Useful and positive strategies

From the moment you stop smoking, you will begin a new stage. In this chapter we present a series of strategies that will help you along that path.

One of the most useful strategies is to avoid risky situations. For that reason, we suggest some risk factors that may predispose you to smoke, so that you can decide whether you want to avoid them:

Risk factors

• Times of day when you used to smoke: after meals, when leaving work, during breaks, etc.
• Associated places: bars, terraces, etc.
• Types of food associated with smoking: heavy meals, alcohol, coffee, etc.
• People who smoke.
• Weight gain can be a concern for people who stop smoking, and a risk factor for relapse. It is worth trying to maintain your weight to prevent weight gain leading to use.
• Difficult experiences: family problems, boredom, stress, crises, a break-up, losing your job, etc.
• Annual celebrations too, such as Christmas, New Year’s Eve, birthdays or holidays, can be occasions when you think about smoking. Alcohol use predisposes to loss of control. We suggest you prepare your response or how you will handle the situation in advance, and that in these risky moments you leave as little room as possible for spontaneity. Preparing will strengthen you.
• The illusion of control, which consists of a false sense of security after a few days or weeks of abstinence. Remember that the drug controls the person, not the other way round.

As for positive strategies, we also suggest a list:

Useful strategies to fight the urge to smoke

• Sport/exercise: helps to maintain an ideal weight, reduce cholesterol and blood pressure, distracts from the urge to smoke, generates wellbeing and relaxation once it has been done, and increases internal coherence (between what you want and what you do), satisfaction, self-control and self-mastery.
• Mindful and balanced breathing. Try to breathe in through your nose and out through your mouth. Use QuitNow’s feature that guides your breathing.
• Talking to someone, avoiding making tobacco the topic of conversation.
• Distraction: going for a walk, playing music at a high volume to occupy the foreground of your attention, reading, etc.
• Wetting your hands, your mouth or your whole body with cold water (or hot water if you feel anxious).

You’ll find more strategies in the next capsules of this module and in modules 2 and 3!

Be careful with strategies that are useful, but not positive! For example, eating lots of sugar, switching to another drug, or engaging in risky behaviours (driving fast, practising extreme sports, etc.) may help you think less about smoking, but these activities can create other drawbacks.

There is no magic formula. There are different tips and strategies that can be useful, but there are no miracle cures. You need to assess which ones work for you.

In that sense, we ask you: What is your ideal way of stopping smoking? How do you think you should stop smoking? It is possible that you have constructed, more or less consciously, that there is a particular or correct way to stop smoking. For example: without help, or without making changes to your routine, or without giving up contexts where there is smoke.

All processes are valid, whether more resources are needed or not. Asking for help is not a sign of weakness and there is nothing wrong with looking for a way to make abstinence as easy and comfortable as possible.

Letting yourself be helped is an indicator of strength because it involves exposing yourself and accepting your own difficulties. Having external resources makes you stronger. In your life there will still be good moments and not-so-good moments. Having new tools will make you better prepared in the face of adversity.

We also explain briefly what types of medicines exist for the treatment of nicotine addiction:

Medication

• Nicotine replacement, in the form of patches, gum or lozenges: no prescription is needed. They are less effective than other medicines. In fact, it should be borne in mind that they consist of taking nicotine through routes other than smoke. This avoids harmful effects on the respiratory tract, and psychologically you continue the process of breaking the habit of the act of smoking, but you may continue to fuel dependence on the drug. If you do not feel a very strong urge to smoke, it is better to avoid it.

  Taking nicotine in the form of gum or a patch will actually encourage your sense of deprivation when you stop. The addiction is perpetuated via another route.

  It should be added that it is much better to use gum, patches or lozenges than to smoke. It has been shown that these resources, although they contain nicotine, are less addictive and less harmful than cigarettes, and can help you quit.

  Under no circumstances are vapes or electronic cigarettes recommended, because either they contain nicotine, or if they do not, they can cause respiratory diseases due to combustion and the smoke that is inhaled.

  Nicotine pouches, also called white snus, should never be an option for quitting smoking. Although they may seem like it, they are not a medicine. They are marketed by large tobacco companies because, unlike snus, they often fall outside the law, as they do not contain tobacco. It is not proven that they help you quit smoking. On the contrary: they contain nicotine salts, which contribute to addiction (in the case of some pouches, nicotine levels have been measured higher than in conventional cigarettes) and toxins such as nitrosamines, benzene, arsenic, lead and mercury.

• Partial agonists of nicotinic receptors. These are medicines that stimulate the receptors that usually receive nicotine from tobacco, but they do so more weakly than tobacco. They reduce the urge to smoke and ease withdrawal symptoms:

  • Varenicline: a prescription is required. The medicine’s active substance has this name, although the brand name of the drug may be different.
  • Cytisine or cytisinicline: a prescription is required. The medicine’s active substance has this name, although the brand name of the drug may be different. In the 1960s it was already used in Eastern Europe. Now it is being used more and more and is replacing varenicline, since it has similar efficacy but fewer side effects. It is a molecule similar to nicotine that comes from the plant called broom. During the Second World War, soldiers would nibble it and realised it calmed their urge to smoke.

• The antagonist of nicotinic receptors, called bupropion: a prescription is required. This drug blocks nicotine receptors by binding to them, but without producing any biological effect of its own. It is also used as an antidepressant and is therefore contraindicated with other psychotropic medicines.

Any medicine can have different effects depending on the person, and all medicines can have side effects.

Medicines cannot replace personal motivation and the decision to change. A medicine taken without truly wanting to stop smoking will probably fail. In fact, in many public healthcare systems, the requirement for prescribing these medicines is that the person wants to stop smoking, and if not, it should not be prescribed.

It is an adjunct, and it can help you feel fewer cravings to smoke, but it cannot generate in you the necessary motivation. At this point we remind you of the first section in which we explained that, in order to move forward, it is necessary to see yourself as an active part of change and not as a mere passive patient who takes medicines.

As it is an adjunct, we say that treatments should be comprehensive. This means they should address all spheres of the phenomenon: psychological, biological and social.

Personal resources

Close your eyes and imagine yourself in the long term: in one year or five. What do you see? What is new in your life? What things have you removed from your life and what things have you kept? Why?

Now, with your eyes closed, imagine that your future version visits you, your self from a year from now. This version of you comes to tell you what resources worked well for them in their process and which did not. What would they tell you?

To finish, imagine that you can travel through time and visit yourself on your deathbed. This future version of you is about to say goodbye to life. Ask them: What are they especially proud of? What has been important in their life? What things were good for them to remove from their life, and what other things enriched it? How did they achieve it? What advice would they give you?

Remember that stopping smoking is more than a one-day decision; it is a process. It can be difficult, but never impossible. Unfortunately, there is no magic formula or fail-safe recipe for quitting, although we know it requires a certain firmness, flexibility, sometimes effort, openness and lots of creativity!