No Smoke November: Expert Insights On Kicking The Habit For Good

Intro: With over 3.5 million Canadians still smoking, quitting can feel like an uphill battle. This November, NICORETTE and the Canadian Cancer Society are teaming up for the No Smoke November Challenge, offering expert advice and support. We spoke with three experts about quit strategies, health benefits, and the motivation to go smoke-free. —Noa Nichol

Nancy Wirtz (Manager of Cancer Prevention, Canadian Cancer Society)

1. Can you discuss the long-term health risks associated with smoking, especially in terms of cancer and respiratory health?
2. Lung cancer is the leading cause of cancer death in Canada with 1 in 4 cancer deaths being due to lung cancer. About 72% of lung cancer cases are due to smoking commercial tobacco. Quitting smoking not only reduces your risk of cancer but also heart disease, stroke, respiratory issues and improves your mental health. In addition, there are many social and financial benefits. Currently over 3.5M Canadians smoke and nearly 80% express a strong interest in quitting. Smokers’ Helpline is here to help them reach that goal.
3. How does the Canadian Cancer Society’s Smoker’s Helpline support Canadians in their journey to quit smoking?
4. Smokers’ Helpline provides free, non-judgmental, confidential and personalized cessation support and counselling to quit smoking or vaping. People can access the services by phone, online or text and connect with live Quit Coaches who can help them create a personalized quit plan, cope with cravings and withdrawals, learn about local programs and access free self-help materials. With the online platform, people can join community forums to connect with others who are quitting or have quit as well as access tools and resources such as the quit calculator to calculate money saved by quitting.
5. How important is community and family support for someone attempting to quit smoking, and what are some examples of effective support systems?
6. A strong support system is essential for successfully quitting smoking and preventing a relapse. A supportive environment offers emotional encouragement, practical advice and motivation throughout the quit journey. A support network may include friends and family to provide emotional support and help manage triggers, health professionals and counselling support like Smokers’ Helpline to provide personalized advice and guidance, along with a structured quit plan, tips and strategies. People may also use physical support such as medications or nicotine replacement therapy to manage withdrawal as well as apps and online resources to track process and stay motivated.
7. How does No Smoke November fit into the Canadian Cancer Society’s broader mission of cancer prevention?
8. No Smoke November encourages people to make a quit attempt with a short-term goal in mind. Quitting for a short period increases motivation and chances of long-term success. People who quit for a week are 9x more likely to quit for good. Using Quit-line support, such as Smokers’ Helpline can also double chances of staying quit with long-term success becoming even greater when this counselling is combined with supports like nicotine-replacement therapy, such as nicotine gum or the patch.
9. What advice would you give to someone who has tried to quit multiple times but hasn’t succeeded yet?
10. Quitting smoking is very difficult and you shouldn’t be discouraged if you’ve had a relapse, this is common and you are not alone, just try again. At Smokers’ Helpline we understand how challenging quitting can be and our caring coaches are here to help you when you’re ready or even if you are just thinking about quitting. You can contact Smokers’ Helpline by calling 1-877-513-5333, visiting smokershelpline.ca or text ‘iquit’ to 123456.

Dr. Sanjukta Mohanta, dentist and a founder of the New Dentist Study Club 

1. What are the main oral health issues that smokers face, and how can quitting help alleviate these risks?

The main oral health issues for smokers are:

• Bad breath
• Tooth staining
• Periodontal disease which leads to tooth loss
• Increased risk of oral cancer

Smokers are 6x as more likely to get oral cancer compared to non-smokers.

Quitting smoking will freshen your breath, reduce tooth staining, decrease tooth loss and reduce the risk of oral cancer.

2. How quickly do oral health benefits, like reduced staining or fresher breath, become noticeable after quitting smoking?

You will immediately notice fresher breath when you quit smoking. Visit a dental office to get your teeth professionally cleaned and you will notice that the stain does not return after you quit smoking.

3. Could you explain how smoking contributes to gum disease and tooth decay, and how quitting might reverse or slow down these effects?

Smoking leads to tooth decay because it dries the mouth. When the mouth is dry, there is less saliva to wash away food and bacteria. Smoking leads to gum disease because it decreases bone levels in the jaws and decreases the attachment of gums to teeth. Smoking also decreases wound healing by impairing blood flow to the gums.

4. For people concerned about the appearance of their teeth and gums, how does quitting smoking contribute to cosmetic improvements in oral health?

Quitting smoking will give your smile a glow up. You will have fresher breath, healthier gums, less decay and whiter teeth.

5. In your opinion, how can dental professionals play a more proactive role in encouraging patients to quit smoking?

Dental professionals can encourage patients to quit smoking by having conversations with them about why they smoke, benefits of quitting, and if they want to quit smoking. They should encourage patients to go on the NICORETTE® website www. nicorette.ca which provides tips on setting goals and rewards, how to get through the first week of quitting and how to deal with cravings. Patients can check out NICORETTE®’s different smoking cessation products to find the best one to help them quit. Dental professionals can encourage patients to take part in #nosmokenovember and to call Smokers’ Helpline for free personalized help.

Dr. Leslie Phillips, clinical pharmacist, smoking cessation expert and professor at Memorial University

1. What are some effective strategies or treatments that can help increase the success rate for those attempting to quit smoking?

Quitting smoking is one of the hardest things a smoker will ever do, but also one of the most rewarding.  Ideally a quit journey should start with a road map. Take a bit of time to prepare.  Here are my suggestions on the components of a good plan:

• Reasons for quitting: Think about your reasons for quitting (e.g. to improve breathing, be healthier, save money, be a role model for others, smell better) and write them down.  Post them where they can be seen every morning for a quick reminder.
• Assess your smoking behaviours:  Estimate how much you typically smoke per day as well as where and when you typically smoke, and if you smoke alone or with others.
• Set goals: It can be easier to break up your goal to quit into smaller, attainable goals. This improves the chances of having some early successes and helps builds confidence.   Are you ready to pick a quit day to work towards?  If so, do you want to reduce your daily use over a period of time (e.g. increase the time between cigarettes and/or eliminate one cigarette each day) leading up to your quit day? Could you start by trying to eliminate smoking in your home or vehicle?
• Identify and manage your triggers:  Triggers are situations, emotions, or routines that are associated with your cigarette use (e.g. coffee, alcohol, stress, driving, after meals, as a break between tasks, other smokers). Once you stop smoking, exposure to these will often “trigger” a craving or urge to light up. Develop a plan to start to separate your smoking from some of your triggers if possible (e.g. limit or avoid alcohol intake, don’t smoke in your car, avoid other smokers, change up your routines, practice stress relief such as mindfulness meditation, yoga, deep breathing, and progressive muscle relaxation techniques).
• Decide on a quit medication.   Quit medications can double to triple your chances of quitting successfully.  They can help prevent cravings and some can also help to manage them when they occur. Nicotine replacement therapies, like NICORETTE®, help reduce withdrawal symptoms and cravings by providing a controlled, lower dose of nicotine.  They are available without a prescription and come in a number of dosage forms including short-acting formulations (e.g. lozenge, gum, inhaler, mouth spray) to help you manage a sudden craving.  Prescription medications (varenicline and bupropion) are also available to reduce the pleasure of smoking and help alleviate cravings.  Cytisine is a natural health product that also improves your chances of quitting. Talk to your pharmacist or other healthcare provider to find a medication and dose that is right for you and to help ensure that you use it in a way that is most effective.
• Mange your caffeine intake:  When you quit smoking, your body takes longer to eliminate caffeine. As a result, two cups of coffee can feel like four cups.  Too much caffeine can cause nervousness, jitters, heart palpitations and insomnia – these can look and feel like nicotine withdrawal.  Try to cut back on how much coffee, tea, colas, or energy drinks that you consume or switch to decaffeinated beverages.
• Get support:  There are support options that can help you plan your quit, manage cravings and provide much needed support and encouragement.  Healthcare professionals, smoking cessation programs, peer support groups and/or helplines, and mobile phone apps all offer assistance.  Having a “quit-buddy” or supportive friend is also helpful.
• Stay Quit: Don’t stop your quit medication too early and make sure you are using it correctly.  Don’t have cigarettes on hand.  Don’t think you can have just one. Don’t underestimate a trigger such as stress or being around other smokers. If you do slip up, don’t blame yourself. Learn from it – what could you do differently next time?  Get back on track right away.

A successful quit often requires a multifaceted approach including pharmacological and behavioural support that is tailored to the individual’s lifestyle and goals.

• Could you elaborate on the physiological challenges of nicotine addiction and why quitting can be so difficult for many?

Nicotine in one of the most addictive substances in society today.  Dependence can begin with the first cigarette and cravings and withdrawal can begin within a month of repeated administration.  The addictive capacity of a substance is related to how quickly it can reach reward pathways in the brain and its subsequent ability to cause a large release of a feel-good chemical called dopamine.  Smoking is the fastest way to deliver nicotine to the brain. When a smoker first starts, their brain receives the nicotine within 7-10 seconds and experiences pleasure (reward) from the resultant release of a dopamine surge. There is no nicotine withdrawal at this point and this positive experience “teaches” the brain to anticipate another reward upon subsequent use.  For many individuals, repeated use of nicotine causes changes within the brain that lead to reduced reward or pleasure and low mood, as well as the development of withdrawal symptoms.  This now negative experience leads to craving and a drive for repeated use to avoid the unpleasantness of abstinence.

Nicotine withdrawal symptoms can include headaches, anxiety, irritability, difficulty concentrating, restlessness, insomnia, hunger, sweating, tremor and dizziness. Withdrawal symptoms can occur within as little as 45 minutes of last use.  While nicotine withdrawal symptoms typically peak within a few days to weeks, the recovery process can take much longer as the brain slowly learns to heal and adapt to a nicotine-free state and the lingering dysphoria and cravings.  

A multifaceted quit plan that includes quit medication to manage the discomfort of nicotine withdrawal and cravings, and behavioural therapies to manage triggers and developing new coping strategies can greatly enhance the chances of success.

3. How do nicotine replacement therapies like NICORETTE® and NICODERM® work, and what role do they play in managing cravings?

Nicotine replacement therapies (NRTs) provide a controlled, lower dose of nicotine, without the carbon monoxide and thousands of chemicals present in cigarette smoke.  The nicotine from these products is less addictive than inhaled nicotine from a cigarette because it gets into the brain much more slowly.  The slower arrival means less dopamine release, and less re-enforcement or pleasure.  The amount of nicotine in NRTs is enough to help manage symptoms of nicotine withdrawal such as anxiety and irritability and cravings, creating a more comfortable experience for the individual as they abstain.   Once the individual has been comfortably quit for a period of weeks, the dose of NRT is typically reduced over time and the individual weaned off nicotine completely. 

NRT products are available in a number of formulations.   A long-acting patch, like NICODERM®, delivers nicotine slowly through the skin over 24 hours, providing a steady, controlled dose of nicotine throughout the day to help prevent/reduce cravings and withdrawal.  A number of shorter-acting nicotine products are available, like NICORETTE®’s gum, lozenge, inhaler, and QuickMist, which deliver nicotine through the cheek. These products can be used regularly to help manage nicotine withdrawal and cravings, but their shorter duration of action means they can also be used “on-demand” to treat sudden cravings and curb the urge to smoke, or to assist individuals in situations for which they must temporarily refrain from smoking.   Short-acting NRT products can also be used on demand in combination with the longer-acting patch. This is called combination NRT and is more effective than using a single NRT product.

These products may have other benefits. The variety of dosage forms of short-acting NRT allow individuals to choose the form that best meets their needs/lifestyle.  They can also provide a “fidget-factor” experience helping individuals manage the loss of the hand-to-mouth rituals caused by smoking.

4. What immediate health benefits can a smoker expect to experience after quitting, even in the first week?

Immediate health benefits can start to occur once an individual quits as the body is no longer exposed to the harmful chemicals in cigarettes. Even in the first week, individuals can experience significant positive changes in their health…

• Within 20 minutes….Blood pressure and heart rate drop
• Within 8 hours…Carbon monoxide levels decline and oxygen levels return to normal in tissues and organs making them function better and your hands and feet can start to feel warmer.
• Within 24 hours…risk of heart attack starts to decline as the body’s clotting system return to normal.  The lungs also begin to heal as cilia (tiny hair-like structures that line the airways) begin to beat and clear out mucus and cigarette debris.
• Within 48 hours…Taste and smell improve as nerve ending start to regenerate.
• Within 72 hours…breathing gets easier as airways relax.  Shortness of breath and wheezing lessons.
• Within 1 week…circulation improves and energy levels are boosted – physical activity becomes easier.

These early improvements can help bolster motivation to quit

5. From a pharmacist’s perspective, how do you recommend individuals handle setbacks or relapses during their quitting journey?

Smoking is an addiction and not a bad habit.  Quitting smoking is difficult and most individuals will attempt to quit many times before quitting for good.  Try to avoid the “all or none” attitude as slips (minor setbacks) and relapses (returns to baseline level of smoking for a week or more) are common occurrences in most people’s quit journey.  Blame the cigarette, not yourself.

View slips and relapses not as failures, but rather as opportunities to learn. What caused the slip up or relapse?   And what could you do differently next time?

For example:

• Did you underestimate a trigger?  Were you around smokers? Did you have cigarettes on hand? Did you use smoking to cope with a stressful event or boredom? Did you drink too much? Did you think you could control your use and have just one? 
• Was there a medication failure? Did you use your NRT properly?  Did you stop/reduce the dose too early?  Do you need a higher dose or a different quit medication?

Pharmacists can help individuals reflect (understand the reasons behind slips and relapses) and adjust (develop strategies to better manage them next time).   They can ensure quit medications are optimized and offer stress-management techniques and provide encouragement, compassion, and emotional support.   Every slip, every quit is an opportunity to learn and brings the individual another step closer to success.