BecomeAnEX FAQ

Cravings become less intense and less frequent with time, but may not disappear forever. About half of people who have quit for longer than 6 months report having occasional strong cravings. Some (about 10%) report having a strong cravings at least monthly. However, these extended cravings do not seem to put a person at any more danger of relapse than people who do not experience intermittent cravings. There are two types of craving, "background craving" and "triggered craving." Background craving fluctuates throughout the day and is related to withdrawal from tobacco. Background cravings tend to increase for a few days to a week after your last tobacco use, and gradually dissipate. "Triggered cravings" are a second type of craving caused by the pairing of internal or external 'triggers' to use tobacco. These cravings have a rapid onset, and more short-lived than background craving.

Extended use of medication, rewarding alternative healthy habits, mindfulness techniques, and physical activity all have been found to reduce these types of cravings.

The good news about cravings is that they are relatively short-lasting whether a person uses tobacco or not! Distracting yourself from a craving isn't as much about NOT thinking about tobacco, but choosing something else on which to focus. Since most urges will last between 3-5 minutes before they pass, distractions don't have to be time-consuming or complicated. Here is a link to a helpful infographic on 100 things to do instead of smoke: https://excommunity.becomeanex.org/blogs/Mark-blog/2015/07/31/what-to-do-instead-of-smoking

Nicotine is a mood-altering drug that creates dependence when used in high doses such as smoking. Feelings of anxiousness, depression, or impatience are common symptoms of withdrawal when the body stops receiving high levels of nicotine.

The process of going tobacco-free comes with its challenges as the body is working to return to a healthy state physically and mentally. Withdrawal commonly peaks within the first 3-5 days of quitting and normalizes after 2-4 weeks of stopping tobacco use. This process can vary between individuals and may last for several months. Here are some common symptoms of withdrawal:

• Feeling down or sad, irritable, on edge, or grouchy
• Having trouble sleeping, feeling restless and jumpy
• Having trouble thinking clearly and concentrating
• Slower heart rate
• Feeling more hungry or gaining weight
• Coughing or producing more phlegm

Remember that these symptoms are temporary and will go away the longer you stay quit!

No matter how old you are, it is never too late to quit tobacco. Within minutes of stopping smoking, positive changes are taking place within your body. The longer you remain tobacco-free, the lower your risk of developing tobacco-related illnesses such as cancer and heart disease. Research shows that among smokers who quit at age 65, men can gain 1.4–2 years of life and women can gain 2.7–3.4 years.

Withdrawal symptoms can last a few days to a few weeks. The habitual trigger to use tobacco will become less intense rather quickly, but can last many months. Medication, counseling, and environmental changes can help make withdrawal more manageable. Unfortunately, many people who become addicted develop a life-long sensitivity, so that after many years of abstinence, even one cigarette can cause adaptations in the brain to occur very quickly bringing about a return to regular smoking, so it is important to not smoke even "just one."

Cigarettes are very addicting. When you inhale smoke from a cigarette, it delivers large amounts of nicotine to your brain very quickly. This stimulates a release of dopamine, a chemical transmitter that is responsible for attention, reward, and habit forming. Particular activities like taking a break or drinking coffee, or feelings such as stress, boredom, or anger, become associated or reinforced with using tobacco. These associations can be very strong and unconscious. It might even seem like your body reaches for a cigarette before your mind even realizes it. In addition to the automatic habit, many people have uncomfortable withdrawal symptoms. Withdrawal happens because the brain has changed, so that nicotine is now needed to produce what was once a normal amount of dopamine. Your ability to resist the habit of reaching for a cigarette and the intensity of withdrawal varies from person to person due to a number of factors, including the availability of cigarettes, life stressors, and genetics. You can learn more about tobacco addiction in the 3 minute video available at https://www.youtube.com/watch?v=5ewwzazHfq4

Using tobacco is not better than gaining weight! Gaining a few pounds when quitting tobacco is not a risk factor for any of the tobacco-related diseases that smokers are at higher risk of having. Gaining weight is often something that occurs when people quit, but should not be a barrier to try and make a quit attempt. Ask your health provider about seeing a registered dietitian, as they can help you devise an eating and exercise plan to help you when you quit.

On average, smokers weigh 10 pounds less than nonsmokers. When a person stops smoking, typical weight gain is around 8-10 pounds within 6-12 months of quitting. Significant weight gain can be a fear for many people who are thinking about stopping smoking. However, research shows that only 13% of smokers gain more than 10 pounds. The lifestyle changes you choose to make following a quit attempt can influence how much weight you may gain.

It is possible to quit without gaining weight! Here are some general tips for minimizing weight gain while quitting:

• Increase the amount of exercise that you do. This seems to be the method that makes the most sense, since exercise can also help manage those cravings and can burn the calories.
• Exercise may address psychosocial and physiological needs that nicotine replacement alone does not address.
• Exercise (as little as 10 minutes) reduces withdrawal symptoms and urges to use tobacco:
  • Reduces nicotine craving
  • Reduces feelings of tension
  • Reduces subjective stress

People often substitute the oral fixation of tobacco use with food, and often that food is unhealthy – for example: foods that are high in sugar and fat. Nicotine increases metabolism about 10%, so when you quit tobacco it's important to readjust food intake or increase exercise to counteract the effects that nicotine has.

Talk with your health care provider about using nicotine replacement medication while nursing. Smoking while nursing has clear risks: many chemicals in tobacco smoke cross over into breast milk. Nicotine replacement is certainly a safer alternative, but also has risk for the baby.

Stopping tobacco can only be helpful to you and your baby. It is absolutely not true that quitting smoking is harmful to you or your baby.

Research has demonstrated that smoking as little as one cigarette per day increases the risk of developing heart disease and cancer. Exercise and healthy eating is recommended for everyone. To put the impact of smoking in perspective, the stress on your heart of smoking one pack of cigarettes per day is about equal to being 90 pounds overweight.

If you have questions or concerns about your health, you should see your doctor to arrange any recommended tests. Cigarettes contain more than 7,000 chemicals, many of which are dangerous to our health. The chances of developing a tobacco-related illness increase with continued tobacco use. Stopping tobacco is one of the best things you can do to improve your health.

The short answer is that both are unsafe to consume. As previous World Health Organization Director-General Dr. Gro Harlem Brundtlan put it, "A cigarette is the only consumer product which, when used as directed, kills its consumer." While there are additives in many tobacco products, it is the combustion (or "burning") of the tobacco leaf itself that creates thousands of dangerous chemicals. Smoking natural or manufactured tobacco will still produce carbon monoxide and other harmful chemicals from burning the cigarette.

Stopping smoking before and after surgery has many benefits that can lead to better and faster healing. Within 12 hours of stopping smoking, your heart and lungs start working better, and your blood delivers more oxygen to your body. Getting more oxygen helps you heal faster and reducing the risk of problems happening during and after surgery such as wound infections, breathing problems, and heart attacks. A surgery can make for a great time to quit, too. Smokers who quit before or at surgery report fewer cravings and are more than twice as likely to succeed in stopping long term. Learn more about smoking and surgery.

There is strong evidence for substantial health gains from stopping smoking completely, but not much evidence that reducing smoking, in the absence of quitting, improves health. There may be minor health benefits from reducing by more than 1/2 the number of cigarettes smoked per day, but stopping smoking completely is the only sure way to improve health.

Absolutely not true: Stopping smoking does not increase your chances of getting cancer or any other illness. Stopping smoking will almost immediately begin to reverse the processes that lead to cardiovascular disease and over time reduce risk for cancer. This myth probably began because many people are motivated to stop smoking when they don't feel well and may be experiencing symptoms indicating that an underlying disease process has already begun. However, even in this case, stopping smoking can only improve your health.

About 20-25% of people who take Chantix will experience vivid dreams. Some people report they enjoy the dreams, and others find them bothersome. Why Chantix causes vivid dreams is not understood completely. Chantix does stimulate dopamine, a neurotransmitter that is implicated in dreaming, and this may in part explain this effect.

Every quit attempt is a step in the right direction and should be encouraged as long as the treatment is safe. Many alternative therapies are offered to help people quit tobacco - many that claim very high success rates. While acupuncture and hypnosis may work for some, recent research shows minimal benefit for most smokers who try them. The best approach to quitting is to combine quitting medications and a behavioral program like EX.

Chantix reduces cravings by binding to nicotine receptors in the brain and activating them. It also partly blocks nicotine from tobacco from binding to those receptors. It seems to become more effective over time. The typical starter pack is designed to be used a week before an individual's quit date. The recommended length of treatment with Chantix is 12 weeks. It is important to talk with your health care provider about the best schedule and dose for you.

If you develop itching or red skin at the site of your patch, here are several recommendations to consider:

• Remove the old patch after applying a new one each day.
• Rotate the patch site each time a new patch is put on.
• Apply 1% hydrocortisone cream to the irritated area 2-3 times a day.

If you see continued irritation that is not relieved by the cream, contact your health care provider.

Nicotine replacement medications can be used on their own or in combination with another. It is recommended to talk with your health care provider about whether NRT is right for you and to determine an appropriate medication and dosing plan.

Many major studies have looked at smokers with heart disease diagnoses who use NRT and have found no increased risk. It is important and may be beneficial to speak with your health care provider before starting a cessation medication plan.

The FDA has determined that there are no significant concerns with using NRT products when a person slips and smokes. If you slip while trying to go tobacco-free, don't give up! Throw away whatever tobacco you're using, continue using quitting medications, and re-commit to your EX Plan.

Cigarettes are highly efficient delivery devices for the drug nicotine. The amount of nicotine in nicotine replacement therapy (NRT) is less than in cigarettes and it is delivered more slowly. Thus, the risk of addiction in NRT is very low compared to smoking cigarettes.

Studies show that nicotine replacement therapy (NRT) has the potential to double quit rates, though 'real world' studies show that many people neither use NRT as directed nor for as long as needed. While some tobacco users do quit 'cold turkey', it is quite difficult and success rates are very low. One way to maximize the benefits of NRT is to use it at the same time as behavioral counseling.

There is a big difference between a slip and a relapse (returning to old pattern of behaviors) and how you think about it can greatly impact your success in quitting. If a slip occurs, immediately getting back on a solid plan to remain abstinent is important. Although the formal definition of a relapse varies among experts, most would consider a return to daily smoking as a relapse.

There is no safe level of exposure to secondhand smoke (SHS). SHS has been shown to cause a multitude of health issues to non-smokers exposed to SHS including lung cancer, heart disease, and respiratory illness. Click here to learn more about the risks of SHS smoke: http://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/health_effects/index.htm

Secondhand Smoke (SHS), also known as environmental tobacco smoke, is the smoke produced from another person's cigarette, pipe, or cigar use. There are two forms of SHS - mainstream and sidestream. Mainstream smoke is that which is exhaled from another person that we then inhale. Sidestream smoke is the smoke that comes from the burning tip of a tobacco product. Sidestream smoke is thought to be the more toxic of the two.

You can set your quit date on your My EX Plan page.

While tobacco use is an individual decision and quitting begins with a personal decision, there are many ways support people can help their loved ones achieve and maintain a tobacco-free life. Some suggestions include:

• Be patient and understanding during the withdrawal period
• Never suggest a former tobacco user go ahead and use tobacco "just this once"
• Remind them that urges will soon pass and become less frequent
• Express your confidence in their ability to become tobacco-free
• Understand the need to avoid tobacco users and situations that are linked to tobacco
• Recognize that tobacco dependence is a chronic disease and may require multiple quit attempts

Electronic cigarettes are different from smoked tobacco products in that they deliver nicotine by vaporizing a liquid solution rather than burn organic material like a cigarette. Though people who use vaping devices will not inhale the tar and carbon monoxide they would get from tobacco smoke, e-cigarettes contain a number of other chemicals that are known carcinogens and toxins. Research on short-term health effects indicate reasons for concern and the risk of repeated, long-term exposure to the combination of "e-juice" chemicals are unknown. Additionally, these liquid solutions are not currently regulated in a number of countries. It is for these reasons among others that many healthcare providers do not recommend e-cigarettes as safe alternatives, although many researchers believe that e-cigarettes are likely to be better than combustible cigarettes. Continued use of cigarettes while also using e-cigarettes ("dual-use") is also not recommended, as it may prolong use of cigarettes among those considering quitting.

There are several key differences between the nicotine inhaler and electronic cigarettes. The nicotine inhaler is a smoking cessation device that delivers non-visible nicotine vapor when puffed into the mouth. It has been demonstrated to help people stop smoking and follows safety standards regulated by the FDA. Inhalers do not contain batteries and other liquids. Electronic cigarettes, while popular, are unregulated nicotine delivering devices that come in many different shapes and sizes. Visit Dr. Hays' blog on electronic cigarettes to learn more about them: https://excommunity.becomeanex.org/community/expert-advice/blog/2015/05/15/faqs-about-electronic-cigarettes

While some newer models of electronic cigarettes deliver nicotine more efficiently than older models, the effectiveness of e-cigarettes for smoking cessation is modest and appears to be comparable to the nicotine patch when combined with minimal behavioral support. It should also be noted that e-cigarettes are not currently regulated by the FDA as a smoking cessation device.

To quit e-cigarettes, you can apply many of the same techniques as you would to quit cigarettes or other tobacco. The BecomeAnEX interactive tools, videos, and information about nicotine addiction, making a quit plan, and coping with cravings and triggers still apply! The EX Community will also help support you on your quitting journey, no matter whether you're trying to quit smoking or vaping.

We also have some resources specific to quitting e-cigarettes. Sign up for our e-cigarette specific text messages by texting QUIT to 202-804-9884 or by adjusting your profile settings on EX to start receiving text messages.

Quitting smoking can change the way some medications work, especially those used to treat severe mental illness. For many people, quitting means they need less of their other medications.

You should discuss any changes in medication with your health care provider. If you have serious mental illness, you should tell your doctor when you are stopping tobacco so you can talk about any medication changes. Learn more about quitting with a mental health condition.

As you are quitting, you might feel irritable or restless, have trouble sleeping or concentrating, or feel anxious, depressed, or hungry. Don't worry! In most cases, these are symptoms of nicotine withdrawal, and not your mental health condition getting worse. These feelings usually go away in a few days. Once you get past the withdrawal symptoms, quitting smoking can make you feel as good as using anti-depressants. Learn more about the effects of quitting on mental health conditions.

Many people with mental health conditions also have other life challenges that make it harder to quit. These may include: more friends who smoke, stronger physical dependence on cigarettes, and fewer resources. However, if you have a mental illness and you use tobacco, YOU CAN QUIT with the right treatment, support, and medication!

Tobacco users with mental illness want to quit as much as any other users! Most have tried to quit in the past, and more than half are thinking about quitting within six months.

Snuff, chewing tobacco, and snus can cause serious health problems. While it causes less harm than cigarettes, smokeless tobacco is not safe. It is addictive and contains many cancer-causing ingredients.

Stopping all tobacco products, including smokeless tobacco, is the healthy thing to do. There is no safe level of tobacco use.

Read more about the health effects of chewing tobacco here: http://www.mayoclinic.org/healthy-lifestyle/quit-smoking/in-depth/chewing-tobacco/art-20047428?pg=2

Smokeless tobacco of any kind has not been shown to help smokers stop smoking cigarettes.

To quit snuff, chewing tobacco, or snus, you can apply many of the same techniques as you would to quit cigarettes or other inhaled tobacco products. There are some differences: Dippers and chewers may want to plan something to do to replace the feeling of having the snuff, chewing tobacco, or snus in their mouth. Some people use a non-nicotine, non-tobacco herbal chew as a replacement. Others use mints or gum. Still others use nicotine lozenges or gum to make those first few days and weeks of quitting more comfortable. Whatever you do, think about how and when you use your snuff, chewing tobacco, or snus, and come up with strategies to beat each kind of trigger.

The BecomeAnEX interactive tools, videos, and information about nicotine addiction, making a quit plan, and coping with cravings and triggers still apply! The EX Community will also help support you on your quitting journey, no matter what you’re trying to quit using.

Smokeless tobacco of any kind causes

• Tooth decay
• Tooth loss
• Gum disease

Using snuff, chewing tobacco, snus, or other smokeless tobacco products also makes it more likely that you’ll develop:

• Cancer of the mouth, throat, larynx (voice box), esophagus (food pipe), kidney, and pancreas
• Cardiovascular disease
• Stroke
• Diabetes

Different products have different amounts of toxic ingredients. This is true even between different brands of the same product. For example, one study of moist snuff brands found that the most toxic brand had 18 times more cancer-causing agents than the least toxic brand.

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