My Doctor Online The Permanente Medical Group

Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

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Quitting Tobacco

If you smoke or use tobacco products, quitting is the best thing you can do for your health and the health of your loved ones. Good planning, support, and the latest quit tobacco medications can help you succeed.

Out with the Old, In with the New

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Congratulations! If this is the day you're quitting smoking, you have just made one of the best decisions you could for your health. Think about it: Even if you put out your last cigarette less than an hour ago, you are now smoke-free and have already begun experiencing the benefits.

Throw it all away 

After you have your last cigarette, throw away all of your cigarettes, matches, lighters, and ashtrays. Try to get them as far away from your house as possible – drop them in a dumpster downtown or destroy your cigarettes (soak them in water, cut them into pieces) before you throw them away. This will help you view them as "out of the question" and keep them from being a temptation.

Look forward to your new life 

The day you have your last cigarette is your last day as a smoker, but it's also the first day of your smoke-free life. Celebrate these changes by looking forward rather than back:

  • Visit the dentist and have your teeth cleaned to get rid of tobacco stains.
  • Drop your favorite clothes at the drycleaners and think about how good they'll smell when you pick them up in a few days.
  • If you can, get your carpet and drapes cleaned, or splurge and have your whole house cleaned top to bottom to celebrate your new tobacco-free home.

Remember What's Important

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You have a unique and meaningful set of reasons for wanting to quit smoking. As you approach your quit date and then spend your first few days without using tobacco, revisiting those reasons can help you stay motivated and committed. You might find yourself becoming distracted by withdrawal symptoms or by the differences between your new smoke-free life and your old one. Keeping your motivations close at hand can help you remember that you're doing this for very real and important reasons.

Your new nonsmoking identity   

It can be helpful to deliberately think of yourself as a nonsmoker, several times a day. It can even be helpful to say aloud, "I do not smoke. I am a nonsmoker." Remember:

  • You'll have fewer colds.
  • Your shortness of breath and cough will decrease.
  • You'll have more spending money.
  • You'll have more energy and stamina.
  • You and your house, hair, clothes, breath, and car will smell better.
  • You'll look better and feel healthier.
  • You'll have a new sense of control over your life. 
Focus on immediate health benefits 

Within 12 hours after you have smoked your last cigarette, your body will begin to heal itself. The levels of carbon monoxide and nicotine will drop rapidly, and your heart and lungs will begin to repair the damage caused by cigarette smoke.

Within a few days, remarkable changes begin to happen in your body, including:

  • Your sense of smell and taste improves.
  • The level of carbon monoxide in your blood decreases to healthy levels, and the oxygen level in your blood increases.
  • You will breathe easier, and your smoker's hack will begin to go away, although you may notice that you will continue to cough for a while.

In a few weeks to a few months:

  • Your circulation will improve.
  • Walking will become easier.
  • You will breathe more easily – in fact, your lung function can increase by up to 30 percent.
  • Your coughing, sinus congestion, fatigue, and shortness of breath will decrease.
  • Your energy level will increase.

Focus on the benefits still to come. In as little as 5 years, your risk of stroke may be reduced to that of people who have never smoked. In 10 years, your risk of lung cancer will decrease by half.

Celebrate these changes and remember that every day without tobacco improves your health.

Stay Busy

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Especially in the first few days after you quit, give yourself as many reasons not to smoke as possible. Keeping busy can be an effective strategy, especially if you fill your schedule with supportive people and activities to help keep your mind off quitting.

Choose activities that are incompatible with smoking  

Putting yourself in situations where it is difficult or impossible to smoke can be a helpful way to reinforce you own motivation. Swim, go to the movies, play tennis, and spend time with people who know you're quitting and who can help you. Avoid places where smoking is permitted or ones that have strong associations for you and will make you want to smoke.

Avoid risky situations

Especially as you're starting out as a nonsmoker, it's important to limit your exposure to high-risk situations that will make you want to use tobacco. It is important to:

  • Avoid drinking alcohol for the first few days or weeks, or limit your consumption to only 1 or 2 drinks.
  • Avoid areas where people may be smoking. If you have friends or family who smoke, ask them not to smoke around you.
  • Avoid or minimize stressful situations that might make you want to manage your stress with tobacco. Avoid these situations as much as you're able to and work on managing your stress in smoke-free ways.
Additional References:

Manage Withdrawal Symptoms

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Your body has become accustomed to a regular supply of nicotine and tobacco. When you quit tobacco, you may experience some symptoms of physical withdrawal, including:

  • Sore mouth or throat, cough
  • Intense craving for nicotine
  • Anxiety, restlessness, frustration
  • Depressed mood
  • Difficulty concentrating
  • Headaches
  • Irritability
  • Fatigue, difficulty sleeping
  • Hunger 

Quit tobacco medications are proven to be effective in easing some of these withdrawal symptoms. Take steps to treat the symptoms you experience by trying the following:

  • Ice water, herbal tea, lozenges, or hard candy all can help with mouth and throat discomfort.
  • Manage headaches, stress, and irritability with relaxation techniques like yoga, slow walks, meditation and guided imagery, or a warm bath or shower.
  • Sleep better by avoiding caffeine late in the day and relaxing before bed. Nicotine actually decreases the effectiveness of caffeine, so it can help to decrease the amount of caffeine you consume just after quitting.
  • Take naps to fight fatigue. Remember that your body is healing – don't exercise too much for the first few weeks and get plenty of rest.
  • Manage hunger with frequent, healthy snacks. A healthy diet while you're quitting can nourish your body and help prevent weight gain. If you're experiencing irregular bowel movements, add fruit, vegetables, and whole grains to your diet.
Additional References:

Use Your Coping Strategies

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Put your planning into action to manage the situations you feel will make you want to smoke. Continue to develop your quit plan as you learn more about what works and doesn't work in the first few tobacco-free days.

Anticipate triggers

Anticipating the situations that make you feel like using tobacco is an important way to prepare for quitting. These triggers are different for everyone, but may include:

  • Driving in your car
  • Talking on the telephone
  • Drinking coffee
  • Finishing a meal
  • Being with people who are smoking
  • Drinking alcohol
  • Feeling stressed, upset, bored, or down 

Now that your quit day has arrived, it's useful to stay aware of these triggers and try to avoid them as best you can. Some (eating, stress, and others) are unavoidable, so it's good to anticipate the cravings you may experience and have a plan in place to manage the situation without using tobacco.

Fight urges

There are many ways to fight cravings and urges caused by quitting tobacco. You're the best judge of what's the most useful for you, but some or all of the "Six D" strategies may help you resist the urge to smoke:

  • Delay. Remember that an urge to smoke usually lasts just a few minutes. Wait 5 or 10 minutes. You may find that the craving becomes less intense or passes altogether.
  • Distract yourself. Do things to keep busy and take your mind off your urge to smoke. Call a friend or family member, busy yourself with work, or go for a walk. It may help to keep your hands busy. Draw or knit, type, work in your garden or around the house.
  • Drink water. Staying hydrated is good for you. Drinking water is a good way to delay an urge and satisfy the hand-mouth habit.
  • Do something different. If you're fighting urges, try switching to an entirely different activity. Avoid situations that remind you of smoking and switch up your routine to help break the habit.
  • Deep breathing. Learn how to deep breathe slowly into your stomach and out through your mouth. Deep breathing can relax your body and clear your mind so you can refocus on what's important.
  • Don't give up. Quitting tobacco may not be easy, but it does get easier with time. Cravings and withdrawal become manageable and then lessen with time.  Every day you fight urges and cravings puts you more in control and less at the mercy of tobacco.   
Find new ways to cope as new triggers arise 

No plan is foolproof. Even a carefully built quit plan needs to be flexible enough to respond to challenges. If a coping strategy you've chosen is less effective in relieving withdrawal or fighting cravings, switch to plan B. Having a couple of strategies in your pocket can help you react if you notice one of your coping strategies isn't working.

Variety in coping strategies can help. What works well once may become less effective with time. It can help to have a second set of strategies to try to replace the ones you used just after quitting.

Monitor your Medications

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Quit tobacco medicines are drugs that help people quit smoking. They can ease the cravings and other symptoms you might feel as your body withdraws from nicotine, the addictive drug in cigarettes and other tobacco products. This allows you to focus on your other strategies for living life without tobacco. People who use quit tobacco medications are twice as successful at becoming smoke-free as people who don't.

Right type, right amount

After you stop smoking, pay attention to the way you feel. The right amount of the right type of medication should relieve some of your cravings and withdrawal, so you can function more or less normally.

If you are using medications and are experiencing intolerable symptoms of withdrawal or if you are experiencing intolerable side effects, let us know as soon as possible. We may be able to recommend a different dosage, medication, or combination of medications to help you.

Nicotine withdrawal

When you quit tobacco, you may experience some symptoms of nicotine withdrawal. This is a normal part of your body adjusting to life without nicotine. Common symptoms of withdrawal may include:

  • Intense craving for nicotine
  • Tension, anxiety
  • Irritability
  • Depression
  • Headaches
  • Difficulty in concentrating
  • Fatigue, drowsiness, and trouble sleeping
  • Increased appetite and weight gain
  • Nausea
  • Constipation or diarrhea
  • Decreased heart rate and blood pressure  

If these symptoms are intolerable, the amount or type of medication that you're taking may be adjusted to better reduce symptoms. If you're using the patch, you'll get a steady supply of nicotine throughout the day, but other types of nicotine replacement medication, like the gum and lozenge, allow you to use the amount that works best for you up to a maximum dosage. If you're experiencing symptoms of withdrawal that are too strong to manage with the medication you have been prescribed, let us know so we can review whether adjusting your treatment would help.

Nicotine overdose

Rarely, people can experience nicotine overdose from using too much nicotine medication. This is most common in children who accidentally chew nicotine gum or play with nicotine patches. Follow your doctor's instructions on the quit tobacco medications you're using and keep nicotine replacement and tobacco products away from children.

Additional References:

Get Support

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Getting support from your friends, family, community, and health care team can help you feel better about quitting and be more successful in the long term. Supporting yourself is important, too, as is celebrating your successes. It can be helpful to:

  • Tell your friends and family you plan to quit and ask for their support and understanding as you quit. Let them know you might be tense for a while.
  • Join a support group and share your experiences with others who are going through the same thing.
  • If someone you know smokes, ask that person to quit with you or at least not to smoke around you.
  • Cut yourself some slack. It's normal to be tense and irritable while you quit. Get lots of rest, avoid stressful situations as best you can, and take care of yourself.
  • Treat yourself to a spa day, a shopping trip, a new gadget or a getaway weekend. Help fund your reward with money you've saved by not buying cigarettes. Congratulate yourself – you are successfully doing something that's difficult and essential for your health.

Related Health Tools:

Classes and Coaching
Interactive Programs
Podcasts

See more Health Tools »

If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.

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