Meet the Participants
Certified nursing and medication assistant in Menomonie, Wisconsin
Age at first puff : 11
Past quit attempts: cold turkey, various support groups, hypnosis
Sharon says: "I used to smoke 20 to 25 cigarettes a day—Marlboro Reds—and then I cut back to about five a day. Just about any strong emotion, whether I'm celebrating or can't stop crying, makes me want a cigarette. Smoking gives me courage, helps me face things. However, when I quit and I'm succeeding, I feel invincible. On July 1 last year I quit cold turkey, and I started gaining weight. I thought I should smoke for a bit to lose a few pounds. But being skinny and hacking up tar is no good, either."
Dr. Schroeder's suggestion: A short-acting form of nicotine replacement therapy (NRT), such as gum, to use when a craving comes on—this is probably all she needs since she smokes so few cigarettes. (NRT aids may temporarily prevent weight gain, possibly due to nicotine's effect on neurotransmitters that suppress appetite, according to Schroeder's colleague Karen Hudmon, an associate professor at Purdue University School of Pharmacy.) And the Oprah.com group is a good support system.
Retired bank teller in Norwich, Connecticut
Age at first puff: 22
Past quit attempts: the patch, gum
Roberta says: "I go through about a pack or more of Capri Menthol 120s a day. You'd think I'd know better. My father passed away from a smoking-related cancer, and my favorite uncle died of lung cancer. My father-in-law has emphysema and COPD (chronic obstructive pulmonary disease)—he lives next door. And I have COPD myself—I know smoking is one of the causes. But my mother is in the final stages of Alzheimer's, and it's so depressing that it just makes me want to smoke. Recently, I was nervous about the results of some medical tests, so what did I do? I went out and spent $5.22 on a pack."
Dr. Schroeder's suggestion: A higher dose (21 to 22 milligrams over 24 hours) patch than she used before, in combination with NRT lozenges, gum, nasal spray or inhaler. "Since she's had some personal stressors that are causing her to turn to cigarettes for comfort, cognitive behavioral therapy is another avenue she may want to explore. It could help her retrain the thought process that makes her smoke," he says. The fact that she already has lung disease means she can't fool around.
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.
Manager of an orthodontics office in Toledo
Age at first puff: 12
Past quit attempts: Wellbutrin, cold turkey
Lisa says: "I've tried to quit with meds before, but I don't like taking that route. For me, smoking is more of a social addiction than anything. The initial craving passes if you wait. On a girls' night out with my smoking co-workers, however, I'll light up. And I bum one to five cigarettes a day. I take only a few puffs. But I feel as though I have no self control."
Dr. Schroeder's suggestion: NRT gum or lozenges for when Lisa is out with the girls. (As in Sharon's case, this is probably enough.) Staying active on the message board is a good way to address Lisa's "social addiction"; rather than lighting up with her friends, she can identify with the ex-smoker group. "Her risk of weight gain, which she's concerned about, is low because she's a relatively light smoker," he says. Still, she should try to start an exercise program before she quits.
Machine operator in a stainless steel cutting factory in Hillsdale, Michigan
Age at first puff: 22
Past quit attempts: the patch
Linda says: "After finding the O board and quitting for five weeks, I started smoking again, right after my husband, Dale, began. Truthfully, I go through about two and a half packs daily. I don't think I'm strong enough to quit without my husband stopping—and my daughter, who lives with me, smokes as well. My husband has been sick lately and in the hospital with pneumonia—the cigarettes act as my calming nerve pill. It's a physical craving, too. I do wish I could make over my life and myself. But sometimes I just feel like a lost cause."
Dr. Schroeder's suggestion: Linda is another smoker who would benefit most from combination therapy—the patch, NRT gum or lozenges, and Zyban. Chantix alone is also an option. Linda has a tough challenge with her husband smoking, but perhaps his health problems will shake up the motivation.
Note: Dr. Schroeder's suggestions should not be considered medical advice. If you need medical help to quit smoking, consult your physician.