As a primary care doctor I talk about a lot with my patients about stopping smoking. Risks of smoking, how to stop smoking… I had a ex-smoking friend ask me the other day why I bother talking with people about stopping smoking since there isn’t anything I can do to help them anyways. My jaw just about hit the floor. Then I started wondering how many people think this way. And then I decided to write this post about different ways that your physician can help you stop smoking. The main ways are through motivational interviewing, medications, and referrals to other resources.
Motivational interviewing deals with trying to help people understand their reasons for wanting to make a behavior change, and by doing so increasing their motivation to change and hopefully making a commitment to change. It isn’t about lecturing the patient on the evils of smoking, rather on helping patients to explore their ambivalence about making a change and working towards goals they wish to work towards. These goals may involve behavioral changes or may also include medications or referrals to outside sources.
There are several kinds of medications that people use to help quit smoking. There are two prescription medications Chantix and Zyban (also known as wellbutrin). These medications are used for 3-6months frequently as patients stop smoking and establish other behavior patterns. If someone has a tendency to deal with their emotions by smoking I find Zyban to be especially helpful. Also – Zyban can be prescribed for <$50/mo where as Chantix may be more like $4-500/mo if insurance doesn’t cover it. So, I tend to start with Zyban as long as the person is a good candidate for it.
Nicotine replacement therapy (NRT) is another medication option. People use patches, gum, lozenges. A lot has been written about them – I find the American Cancer Society to be a reliable resource and this is a link to their information about nicotine replacement therapy options. I usually recommend starting with patches and/or gum to people who are smoking a pack a day or more or who have withdrawal symptoms when they stop smoking. NRT can be used in combination with zyban or chantix if desired. More recently people have started using e-cigs too, but I am hesitant to recommend the e-cigarettes because I have seen most people switch to them and then not actually wean themselves off of them. While this does help with second hand smoke exposure, I am not convinced there may not be long term health risks from inhaling them. When people use the patch the strength they start out on depends on how much they have been smoking – and then decrease the strength of the patch after a month or so. When using the gum it is important to pay attention to how it is used. Many people chew it like gum – and that leads to them swallowing the nicotine and getting nauseated. To use the gum properly you chew and then PARK it along the gum line – as if it were dip – and the nicotine is then absorbed that way. Some insurances cover nicotine replacement systems if it is written as a prescription, also HSA/FSA plans may cover them with a prescription – so please check to see if this is a benefit you have. If you quit smoking, your health care costs will go down. That is why insurances may cover it – so if you have this as a benefit please don’t feel guilty about using it.
One of the more common places I refer people to is 1-800-QUIT-NOW. All they do is talk with people about stopping smoking. It is a free call and they can do follow-up calls with people if they want. If you prefer to get more information on-line first the website is www.quitnowkentucky.org . Another place I refer people to is an app called Smoke Free – Quit Smoking Now – it is available for both iPhones and androids.
***Note *** This post, like all my other posts, is for general medical information only and is not to be taken as direct advice. Please consult your personal physician for more information.