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    <span style="font-size: 24pt; font-family: Arial">How to give up smoking</span><p
        class="author">
        <span style="font-family: Times New Roman">by </span><a href="/health/aboutus/bio/lavelle_p.htm">
            <span style="font-family: Times New Roman">Peter Lavelle</span></a></p>
    <p class="raise">
        <span style="font-family: Times New Roman">Want to give up smoking, but don't know how
            to do it? A team of researchers has analysed what works and what doesn't.</span></p>
    <p class="date">
        <span style="font-family: Times New Roman">Published 17/08/2006</span></p>
    <div class="clear">
    </div>
    <p class="raise">
        <span style="font-family: Times New Roman">The terrible effects of smoking are so well
            known that we don't need to go into them. Besides, now we've got pictures of them
            in all their horror on cigarette packets, TV screens, magazines, and the sides of
            buses.</span></p>
    <p class="raise">
        <span style="font-family: Times New Roman">By now, everybody's got the message. And
            the overwhelming majority of smokers do want to give up. But how? Giving up is hard
            yakka - especially the first few days and weeks, when the body withdraws from its
            dependence on nicotine, making you irritable, aggressive, anxious, depressed, sleepless
            and nauseous.</span></p>
    <p class="raise">
        <span style="font-family: Times New Roman">The easiest thing seems to be to light up
            a smoke. And then you're back to square one.</span></p>
    <p class="raise">
        <span style="font-family: Times New Roman">Still, giving up is easier than it was 30
            years ago, thanks to a whole range of treatments - nicotine patches, various drugs,
            counselling, group therapy, etc.</span></p>
    <p class="raise">
        <span style="font-family: Times New Roman">Which works best? Researchers at the Cochrane
            Collaboration - an international network of researchers - recently updated their
            research into the various quit smoking treatments on offer.</span></p>
    <p class="raise">
        <span style="font-family: Times New Roman">Nicotine replacement therapy should be the
            first port of call for anyone who is a moderate to heavy smoker trying to give up,
            they say.</span></p>
    <p class="raise">
        <span style="font-family: Times New Roman">Nicotine replacement therapy (NRT) first
            appeared in the 1980s as nicotine chewing gum and in the 1990s as patches. It is
            now also available as inhalers, lozenges and tablets you place under the tongue.
            In Australia, they're available without prescription from pharmacies (some are even
            available from supermarkets). They're not subsidised by the Pharamecutical Benefits
            Scheme - the PBS - however, and cost between five and 10 dollars a day.</span></p>
    <p class="raise">
        <span style="font-family: Times New Roman">For people who smoke more than 10 cigarettes
            a day, nicotine replacement therapy boosts the odds of quitting by a factor of 1.5
            to 2, say the researchers.</span></p>
    <p class="raise">
        <span style="font-family: Times New Roman">It doesn't matter what form you use (patches,
            gum etc). They all work equally well, but patches are simplest to use. If using
            patches, an eight-week course seems to be enough. Using them for longer doesn't
            improve the chances of quitting. Using patches for 16 hours is just as effective
            as using them 24 hours a day. If using gum, heavy smokers (more than 20 a day) should
            use the higher dose 4mg rather than 2 mg gum. Heavy smokers may need to use combinations
            - gum plus patches, for example.</span></p>
    <p class="raise">
        <span style="font-family: Times New Roman">People who've had heart trouble in the past,
            or who are pregnant or who are breastfeeding, should consult their doctors before
            using NRT.</span></p>
    <p class="raise">
        <span style="font-family: Times New Roman">However, for mild smokers, under 10 a day,
            they don't work. Why not? Because these people aren't smoking enough to have become
            addicted to nicotine.</span></p>
    <p class="raise">
        <span style="font-family: Times New Roman">Other signs of nicotine addiction are getting
            cravings, smoking within 30 minutes of waking, and getting withdrawal symptoms in
            previous quit attempts. People who don't have these symptoms may not benefit from
            NRT either.</span></p>
    <p class="raise">
        <span style="font-family: Times New Roman">Some people have side effects from NRT. The
            patches can cause skin irritation or rashes, and the gum can sometimes cause aches
            in the jaw or stomach problems. Inhalers can irritate the membranes inside the nose,
            particularly in those prone to sinusitis or a runny nose. There's an alternative
            drug available - bupropion (trade name Zyban) which needs a doctor's prescription
            and is available with some restrictions on the PBS. It's suitable for some people
            who don't tolerate NRT.</span></p>
    <p class="raise">
        <span style="font-family: Times New Roman">A range of other drugs are sometimes used
            - anti-anxiety drugs like benzodiazepines and antidepressants - but studies have
            shown they don't work, say the Cochrane researchers. The antihypertensive drug Clonidine
            works, but it has unpleasant side effects.</span></p>
    <p class="raise">
        <span style="font-family: Times New Roman">What about alternative treatments? Acupuncture
            is no better than placebo, say the researchers. As for hypnotherapy, there's not
            enough evidence to say yes or no.</span></p>
    <p>
    </p>
    <p>
    </p>
    <h3>
        <span style="font-size: 18pt; font-family: Times New Roman">Counselling</span></h3>
    <p class="raise">
        <span style="font-family: Times New Roman">But many people don't like the idea of using
            any kind of medication to quit. They feel the whole idea is to get away from using
            drugs.</span></p>
    <p class="raise">
        <span style="font-family: Times New Roman">Counselling is an effective alternative for
            these people, say the researchers. But it has to be intensive and ongoing.</span></p>
    <p class="raise">
        <span style="font-family: Times New Roman">Less effective is simple quit smoking advice
            from a doctor, which often takes place during a consultation for some other problem
            and tends to be brief and perfunctory. It's better than no advice or no treatment,
            but not by much. The same goes for self-help materials like the Quit pack; they
            help those who are highly motivated to quit anyway, but don't help as much as intense
            counselling.</span></p>
    <p class="raise">
        <span style="font-family: Times New Roman">What about those on NRT? Does counselling
            help them? This is less clear - but recent studies suggest that yes, counselling
            will add to the effectiveness of NRT. The more intensive the counselling the better.</span></p>
    <p class="raise">
        <span style="font-family: Times New Roman">What about good old fashioned sheer will
            power? About half of the smokers who succeed in quitting manage to do so without
            any particular support program or treatment. (Cold turkey - sudden abrupt complete
            cessation - is more likely to be successful than gradually reducing the number of
            cigarettes down to zero).</span></p>
    <p class="raise">
        <span style="font-family: Times New Roman">But it's harder. Without any help, the chances
            of successfully giving up are one in 10. Using a treatment like NRT and/or counselling
            can reduce this to about one in five.</span></p>
    <p class="raise">
        <span style="font-family: Times New Roman">Either way, if you persist you'll manage
            it. But with treatment, you'll probably get there a lot sooner.</span></p>
    <p class="raise">
        <span style="font-family: Times New Roman">And the horrible ads will no longer bother
            you.</span></p>
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