For seven years, from kindergarten through sixth grade, they’ve walked through the same halls and lived by the same rules with pretty much the same kids around them. In the final year, they’ve been the “big kids” of the school, assisting as reading buddies for the kindergarteners and serving as role models for all of the younger students. Now it’s on to middle school. Now it’s on to being a preteen.

Early in my career, I taught English in what was then known as junior high. I’d watch those new seventh graders enter each year with their new backpacks and scared faces. They looked sooo young compared to the ninth graders who were the bosses of the school.

They’d often get lost trying to find their classes in a much bigger school. They’d get confused by a rotating schedule of classes. They’d forget how to find their lockers. Since four elementary schools converged in one middle school, they had to reestablish their friend groups and find new people to share a table with in the lunchroom. They had to get used to having four or five or more teachers instead of one or two. And they had to learn how to take homework much, much more seriously. No wonder they looked scared. No wonder the absence rate in the first few weeks was sky high.

Parents can do a great deal to help with the transition. When kids enter a new environment with some sense of what to expect, they are more likely to be successful and less likely to be overwhelmed. Help your child manage by taking some steps before school starts.

Getting Comfortable

• Visit the new school. Help your child figure out the layout. Some schools are organized with each grade being in a different section of the school. Others are organized by department with the English department in corridor A and the math department in corridor B. Still others are organized by “teams” of teachers working together with a set group of students in a block of classrooms.Find out how the school is organized. Then see if you can get a tour with an older student or school personnel. Walk around until your child has a sense of where to find classes, the library, the gym, and the cafeteria. Remind him that it will look different when there are hundreds of kids crowding the halls.
• See if your student can meet some of her teachers or the guidance counselor. Often staff are setting up classrooms in the weeks before school starts. Most are happy to take a couple of minutes to shake hands and say hello. Don’t overstay your welcome. These people have a lot to do. But just knowing what a few teachers look like can make your student feel more comfortable.
• Clothes. Yes, clothes. For a middle schooler, the idea of going to school looking decidedly uncool is terrifying. Help your child think about how he wants to present himself that first day. That doesn’t mean that you need to spend a lot of money on new clothes. It does mean looking together at what your child has and what he needs to feel self-confident. Check out back to school sales. But also remember that “Sal’s Boutique” (the local Salvation Army store), thrift shops, and yard sales can be treasure troves of fashion.
• Mornings. Ugh. Most middle schools start far earlier than elementary school. Two weeks before school starts, get everyone used to going to bed and getting up earlier. It’s a huge adjustment for some families. But a tired kid isn’t going to do well in school. Set up a healthy sleep routine from the start.

Acts of violence have always been a part of human nature and will continue unless we become some sci-fi world with better living through chemistry and genetic manipulation. Sure, there are general reasons the experts will point to, such as alienation; access to guns; too much exposure to violence; a society whose leaders lack values; and families who are disconnected from community.

But the reality is that the great majority of teenagers are growing up in this environment and not killing anyone. That doesn’t mean we should ignore steps to reduce the negative influences on their lives and ours. It does mean that no matter what we do, there will always be tragedies. We simply do not have that much control over another person’s life. That is a frightening reality for most parents to accept.

But this doesn’t mean that parents shouldn’t be doing things that make it more likely that their children would turn out okay. Inside each home there are parents asking if their son or daughter could be in trouble and the parents might not know it. Or, even scarier, there are parents who see their children struggling and feel powerless to help. What do we know that will help?

Well, the research points to the same issue nearly every time: children who have stronger relationships with their parents are less likely to end up in serious trouble. My emphasis on “serious” is because too often parents are upset about issues that are not life-threatening or life-determining. Clean rooms, grades and homework, being disorganized, being impulsive and screwing up, foul language, a few extra holes in an ear, some grungy friends, some broken curfews, or the protective or manipulative “lies” that children use to try to get away with things – all normal adolescent behaviors that do not alone signify a child “going down the tubes.”

Adolescence is a time for many teens to experience disconnection and disorientation, to become confused and uncertain about their values or about their capacity for success. It is a time to be scared about changing bodies and changing friends and experiencing failures when success may have usually come easily. It is a time to defy and distrust authority. It is a time, especially in with the phenomenon of the Internet, when teens’ worlds expand exponentially and it is quite a challenge for them to digest and manage all to which they are exposed.

Parents often respond to this by waging battles for control. While it is essential to have some unequivocal rules that involve health and safety and to seek help from others if there are signs of more serious trouble (e.g., depression, explosive outbursts, eating disorders, substance abuse, marked change in personality), it is particularly important to focus less on content and more on process.

What does this mean? Simply, that nothing is a substitute for maintaining the connection between you and your teenager. Time must be found for one-to-one interactions. Parents must be ready to give their attention when a teenager is suddenly ready to talk. Parents need to spend some time inside the world of their teenager and try to do so without being too judgmental. Do errands and chores together. Find an activity that can be shared. Take a teenage child out to dinner occasionally. A parent whose work involves travel can bring along a teenage child and turn it into a significantly valuable time together. Know each other!

Remember that you most likely did some things wrong along the way. It can be helpful to share that. Why should your child be open with you if there is not some reciprocity? That includes sharing some of your current anxieties or mistakes. We all mess up. We all have our vulnerabilities. We all seek safety and security. In that way, you and your teen have much in common. The key difference is that a teen’s life has few real choices and does not have a valued place in our society. We ask them to be responsible but there is little immediate reinforcement for that except to keep the adults from being angry and disappointed with them. Believe in your child, even when he or she is struggling, or simply not meeting your expectations.

For some parents, there is the harsh reality that, despite doing a good job, their child is having significant problems, and the parents are being shut out while nothing seems to be helping. This is definitely painful and scary. Even with professional help and support from school staff, some child will fall into a “black hole,” influenced by biology, peers, and social forces. This underscores another reality about the tragedies that have been taking place: All the perpetrators have been male.

Our society gives out powerful messages that are absorbed by our children. What girls hear and respond to leads them to turn against themselves, especially in the form of eating disorders (and a skyrocketing rate of smoking). What boys hear and respond to leads them to turn against others, in acts of verbal and physical abuse. In the face of all this, parents are worried, possibly more than ever, about the health and success of their children.

But I must return to my primary message of urging parents to have a more optimistic outlook and to not let their anxiety sabotage what is most important, the relationship each parent has with each child. A friend and colleague, Bob Brooks, often speaks about the resiliency of children and what contributes to it. The research clearly indicates that the presence of a “charismatic adult” is one of the primary predictors of turning out okay.

So often I read the stories of successful adults who grew up under terrible circumstances and there is always reference to a parent, relative, teacher, or coach who believed in them and provided guidance and an available ear when needed. Dr. Brooks often ends his presentations by challenging parents to be that charismatic adult in the lives of their children. It is no guarantee that everything will turn out all right. Nothing can do that. But it does make it much more likely that you will end up with an adult child who is not only doing well but is also your friend.

Nearly half of all the cigarettes sold in the U.S. are smoked by people with a serious mental illness, according to a study in the Journal of the American Medical Association in 2000. People with schizophrenia, bipolar disorder and other mental illnesses are twice as likely to smoke as the general population, and they tend to smoke about 50% more cigarettes per day.

Beck discusses a pilot program at the International Center for the Disabled (ICD) that began in January that is challenging today’s culture regarding smoking among the mentally ill: that persons with serious mood disorders don’t want to quit, and they shouldn’t if the withdrawal will create even more depression and other symptoms that are best left alone. Smoking is often used as a reward for good behavior in psychiatric hospitals and is not discouraged because it satiates the patients.

But the nicotine fix comes with great risk. Beck explains:

Smoking can take a heavy toll on patients already struggling with mental-health issues. People receiving Social Security disability spend one-quarter to one-third of their income on cigarettes each month. And people with serious mental illnesses die, on average, 25 years earlier than the rest of the population, largely due to high rates of smoking-related illnesses like cancer, heart disease and stroke.

Concern over the physical health of such patients—and high medical costs—has prompted some states to begin addressing the issue. About 60% of state mental hospitals now prohibit smoking. But only one-third of them offer treatment to help patients quit. And few people living on their own with mental-health problems have access to smoking-cessation programs.

The pilot program is using nicotine-replacement therapy and one-on-one counseling with therapists trained in this area, and is already having positive results. For many patients, giving up smoking has increased their confidence and motivated them to pay better attention to their health. They have found that smoking didn’t really help with stress; in fact, it may have contributed to it.

Beck explains that the ICD program is funded by a grant from SAMHSA, the Substance Abuse and Mental Health Services Administration, to test model programs integrating medical and mental-health care. She reports, “Of ICD’s 500 patients, many of whom are homeless, jobless and struggling with legal and family problems as well as their psychoses, 35 are now working to quit smoking or have stopped.”

The team took figures from over 1,000 men and women aged 18, 21 and 25 years. Smokers had more than twice the rate of depression. Using a computer modeling approach, their analysis supported a pathway in which nicotine addiction leads to increased risk of depression.

In the British Journal of Psychiatry, the researchers wrote, “The best-fitting causal model was one in which nicotine dependence led to increased risk of depression.” They suggest two possible routes, one involving common risk factors, and the second a direct causal link.

According to the researchers, “this evidence is consistent with the conclusion that there is a cause and effect relationship between smoking and depression in which cigarette smoking increases the risk of symptoms of depression.”

Professor David Fergusson, the study’s lead researcher, said, “The reasons for this relationship are not clear. However, it’s possible that nicotine causes changes to neurotransmitter activity in the brain, leading to an increased risk of depression.” But he adds that the study “should be viewed as suggestive rather than definitive.”

Writing in the same journal, Marcus Munafo, PhD of Bristol University, UK, reports that cigarette smokers often talk about the antidepressant benefits of smoking. “But evidence suggests that cigarette smoking may itself increase negative affect [emotion], so the causal direction of this association remains unclear,” he writes.

As Munafo points out, the role of nicotine in depression is complex, because smokers often feel emotionally uplifted following a cigarette. Bonnie Spring, PhD, at Hines Hospital, VA Medical Center, Illinois, looked at the link. Spring explains that depression-prone smokers are thought to self-administer nicotine to improve mood. But little evidence supports this view, so she examined nicotine’s effect on depression.

Her team recruited 63 regular smokers with no history of diagnosed depression, 61 with past but not current depression, and 41 with both current and past depression. All were given either a “nicotinized” or a “denicotinized” cigarette following a positive mood trigger.

Those who had experienced depression showed an enhanced response to the positive mood trigger when smoking a nicotinized cigarette. The researchers wrote, “Self-administering nicotine appears to improve depression-prone smokers’ emotional response to a pleasant stimulus.” The reason for this effect is not clear.

This study was followed up in 2010 by scientists at the University of Pittsburgh. Kenneth A. Perkins, PhD and colleagues looked at whether smoking can improve a negative mood.

Again using nicotinized and denicotinized cigarettes, they found that smokers do feel better after a cigarette, but only when they haven’t smoked since the previous day. The improved mood after abstinence from smoking was a “robust” finding. However, cigarettes “only modestly” improved negative mood due to other sources of stress — in this case, a challenging computer task, preparing for a public speech, and watching negative mood slides.

The researchers say that relief from negative mood due to smoking depends on the situation rather than nicotine intake: “These results challenge the common assumption that smoking, and nicotine in particular, broadly alleviates negative affect.”

One major factor must be the smoker’s expectations. These were investigated by a team at the University of Montana. They write, “Expectancies about nicotine’s ability to alleviate negative mood states may play a role in the relationship between smoking and depression.”

They asked 315 undergraduate smokers to complete a survey, which supported the theory. Smokers believed that “higher levels of tobacco smoking will reduce negative emotions.” This expectation “fully explained the link relationship between depressive symptoms and smoking,” the researchers said.

Could the link between tobacco smoking and depression actually be due to other substance dependencies? A team from Switzerland thinks not. After surveying 1,849 men and women they found that alcohol and cocaine dependence were also significantly linked to depression. But when taking this into account, “the association between smoking and depression still remained statistically significant. This study adds support to the evidence that smoking is linked to depression,” they concluded.

So it seems that the evidence is stacked against nicotine as a mood lifter, despite widely-held beliefs to the contrary.

References

Boden, J.M., Fergusson, D. M. and Horwood, L. J. Cigarette smoking and depression: tests of causal linkages using a longitudinal birth cohort. The British Journal of Psychiatry, Vol. 196, June 2010, pp. 440-46.

Munafo, M. R. and Araya, R. Editorial: Cigarette smoking and depression: a question of causation. The British Journal of Psychiatry, Vol. 196, June 2010, pp. 425-26.

Spring, B. et al. Nicotine effects on affective response in depression-prone smokers. Psychopharmacology, Vol. 196, February 2008, pp. 461-71.

Schleicher, H. E. et al. The role of depression and negative affect regulation expectancies in tobacco smoking among college students. The Journal of American College Health, Vol. 57, March-April 2009, pp. 507-12.

Perkins, K. A. et al. Acute negative affect relief from smoking depends on the affect situation and measure but not on nicotine. Biological Psychiatry, Vol. 67, April 2010, pp. 707-14.

Wiesbeck, G. A. et al. Tobacco smoking and depression–results from the WHO/ISBRA study. Neuropsychobiology, Vol. 57, April 18, 2008, pp. 26-31.

Selig opens the book with her reasons for writing it, stating that “knowing how to change is a life-and-death matter for many people, not just a lifestyle choice.” She ponders, “Why do so many people find it next to impossible to change destructive habits, even when they want to?” She cites her own personal experiences with habit change, stating that her aunt’s death from lung cancer prompted her own decision to quit smoking.

Selig coined the term “changepower” and defines it as “the ability to combine self-change techniques with techniques that rely on other people, places, and things…the capacity to use both internal and external motivation to exercise self-control.” She differentiates changepower from willpower in that willpower refers to the ability to control one’s behavior through the use of internal motivation only.

Prior to detailing the stages, Selig guides readers to finding out where they stand on the “Wheel of Change.” She describes how habits form and why they are so hard to overcome. She encourages various action steps in “Try This” boxes throughout each chapter to help the readers assess themselves as they go along. In discussing how strong a habit can be, she refers to brain chemistry, stating “neurons that fire together, wire together.” As a result, our brains begin to function on autopilot when it comes to bad habits; the more often you act on your habit, the more likely your brain can perform the habit without much thought at all.

Selig integrates scientific information and current research, along with a collegial, conversational tone to teach each stage of change. Using inspirational quotes and stories from former students of her habit change course, she gently but effectively points out reasons to change bad habits, and offers motivational tips. For those who are not yet ready to change (Pre-Contemplation Stage), Selig suggests having “a chat” with your future self, keeping in mind that, “true self-care means never having to say ‘I’m sorry’ to your future self.” This is especially relevant for habits that are endangering your health and quality of life or the health and quality of life of the ones you love.

Each stage of change receives a few chapters in which the stage is explored, steps are provided to work through the stage, along with “troubleshooting” for difficulties, and a plan of action is suggested. Depending on the stage, this plan of action can be passive (e.g., think about when you might want to change) or active (e.g., develop a written list of goals and how you will achieve these goals, then implement them).

In the final stages of the book (Relapse, Maintenance, and Termination), Selig focuses on how to handle slip-ups (lapses), returning to your habit (relapse), and determining if your habit change will require life-long maintenance or if termination is an option. Selig cites grim statistics in her chapter on relapse, stating that, “the first time around only about 20 percent of habit changers make it through all the stages.” That leaves about 80 percent of would-be habit changers experiencing a lapse, relapse, or just plain giving up. But, there is hope. She goes on to say that, “even if you relapse you are still more likely to achieve your habit change goal within six months than someone who has not tried at all.”

Overall, Selig does a good job of bringing a fresh perspective on an old subject. She seamlessly integrates research on habit change with anecdotal, personal stories from her students, and from her own struggles with habit change. She strikes a good balance between expert and caring friend without coming across as condescending or pushy.

Selig uses a motivational interviewing approach to help readers see what is best for them while providing tools along the way to aid self-discovery. Another great aspect to this book is that it can be used for any habit. The suggestions throughout the book focus on the most popular habits that people want to change (diet, exercise, quitting smoking, alcohol, or other drugs, and procrastination); however, the tools can be used for any habit.

Changepower! 37 Secrets to Habit Change Success is a valuable resource for individuals looking to change a bad habit. It can also serve as a guidebook for people in the helping professions who are often faced with clients looking for advice on how to change bad habits. Its easy to understand format makes it ideal to refer clients to, and the small modules and “Try This” action steps can serve as bibliotherapy and behavioral homework.

Even in cases where you wouldn’t necessarily refer to the book as a direct reference, this book should be required reading in psychology courses in order to help students better understand the motivation behind why we change. This book can’t provide all the answers to that question, but it does a pretty good job at trying!  

Changepower! 37 Secrets To Habit Change Success
By Meg Selig
Routledge: October 2009
Paperback, 281 pages
$19.95

Keeping Your Guard Up

Your body has changed since you began to smoke. Your brain has learned to crave nicotine. So certain places, people, or events can trigger a strong urge to smoke, even years after quitting. That’s why you should never take a puff again, no matter how long it has been since you quit.

At first, you may not be able to do things as well as when you were smoking. Don’t worry. This won’t last long. Your mind and body just need to get used to being without nicotine.

After you’ve quit, the urge to smoke often hits at the same times. For many people, the hardest place to resist the urge is at home. And many urges hit when someone else is smoking nearby. Look at your Craving Journal (PDF) to see when you might be tempted. Then use the skills you’ve learned to get through your urges without smoking.

As you go through the first days and weeks without smoking, keep a positive outlook. Don’t blame or punish yourself if you do have a cigarette. Don’t think of smoking as “all or none.” Instead, take it one day at a time. Remember that quitting is a learning process.

Now that you aren’t buying cigarettes, you probably have more spending money. Think about starting a “money jar” if you haven’t already. Put your cigarette money aside for each day you don’t smoke. Soon you’ll have enough money to buy a reward for yourself.

Many ex-smokers had to try stopping many times before they finally succeeded. When people slip up, it’s usually within the first three months after quitting. Here’s what you can do if this happens:

• Understand that you’ve had a little slip. You’ve had a small setback. This doesn’t make you a smoker again.

• Don’t be too hard on yourself. One slip up doesn’t make you a failure. It doesn’t mean you can’t quit for good.
• Don’t be too easy on yourself either. If you slip up, don’t say, “Well, I’ve blown it. I might as well smoke the rest of this pack.” It’s important to get back on the non-smoking track right away. Remember, your goal is no cigarettes – not even one puff.
• Feel good about all the time you went without smoking. Try to learn how to make your coping skills better.
• Find the trigger. Exactly what was it that made you smoke? Be aware of that trigger. Decide now how you will cope with it when it comes up again.
• Learn from your experience. What has helped you the most to keep from smoking? Make sure to do that on your next try.
• Are you using a medicine to help you quit? Don’t stop using your medicine after only one or two cigarettes. Stay with it. It will help you get back on track.
• Know and use the tips in this Guide. People with even one coping skill are more likely to stay nonsmokers than those who don’t know any. START to stop again!
• See your doctor or another health professional. He or she can help motivate you to quit smoking.

• Finding New Things to Do
• Remember Instant Rewards
• The Long-term Rewards of Quitting

You can also try these tips:

• Keep other things around instead of cigarettes. Try carrots, pickles,
  sunflower seeds, apples, celery, raisins, or sugarfree gum.
• Wash your hands or the dishes when you want a cigarette very badly.
  Or take a shower.
• Learn to relax quickly by taking deep breaths.
  • Take 10 slow, deep breaths and hold the last one.
  • Then breathe out slowly.
  • Relax all of your muscles.
  • Picture a soothing, pleasant scene.
  • Just get away from it all for a moment.
  • Think only about that peaceful image and nothing else.

• Light incense or a candle instead of a cigarette.

Where you are and what is going on can make you crave a cigarette. A change of scene can really help. Go outside, or go to a different room. You can also try changing what you are doing.

No matter what you do, don’t fall into the false belief that, “Just one won’t hurt.” It will hurt. It will undo your work so far.

Remember: Trying something to beat the urge is always better than trying nothing.

Find New Things To Do

Starting today you may want to create some new habits. Here are some things you might try:

• Swimming, jogging, playing tennis, bike riding, or shooting baskets. It’s hard to smoke and do these things at the same time. How about walking your dog?

• Keep your hands busy. Do crossword puzzles or needlework. Paint. Do woodworking, gardening, or household chores. You can also write a letter or paint your nails.
• Enjoy having a clean tasting mouth. Brush your teeth often and use mouthwash.
• Take a stretch when you’re tempted to reach for a cigarette.

Set aside time for the activities that satisfy you and mean the most to you. There are natural breaks even during a busy day. After dinner, first thing in the morning, or just before bed are good examples. You’ll also need plenty of rest while you get used to your smoke-free lifestyle.

Remember the Instant Rewards of Quitting

Your body begins to heal within 20 minutes after your last cigarette. The poison gas and nicotine start to leave your body. Your pulse rate goes back to normal. The oxygen in your blood rises to a normal level.

Within a few days you may notice other things:

• Your senses of taste and smell are better.
• You can breathe easier.
• Your “smoker’s hack” starts to go away. (You may keep coughing for a while, though.)

The nicotine leaves your body within three days. Your body starts to repair itself. At first, you may feel worse instead of better. Withdrawal feelings can be hard. But they are a sign that your body is healing.

The Long-term Rewards of Quitting

Tobacco use in the United States causes more than 450,000 deaths each year. Of those deaths, 170,000 are from cancer.

After you’ve quit, you’ve added healthy, full days to each year of your life. You’ve greatly lowered your risk of death from lung cancer and other diseases including:

• Heart disease
• Stroke
• Chronic bronchitis
• Emphysema
• At least 13 other kinds of cancer

You’ve also cut back on dangerous secondhand smoke for your loved ones. Finally, by quitting smoking, you’re setting a good example. You’re showing young people that a life without cigarettes is a longer, healthier, happier life.

Using Your Support Program

If you decided to use a support program, use it fully. Go to the sessions. Call your telephone quitline. Visit your favorite quit-smoking websites. The more support you get, the more likely you will quit for good.

Are you using medicine to help you quit? If so, follow the directions. If you don’t, you’re more likely to go back to smoking. Also, don’t rush to stop using the medicine. Stick with it for at least 12 weeks. Or follow your doctor’s advice.

Keep Busy

• Keep very busy today — the busier, the better. Go to a movie. Exercise. Take long walks. Go bike riding.

• Spend as much free time as you can where smoking isn’t allowed. Some good places are malls, libraries, museums, theaters, department stores, and places of worship.
• Do you miss having a cigarette in your hand? Hold something else. Try a pencil, a paper clip, a marble, or a water bottle.
• Do you miss having something in your mouth? Try toothpicks, cinnamon sticks, lollipops, hard candy, sugarfree gum, or carrot sticks.
• Drink a lot of water and fruit juice. Avoid drinks like wine and beer. They can trigger you to smoke.

Stay Away from What Tempts You

• Instead of smoking after meals, get up from the table. Brush your teeth or go for a walk.

• If you always smoke while driving, try something new: Listen to a new radio station or your favorite music. Take a different route. Or take the train or bus for a while, if you can.
• Stay away from things that you connect with smoking. Do it today and for the next few weeks. These smoking connections may include things like watching your favorite TV show, sitting in your favorite chair, or having a drink before dinner.
• Do things and go places where smoking is not allowed. Keep this up until you’re sure that you can stay smoke-free.
• Remember, most people don’t smoke. Try to be near nonsmokers if you must be somewhere you’ll be tempted to smoke, for example at a party or in a bar.

Remember Your Smoking Triggers

Certain things trigger, or turn on, your need for a cigarette. They can be moods, feelings, places, or things you do.

Knowing your triggers is very important. It can help you stay away from things that tempt you to smoke. It can prepare you to fight the urge when you are tempted.

• Stay away from places where smoking is allowed. Sit in the non-smoking section at restaurants.
• Keep your hands busy. Hold a pencil or paper clip. Doodle or write a letter. Carry a water bottle.
• Stay away from people who smoke. Spend time with non-smoking friends.
• Put something else in your mouth. Chew sugarfree gum. Snack on a carrot or celery stick. Keep your mouth and hands busy with a toothpick, sugarfree lollipop, or straw.
• Drink less or stay away from alcohol. Drinking alcohol often makes people want to smoke. Drink juice, soda, or ice water instead.

Remember that the urge to smoke will come and go. Cravings usually last only for a very brief period of time. Try to wait it out.

Many people just can’t handle how they feel after they quit. They start smoking again to feel better. Maybe this has happened to you. Most people slip up in the first week after quitting. This is when feelings of withdrawal are strongest.

There are medicines that can help with feelings of withdrawal:

• Nicotine gum
• Nicotine inhaler
• Nicotine lozenge
• Nicotine nasal spray
• Nicotine patch
• Bupropion SR pills
• Varenicline pills

Using these medicines can double your chances of quitting for good. Ask your doctor for advice. But remember: Medicine alone can’t do all the work. It can help with cravings and withdrawal, but quitting will still be hard at times.

Here is more information about the different medicines. Also see the Medication Guide.

Nicotine Gum, Patch, Inhaler, Spray, and Lozenge (NRT)

Nicotine gum, patches, inhalers, sprays, and lozenges are called nicotine replacement therapy (NRT). That’s because they take the place of nicotine from cigarettes. NRT can help with withdrawal and lessen your urge to smoke.

You need a prescription to buy the inhaler and nasal spray. But you can buy nicotine gum, nicotine patches, and nicotine lozenges on your own.

Other Medicines

Bupropion SR is a medicine that has no nicotine. You need a prescription to get these pills. They seem to help with withdrawal and lessen the urge to smoke.

Some people have side effects when using bupropion SR pills. The side effects include dry mouth and not being able to sleep.

This medicine isn’t right for:

• Pregnant women
• People who have seizures
• People with eating disorders
• Heavy drinkers

Ask your doctor, dentist, or pharmacist if this medicine is right for you. Make sure to use it the right way if your doctor prescribes it.

Varenicline is also a medicine that has no nicotine. You need a prescription to get these pills. This drug may help those who wish to quit by easing their withdrawal symptoms and by blocking the effects of nicotine from cigarettes if they resume smoking. The side effects include stomach complaints such as nausea and vivid dreams.

There have been rare reports of mood swings, depression and suicidal thoughts. Your doctor will want to monitor this carefully. Please check the FDA website for updates about this medication: www.fda.gov.

This medicine isn’t right for people with kidney problems and women who are pregnant, plan to become pregnant, or are breastfeeding.

Ask your doctor, dentist, or pharmacist if this medicine is right for you. Make sure to use it the right way if your doctor prescribes it.

Thinking About Using NRT?

• Ask your doctor, dentist, or pharmacist if nicotine gum, the patch, or some other kind of NRT is right for you. These medicines can cause side effects in some people. Some people should not use NRT without a doctor’s help. Pregnant women are a good example.
• Be patient. Using NRT correctly can take some getting used to. Follow the instructions and give it some time.
• Don’t mix tobacco and NRT. Having one or two cigarettes while you use the gum, patch, nasal spray, inhaler, or lozenge is not dangerous, but your goal is to quit smoking for good. Use NRT only when you are ready to stop smoking. If you do slip up and smoke a cigarette or two, don’t give up on NRT. Keep trying.
• Start out using enough medicine. Use the full amount of NRT in the instructions. Don’t skip or forget to use your NRT after you first stop smoking.
• Slowly use less and less medicine. But don’t stop completely until you’re ready. You can set up a schedule with your doctor or pharmacist.
• Keep some of the medicine with you after you stop using it. This way you’ll be ready for an emergency.
• Wait a half hour after using the gum, lozenge, or inhaler before you eat or drink anything acidic. Acidic foods and drinks can keep nicotine gum and inhalers from working. Acidic foods and drinks include tomato sauce, tomatoes, oranges, lemons, grapefruit, coffee, soda, orange juice, and grapefruit juice.

Bottom line: Read the instructions that come with the medicine. Talk to your doctor or pharmacist if you have any questions.

S = Set a quit date.
T = Tell family, friends, and coworkers that you plan to quit.
A = Anticipate and plan for the challenges you’ll face while quitting.
R = Remove cigarettes and other tobacco products from your home, car, and work.
T = Talk to your doctor about getting help to quit.

Set a Quit Date

Pick a date within the next 2 weeks to quit. That gives you enough time to get ready. But it’s not so long that you will lose your drive to quit.

Think about choosing a special day:

• Your birthday or wedding anniversary
• New Year’s Day
• Independence Day
• World No Tobacco Day (May 31)
• The Great American Smokeout (the third Thursday of each November)

If you smoke at work, quit on the weekend or during a day off. That way you’ll already be cigarette-free when you return.

Tell Others your Plan to Quit

Quitting smoking is easier with the support of others. Tell your family, friends, and coworkers that you plan to quit. Tell them how they can help you.

Some people like to have friends ask how things are going. Others find it nosy. Tell the people you care about exactly how they can help. Here are some ideas:

• Ask everyone to understand your change in mood. Remind them that this won’t last long. (The worst will be over within two weeks.) Tell them this: “The longer I go without cigarettes, the sooner I’ll be my old self.”

• Does someone close to you smoke? Ask them to quit with you, or at least not to smoke around you.
• Do you take any medicines? Tell your doctor and pharmacist you are quitting. Nicotine changes how some drugs work. You may need to change your prescriptions after you quit.
• Get support from other people. You can try talking with others one-on-one or in a group. You can also get support on the phone. You can even try an Internet chat room. This kind of support helps smokers quit. The more support you get, the better. But even a little can help.

Anticipate and Plan for the Challenges You’ll Face While Quitting

Expecting challenges is an important part of getting ready to quit.

Most people who go back to smoking do it within three months. Your first three months may be hard. You may be more tempted when you are stressed or feeling down. It’s hard to be ready for these times before they happen. But it helps to know when you need a cigarette most.

Look over your Craving Journal (PDF). See when you may be tempted to smoke. Plan for how to deal with the urge before it hits.

You should also expect feelings of withdrawal. Withdrawal is the discomfort of giving up nicotine. It is your body’s way of telling you it’s learning to be smoke-free. These feelings will go away in time. If you need further help with smoking withdrawal, these medications may help.

Remove Cigarettes and Other Tobacco From Your Home, Car, and Work

Getting rid of things that remind you of smoking will also help you get ready to quit. Try these ideas:

• Make things clean and fresh at work, in your car, and at home. Clean your drapes and clothes. Shampoo your car. Buy yourself flowers. You will enjoy their scent as your sense of smell returns.

• Throw away all your cigarettes and matches. Give or throw away your lighters and ashtrays. Remember the ashtray and lighter in your car!
• Have your dentist clean your teeth to get rid of smoking stains. See how great they look. Try to keep them that way.
• Some smokers save one pack of cigarettes. They do it “just in case.” Or they want to prove they have the willpower not to smoke. Don’t! Saving one pack just makes it easier to start smoking again.

Don’t use other forms of tobacco instead of cigarettes

Light or low-tar cigarettes are just as harmful as regular cigarettes. Smokeless tobacco, cigars, pipes, and herbal cigarettes also harm your health. For example, bidi cigarettes are just as bad as regular cigarettes. Clove cigarettes are even worse. They have more tar, nicotine, and deadly gases. All tobacco products have harmful chemicals and poisons.

Talk to Your Doctor About Getting Help to Quit

Quitting “cold turkey” isn’t your only choice. Talk to your doctor about other ways to quit. Most doctors can answer your questions and give advice. They can suggest medicine to help with withdrawal. You can buy some of these medicines on your own. For others, you need a prescription.

Your doctor, dentist, or pharmacist can also point you to places to find support or toll-free quit lines. The National Cancer Institute’s Smoking Quitline can help, too. It can help you find support in your area. (Information specialists are available to answer smoking-related questions in English or Spanish, Monday through Friday, 9:00 a.m. to 4:30 p.m. local time. Call toll free in the United States, 1-877-44U-QUIT (1-877-448-7848).)

If you cannot see your doctor, you can get some medicines without a prescription that can help you quit smoking. Go to your local pharmacy or grocery store for over-the-counter medicines like the nicotine patch, nicotine gum, or nicotine lozenge. Read the instructions to see if the medicine is right for you. If you’re not sure, ask a pharmacist.

Quitting is also hard because smoking is a big part of your life. You enjoy holding cigarettes and puffing on them. You may smoke when you are stressed, bored, or angry. After months and years of lighting up, smoking becomes part of your daily routine. You may light up without even thinking about it.

Smoking goes with other things, too. You may light up when you feel a certain way or do certain things. For example:

• Drinking coffee, wine, or beer
• Talking on the phone
• Driving
• Being with other smokers

You may even feel uncomfortable not smoking at times or in places where you usually have a cigarette. These times and places are called “triggers.” That’s because they trigger, or turn on, cigarette cravings. Breaking these habits is the hardest part of quitting for some smokers.

Quitting isn’t easy. Just reading this guide won’t do it. It may take several tries. But you learn something each time you try. It takes willpower and strength to beat your addiction to nicotine. Remember that millions of people have quit smoking for good. You can be one of them!

Pregnant women who breathe secondhand smoke have many risks:

• They may lose their babies.
• Their babies may be born small.
• Their babies are more likely to die of SIDS (Sudden Infant Death Syndrome).
• Their children may be cranky, restless, and get sick more often.
• Their children are more likely to have learning problems.

Children who breathe secondhand smoke have troubles too. They are much more likely to have breathing problems such as asthma. They also get more ear and lung infections (like pneumonia).

Pregnant or thinking about having a baby?

Women who smoke have a harder time getting pregnant. And you face more dangers if you do get pregnant:

• You may lose the baby or have a stillborn (dead) baby.
• Your baby may be born small.
• Your baby is more likely to die of Sudden Infant Death Syndrome (SIDS).
• Your baby may be cranky, restless, and get sick more often.
• Your baby is more likely to have learning problems.

The good news is that quitting can help you have a healthy baby. It helps to quit at any time while you are pregnant. It’s even better to quit before you get pregnant.

Third-Hand Smoke

Cigarette smoke gases and particles that cling to smokers’ hair and clothing, not to mention cushions and carpeting, has been called “third-hand smoke.” The residue includes heavy metals, carcinogens and even radioactive materials that young children can get on their hands and ingest, especially if they’re crawling or playing on the floor.

Doctors from MassGeneral Hospital for Children in Boston coined the term “third-hand smoke” to describe these chemicals in a new study that focused on the risks they pose to infants and children. The study was published in the January 2009 issue of the journal Pediatrics.

Among the substances in third-hand smoke are hydrogen cyanide, used in chemical weapons; butane, which is used in lighter fluid; toluene, found in paint thinners; arsenic; lead; carbon monoxide; and even polonium-210, the highly radioactive carcinogen that was used to murder former Russian spy Alexander V. Litvinenko in 2006. Eleven of the compounds are highly carcinogenic.

Think about why you want to quit

1. Decide for sure that you want to quit.

Promise yourself that you’ll do it. It’s okay to have mixed feelings. Don’t let that stop you. There will be times every day that you don’t feel like quitting. You will have to stick with it anyway.

2. Find reasons to quit that are important to you.

Think of all the possible reasons to quit, including those that may not be directly health-related. While health-related reasons are the most powerful (lung and associated cancers strike smokers at greater frequency and earlier than in non-smokers), other reasons may also help motivate you:

• I will feel healthier right away. I will have more energy and better focus. My senses of smell and taste will be better. I will have whiter teeth and fresher breath. I will cough less and breathe better.
• I will be healthier the rest of my life. I will lower my risk for cancer, heart attacks, strokes, early death, cataracts, and skin wrinkling.
• I will make my partner, friends, family, kids, grandchildren, and co-workers proud of me.
• I will be proud of myself. I will feel more in control of my life. I will be a better role model for others.
• I will no longer expose others to my second-hand smoke.
• I will have a healthier baby. (If you’re pregnant)
• I will have more money to spend.
• I won’t have to worry: “When will I get to smoke next?” or “What do I do when I’m in a smoke-free place?”
• I will have more time for myself, instead of taking cigarette breaks, rushing out to buy a pack, or searching for a light
• I will be able to walk up stairs without being short of breath or coughing as much
• I will set a better example for my children

3. Write down all the reasons why you want to quit.

List ways to fight the urge to smoke, too. (You will find tips for coping later in this guide.) Keep your list where you’ll see it often. Good places are:

• Where you keep your cigarettes
• In your wallet or purse
• In the kitchen
• In your car

When you reach for a cigarette you’ll find your list. It will remind you why you want to stop.