Oprah meets her smoking-addicted guests.

Oprah and Dr. Oz are kicking off a campaign to help 45 million Americans "Breathe Free" and stop smoking—for good! But first, eight of the show guests take their last cigarette drags before making the commitment.

Standing outside on a bone-chilling Chicago winter morning, they admit to a range of shocking emotions—all a reflection of their smoking addiction.

"It is most embarrassing."

"I'm a nervous smoker, and I'm going to smoke more because I'm scared. Just talking about quitting freaks me out."

"[Quitting] is like a grieving process. It's like losing a best friend."
Dr. Oz on smokers, quitting and fear.

Dr. Oz says the hardest thing about getting the 45 million Americans who smoke to quit is that they already know how bad smoking is for them—every pack actually tells a smoker about the dangers of premature aging, disease and death. "They seem like very rational people, right? They find a way to work, they get up in the morning, they can do all kinds of things. Yet despite being so rational, they keep trying to kill themselves," Dr. Oz says. "This is an effort for us to understand the biology of addiction."

Smokers continue to smoke not because of a lack of willpower, Dr. Oz says, but because of fear. "People are scared of what's going to happen," he says. "First of all, if I do it and I fail, I may be less worthy. And if I do it and succeed, am I going to be normal?"
Dr. Oz shows how nicotine affects the brain.

One thing most people don't consider is how smoking affects their brain. After each puff, the nicotine reaches your brain within seconds. "They go to this part of the brain just above the ear … called the insula," Dr. Oz says.

In the insula, the nicotine opens your brain's receptors and allows dopamine to flow in. "Dopamine is the ultimate addictive element in our body," he says. "When we have really good sex, dopamine comes out. When we have a double chocolate cheesecake, dopamine goes out. You do drugs, dopamine gets stimulated. … Cigarettes are as addictive as heroin.
'Nonsmoking Aubrey' and 'smoking Aubrey'

At 29, Aubrey says she's smoked for more than half her life. Those years of smoking have already done some damage to her body, both inside and out. If she continues to smoke, the damage will only intensify.

On the left is a computer model of what Aubrey could look like in 30 years if she stops smoking now. "You'll age a little bit," Dr. Oz says. "Your hair will change; your skin won't be quite as bouncy. But when you have four grandkids, you're still going to look pretty hot!"

On the right is what Aubrey could look like if she keeps smoking for the next 30 years. "The smoking sucks up nitric oxide, a very important chemical that gives your skin bounciness. It also destroys the arteries of the body. So you see the wrinkles, especially this pattern of wrinkle around the lips? Very typical of cigarette smokers."

The difference on the outside between "nonsmoking Aubrey" and "smoking Aubrey" pales in comparison with the difference on the inside. "The inside of that woman … is not just rusting out the infrastructure of her skin," Dr. Oz says. "She's rusting her kidneys, her heart, her brain, your fertility, your sexuality. It all goes the same way."
Danielle is ready to quit.

Dr. Oz's call to all smokers is not beat yourself up because you haven't been able to stop smoking. Instead, arm yourself with tools so you'll never want a cigarette again.

Danielle is a 28-year-old mother. "Every time I try and quit, my husband always says, 'Who's stronger, you or the cigarette? Who's stronger?' Every time, the cigarette's always stronger because I always go back."

In a telling exercise, Danielle adds up how much her smoking addiction has cost her—it's $22,428 over 14 years. "Wow, that's $22,428 that I've spent on cigarettes—$22,428 that I've spent on killing myself slowly," she says.
Cynthia actually quit smoking for four years.

For most of the past 30 years, Cynthia has been a smoker…even continuing to light up after watching her father die of lung cancer. "I had the experience of spending those last days with him. I watched him take his last breath. Or, should I say, I watched his last breath being taken away from him," she says. "It really hurt me, and it was a horrifying experience. And after all of that, after going through all of that, I still smoke."

At one point, Cynthia actually quit smoking for four years. "What I learned in quitting for four years is I'm always going to be a smoker," she says. "I had that one cigarette after four years, and it was back as if it had never stopped before. I'm finding it very hard to stop now."
Funeral director Leon can't quit smoking.

In his job as a licensed funeral director, Leon knows exactly what smoking can do to a person's body.

"I see the autopsy of people. I've seen their lungs; I've seen how black they are, what it does to them," he says. "I've had medical examiners show me what the effects of smoking are, and I still smoke. That's how powerful it is."
Nicole kept her smoking a secret.

Nicole says she's ashamed to admit she's been smoking for years…but until recently, her parents didn't even know.

"I told them before [the show] so they wouldn't be totally shocked," she says. "My mother said, 'You don't smoke.' 'Yes, I do.' My sister talked to my mother, and my mother still didn't believe her. She said, 'Mom, Nicole is actually in Chicago. She's going to Oprah to quit smoking."
Gail describes her smoking addiction.

Even after both of her parents died from smoking related diseases, Gail says she can't kick her addiction. When she was diagnosed with ovarian cancer at age 18, she says she would sneak out of the hospital during chemotherapy sessions to smoke.

"With all three of my children, after I gave birth to them, when most mothers would be so filled with joy over this little life that's in the room with them, I was trying to figure out how I was going to sneak out of the hospital and get downstairs quickly to get a cigarette," she says.
Wendie wants to quit for her daughter Bailie.

Wendie says she sometimes smokes in her car and not alone. Her 5-year-old daughter Bailie is sitting in the back seat. Even though Wendie says she doesn't want anything bad to happen to Bailie, she can't put the pack down. "She's had pneumonia and she has allergies," she says. "But it's not enough, because the addiction is so powerful."

Bailie agrees with her mom—it's time for Wendie to stop. "I've been telling my mom all about quitting the smoking because my mom usually smokes every single day," she says. "It's bad for her lungs, and it will make you die really bad. You should listen to the people that tell you to stop."

Dr. Oz says if Wendie needs more motivation than her own health to quit, she can refer to this startling fact—for every four cigarettes she smokes, the secondhand smoke is as if Bailie is smoking one. "She's already smoking," he says.

"I can give you all of the numbers—there are 250 toxic chemicals in cigarettes, and 50 can cause cancer. But you know all that stuff. That's why we don't want to spend a lot of time on this show telling you all the bad things that can happen," Dr. Oz says. "We want to dive into the root reasons of why we don't change."

At age 36, Cassandra says she has already been smoking for 15 years—and she's been married to a nonsmoker for seven. "It's turned our life inside out," she says.

Even during the freezing-cold winter months, Cassandra steps outside to have a cigarette. To keep the smell of smoke from clinging to her, Cassandra says she even has a special set of "smoking clothes" she puts on before lighting up. "If I was going inside the home, I would put on my nonsmoking clothes after I washed up and gargled," she says.

Although she says none of her family or friends smokes, cigarettes are a big part of Cassandra's life. "Everything that I do, I associate with smoking," she says.

As a nurse, 54-year-old Debbie often tells patients they should quit smoking. In her life outside of work, Debbie has been a smoker for 34 years.

Debbie doesn't just want to quit smoking for herself—she wants to set a good example for her two daughters who also smoke. She says she hopes quitting will inspire them to do the same.
A healthy lung and a diseased lung

Using real human lungs, Dr. Oz shows the havoc smoking can wreak. The healthy lungs of a nonsmoker, he says, look pink and supple. "It's not as pink as it usually is because it's been preserved," he says.

Dr. Oz contrasts the healthy lungs with the damaged lungs of a smoker. Dr. Oz says this lung's moth-eaten appearance is evidence of emphysema, which is a condition of chronic obstructive pulmonary disease, or COPD. He also points out a lump that denotes lung cancer.

"People keep thinking it's about cancer. Cancer's the tip of the iceberg," he says. "Emphysema and COPD is what people ought to wake up to as the big health risk for smoking."
Dr. Oz shows how smoking can damage the lungs.

Dr. Oz explains that smoking causes changes in the lungs that can lead to emphysema and COPD. "It's the biggest reason that we have lung problems in this country," Dr. Oz says. "[It's] the number four cause of death, and people never hear about it."

Air taken into the lungs enters little tubes called alveoli. "They're like little bubble pops," Dr. Oz says. "As you smoke, you break down those barriers and you pop them. So you take these very nice grape-like structures and you turn them into these big sacs that no longer can exchange air with the outside world. Then when these coalesce and come together, they form these large blebs on the outside of the lung. … That air is not helping you because it can't get into your body and exchange with your blood. So literally as these blebs get larger, they push the normal lung away and you suffocate yourself."

Ten smokers volunteered to have their lungs tested for these effects using state-of-the-art technology at Heart Scan of Chicago. Of the 10, Dr. Oz says six had changes in their lungs that indicated emphysema.

Debbie was one of the patients whose lungs showed signs of emphysema. "You already have, on a scale of 5, 3.5-level emphysema. It's pretty significant," he says. "We get worried about this because this doesn't get better. You can prevent it from getting worse and, depending on how you treat yourself, you can nudge it. But it never gets completely better once you have it." In addition to the effect on her lungs, Dr. Oz says Debbie's heart scan showed a problem. "You have a blockage already. That's actually nicknamed the widow maker," he says. "We're going to have to get a stress test on you to make sure that that's not a life-threatening problem."

Debbie smoked a cigarette right after learning her results. "But my last cigarette was last night. I have a patch on," she says. "The result doesn't surprise me, but it does scare me."

Dr. Oz also found some emphysema changes in Wendie's lungs. "On a scale of 5, it's 2, but you're a very young woman," he says. The doctor expressed more concern about a shadow that showed up on the scan. "Because you're a smoker, these kinds of shadows really concern us, and we start thinking about lung cancer. So we want to repeat the study again in a few months to see if it's changed at all," Dr. Oz says.
Dr. Daniel Seidman

With all the life-threatening effects of smoking, why can't smokers just stop? Dr. Daniel Seidman, a leading expert on smoking addiction at Columbia University Medical Center, says people have conflicting thoughts about quitting. "You have the smart brain that's cultured and educated and understands that [smoking is] going to hurt your family and hurt your body," he says. "Then, you have the old reptilian brain that wants what it wants when it wants it. You're at war with yourself."

To end the war, Dr. Seidman says you must "wave the white flag" and admit you need help in ending your addiction. "Smokers are not all the same. Some people can quit on their own and relatively easily, and some people will say it's the hardest thing they ever did. So they need the tools, and they need to make the effort," he says. "It's not just about the motivation—they have to make a commitment. They have to make the effort and need some guidance and outside help to be successful with it."

Once you've made the decision to live a smoke-free life, Dr. Oz, Dr. Seidman and Dr. Michael Roizen suggest following a four-step plan.

Step 1: Face the truth.

Take the quiz to determine what kind of smoker you are. Dr. Oz says learning how out of control you really are is an important realization. "Once you realize you're out of control, it helps you build your commitment and be willing to make the effort so you're not smoking at all," he says. "If you're smoking a little bit, that cigarette's going to make you want to have the next cigarette, and it's not going to go well."
Dr. Oz

Step 2: Prepare yourself mentally and physically to quit smoking.

Dr. Oz says it's imperative to set a "quit date"—your first day of breathing free—between two weeks and a month ahead of time. During those last few weeks before your quit date, Dr. Oz says you should prepare yourself for a life without cigarettes.

An addiction to smoking has physical, social and emotional components, Dr. Oz says, so it's important to have a battle plan on all fronts. To begin your strategy, Dr. Oz suggests writing a list of all the reasons why you want to keep smoking and a list of the reasons why you want to quit. "Help that reptilian brain that Dr. Seidman was talking about at least retreat a little bit so the smart, higher brain can start to do its job, which is to get you to do the right things," he says.

Get some ideas for your smoke-free strategy.

If you smoke out of habit, Dr. Oz suggests taking up a healthy, new habit—like walking—in its place. "The most common reason women give for not stopping smoking when they're young is weight gain," he says. "So the first thing we want you to do is start walking, because if you don't get on a weight reduction program, if you stop the cigarettes, you will gain weight."

In addition to preventing weight gain, Dr. Oz says walking has other benefits in your battle to breathe free. "If you've got a program that makes sense for you, and you're feeding your brain the right nutrients … you'll lose weight, and you'll be alert and ready to make these difficult moves like stopping cigarettes."
Ben Affleck

Step 3: Visit your doctor, find support and prepare for your first smoke-free day.

Before your quit date, Dr. Oz says you should talk to your doctor about the different medical options that can help you remain smoke-free. You can ask your doctor about several medications and aids.

Check out this list of questions to ask your doctor .

When actor Ben Affleck finally kicked his 20-year smoking addiction, he used a different approach—hypnosis. Ben smoked a pack of cigarettes a day for years, until his impending fatherhood prompted him to cut cigarettes out for good. "I finally decided to quit smoking when I was going to have a child, and that was the thing that sort of put it over the top for me," Ben says.

Once he made the final decision, Ben says he went to a hypnotist recommended by his friend, Matt Damon. "He sips water and just talks to you for an hour and explains to you how nicotine is poison," Ben says. "And it seems really, like, 'How could this help me?' And all of a sudden you think, 'This is asinine that I had been doing this to myself for all these years.'"

According to Dr. Oz, understanding your reasons can be vital. "Ben stopped because of his kid. That's internal. That's not someone else giving him a hard time and browbeating him. He's doing it for the right reason," he says. "We should be very cautious about the reasons we pick. Otherwise, we'll run into that same ambivalence that many of us have when we make any kind of behavioral change. Deep down inside, in our core essence, looking at the authentic us, what's the reason to stop smoking? We've got to figure that out to get going."
Dr. Oz and Oprah

Step 4: Protect yourself against a relapse.

So you've taken all the steps, your quit date has passed and you're breathing free—but you feel like having just one more cigarette. What now?

Turn to your support system. Whether you and a buddy decide to quit together or you find a support group, you should have someone to turn to when the cravings rear their ugly head.

Find support for your smoke-free life!

So how do you avoid those relapse triggers? Being assertive can help you stay out of social situations that might tempt you to light up. "When your buddy calls up and says, 'Let's go down, grab a drink together, and then we'll go over to the movie,' you've got to say, 'You know, I love you, but I'm not doing that because I know what's going to happen if I do that.'"

When you're really in a crunch, Dr. Oz says you should also have some last-ditch escape mechanisms to steer your focus away from cigarettes. "It can range from other things to put in your mouth, like cinnamon sticks or tea. File your nails," he says. "Do something that distracts you at those times of crisis."
Dr. Michael Roizen

At first, a person who quits smoking will feel some discomfort—but the doctors say that's okay. "We are not comfortable being uncomfortable," Dr. Oz says. "[But] that is the single best way to grow in life. You all have the beautiful opportunity to get through cigarette smoking, which is going to make you a lot better equipped to deal with other realities in life."

When you're preparing for your quit date, you should be ready for the discomfort withdrawal can bring. Dr. Roizen emphasizes that while you might feel bad at first, you will feel better in about a month. "When you first withdraw from a drug—and nicotine in cigarettes is a drug—you feel bad. It's like withdrawal from anything," he says. "That's why we give [some patients] the [nicotine] patch to help you feel a little better. But it's not the same high. When you inhale it, you get a much higher level. And so over time, you withdraw from that, you replace it, and you end up feeling normal again."

Aside from physical symptoms, which usually are temporary, Dr. Seidman says you must deal with the emotional issues that come with quitting. "Sometimes there's other things hiding behind the smoke," he says. "You might have problems with your mood or anger or other things like that. And if it doesn't get better, it's important to realize that whatever's wrong with you, smoking is not the best medicine for you."