Addiction experts and non-smoking advocates are well aware that overcoming the dependency on tobacco is no easy task, especially for long-time smokers. But they say there are numerous aids that increase the odds of making that forever break from cigarettes a reality.
Understanding the enemy — and its physical and psychological holds — is the first step towards success, suggests Dr. Peter Selby, chief of the addictions program at the Centre for Addiction and Mental Health (CAMH) in Toronto.
Not only are smokers addicted to the nicotine in cigarettes, but also to the physical act of smoking.
"The action of taking the hand to the mouth has been repeated so many times that it becomes overlearned," says Selby. "The habit part is so difficult to stop, because that gets triggered at different times of the day, with different cues, like drinking alcohol or having a meal or taking a break.
"So the biology interacts with the psychology. And if you're put in environments where you're seeing people smoking, having access to cigarettes, that's why it becomes so hard for the person to stop and stay stopped."
An addiction to any drug, including nicotine, warps a person's thinking processes, he says. "They feel that they cannot function or survive without that drug."
Smokers will often personalize their relationship with cigarettes, considering them like a best friend that has been with them through good times and bad, Selby says.
"One of the things we have to help them think about is it's more like an abusive lover. In the short term, it does great things for them, but in the long term it's killing them and they have to break up with that relationship," he says.
Unlike using heroin or cocaine, whose downsides are more quickly evident, the adverse health effects from cigarettes are more akin to a slow burn, often lulling smokers into a false sense of security.
"This one's like guerilla warfare, it's embedding in your body. When you have a cigarette you're getting 4,000 chemicals, you're getting 60 cancer-causing chemicals, and those things accumulate and they're slowly working away and causing you harm."
Besides contributing to many health conditions, among them high blood pressure and cardiovascular disease,
30 per cent of all cancer deaths in Canada directly result from tobacco use, says John Atkinson, director of tobacco control and cancer prevention at the Canadian Cancer Society's Ontario division.
Smoking is behind 80 per cent of lung cancer deaths.
"It still remains the No. 1 preventable cause of disease and death," says Atkinson. "We know the No. 1 thing an individual can do to lower their risk of cancer is quit smoking."
At a CAMH clinic that tries to help smokers butt out for good, participants are advised to come up with a comprehensive plan that includes a firm quit date, tips on getting through the physical and psychological aspects of dependency, and counselling on the pitfalls to avoid and what to do if one slips and lights up.
"So we talk about the things you need to pay attention to, like environment — where you're working, living, playing — that could be modified so you're not triggered to smoke," said Selby.
"Make sure you pick your date right and you optimize it. Get a plan. If you get a craving, ask 'What can I do. What do I have on hand," he says, pointing to rescue medications like nicotine gum, spray or lozenges.
Indeed, CAMH experts believe combining such over-the-counter products as the patch or oral nicotine replacements with either the prescription medication Zyban or Champix offers the best chance for successfully crushing the cigarette habit.
"Generally, quitting is a process and not an event," says Selby, noting that this double-barrelled approach has been shown to roughly double or triple the odds of succeeding over the long term.
"Current research suggests combining two forms of treatment works better than either one alone."
While some smokers can quit cold turkey, using willpower alone, that strategy can wear thin for many people, says Selby, advising them to seek support through self-help booklets, calling a quit line, seeing a health practitioner or getting into a specialist clinic.
"All of those things should be brought in because you're learning to undo something that has been so ingrained in your brain. It's not a miracle; you need to work at it to make it happen."
Atkinson says the Canadian Cancer Society offers a printed self-help guide to quitting and a national toll-free smokers helpline — 1-877-513-5333 — that serves most of Canada, providing "quit coaches" to help callers trying to butt out for good. B.C., Alberta, Quebec, and Newfoundland and Labrador have separate quit lines.
There is also the society's online program — www.smokershelpline.ca — that offers advice, quit coaches and an online community where smokers in the process of quashing their addiction can connect.
"There is no magic bullet, unfortunately, for quitting smoking," agrees Atkinson. "It does still take, on average, five to seven times for people to be successful in quitting."
For those who have quit for six months, research shows there is a five per cent risk of starting to smoke again, and after a year of being tobacco-free, the chances of starting to light up again are another five per cent — usually because of stress, says Selby.
"The problem is most people end up relapsing within the first three weeks of making that quit attempt and they give up trying. And what we are saying is: 'No, no, let's shift that so you are staying in the process,'" he says.
"It's never too late to quit. Even people in their 60s and 70s and 80s. You can see a benefit to their longevity and quality of life.
"The only time it's too late is when the person has died and we failed to act."