Homemaker in Manitowoc, Wisconsin
Age at first puff: 23
Past quit attempts: the patch, gum, cold turkey
Ann says: "Smoking is always on my mind. Right now I'm up to about a pack and a half of menthols; I don't even care which brand, as long as it's on sale. I actually did quit once for about 46 days, but then I had 'just one.' I've broken cigarettes in half and taped them back together. I've wet them, tossed them in the trash, then tried to dry them in the microwave. I'm hooked."
Dr. Schroeder's suggestion: Ann has a strong physical dependence, so a triple therapy might be most effective: Zyban (bupropion, which is basically the same drug as the anti-depressant Wellbutrin), a high-dose patch, and a short-acting NRT, such as gum. Because she struggles with feelings of anxiety and depression, the Zyban might be particularly helpful. The other option is Chantix (varenicline)—a new drug which "targets the nicotine receptors in the brain, so you don't have so much of a craving," says Dr. Schroeder—by itself, which works very well for addicted patients (the research isn't in yet on combining the drug with other therapies). "I also encouraged Ann to set a quit date about a month away," he says. "She can use that time to make adjustments in her life—to really prepare to stop smoking for good." Schroeder recommends environmental changes such as letting people know that you're about to quit, throwing away ashtrays, airing out your house—practicing being a nonsmoker even before you quit.