Tina Selwood gave up smoking five weeks ago. Now 35, she's smoked 15 a day since she was 15, and has tried to quit dozens of times. She's had plenty of incentives; a child with breathing problems, and a father who smoked and had a heart attack at a young age. She's tried nicotine patches, chewing gum and hypnotism. This time, she went cold turkey and says that after five weeks it gets harder all the time. But she's adamant she's not going back to the cigarettes. 'My children told me I stink,' she says and it's that phrase, and the cost, that is keeping firm her resolve.
What Tina and thousands like her are discovering as their new year resolution wavers or fails, is just how hard it is to quit. But experts say that smokers make it even harder for themselves if they don't use nicotine replacement therapy (NRT) to soften the blow.
Clive Bates, director of the campaigning organisation, ASH (Action on Smoking and Health) says: 'Smokers should use NRT products for at least three months to help them quit, because they work.'
Quitting is all about dealing with the addiction to nicotine and NRT takes the edge off the craving, helping you to a soft rather than a crash landing.' Nicotine's effect on the brain is similar to that of heroin and cocaine. They all trigger the release of the chemical dopamine, which is associated with feelings of pleasure. In the long term, the brain needs larger doses of nicotine to experience the same level of pleasure.
Tina Selwood eschewed NRT partly because of fears about its safety. But NRT is much safer and less addictive than cigarettes. Safer, because it's the tar, carbon monoxide and other chemicals in cigarettes that are carcinogenic and bad for the heart. And less addictive, because NRT delivers nicotine more slowly and in lower doses than a cigarette does.
'When you smoke, your brain gets a huge rush of nicotine within 30 seconds whereas NRT allows gradually lower doses which are delivered less rapidly,' says Bates.
Quitting is never easy, but it's harder for some than others, according to Robert West, professor of psychology at St George's Hospital Medical School, London. Of 13 million smokers in the UK, eight million want to stop and four million make at least one attempt to stop every year. But only a dismal 1 per cent actually manage to stop for good.
'There's a myth that women find it harder to quit than men, though both sexes find it equally hard,' says West. 'Men tend to be more physically dependent because they tend to smoke more cigarettes per day and to smoke first thing in the morning which are the two main indicators of how addicted you are. But women say they feel more emotionally dependent on smoking than men.' Gender differences also determine why people decide to quit, and why they slip back. 'Women tend to give up for the kids, and men give up for their own health and because they worry about fitness. And men tend to start smoking again when they drink, whereas women slip back when stressed or if they start to put on weight,' says West.
Clive Bates says giving up is particularly hard for heavy smokers and those who light up within five minutes of waking up. Some chain-smokers may be genetically predisposed to nicotine addiction because they carry an efficient form of the gene CYP2A6 which allows them to clear nicotine quickly from their systems so they're left wanting more.
'When you decide to quit you need to prepare, set a date, and get yourself mentally ready for a siege against your addiction,' says Bates. 'Think about your diet, and exercise so you don't put on lots of weight. Change your routine to avoid the pub on Friday night or other triggers that are likely to make you restart.
'For the first three days, you're going to feel very rough, then you start to recover. After the first month, your chances of not sliding back improve dramatically. After a year, you should be home and dry. But it's a life-long struggle and many ex-smokers still experience a frisson going past the duty-frees even years after their last cigarette.'
Nicotine replacement therapy
A range of products, all of which will help. None is available on NHS prescription although your GP can offer a private prescription which may prove cheaper than buying over the counter.
Nicotine patches: Start with higher dose if you smoke 10 or more a day. Not visible but not controllable - deliver a set amount so you can't get more nicotine quickly when the craving's strong.
Nicotine pills: Launched last month - the microtab, placed under the tongue. Unobtrusive and easy to control dose, but it may cause some indigestion. Most smokers need one an hour if they smoke under 20 a day, while heavier smokers will need two. After three months the dose can be tailed off.
Nicotine gum: Start with 2mg but try greater strength if craving still high. Some find the taste unpleasant at first but you get used to it. Not very obvious and you can control the dose.
Nicorette inhalator: A plastic holder with nicotine cartridge in the end which you draw on like a cigarette. Delivers a relatively quick fix and you can control dose, but some say it looks like a tampon hanging out of your mouth.
Nasal spray: Nicotine solution to spray up the nose. A recent study showed that using nasal spray and patches in combination gives good results. The quickest fix of all and easy to control dose. But looks obvious and may irritate nose.
Helplines: (See below) An invaluable source of information and support when you're wavering. Keep the number next to the phone.
Smoking cessation clinics: Smokers are up to four times more likely to quit by attending specialist clinics than by relying on will-power alone. However, beware extravagant claims, and prices, of some commercial clinics.
Hypnotherapy and acupuncture: Little evidence that they help, but some individuals do benefit.
Herbal cigarettes: Not recommended, as they contain harmful tar and carbon monoxide and reinforce the habit.
Lozenges, capsules, tablets: Some products contain silver acetate which gives an unpleasant taste, others have small amounts of nicotine to help reduce craving but less than NRT products. May help some people, but few products have been clinically tested.
Smokers' helplines:
England 0800 00 22 00
Scotland 0800 84 84 84
N.Ireland 01232 66 32 81
