Arthritis Self-Management

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Smoking and RA

by Wendy McBrair, BSN, MS, CHES

When you start thinking about quitting, there’s no need to jump right in. Review the strategies described later in the article, such as using medicines and/or nicotine replacement and setting up a support team or program. Consider yourself, your likes and dislikes, and which strategies you would feel most comfortable with. Think about why you want to stop smoking. Your goal is to improve your health, of course, but you should take time to think about the barriers that might get in your way. You might be afraid you’ll gain weight or have less energy, or you might be worried about your reactions to stress or the effects that not smoking will have on your mood. These barriers to change need to be addressed and planned for as well. When you are ready, it will be time to take the next step.

Making a plan

Although a few people can quit by going “cold turkey,” most of us need help. Start with a written plan that includes a contract with yourself or someone else. This is an effective way to help you follow through. Your plan should include a “stop day” and a list of the strategies you think will help you quit. You should also plan to address symptoms of nicotine withdrawal.

Identifying a “stop day.” Choosing the day on which you stop smoking is important. Planning for that day puts the whole process in your control. It should be a day that isn’t filled with stress but is instead filled with fun and camaraderie with nonsmokers. Perhaps a workday is good for you, when you are very busy. Or perhaps you will want to take a relaxing walk on your stop day, go out to dinner at a smoke-free restaurant, or visit with the grandchildren. Make sure the activities you do on your stop day are not associated with smoking, and avoid any place you associate with smoking. The American Cancer Society (ACS) sponsors the Great American Smokeout day every year, usually on the third Thursday in November. You may find it helpful to quit on a day when you know thousands of others are quitting too. (Go to the ACS Web site to learn more about this day and find quitting resources.)

As the stop day draws near, make sure you throw away all your cigarettes and ashtrays. Stock up on oral substitutes such as coffee stirrers, sugarless gum, straws, or toothpicks. Drink lots of fluids and juice. And avoid negative self-talk such as “I just can’t do this so I’ll start next week” or “My father lived to 80 and he smoked.” Mark the date on the calendar and be prepared to stop on that day.

Gathering your support team. Before you quit, you may find it useful to enlist others to help you along the way. Clearly your physician should be part of your team. He or she can advise you on options such as nicotine replacement, medicines, and support programs in your area. In addition to your physician, a support team might also include phone, individual, or group counseling. The ACS Quitline, ACS Quit For Life, Nicotine Anonymous groups, or a local Stop Smoking Program near you can help provide this counseling. (Go to www.cancer.org or call 800-227-2345 for more information on counseling.) Make sure you investigate each option to see whether you think it will work for you. And don’t forget that your support team includes your family and friends. If family members smoke or you visit with people who smoke, your chances for success are lower. Surround yourself with people determined to help rather than undermine your efforts.

Nicotine replacement options. Nicotine replacement helps to reduce uncomfortable withdrawal symptoms and is usually used by people who smoke more than 10 cigarettes a day. Nicotine replacement comes in many forms, including patches, gum, nasal spray, inhalers, and lozenges. Some of the forms are prescription, some over-the-counter. There’s research suggesting that using the patch, which is long-acting, in combination with short-acting products might work better than a single product, but this hasn’t been proved, and it’s not clear what doses are safe and effective. Don’t use more than one product without talking to your doctor. Most replacement products are meant to be used for a limited time, from several weeks up to five months. Again, working with your doctor can help you choose the right replacement, take it properly, and decide when to taper down and finally stop.

Medicines. Doctors may also prescribe medicines that can help you stop smoking. These include bupropion (Zyban), varenicline (Chantix), nortriptyline (Aventyl, Pamelor), and clonidine (Catapres). Zyban is an antidepressant approved by the FDA to reduce nicotine withdrawal symptoms. It can be used with nicotine replacement and is best started one to two weeks before the predetermined stop day. Chantix is also FDA-approved to help with nicotine withdrawal as well as reduce the pleasurable feelings of nicotine. Some doctors prescribe the antidepressant nortriptyline or the blood-pressure-lowering medicine clonidine to help people trying to quit. Although these drugs are approved by the FDA for some uses, they are not approved for this use. Make sure you review all of your medicine options with your physician.

Last Reviewed on May 30, 2012

Wendy McBrair spent 30 years as a health-care professional in the fields of rheumatology and orthopedics, where she specialized in patient and community service, patient education, and advocacy.

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