disturbance or weakness. For more dependent smokers the spray can be used in combination with a nicotine patch.

    Nicotine oral strips 

    Nicotine mouth strips were introduced in 2014 and also provide relief when smokers either anticipate or experience cravings following exposure to triggers such as the smell of smoke. The thin film is removed from the individual sachet and placed on the tongue. With the mouth closed and the film pressed to the roof of the mouth, the strip dissolves completely in about 3 minutes.

    Oral strips release 2.5 mg of nicotine, about the same amount of nicotine found in 2 mg nicotine gum or a 2 mg lozenge. The oral film is suitable for smokers who are less addicted and are able to delay their first cigarette for at least 30 minutes after waking. More dependent smokers can combine the oral film with nicotine patches. 

    Inhalator

    The Inhalator works by providing nicotine into the lining of the mouth where it is absorbed. The Inhalator contains 15mg of nicotine. Each cartridge lasts for about 40 minutes with continual use.

    The Inhalator mimics the act of smoking and therefore assists with hand-to-mouth behaviour as well as treating nicotine addiction. It is puffed rather than inhaled as it is important for the nicotine to be held in the mouth where it is absorbed. 

    Gum

    Nicotine gum can be used to actively control nicotine cravings when they are felt. The gum contains nicotine which is absorbed through the lining of the mouth and then enters the blood stream.

    Chew Park Chew: Gum is available in two strengths, 2 mg and 4 mg, and needs to be chewed in a particular way to achieve maximum benefit. The gum should be chewed slowly until a peppery taste becomes strong and/or a tingling sensation is noticed. It then needs to be ‘parked’ between the gums/teeth and cheek until the taste has faded and then chewing is repeated.

    The gum is available in a variety of flavours such as mint, fruit and the ‘classic’ nicotine flavour. Adverse effects of gum usage can include nausea and vomiting, indigestion, hiccups and occasionally headaches if the gum is chewed too rapidly. These unpleasant effects can be minimised by using the products as recommended.

    Lozenge 

    The nicotine lozenge can be used to actively control nicotine cravings when they are felt. The lozenge is available in three strengths, 1.5 mg, 2 mg and 4 mg. The stronger lozenge is recommended for more nicotine dependent smokers.

    The lozenge is placed in the mouth and occasionally moved from side to side until completely dissolved, usually within 30 minutes. The nicotine from the lozenge is absorbed through the lining of the mouth. The lozenge should not be chewed or swallowed whole. People should not eat or drink while the lozenge is in the mouth.

    This form of NRT is suitable for people who have problems with gum but prefer an oral form of NRT. Adverse effects are similar to the gum.

    Product Dosage (as a guide)
    Combination Therapy For people with a Heavy dependence on nicotine and who experience cravings using only one form of NRT
    • 25 mg/16 hour patch in combination with 2 mg gum or lozenge
    • 21 mg/24 hour patch in combination with 2 mg gum or 2 mg or 1.5 mg lozenge
    • patch in combination with any intermittent form of NRT
    Patch    Heavy to Moderate dependence:
    21 mg/24 hour patch or 25 mg/16 hour patch

    Moderate to Low dependence:
    14 mg/24 hour patch use 1 patch daily
    Nicotine Mouth Spray One or two sprays under the tongue or onto the inner cheek to relieve cravings. Maximum of 4 sprays an hour or 64 sprays a day.
    Nicotine Oral Strips Use 1 oral strip every 1 to 2 hours and up to 15 strips per day.

    After 7 weeks of use, gradually lengthen time interval between use of oral strips
     
    7–9 weeks: 1 strip every 2–4 hours

    10–12 weeks: 1 strip every 4–8 hours

    After 12 weeks: 1 strip in situations where strongly tempted to smoke.
     

    Inhalator 1 cartridge when you have an urge to smoke or every 2–4 hours

    for best results use 3–6 cartridges per day

    Gum Heavy to Moderate dependence:
    4 mg (after the first 2 weeks you may prefer to use the 2 mg gum)

    Moderate to Low dependence: 2 mg
    use 1 piece per hour or 10–15 pieces per day
    Lozenge

    Heavy to Moderate dependence:
    4 mg lozenge

    Moderate to Low dependence:
    2 mg lozenge or 1.5 mg lozenge
    4 mg and 2 mg lozenges (9–15 per day)
    1.5 mg lozenge (9–20 per day)

    Quitting medications 

    Quitting medications may assist with physical withdrawal symptoms such as nicotine cravings.

    Even with medication, you may get cravings in situations where you used to smoke. Habits and emotions are strong triggers for smoking. Understanding your triggers can help you to plan how to cope.
     

    Champix/Varenicline 

    Champix is an oral medication that reduces cravings and the negative effects of nicotine withdrawal. Champix became available in Australia in 2008 and can be obtained on prescription from your doctor.

     

    Champix works by blocking the effects of nicotine in your body. There are receptors for nicotine in the brain. When cigarette smoke is inhaled, nicotine attaches to these receptors. This sends a message to a different part of the brain to release a chemical called dopamine. Dopamine gives a feeling of pleasure which only lasts for a short time. The body wants to repeat this feeling reinforcing the need to keep smoking.

    Based on research, it is believed that Champix works by activating these receptors and blocking nicotine from attaching to them. Champix does not contain nicotine and is not addictive.

    People using Champix often find they enjoy smoking a cigarette less and sometimes find smoking becomes distasteful.

    Important recommendations and information about Champix: 

    • It is not recommended in pregnancy or for women who are breast feeding.
    • It is not recommended for under 18 year olds.
    • If people have kidney problems, fits or convulsions, use insulin, asthma medications, blood thinners or have a history of mental illness it is important to discuss the use of Champix with their doctor.
    • There have been some reports of Champix affecting mood and behaviour; this includes depression and thoughts of selfharm or harming others. That is why it is important for people to tell the doctor if there is a history of mental illness before starting to take Champix.
    • It is important to use caution when driving and operating machinery until an individual knows how quitting and/or Champix may affect them.

    Using Champix 

    Champix is a 12 week or 24 week course of medication depending on your doctor’s advice and your quitting progress. The initial script covers 4 weeks of treatment then it is important to return to your doctor for a follow up script for another 8 weeks of medication.

    Take Champix with a full glass of water. Some people find it better to take Champix with food.

    Days 1 -3 0.5 mg once daily White tablet
    Days 4 - 7 0.5mg twice daily    White tablet
    Day 8 - to end of treatment (12 wks) 1 mg twice daily Blue tablet

    It is recommended that you begin taking Champix medication while you are still smoking and then as Champix builds up in the body most people find they can reduce the number of cigarettes they smoke. It is then advised to have a go at quitting smoking between day 8 and day 14.

    Quitting smoking can take a little longer for some people so don’t be discouraged if you’re not ready to quit by day 14. Just work towards reducing your daily smoking and then have a go at quitting when you feel ready.

    Many people who smoke have developed habits and routines around their smoking such as smoking with a cup of tea or coffee, smoking after meals or during breaks. Some emotions can also be triggers for people’s smoking. Feeling stressed, angry, upset or even happy can be a trigger for smoking. Champix assists with the symptoms of nicotine withdrawal however most people find it helpful to use some strategies to manage their smoking triggers.

    Champix is a useful aid in treating nicotine addiction, but motivation to quit smoking is still the most important ingredient for success. Getting some Quitline support can also increase your chances of successfully quitting.

    Possible side effects of Champix 

    Champix has been associated with changes in mood or behaviour in some people. It is important to discontinue using Champix if changes in mood or behaviour are observed and consult your doctor for further advice. Some of the more common Champix side effects can include:

    • nausea (usually mild): to reduce nausea, take with a full glass of water and with some food
    • headache
    • insomnia
    • abnormal dreams
    • dizziness
    • feeling tired or fatigued
    • increased appetite
    • changes in taste.


    It is important to consult your doctor if you are concerned about any side effects. 

    How much does Champix cost? 

    The cost per prescription is subsidised by the Australian Government through the Pharmaceutical Benefits Scheme. Each prescription costs around $6.00 for holders of a (Centrelink) Health Care Card, otherwise the cost is around $36.90 (CPI adjusted yearly) for other patients.

    For more information about Champix please read the Consumer Medicine Information (CMI) available at http://pfizer.com.au/champix

    Cutting down to quit 

    Cutting down is cutting back your daily cigarette total over time.

    You may not feel ready to quit right now, but want to do something about your smoking. Cutting down is a great way to look at your habits and triggers  and understand what it will take to ultimately quit.

    When you cut down, you will notice some improvements to your health and to your finances. However, there will continue to be nicotine in your body and you will continue to experience cravings.

    The hardest thing about this method is sticking to it. There's always the temptation to have the cigarette instead of going without or using nicotine replacement therapy. If you’re having problems reducing your smoking, call Quitline to chat with a counselor through strategies that may help you. 

    If you were to cut down your cigarettes, how would you do it?

    There are a number of ways to gradually reduce the number of cigarettes you smoke.

    You could try:

    • smoking five cigarettes less every day until you aren't smoking at all (count out how many you are allowed that day, and don't smoke any more)
    • delaying your first cigarette by a hour each day
    • using nicotine replacement therapy products like patches or gum/lozenges. These products give you some of the nicotine you would normally get from cigarettes so people feel much less like smoking when using a patch. Another approach is to replace some of your normal cigarettes with a nicotine gum or lozenge, increasing replacements until you are not smoking at all.

    It’s important to remember that quitting smoking completely is best for your health and reducing your risk of getting smoking associated diseases and conditions. 

    Cold turkey 

    Quitting smoking ‘cold turkey’ means abruptly stopping smoking without using any quitting medications to assist. For some people this is the most successful way to quit smoking.

    When you quit smoking, you will begin to feel the benefits straight away. The healing process begins and noticeable changes occur.

    Planning to cope  with your triggers, cravings and withdrawal symptoms will increase your chance of success.

    E-cigarettes 

    Unlike traditional nicotine replacement therapy, such as patches and gum, the use of e-cigarettes containing nicotine cartridges has not been approved by Australia’s regulatory agency for medical drugs and devices, the Therapeutic Goods Administration. It is not legal to sell the nicotine component of e-cigarettes in South Australia, however many people obtain these from other sources (it is legal to possess an e-cigarette containing nicotine).

    E-cigarettes look similar to traditional cigarettes. An electronic cigarette is a rechargeable battery powered personal vaporizer (PV) or inhaler, often in the form of a cigarette, and can contain either flavoured nicotine liquid or refills with no nicotine. The nicotine strength can also be varied according to the user's requirement.

    E-cigarettes are used like a cigarette, the user inhales the vapour through the replaceable cartridge that contains synthetic nicotine or another flavour dissolved in propylene glycol (the chemical found in smoke machines) or glycerol. There is no actual smoke produced, but the vapour that is inhaled exhibits many of the properties of smoke missing from other nicotine delivery devices such as the inhalator which is a smoking cessation product. Smoking an e-cigarette is called ‘vaping’ for this reason.