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alt.support.stop-smoking FAQ(4/5)

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           FREQUENTLY ASKED QUESTIONS (FAQ)

                         FOR

              ALT.SUPPORT.STOP-SMOKING (AS3)
              ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~   

         Part 3: TECHNIQUES, TROUBLESHOOTING, AND TIPS

They don't get to smoke, they have to smoke.
- Dave Whiteis

Why so sad and woebegone? Will the world not heed you? Courage! Even you
have won friends you may rely upon when they really need you - Piet Hein

30. What is the best method for quitting?

The best method to use for quitting is the method that works for you. If
one method doesn't help, try another! Don't let external images get in the
way of your success (such as, it's weak to use the patch, or acupuncture is
too New Age). Whatever works for you is a good method - with one big
caution: be very wary of using unmedical miracle cures you may see
advertised on the WWW or - gasp! - occasionally on AS3. They can be, at
best, very overpriced, and at worst, dangerous. Please be cautioned that
AS3 does not condone or encourage the practice of advertising on Usenet,
and it does not recommend any product which may be advertised on the group.

Here is information on some conventional and not so conventional tools for
smoking cessation, along with some feedback from AS3 members. And remember,
being prepared is key, no matter which method you try.

  a. Rational Emotive Therapy (RET)

I put this one first because it can be - and IMHO, should be, - used in
conjunction with any of the other methods listed in this section. It also
seems to me to be closely related to the advice of Allen Carr, whose method
is described below.

Don't shy away from what may sound like a technical discussion; RET
basically is no more than a way of changing your attitude.

Steve Polansky ("DD [Dare Devil] Steve") introduced RET to the group in a
follow-up to a post by Shirley Shaw.

Shirley observed:

"The fear was the most uncomfortable thing about the day. Perhaps that is
one of the reasons we smoked...the fear of being uncomfortable."

DDSteve responded:

"I had an opportunity several years back to be introduced to Rational
Emotive Therapy [RET]. About all I remember is that: between the occurrence
of an event and our reaction to it, there is a mental dialogue that
probably determines what our reaction will be to that event. ... [T]he
dialogue is usually one that we are unaware of on a conscious level.
=46urther, that by altering the script of that dialogue, we will alter our
reaction to the event.

"When I look back at why I smoked, what I remember is that I seldom smoked
a cig because it tasted good or because it felt good. I usually, like any
chemical addict, smoked so that I wouldn't be/feel uncomfortable. A sagging
nicotine level brought on that awful feeling we called a nicotine fit. What
were its characteristics? Nervousness, trembling, sweating, irritability? I
remember these and there are probably others, all uncomfortable sensations.

"And how did we 'cure' the condition? We smoked a cigarette. Pretty simple
solution, and effective. This is where I see the internal dialogue being
established. As neophyte smokers we 'learned' to relieve discomfort by
smoking a cigarette. I'm sure very few of us willingly waited till we were
uncomfortable. The onset of the sensations associated with a sagging nic
level triggered a response that, with practice, happened more
automatically, [until] we were no longer consciously in the loop.

"Here is where I make a connection that may not be valid. Once we had
established the dialogue that went "when I feel a sensation that feels like
a nic fit, smoke a cig to cure it", then any event that produced feelings
similar to a nic fit should/could be cured by smoking a cig. I very much
doubt that we looked closely at why we lit a particular cig. With every cig
smoked, with every repetition, the pattern became more ingrained.

"... I was talking to a friend who had quit cold turkey a few months
earlier. He was telling me how much he wanted a cig. That sometimes he
craved them so badly he felt like he was being turned inside out. Talking
to him, it seemed that the only thing that had changed was that he was no
longer putting a cig in his mouth. But the rest of his habit was somehow
still intact. He really believed that a cig would relieve his discomfort. I
wonder if his inner dialogue is telling him that 'a cig will make you feel
better'.
=2E..
"If we don't alter the script, we run the risk of relapse. If we do change
the script, we can comfortably and confidently carry on with our lives with
no risk of relapse."

  b. Cold Turkey

This is certainly the cheapest, oldest, and simplest method: just stop
smoking. Aside from its economic and operational advantages, going Cold
Turkey means that the nicotine in your body will clear itself out as fast
as possible - so your withdrawal period will be short, but it will also be
intense.

  c. The Patch

(Material for this FAQ was contributed from various sources, as credited.)

[Adapted from Brad Olin's contribution.]

The 'patch' is the common name for a nicotine replacement therapy (NRT)
which delivers varying dosages of nicotine to the bloodstream via a plaster
which adheres to the skin. There are several brands of the patch available,
manufactured by different drug companies in different dosages and with
slightly different properties, but all operate by weaning the nicotine
addict off the drug over a period of weeks or months. (Nicotine gum is
another form of NRT - see below.) Your body has become addicted to
nicotine, and nicotine addiction is a medical problem that can be treated
medically. However, NRT is not a sure-fire way to quit smoking.

Used properly, the patch can provide relative comfort from the physical
symptoms of withdrawal (e.g., irritability, frustration, anger, anxiety,
difficulty concentrating, restlessness), allowing those who feel
overwhelmed by the physical addiction some relief while dealing with the
behavioral habit. The discomfort felt when going from smoking to the patch,
or when reducing dosages, is not as sharp as that felt when going cold
turkey. But, some quitters contend that because the patch stretches
withdrawal out over a longer period of time, it isn't any easier than
quitting cold turkey.

Cravings may not be as intense when using the nicotine patch, but do not
expect them to disappear magically. For most smokers, nicotine addiction is
just one part of the habit. We develop behavioral and psychological
addictions as well. Certain feelings, times of the day, or activities all
become strong cues and make us crave a cigarette.

How many cigarettes does a patch equal? The nicotine released from the 21mg
patch during a 24-hour period is roughly equivalent to that ingested from a
pack of 20 cigarettes, whether they be high or low tar and nicotine.
(Cigarettes are made 'light' by modifying the filter, not the tobacco; but
it has been shown that smokers of 'Lights' and 'Ultra Lights' then modify
the way they hold and inhale cigarettes, so that they get the same amount
of nicotine as with the stronger brands.) You and your medical provider or
pharmacist/chemist will determine, based upon factors such as your weight,
general health, and smoking habits, the nicotine dosages you use and the
length of time you will remain at each level.

Nicotine from the patch is not delivered to the bloodstream in the same way
as it is when you smoke. When you inhale, the nicotine in cigarette smoke
enters your bloodstream through your lungs. It is carried to your brain
very quickly (faster than an injection into your veins) and it almost
immediately satisfies your craving. At least for the moment. The amount of
nicotine in your blood is known as 'blood nicotine level.' After a
cigarette, the level of nicotine drops quickly. When it gets to a low
level, your body signals that it needs more and you experience a craving.
The desire is temporarily satisfied when you inhale your next cigarette.
You may need a cigarette every 20 to 30 minutes. Throughout the day your
blood nicotine level is raised and lowered like a roller coaster, and your
system becomes a participant in a constant 'need-feed' cycle of addiction.

The nicotine patch, on the other hand, delivers the drug at a controlled
rate into your bloodstream through your skin. The rate is intended to be
steady, but it's not perfect. When the patch is first applied, the blood
nicotine level quickly increases to its peak at about the two hour period;
it remains at peak delivery through about the sixth hour; then it slowly
tapers off through the remainder of the 24 hour cycle.

[Please note that nicotine remains in the blood for several hours even once
the patch is removed; therefore, it is crucial that once you begin using
the patch, you do not smoke. A nicotine overdose can result in illness,
heart failure, even death. Also, a significant amount of drug remains in
the patch itself even once it is discarded. See information provided by
Michiko Walraven further on in this section.]

While nicotine is nicotine regardless of its delivery system, using the
patch is not as harmful for you as continuing to smoke cigarettes. First,
you receive no more nicotine, and usually far less, through the patch than
you do from smoking. The patch does not contain tar or the poisonous gases
that are found in cigarettes. The patch does not present health hazards,
via second hand smoke, to those who share your living space. And most
important, the patch is easier to stop using. It is not associated with
qualities such as sexiness, rebelliousness, or creativity; nor will you
look to it to see you through tough times or to join you in celebrations
(though you may find yourself giving it a little pat now and again)! And,
as explained above, the relatively constant nicotine level supplied by the
patch, delivered passively and regardless of whether you think you need it
or not, ends the need-feed cycle, allowing the body to disassociate itself
from the expected reactions to nicotine intake.

It is unfortunate that the cost of the nicotine patch sometimes presents a
barrier to its use, and although national governments and insurance
companies agree that smoking is a highly significant source of senseless
illness and premature death, few back up this belief by subsidizing the
cost of this treatment. But even if your health insurance won't pay for the
patch, remember that the cost of using the patch is usually no more than
continuing to smoke a pack a day. And patch use will usually end within 10
to 16 weeks; cigarette buying never ends until the smoker stops, one way or
another.

Not everyone can use the nicotine patch, so be aware of potential medical
side effects associated with using the patch. It is possible, and not
uncommon, to have some mild itching, burning, or tingling when the patch is
first applied. This is normal and should go away after about an hour. After
you remove a patch, the skin underneath might be somewhat red. Your skin
should not stay red for more than a day. If you get a skin rash after using
the patch, or the skin under the patch becomes swollen or very red, call
your doctor. You might be allergic to one of the components of that
particular company's patch. You can try switching brands, and see if you
react more favourably. And, if you know you have problems with adhesives
plasters/bandages, then consult your doctor before using the patch.

Most brands of the patch comes in different dosages, and using the wrong
one could result in side effects including headaches, dizziness, upset
stomach, diarrhea, blurred vision, weakness, and vivid dreams. Also, you
must inform your doctor that you are using the patch if he/she prescribes
other medication.

The happy side effect: Many people using the patch, especially one of the
brands designed to be worn round-the-clock, experience unusually vivid
dreams. One friend told me that the patch gave him extremely erotic dreams
every night! It seems that the patch's steady nicotine delivery system
keeps the brain relatively active even during sleep, which in turns
produces lively dreams.

If the patch is causing insomnia, however, or if the excessive dreaming is
disturbing, ask your doctor about switching to a 16 hour patch, or removing
the one you're using during the night.

[From The Journal of the American Medical Association. Distributed by: JOIN
TOGETHER: A National Resource for Communities Fighting Substance Abuse.
Tel. 617/437-1500. Fax. 617/437-9394. 441 Stuart Street, Sixth Floor,
Boston, MA 02116. info@jointogether.org]

_The Effectiveness of the Nicotine Patch for Smoking Cessation: A
Meta-analysis_

- Michael C. Fiore, MD, MPH; Stevens S. Smith, Ph.D.; Douglas E. Jorenby,
Ph.D.; Timothy B. Baker Ph.D.

"Our objective was to estimate the overall efficacy and optimal use of the
nicotine patch for treating tobacco dependence. Our data sources were from
nicotine patch efficacy studies published through September 1993,
identified through MEDLINE, Psychological Abstracts, and Food and Drug
Administration new drug applications. Our study selection was double-blind,
placebo-controlled nicotine patch studies of 4 weeks or longer with random
assignment of subjects, biochemical confirmation of abstinence, and
subjects not selected on the basis of specific diseases (e.g., coronary
artery disease). Pooled abstinence rates and combined odds ratios (ORs) at
end of treatment and 6-month follow-up were examined overall and in terms
of patch type (16-hour vs 24-hour), patch treatment duration, dosage
reduction (weaning), counselling format (individual vs group), and
intensity of adjuvant behavioral counselling. Across 17 studies (n=3D5098
patients) meeting inclusion criteria, overall abstinence rates for the
active patch were 27% (vs 13% for placebo) at the end of treatment and 22%
(vs 9% for placebo) at 6 months. The combined ORs for efficacy of active
patch vs placebo patch were 2.6 at the end of treatment and 3.0 at 6
months. The active patch was superior to the placebo patch regardless of
patch type (16-hours 24-hour), patch treatment duration, weaning,
counselling format, or counselling intensity.

"The 16-hour and 24-hour patches appeared equally efficacious, and
extending treatment beyond 8 weeks did not appear to increase efficacy. The
pooled abstinence data showed that intensive behavioral counselling had a
reliable but modest positive impact on quit rates. Our conclusions were
that the nicotine patch is an effective aid to quitting smoking across
different patch-use strategies. Active patch subjects were more than twice
as likely to quit smoking as individuals wearing a placebo patch, and this
effect was present at both high and low intensities of counselling. The
nicotine patch is an effective smoking cessation aid and has the potential
to improve public health significantly.

"Abstract Source: Fiore M.C., Smith S.S., Jorenby D.E., Baker, T.B., (1994)
The Effectiveness of the Nicotine Patch for Smoking Cessation: A
Meta-analysis. The Journal of the American Medical Association, JAMA 271
(24) 1940 Article Source: Fiore M.C., Smith S.S., Jorenby D.E., Baker,
T.B., (1994) The Effectiveness of the Nicotine Patch for Smoking Cessation:
A Meta-analysis. The Journal of the American Medical Association, JAMA 271
(24) 1940-1947. Date: 8/9/94"

[From Michiko Walraven, michiko@islandnet.com]

Warning to Patch Users

This is a summary of an article I found yesterday morning in our local
newspaper. I hope this will help all the patch users who live with small
animals/children:

Excerpts from Victoria Times-Colonist, Jan 12, 1995, page B3.

"A man in Duncan, BC has been on nicotine patch for the past 40 days trying
to quit smoking. He noticed that the patch sometimes gets loose and falls
off. So, he has been using duct tape on occasion. Last night his patch fell
off during his sleep, and his pet kitten (11-month) accidentally swallowed
it. The cat survived her nicotine blast and was recovering fine at the time
of newsprint. BC Drug and Poison Information Centre representative says:
'With nicotine patches, when children get them stuck on them, we've had
problems with nicotine toxicity where they get very shaky, stomach cramping
and if untreated sometimes there's always the risk of seizures.' She
recommends that users of patches consider returning the used patches to
their pharmacies for proper disposal rather than just throwing them out
with the normal trash. The spent patches could still contain traces of
medicine."

  d. Nicotine Gum

Another form of nicotine replacement therapy (NRT) is chewing gum laced
with nicotine (sold under the brand name Nicorette in Canada, the U.S., and
Europe. Like the patch, it provides nicotine to the person quitting smoking
via a less psychologically- attractive delivery system, and allows for a
more gradual (and theoretically more comfortable) departure of the drug
from the bloodstream. Another factor which might appeal to some people is
that the quitter has full control over gum use; unlike the patch, which is
designed to deliver a steady and constant flow of nicotine, the gum is used
in response to withdrawal cravings. You use it when you feel the need, and
wean yourself off the drug by using fewer pieces of the gum per day. Even
if you take months to go off the gum entirely, you will still be realizing
many health benefits from not smoking.

That the nicotine gum requires the user to take an active role in nicotine
dosing may make it an undesirable tool for some people. It may seem too
much like smoking in that you are responding to the body's urges for
nicotine by supplying it on an as-needed basis, only with gum rather than
with a cigarette. OTOH, you may prefer to have control rather than use the
patch, which sends nicotine to you whether you think you want it or not.
If you find the gum upsets your stomach, you may be using it incorrectly.
The package directions for Nicorette gum specify that you should chew a
piece with small chews every minute or so, and "park" it between your cheek
and gums when you're not chewing. The package also states most of the
nicotine will be released within the first thirty minutes. If you chew
Nicorette like regular gum before the nicotine is released, this could and
probably will upset your stomach. Note that after the 30 minutes you can
treat it as regular gum and chew as often or as vigorously as you want.

  e. Nicotine Nasal Spray
[Provided by Dixie, randixoe@digisys.net]

"The spray is called Nicotrol NS and is manufactured in the U.S. by McNeil
Pharmaceutical. It was just approved by the FDA in July of 1996. It is a
prescription medicine. It is sold in a spray bottle containing 10 mg/ml
nicotine in an aqueous solution. Each time you spray the Nicotrol NS into
each nostril you receive about the same amount of Nicotine as smoking 1
cigarette.

"One spray in each nostril is considered 1 dose. Instructions are not to
use more than 5 doses per hour or more than 40 doses in 24 hours. The
suggestion is to use the spray no longer than 3 months. The cost is $38.30
for 1 bottle that contains approximately 100 doses (200 sprays).

"Now for my experience with this nose spray. Although I had the
prescription for Nicotrol NS, I wanted to see if I could quit 'cold turkey'
first. Well the first day, towards afternoon I was turning into a miserable
bawling mess. I decided to try the Nicotrol NS and to my amazement within 1
minute I was a new girl. I couldn't believe how well it worked, compared to
the patches I had tried years ago.

"That day I used the spray 6 times. Since then I have used the spray about
15-16 times a day. I really don't want to use any more than I have to
because in a couple of weeks I'll want to discontinue the use of the spray
also.

"The nose spray really did sting some when I first used it but doesn't
bother me much at all now. (They do give a warning for people who have
sinus problems, etc. to check with their doctor before using.)

"From everything I've researched on this Nicotrol NS I think that someone
who isn't careful could have problems being addicted to and continuing the
spray longer than appropriate. My suggestion to anyone who decides to use
it is to use as little as you can but don't let yourself get to the panic
stage before you use it. I was smoking 2 1/2 packs a day when I quit and
like I said I'm using about 15-16 doses a day. If I did that for a whole
month it would end up costing me about $190-$200 per month."

  f. Cutting down

Is there one among us who has not tried cutting down our tobacco intake at
one time or another? Perhaps you weren't even thinking of quitting smoking
as the ultimate goal, but of trying to reduce the damage or risk or save a
little money. I have personally notched many a cardboard matchbook cover in
my day. What I got for my trouble was an obsession. How much time has
passed since my last smoke? Can I have another yet? How do I make this <x>
number of cigarettes last me through <y> hours?

It would seem to be self-evident that gradually cutting down on smoking
would be a viable means to quitting altogether. After all, the less you
smoke, the less drug in your system, and this is the logic behind the
nicotine patch and Nicorette gum, right? But in fact, whether your goal is
to smoke less or to quit entirely, you're not doing yourself any favours by
cutting down, because each cigarette that you light sets you right back
down in the middle of your addiction cycle. The further apart you stretch
the supply of drug, the longer you suffer the discomfort of withdrawal. The
only way out of this cycle is to stop feeding the addiction altogether.
That way, the body eventually gives up demanding the drug, and you're on
the road to freedom.

Switching to a lighter brand might seem sensible, and theoretically it is.
But keep in mind that what makes a cigarette's nicotine content less is
manipulation of the filter, not the tobacco, and smokers in reality manage
to compensate for that manipulation by holding the cigarette a certain way
and/or inhaling more deeply.

Having said this, there are some people who have quit by cutting down,
delaying smoking further and further into the day, limiting the places
where they smoke, and/or switching brands. And if it works for you, great!
If not, next time you can try another strategy. The important thing is that
you keep trying to quit.

  g. Acupuncture/Acupressure

     i. Before quitting

[Contributed by Grant N. Mazmanian <grantmaz@ix.netcom.com>]

"QUOTE I went to an M.D. specializing in anesthesiology at a local hospital
outside of Philadelphia at the recommendation of a friend. The doctor gave
me references and claimed a 75% success rate. I called several doctors and
nurses at the hospital and they all reported the same results: they stopped
smoking after one or two treatments, minimal withdrawal symptoms, little or
no weight gain and no apparent side effects. They all had tried to quit
several times and failed and were very enthusiastic about the procedure.

"My visit lasted about an hour. Sterile, disposable acupuncture needles
were inserted along my arms, hands, ears and head. There was little to no
pain. A final needle was placed on the top of my head and an electrode was
connected to a mild electric current. I rested in a chair during the
procedure.

"At the end of treatment, I was given an herb to mix with hot water to make
a tea. I was instructed not to smoke and if I had any cravings, to drink
the tea. If the tea didn't work, the doctor gave me his beeper number.

"For the first few days I felt a craving but I didn't know what I wanted;
it wasn't for a cigarette but I was at a loss to describe what the craving
was for. I called the doctor about it and he told me that it was a normal
response. I went for a second session because I wanted to reinforce the
first treatment but I honestly didn't think I needed it. After a week, the
craving subsided. The usual cigarette 'triggers were gone after two weeks."

[N.B. - Grant does not know the herb he was given - ed.]

      ii. After quitting

[Contributed by Tina <tivity@dti.net>]

"I was getting discouraged that after sooooo many days without nicotine, I
was still longing to smoke all the time. It didn't seem to make sense to
reintroduce nicotine into my system via gum or patches (though if I'd
planned my quit, I would have used one of them). I went to an acupuncturist
instead, and thought I'd post a report. ...

"After swabbing my ears with alcohol, she used long tweezers to poke a
little ring into the upper arch of my left ear, and another one at the
nest-like hollow in the lower part of my right ear. These rings are less
than 1/8 inch diameter, and though they seem to be laying flat on the skin,
they must have a pointy part facing into the skin because a) I could feel
them being placed as if they were poking my skin (although this might have
been the tweezers) and b) I was instructed to tap the rings to activate the
pressure points in question. Using small pieces of clear surgical tape, Dr.
Lee secured the rings to my ears. She issued the following instructions:
lightly tap the points 20 times each morning upon awakening; tap them 5-7
times any time I feel the urge for a cigarette. I could swim, shower,
sleep, etc without fear of disturbing the rings, but I shouldn't scratch at
them. They would help me be free of urges to smoke, and even if I did have
a cigarette, it would taste bad and I wouldn't want to smoke it. (Junkie
thinking ALERT: It did cross my mind to test this theory....) Because I had
already quit for 2 weeks, she thought a week would do me, and I should drop
by (no appointment needed, because it's so fast) to have the rings removed.
The visit cost $50.

"So, how is it, you're asking. From the first, I noticed that tapping the
rings did seem to help get over cravings. The first day, I did this many
many many times. Fewer the second day, and, you guessed it, fewer each day
than the last. Also, I could feel a little soreness, especially in the
left, at the beginning, and this too diminished.

"The experience, especially noticeable with the 20 a.m.-taps, is sorta...
Eastern. That is, the cravings don't feel like they're being wiped out, as
if with a drug, but rather that you are becoming slightly better balanced,
and therefore your need for something to fix you, like a cigarette, is
less. I can't imagine that this subtle effect would be enough to have made
me quit had I still been smoking. And I have not tried what it would taste
like to smoke a cigarette."

  h. Hypnosis

[Contributed by Michiko Walraven <michiko@islandnet.com>:

"I had decided to use hypnosis simply because: (1) I knew I did not have
strong willpower; (2) I honestly believed that I would go under very
easily. Also, the initial session was covered by our medical insurance,
since it was a referral from my physician. My appointment with the doctor
(a General Practitioner with a certificate for hypnotherapy) was 9 a.m. on
my birthday (sheer coincidence, which turned out to be a great motivator
later). I had my last smoke in the car in the parking lot at 8:59 a.m. The
doctor asked me at the beginning of the session to describe to him why I
was going to quit. It was, I told him, because I knew I had to quit
eventually, and that it was as good as any other time (rather laid-back
attitude). One thing I really emphasized was that I didn't want to turn
into an ex-smoker who would become a strong anti-smoker, poking his/her
nose into everybody else's (i.e. smoker's) business.

"My session began. He asked me to look back for the first happy moment I
could remember as a non-smoker. That took a lot of going back... I had been
a smoker since 16 or so. I was about 12 years old or so in that image. The
doctor then told me that I no longer needed to smoke, and asked me if I
could visualize myself being a non-smoker in that image, only at the
current age. After some time I would see myself being a non-smoker. He then
asked me if I could see myself being a non-smoker one week from that day,
one month, 3 months, etc. etc. finally down to one year from that day.
=46ortunately I could really see it.

"That was basically it. I did not become violently ill at the smell or
sight of smoke, I did not turn into a radical anti smoker. I am just a
happy and proud non-smoker for over two years now. Of course this newsgroup
helped a LOT, particular at the beginning, and when I was going through
some legal/family trauma. Sure, the thought comes to me 'Boy, a smoke would
really hit the spot' once in awhile. But if necessary, I can always go back
for a follow-up session. Actually I was told to have an follow-up after 2
weeks/months, but never bothered because (1) I did not need it all that
much, and (2) it would cost me $80.00 CDN. (First session was covered by
the medical insurance, lucky!)

"If you are interested, ask your family doctor. That is exactly what I did,
and he recommended doctors who could do hypnotherapy (1 hr) for my purpose.
It was strictly a private session. I don't know how a group session would
have worked for me, since I wasn't interested."

Here is more on hypnotherapy, from a licensed practitioner.

Bob Christofferson asked a hypnotist who posted to AS3:

"Do you have any advice for how to select a hypnotherapist? Is one session
enough, or are results better with more sessions? Are group sessions any
good? Is there a way for a person to tell if he or she would be a good
candidate for hypnotherapy? Is that enough questions for now? :) "

Edward Hutchison, a practicing hypnotist, responded:

"First, I don't know any sure guide to picking a lawyer, a good school, a
wife ... or a hypnotherapist.  There really aren't any good accrediting
agencies with universal recognition for hypnotists or psychotherapists so
about all I can suggest would be to ask friends or perhaps your family
doctor.  But, to be honest, although hypnosis is taught at some medical and
dental schools it is not a part of the typical MD's training. Consequently,
not enough of them are aware of its full potential and some patient might
ask a question about it and, as you probably know, MD's are bred to never
say 'I don't know.'

"As to the number of sessions:  it depends. I prefer to see people once,
and for about 70%, that one visit is enough to quit smoking.  Crassilneck
and Hall have published a study with an 82% success rate but it is
predicated upon four sessions and the only subjects seen were males with a
medical referral.

"I have conducted numerous group sessions - usually where some employer
undertakes the expense of the program.  The success rate is only about 50%.
But in terms of cost-effectiveness these programs, especially in the
absence of other options, can be very worthwhile. They last three hours
(with two brief breaks) as opposed to about 70 minutes for the individual
sessions.

"The last question is the easiest. Virtually everyone with the intelligence
to ask the question is a good candidate for hypnosis.  That is to say,
about the only people who have any difficulty in obtaining the light trance
necessary for stop-smoking suggestions are those who are very dull and
those who are actively psychotic.  In a long private practice I have only
about one percent who were, in my opinion, refractory to hypnosis.  Of
course, the goal is not hypnosis, but change, and unfortunately no good way
exists to measure the motivation so essential to all change."

  i. Herbs

Herbal Teas. Excerpt from: Using Herbs To Quit Smoking by Elizabeth
Phillips, "The Herb Quarterly"(ISSN 0163-9900), Winter 1993.

A regimen of teas to take for a few weeks:

   * First thing in the morning to relax: 1/2 teaspoon valerian root; 1/2
teaspoon chamomile
   * 11 AM to aid in withdrawal: 1/2 teaspoon licorice root; 1/2 teaspoon
comfrey
   * Noon to cleanse blood: 1/2 teaspoon black cohosh; 1/2 teaspoon burdock
root
   * 2:30 PM to clear lungs: 1/2 teaspoon slippery elm; 1/2 teaspoon
fenugreek. NOTE: if after two days you are not coughing or bringing up
mucous, you can discontinue this tea)
   * 4:00 PM to aid in quitting: 1/2 teaspoon magnolia; 1/2 teaspoon pepperm=
int
   * 6:00 PM to boost immune system: 1 teaspoon of Echinacea in a cup of
boiling water

These teas are brewed for ten minutes in four ounce teacups. Of course
there are always words of caution: check with your doctor before trying any
herbal remedy. Do not mix herbal remedies with over-the-counter
prescription medication. If you have allergies to ragweed or hay fever to
not take chamomile. You can substitute skullcap. If you have heart problems
do not take licorice root or goldenseal tabs. If you have high blood
pressure do not take vitamin E capsules. I would further recommend that you
get a copy of this article ... this tea regimen is for 3 WEEKS ONLY.

Thanks to the original poster, Barbara R.

  j. Cream of Tartar

A few of us (myself included) saw this remedy presented on some breakfast
television-type show, and one poster shared his experience:

Mark <river1824@andorra-c.it.earthlink.net> wrote:

"Well, I am getting ready to quit ... I have been using the cream of tarter
for a few days now. What you do is take 1/2 teaspoon in a glass of orange
juice, and it pulls the nicotine out of your system. You might sweat it out
at night or urinate more. You can buy cream of tarter at the grocery store
at the cooking spices. Cream of tarter is used to make meringues have more
holding power and also is a component of baking powder (if I remember
correctly). It is natural, as it is the dried powder of the remnants left
in wine vats, from grapes. The idea is to smoke only when you actually
crave ... not habit but craving. As you do this each day, you crave less
and less as more and more nicotine has left your body. The eventual idea is
to work your nicotine level to a tolerable and controllable level, that you
can then quit completely. Without the terrible full strength withdrawal. I
recommend it. It is an inexpensive way that might work for some. I would be
interested in hearing from those that try it. My neighbors tried it with
some success, however, they did not want to quit smoking at the time. They
did, however, notice a difference."

  k. Zyban a/k/a Wellbutrin and Other Antidepressants, w/ or w/o NRT

Wellbutrin (generic name, bupropion) was recently released under the name
Zyban for marketing as a smoking cessation aid.  They are the same drug,
made by the same company, Glaxo-Wellcome.

During testing of the antidepressant Wellbutrin, it was realized that the
test group experienced a reduced desire for nicotine. Studies have since
been done using Wellbutrin as an aid in smoking cessation, both in
conjunction with nicotine replacement therapy (in the form of the patch),
and without. No conclusive results have yet been published. The following
information was written and contributed by Scott Leischow
<leischow@ccit.arizona.edu>.

"Greetings! Wellbutrin is one of several medications being tested for
smoking cessation. Keep in mind that no medication has been found to be
efficacious for a large percentage of people, and that different approaches
work differently for each person. There are data to suggest that Wellbutrin
(bupropion) increases the chances of quitting - see studies by Linda Ferry
at Loma Linda Medical Center. Note that other medications being tested
include Inversine (mecamylamine) in combination with nicotine, lobeline,
cotinine (a metabolite of nicotine) - and new nicotine replacement options
will eventually be available as well, such as nicotine nasal spray,
nicotine inhaler, nicotine lozenge. Mint nicotine gum is now available in
Canada, Mexico, and several European countries, and an even more flavorful
gum is or will be available in the UK (made by Ciba-Geigy). Meds, of
course, are not the answer - they can work to enhance personal motivation.
All of these changes will definitely increase uncertainty about what to use
(if anything), and whether we should be concerned about people using pure
nicotine for long periods of time. There seems to be a growing consensus in
the scientific community that we should not be too concerned about long
term use of nicotine - if the alternative is returning to smoking. Just as
with methadone versus heroin, the lesser 'evil' is the pure nicotine. I am
not suggesting we should not be concerned about long term use, just that we
put it in perspective. Note that I have no financial interest in any
treatment approach - I do research on smoking cessation treatments at the
University of Arizona (including on several of the methods I mentioned
above). Send me a note if you have questions/comments/flames."

But before you run out and demand a prescription from your doctor, please
consider this information, written and posted by Bob Christofferson
<rechris1@facstaff.wisc.edu>:

"Prozac (generically, fluoxetine) is a selective serotonin reuptake
inhibitor (SSRI) and Wellbutrin (bupropion) is a heterocyclic
antidepressant which affects reuptake of dopamine as well as serotonin.
(Because of the affect on dopamine, by the way, Wellbutrin has been tried
for alleviating symptoms of cocaine withdrawal, with inconclusive results.)

"Effexor (venlafaxine) affects reuptake of serotonin and norepinephrine and
only very weakly affects dopamine.

"This will be on the exam, so take notes. :)

"Seriously, most of us have no reason to try to remember this stuff, but
it's worth mentioning, I thought, partly as an example of the individuality
of brain biochemistry. All of the drugs mentioned, and a lot more, are
useful for some people who have symptoms of clinical depression. But the
response to any particular drug by any individual patient is unpredictable
-- it may have no effect, or even make the depression worse. But in someone
else, with the same clinical symptoms, the drug will work a miracle.

"The same sort of individual difference applies, I think, with regard to
smoking cessation -- how hard it is, how long it's hard, what helps --
these are widely different and unpredictable. So, it's worth keeping in
mind that even with all the things we have in common, the experiences of
any one of us may not be very predictive about anyone else. In other words,
I need to keep in mind that even if you do exactly what I did, you may not
have the same results.

"It's also worth comparing to smoking cessation, I think, because in cases
where one antidepressant doesn't work, another one very well might -- just
like one method of smoking cessation may not do it for an individual, but
there are a lot of other choices to try. And (to tie this into a bow) one
method that may be the key to smoking cessation for some people is to take
antidepressant medication. It certainly wouldn't be the first suggestion
I'd make for anyone, but for those who have not succeeded with other
methods, and especially for anyone who thinks they may be using nicotine to
self-medicate depressive symptoms, I would recommend talking to a medical
professional about the possibilities."

  l. Mecamylamine and the Patch

Another drug being tested in conjunction with the nicotine replacement
patch for use in smoking cessation is mecamylamine, a prescription drug
frequently prescribed for high blood pressure. A detailed summary of the
original controlled study, see Clin. Pharmacol. Ther. Vol. 56 no. 1 pp.
86-99; also available on the Internet from the Medline page. Here's the
short, layman's version: Source: The Mirkin Report #6455 (online)

"Jed Rose of Duke University has discovered that 6 weeks of taking a
nicotine skin patch with mecamylamine pills, a drug that blocks the effects
of nicotine, helped more than one third of smokers to stop smoking one year
later. In high doses, both nicotine and mecamylamine have horrible side
effects. High doses of nicotine cause high blood pressure, a fast thumping
heart beat and shakiness. High doses of mecamylamine cause shakiness,
dizziness, fainting, constipation and even convulsions. However, when the
two drugs are combined in low doses, people trying to stop smoking seldom
suffered side effects and many were not smoking one year later. The
recommended doses were standard nicotine skin patches daily and 2.5 mg of
mecamylamine twice a day."

  m. Allen Carr

Discussion of Allen Carr's books (Allen Carr's Easy Way To Stop Smoking
(Penguin; ISBN 0-14-013378-X), later revised and reissued as The Only Way
to Stop Smoking Permanently (Penguin; ISBN 0-14 024475-1)) is the closest
AS3 comes to making a commercial endorsement. So many of us have been
helped by Carr's work that it is a frequent topic of discussion. Even if
one part of the method doesn't seem right for you, something else may be
just the thing that rings your personal bell. Unfortunately, Carr's books
are very difficult to get in North America. See below, a couple of avenues
interested parties might try. But many might be helped even by this summary
of the Carr method, written and contributed by David Moss
<moss@irch.kfk.de> and originally posted to AS3.

"First, Allen Carr's qualifications: he's not a doctor or a psychologist,
he's a guy who smoked five packs per day (I didn't even know that was
possible!) and who quit one day with no difficulty whatsoever. He was so
astounded by this that he subsequently devoted his time to finding out why
quitting had been so easy for him, and then wrote a book about it.

"He understands how smokers' minds work, so he doesn't fill his book with a
load of horror stories on why you shouldn't smoke. We all know that
already, and it doesn't help. Allen Carr turns it around and asks, why
smoke? Our bodies tell us 'have a cigarette' and we give way, or we fight
it with huge amounts of willpower. Instead, we should ask our bodies 'what
for?'. He takes all the stock answers - it tastes good, it helps me relax,
it helps me concentrate, it relieves stress, it relieves boredom - and
disproves them one by one. In fact, we smoke to relieve the withdrawal
symptoms that we all suffer between cigarettes, because nicotine is a fast
acting, fast decaying drug. All the other justifications are
rationalizations which don't stand up to scrutiny. The logical conclusion
is that you shouldn't even think in terms of 'giving up' cigarettes,
because you're not giving up anything - you're just stopping smoking
because you simply don't need cigarettes.

"His next point is that quitting is actually very easy. Most smokers make
the mistake of confusing the physical withdrawal symptoms with the
psychological "crawling up the walls" cravings and panic that you get when
you want to smoke and can't. The actual physical withdrawal symptoms are a
mild, empty, hunger-like feeling, which doesn't hurt and which is easy to
ignore. The psychological cravings, because they're psychological, will
simply cease to exist if you can develop the right mental attitude. For
this reason, Carr is very insistent that the reader continue to smoke until
he's got his attitude right (i.e. until he's finished the book), so as to
avoid the negative experience of a failed attempt to quit. Think about the
question given above - what positive benefits do you get from smoking -
until you're completely convinced that smoking gives you nothing. You don't
need huge feats of willpower, because you're not giving up anything. Making
quitting into a test of willpower only makes it harder. You don't need
replacements like sweets or gum, because you're not giving up anything that
needs replacing. You don't need nicotine patches or nicotine gum, because
you don't need nicotine. Enjoy the withdrawal symptoms, because that's how
it feels when you defeat your addiction.

"We all know that it takes about three weeks for the body to be cleared of
nicotine. But don't think in terms of 'making it' three weeks without a
cigarette, which would lead you to expect something wonderful to happen
after three weeks. Nothing happens, because the physical withdrawal
symptoms are so mild that you don't even notice they've gone. That
wonderful thing happens in the moment you stub out your last cigarette and
become a non smoker. Don't get melancholy and depressed about life without
cigarettes, because you're not giving up anything. Enjoy life as a
non-smoker, it's better in every way. Don't even try to avoid thinking
about cigarettes - every time you think of them, think about how wonderful
it is that you don't need them.

"Allen Carr gives five point that need to be internalized before you begin:

  "1. Be quite clear in your mind, you're going to quit. Not hoping to quit
or trying to quit, just going to quit. It's easy.
  "2. You're not giving up anything, but you're gaining a hell of a lot.
  "3. There's no such thing as 'just one cigarette'. Your choices are to
quit, or to smoke for the rest of your life.
  "4. Don't think of smoking as an unpleasant habit. It's an addiction, and
it's getting worse every day. The right time to quit is now.
  "5. Understand the difference between the chemical addiction and the
'junkie' mentality. As soon as you stub out your last cigarette, you're a
non-smoker. Non-smokers are people who don't use cigarettes.

"If you've really taken these points on board, quitting will be simple and
absolutely painless. You don't believe it? That's not surprising, we've all
been brainwashed by advertising, by films, by society's generally tolerant
attitude to smoking, and by our own addiction. You need to open your mind
and think about what Carr is saying in order to ditch this conditioning and
realize that Carr is right.

"Finally, a disclaimer - the above is my personal summary of Allen Carr's
book, and I may have left out or misunderstood something important. If in
doubt, read the book. The title is Allen Carr's Easy Way To Stop Smoking,
and it was published by Penguin Books, London, in 1991. The ISBN number of
my copy is 3-442-13664-4, but be careful because I have the German
translation (Endlich Nichtraucher, Goldmann G1290).

"I very much hope that this information will make quitting as easy for
someone out there as it was for me, and I'd be happy to deal with any
follow-up questions.
David <moss@irch.kfk.de>"

How to get Carr's book in North America:

I've recently heard that an American publisher is being sought for The Easy
Way To Stop Smoking.  In the meantime, for the convenience of those in
North America, here are some options:

1. Order from one of the established Internet booksellers. I've used the
Internet Bookshop, originating in the U.K., without problem, but there are
several others you can check for comparison 'net shopping.

2. Try contacting one of the directors of an Allen Carr clinic. You can
find a listing of the clinics at this URL:
http://www.qwerty.co.uk/allencarr/

3. A company called Videocom sells a package of the book and audiotape for
US$ 29.95 plus US$ 3.50 shipping and handling (U.S. cheques or money orders
in U.S. funds only. They do not offer the book alone. The company's address
is: Videocom Inc., 502 Sprague Street, Dedham, Massachusetts 02026 USA,
Attention: Quit Smoking. If anyone tries the Carr package, I'd appreciate a
report for the FAQ.

  n. Programs

This information was supplied by Carolina Johnson. It is of use mostly to
those in the U.S. and Canada; I would welcome receiving information on
similar organizations from our members in other parts of the world.

American Lung Association, 1740 Broadway New York, NY 10019. (212) 315-8700

The American Lung Assoc. sponsors stop-smoking groups in most cities. It
also publishes an excellent guide to quitting, Freedom from Smoking for You
and Your Family. This book guides readers through a step-by-step 20 day
program that leads to quitting and provides guidelines for remaining a
non-smoker. The book is available from your local chapter of the American
Lung Assoc. (consult your telephone directory for the address and phone
number) or from their national headquarters at the address above.

American Cancer Society, 4 West 35th Street New York NY 10001. (212) 736-303=
0.

Local affiliates of the ACS sponsor a four-session stop smoking program
called "Fresh-Start." Sessions last one hour each and extend over a
two-week period. Sessions focus on behavior modification, goal setting,
mastering obstacles, and social support. The ACS also publishes a free
handbook for potential quitters, the "I QUIT KIT", which is available from
your local chapter (consult your telephone directory for the address and
phone number) or from their national headquarters at the address listed
above.

The Breathe-Free Plan to Stop Smoking Narcotics Education Inc., 6830 Laurel
Street, N.W., Washington DC 20012.
Many local affiliates of the Seventh-Day Adventist Church run a highly
recommended program that is usually led by a pastor physician team. The
Breathe-Free Plan to Stop Smoking is based on motivation, lifestyle,
modification, values clarification, modelling, visualization, affirmation,
positive thinking, and self-rewards. There is also an optional
nondenominational spiritual component. The plan consists of 8 sessions that
take place over three weeks, with periodic phone contacts for one year
thereafter. Prospective group members are invited to attend the first two
sessions before making a decision as to whether to register for the
remainder of the course. During the 3rd week a graduation ceremony is held.
Successful quitters receive a BNS (Bachelor of Nonsmoking degree) during
the 3rd week. MNS (Master of Non-Smoking) degrees are awarded at six
months, and DNS (Doctor of Nonsmoking) degrees at 12 months.

Smokers Anonymous, PO Box 25335, West Los Angeles CA 90025.
This group provides information on starting your own support group.  They
will also let you know if there is a Smokers Anon group in your area. Write
to them at the above address enclosing a self-addressed stamped envelope.
[N.B.: This is not the same organization as Nicotine Anonymous, a 12-step
recovery program. - ed.]

  o. Alternative Healing

Here are summaries of tools and techniques described in New Choices in
Natural Healing (a Prevention magazine book), ed. by Bill Gottlieb
(Pennsylvania: Rodale Press, 1995), pp. 505-507. I haven't tried any of
them except imagery, and make no recommendations or endorsements. They
could help, or they could be a colossal waste of time and money. As one of
my univ. profs used to say, Yer pays yer money and ya takes yer choice.

Aromatherapy
To ride out cravings, mix essential oils as follows: 3 parts lemon, 2 parts
geranium, 1 part everlast (aka 'immortelle' 'helichrysum') in a small
bottle. Inhale from bottle whenever a craving hits. "'Lemon is a
detoxifying agent, and geranium helps balance the adrenal system,' explains
[aromatherapist Victoria] Edwards. 'Everlast is a powerful cellular
rejuvenator and will help your body heal the damage smoking has done.' This
blend is also good when used in a diffuser, says Edwards.

Ayurveda
To help you quit smoking or cut down on your habit, try chewing on small
pieces of dried pineapple (about 1/2 teaspoon's worth) mixed with 1/2
teaspoon of honey, suggests Vasant Lad ... director of the Ayurvedic
Institute in Albuquerque, New Mexico. He says to use this remedy whenever
you desire a cigarette.

=46ood Therapy
No, not eating everything in sight! :) According to Dr. John Pinto of
Cornell University Medical College and a nutrition researcher at
Sloan-Kettering Cancer Center, load up on Vitamin C well beyond the
Recommended Dietary Allowance; its antioxidant qualities will help repair
damage done by smoking. Thomas Cooper, D.D.S. concurs but note, he says to
avoid orange juice if you're using the patch: "By making your urine more
acidic, the juice will clear your body of nicotine faster. But the purpose
of the patch  is to keep some nicotine in your body as you try to wean
yourself off the weed.

Hydrotherapy
The body wrap, or wet sheet pack, can help detoxify your system if you're
trying to quit, according to Charles Thomas, Ph.D. ... This treatment can
be done at home but will probably require help from a partner. After
warming up with a hot shower, lie down on a bed with your entire body
wrapped in a sheet wrung out in cold water. Then wrap yourself in one or
more wool blankets. While the pack feels cool at first, your body heat will
gradually dry the sheet, and you will begin to sweat. Leave the wrap in
place=00=00=00=00=00=00=06=FD to two hours after you start perspiring. Dr.=
 Thomas suggests
using this treatment once a day until you no longer feel as intense a
craving for cigarettes.

Imagery
See yourself smoking. While you're doing it, do you perceive yourself as a
smoker? In your mind, continue to see yourself smoking, but say to yourself
'At this time, I have the habit of smoking, but I am not a smoker,' says
Dennis Gersten, M.D., a San Diego psychiatrist .... Now picture something
that is good for you that you desire tremendously. It could be health,
better looks or more control of your life. Focus on your desire. See
yourself as an incredibly healthy, beautiful or self-reliant nonsmoker. Let
that image overpower any desire that you have to smoke. Dr. Gersten
recommends using this imagery for 10 to 20 minutes twice a day.

Relaxation and Meditation
'Studies have shown that many smokers use tobacco to help them reduce
anxiety and tension. If you meditate, your mind learns another way to
counteract that anxiety, so you may become less reliant on cigarettes,'
says Dr. [Sundar] Ramaswami [a clinical psychologist]. ... Meditate for 20
minutes twice a day or for a few minutes whenever you feel the urge to
smoke, suggests Dr. Ramaswami.


Thoughts to close the Alt.Support.Stop-Smoking FAQ, Part 3:

"The Willpower Method is based on giving up something you want to do and
thus have to resist the desire to continue doing it. The Easy Way is to
change your thinking so that you are not giving up anything, but becoming
free of something that you don't want to do. That way you can enjoy it. -
gecko@ibm.net"

"Once you get to the point where your mind is made up once and for all, it
is very difficult to fail. - Cindi Smith"

Please go on to Part 4.





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