Quitting smoking is not easy, but you can do it. To have the best chance of quitting successfully, you need to know what you’re up against, what your options are, and where to go for help. You'll find this information here.

Why Is It So Hard to Quit Smoking?
Mark Twain said, "Quitting smoking is easy. I've done it a thousand times." Maybe you've tried to quit, too. Why is quitting and staying quit hard for so many people? The answer is nicotine.

Nicotine
Nicotine is a drug found naturally in tobacco. It is highly addictive -- as addictive as heroin or cocaine. Over time, a person becomes physically and emotionally addicted to, or dependent on, nicotine. Studies have shown that smokers must deal with both the physical and psychological dependence to be successful at quitting and staying quit.

Where Nicotine Goes and How Long it Stays
When you inhale smoke, nicotine is carried deep into your lungs, where it is absorbed quickly into the bloodstream and carried throughout your body. Nicotine affects many parts of the body, including your heart and blood vessels, your hormonal system, your metabolism, and your brain. Nicotine can be found in breast milk and even in cervix mucus secretions of smokers. During pregnancy, nicotine freely crosses the placenta and has been found in amniotic fluid and the umbilical cord blood of newborn infants.

Several different factors can affect how long it takes the body to remove nicotine and its by-products. In general, a regular smoker will have nicotine or its by-products, such as cotinine, in the body for about 3 to 4 days after stopping.

How Nicotine Hooks Smokers
Nicotine produces pleasant feelings that make the smoker want to smoke more. It also acts as a kind of depressant by interfering with the flow of information between nerve cells. As the nervous system adapts to nicotine, smokers tend to increase the number of cigarettes they smoke, and therefore the amount of nicotine in their blood. After a while, the smoker develops a tolerance to the drug, which leads to an increase in smoking over time. Over time, the smoker reaches a certain nicotine level and then smokes to maintain this level of nicotine. In fact, nicotine, when inhaled in cigarette smoke, reaches the brain faster than drugs that enter the body intravenously (IV).

Nicotine Withdrawal
When smokers try to cut back or quit, the lack of nicotine leads to withdrawal symptoms. Withdrawal is both physical and mental. Physically, the body reacts to the absence of nicotine. Mentally, the smoker is faced with giving up a habit, which calls for a major change in behavior. Both must be addressed in order for the quitting process to work.

If a person has smoked regularly for a few weeks or longer and suddenly stops using tobacco or greatly reduces the amount smoked, they will have withdrawal symptoms. Symptoms usually start within a few hours of the last cigarette and peak about 2 to 3 days later. Withdrawal symptoms can last for a few days to up to several weeks.

Withdrawal symptoms can include any of the following:

• dizziness (which may only last 1-2 days after quitting) 
• depression 
• feelings of frustration, impatience, and anger 
• anxiety 
• irritability 
• sleep disturbances, including having trouble falling asleep and staying asleep, and having bad dreams or even nightmares 
• trouble concentrating 
• restlessness 
• headaches 
• tiredness 
• increased appetite

These symptoms can lead the smoker to start smoking cigarettes again to boost blood levels of nicotine back to a level where there are no symptoms.

Smoking also makes your body get rid of certain drugs faster than usual. When you quit smoking, it changes the way your body handles these medicines. Ask your doctor if any medicines you take regularly need to be checked or changed after you quit.

Why Should I Quit?

Your Health
Health concerns usually top the list of reasons people give for quitting smoking. This is a very real concern: About half of all smokers who continue to smoke will end up dying from a smoking-related illness.

Cancer
Nearly everyone knows that smoking can cause lung cancer, but few people realize it is also a risk factor for many other kinds of cancer as well, including cancer of the mouth, voice box (larynx), throat (pharynx), esophagus, bladder, kidney, pancreas, cervix, stomach, and some leukemias.

Lung Diseases
Pneumonia has been included in the list of diseases caused by smoking since 2004. Smoking also increases your risk of getting lung diseases such as emphysema and chronic bronchitis. These diseases are grouped together under the term COPD (chronic obstructive pulmonary disease). COPD causes chronic illness and disability, and worsens over time - sometimes becoming fatal. Emphysema and chronic bronchitis can be found in people as young as 40, but are more commonly diagnosed later in life, when the symptoms are more severe. Long term smokers have the highest risk of developing severe COPD.

Heart Attacks, Strokes, and Blood Vessel Diseases
Smokers are twice as likely to die from heart attacks as are non-smokers. And smoking is a major risk factor for peripheral vascular disease, a narrowing of the blood vessels that carry blood to the leg and arm muscles. Smoking also affects the walls of the vessels that carry blood to the brain (carotid arteries), which can cause strokes. Men who smoke are more likely to develop erectile dysfunction (impotence) because of blood vessel disease.

Blindness and Other Problems
Smoking also causes premature wrinkling of the skin, bad breath, bad smelling clothes and hair, yellow fingernails, and an increased risk of macular degeneration, one of the most common causes of blindness in the elderly.

Special Risks to Women and Babies
Women have some unique risks linked to smoking. Women over 35 who smoke and use birth control pills have a higher risk of heart attack, stroke, and blood clots of the legs. Women who smoke are more likely to have a miscarriage or a lower birth-weight baby. Low birth-weight babies are more likely to die or have learning and physical problems.

Years of Life Lost Due to Smoking
Based on data collected in the late 1990s, the US Centers for Disease Control and Prevention (CDC) estimated that adult male smokers lost an average of 13.2 years of life and female smokers lost 14.5 years of life because of smoking. And given the diseases that smoking can cause, it can steal your quality of life long before you die. Smoking-related illness can limit your activities by making it harder to breathe, get around, work, or play.

Why Quit?
No matter how old you are or how long you've smoked, quitting will help you live longer. People who stop smoking before age 50 cut their risk of dying in the next 15 years in half compared with those who continue to smoke. Ex-smokers enjoy a higher quality of life with fewer illnesses from cold and flu viruses, better self-reported health, and reduced rates of bronchitis and pneumonia.

For decades the Surgeon General has reported the health risks linked to smoking. In 1990, the Surgeon General concluded:

• Quitting smoking has major and immediate health benefits for men and women of all ages. Benefits apply to people with and without smoking-related disease.

• Former smokers live longer than people who keep smoking.

• Quitting smoking decreases the risk of lung cancer, other cancers, heart attack, stroke, and chronic lung disease.

• Women who stop smoking before pregnancy or during the first 3 to 4 months of pregnancy reduce their risk of having a low birth-weight baby to that of women who never smoked.

• The health benefits of quitting smoking are far greater than any risks from the small weight gain (usually less than 10 pounds) or any emotional or psychological problems that may follow quitting.

20 minutes after quitting: Your heart rate and blood pressure drops.
(Effect of Smoking on Arterial Stiffness and Pulse Pressure Amplification, Mahmud, A, Feely, J. 2003. Hypertension:41:183.)

12 hours after quitting: The carbon monoxide level in your blood drops to normal.
(US Surgeon General's Report, 1988, p. 202)

2 weeks to 3 months after quitting: Your circulation improves and your lung function increases. (US Surgeon General's Report, 1990, pp.193, 194,196, 285, 323)

1 to 9 months after quitting: Coughing and shortness of breath decrease; cilia (tiny hair-like structures that move mucus out of the lungs) regain normal function in the lungs, increasing the ability to handle mucus, clean the lungs, and reduce the risk of infection.
(US Surgeon General's Report, 1990, pp. 285-287, 304)

1 year after quitting: The excess risk of coronary heart disease is half that of a smoker's.
(US Surgeon General's Report, 1990, p. vi)

5 years after quitting: Your stroke risk is reduced to that of a nonsmoker 5 to 15 years after quitting. (US Surgeon General's Report, 1990, p. vi)

10 years after quitting: The lung cancer death rate is about half that of a continuing smoker's. The risk of cancer of the mouth, throat, esophagus, bladder, cervix, and pancreas decrease. (US Surgeon General's Report, 1990, pp. vi, 131, 148, 152, 155, 164,166)

15 years after quitting: The risk of coronary heart disease is that of a non-smoker's.
(US Surgeon General's Report, 1990, p. vi)

Immediate Rewards of Quitting
Kicking the tobacco habit offers some benefits that you'll notice right away and some that will develop over time. These rewards can improve your day-to-day life a great deal.

• your breath smells better 

• stained teeth get whiter 

• bad smelling clothes and hair go away 

• your yellow fingers and fingernails disappear 

• food tastes better 

• your sense of smell returns to normal 

• everyday activities no longer leave you out of breath (for example, climbing stairs or light housework).

Ready to Learn More?

Visit www.cancer.org for the complete article, which includes topics such as the costs of smoking, benefits of quitting, resources available to help, nicotine replacement, methods that help people quit, how to quit and stay that way, references, and more.

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