What Can I Do to Stop Smoking if Standard Treatments Don't Work For Me?

Thomas Lee, M.D.

Harvard Health

Q. I'm an 84-year-old woman who recently had stents placed in two coronary arteries. The doctors, of course, told me to quit smoking. I told them, as I have told all of my other doctors, that I have tried to quit but just can't. I've tried the patch and Chantix, but neither worked. Support groups aren't for me. I have cut back, but that's as far as so-called willpower goes. Hearing over and over again that I need to quit leaves me feeling depressed and weak. Is there some news about current or future approaches that might give me and others like me some hope?

A. Before I answer your question, let me congratulate you for having tried to quit smoking and urge you to try again. It often takes smokers several "tries" before one takes hold.

As you have discovered, nicotine is a highly addictive substance.

For most smokers, "willpower" alone is not enough. Fortunately, smokers today have a number of tools to fight tobacco addiction. Quit-smoking aids include nicotine replacement (nicotine patches, gums, lozenges, inhalers, and sprays), bupropion (Zyban, Wellbutrin), varenicline (Chantix), counseling and behavior-change therapy, and social support. None are miracle workers.

You mentioned having tried the nicotine patch. Dr. Nancy Rigotti, director of the Tobacco Research and Treatment Center at Harvard-affiliated Massachusetts General Hospital, said that some smokers find success by adding to the patch a short-acting nicotine replacement product, like nicotine gum, lozenge, or inhaler, to handle breakthrough cravings the patch can't counteract.

You also mentioned that Chantix didn't help you. Some people find that Zyban works better for them than Chantix. Researchers are testing whether combining Zyban or Chantix with nicotine replacement is a safe and effective treatment for smoking cessation.

You also said that support groups aren't for you. You don't have to join a group to get support. You can get free, helpful support from the comfort of your home by calling the national quit line at 800-QUIT-NOW. For some people, support is the missing piece of the solution, says Dr. Rigotti.

Several new treatments are under development and investigation. On the medication front, a class of drugs called cannabinoid receptor antagonists may someday be used to help smokers quit. Also in the development pipeline are several anti-nicotine vaccines. They prompt the body to make antibodies to nicotine. When nicotine enters the bloodstream, these antibodies bind to it. The resulting nicotine-antibody complex is much too large to cross into the brain, rendering the nicotine incapable of turning on the brain's nicotine receptors. In theory, this will help break the habit by denying the smoker the pleasurable feelings he or she normally gets from smoking. If cannabinoid receptor antagonists or vaccines pan out as safe and effective smoking cessation aids -- and that is a big if -- it will be years before they're on the market.

Please don't wait for treatments that may never materialize. You have already made a good start by cutting back. If you are serious about taking the next step, work with your doctor or someone who specializes in smoking cessation to figure out a plan tailored for you. I hope this answer doesn't make you feel weak, but gives you some hope and power.

Sometimes people who've struggled to stop smoking and finally quit have the best suggestions.

Thomas Lee, M.D., Editor in chief, Harvard Heart Letter

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