Quitting time

Smokers have a new incentive to quit this Jan. 1, and it's not another New Year's resolution.

Illinois' statewide ban on smoking in restaurants, bars and public buildings takes effect at the start of 2008.

If you want to smoke, you'll be standing in the cold.

But if you want to quit, there's some good news. A new tool has come on the market that could help people who've tried and failed at other methods to quit.

Chantix, made by Pfizer, is a new FDA-approved medication that's unlike any other drug used for smoking cessation. It works on the nicotine receptors in the brain, shutting down these little pleasure factories so a drag on a cigarette no longer produces a euphoric rush.

Smokers who take Chantix find cigarettes simply start to taste bad. Without the nicotine high, all they get is smoke.

"It makes cigarettes taste awful," said Ralph Chvatal, 65, of Woodridge, who is using Chantix to quit smoking after a heart attack. "I don't even like to smoke them."

Smoking cessation experts say Chantix might be a good option when other methods fail.

"It works differently than any other drug we've had so far," said Dr. Diane Wallis, a cardiologist with Midwest Heart Specialists who practices at Advocate Good Samaritan Hospital in Downers Grove.

"It's been very, very helpful for these folks who truly have failed everything," Wallis said. "It's one of the most powerful tools that we have."

In studies by Pfizer, half of smokers who used Chantix had quit after four weeks, versus 12 percent using a placebo.

You can start taking Chantix the day you stop smoking, or you can begin taking the pills a week or so before you plan to ditch the cigarettes, said Lyn Tepper, an advanced practice nurse/pulmonary at Northwest Community Hospital in Arlington Heights.

Be cautious

As with any drug, be cautious if you take Chantix. The Food and Drug Administration has received reports of mood disorders and erratic behavior among some people taking Chantix.

The FDA is still gathering information and advised doctors to monitor patients. It's unclear if Chantix is responsible for the behavior changes because nicotine withdrawal can aggravate existing mental problems.

"I really like the medication, but it has to be used properly," Tepper said. "Anybody who is taking Chantix must be aware that if they have dreams that affect them significantly, they should stop taking the medication and notify their doctor."

Tepper also advises taking Chantix with a full glass of water and with meals because it can upset your stomach.

Just like a pack-a-day habit, Chantix is pricey. A month's supply costs about $120, which is a barrier for many people, Wallis said. Not all insurance companies cover the cost of smoking cessation.

It's not just Chantix. Wallis knows if she writes a prescription for the anti-smoking drug Zyban, her patient likely will pay the full cost. But Wellbutrin, which contains the same anti-depressant, is usually covered.

"It makes no sense to me that they'll pay for the heart attack, they'll pay for the lung cancer resection, but they won't pay for drugs that will help people quit," Wallis said.

Kicking the habit

Other proven methods for smoking cessation include nicotine replacement, whether as a patch, lozenge, gum or inhaler.

Tepper, who counsels smokers on ways to quit, suggests using the patch to control long-term cravings coupled with a lozenge or gum when you have an urge to smoke. Be sure to buy the right strength -- 1 milligram for every cigarette.

"If you're smoking a pack a day, you should start out with a 21-milligram patch," Tepper said. "Too many people start too low. They're not getting enough nicotine replacement, and then they say this didn't work."

Other methods, including acupuncture, hypnosis and laser therapy, have little or no scientific evidence to support they work any better than placebo, Wallis said.

"In my mind, placebo is a pretty powerful drug, and if patients feel it helps them, then I'll support them," she said. "But in terms of relative cost, a course of effective medication might be quite a bit cheaper than laser and hypnosis and acupuncture."

Most people will do better if they combine a drug or nicotine replacement with behavioral therapy, said Stephanie Ross, a clinical psychologist who counsels smokers at Evanston Northwestern Healthcare. Group sessions are widely available.

If you've already tried unsuccessfully to quit, individual sessions can help identify the therapy that's best for you, Ross said.

Whatever method you choose, be aware it might not work the first time. Nicotine is more addictive than alcohol, cocaine and heroin, Wallis said. It can take three months to overcome the effects of nicotine withdrawal.

"If you fail, don't blame yourself," she said. "Try, try again. Talk to your doctor about these therapies. Protect your family and friends from the consequences of secondhand tobacco."

To quit smoking, you can slap on a patch, chew gum or suck on a lozenge. A few prescription medications can help. Or maybe you're the cold-turkey type.

Any of these methods will help you shed the physical addiction to nicotine. But smoking is also ingrained in your emotional memory, and the habit can feel like an old friend when you're facing the stresses of daily life.

That's why you need a backup plan.

Smokers need to learn a new way to relax, find pleasure and manage stress without cigarettes, said Stephanie Ross, a clinical psychologist who counsels smokers at Evanston Northwestern Healthcare.

The most successful methods of quitting smoking combine medication of some kind with behavioral therapy and support, Ross said.

"The goal of behavior therapy is to give people long-term strategies they can use," Ross said. "For some people, the cravings don't go away. Ever."

Here are a few ways Ross helps smokers reduce the urge to smoke.

Go easy. Ross recommends you reduce your smoking 20 percent a week. If you smoked a pack a day, you'll cut out four cigarettes a day the first week, and it will take you five weeks to quit. "The more comfortably you can get someone off nicotine, the greater the chance of success," Ross said. Cold turkey is OK as long as it's your idea and you're motivated to do it, she said.

Smoke by the clock. While weaning yourself off cigarettes, schedule your smoke breaks at increasingly longer intervals. This helps break the habit to reach for a cigarette every time you drink coffee or hop in the car.

"If you can teach people to smoke by the clock or some external cue, it's sometimes easier to reduce their intake," Ross says.

Be mindful. When you're smoking, smoke. Don't do anything else, Ross advises.

Keep a smoking diary. Record your cigarettes along with the emotions and activities you associate with cigarettes. "People can really gain an awareness of their behaviors," Ross says.

Find substitutes. Identify something other than cigarettes to help you relax, such as taking a walk, chewing gum, eating a healthy snack or doing a crossword puzzle. Plan how you'll handle talking on the phone, driving your car or going out with smoking friends if that's when you used to light up.

Manage stress. Ross encourages people to continue to take breaks throughout the day, but without the cigarette. Meditation and deep breathing can also help manage stress.

Get some support. "People should be open with their physician, their family and ask for help," Ross said. "There's a lot of help available out there."

Resources to help you quit

• Illinois Tobacco Quit Line -- Call (866) QUIT YES to talk to certified cessation counselors to help you design a program or get information about programs available at local health departments or hospitals.

• Quitnet.com -- This site, associated with Boston University School of Public Health, offers research-based advice on quitting smoking, a guide to medications and a community of smokers and ex-smokers to support you.

• The American Heart Association (americanheart.org), the American Cancer Society (cancer.org) and the American Lung Association (lungusa.org) all offer information about the health risks of smoking and guidance for quitting.

• CommittedQuitters.com -- The maker of NicoDerm CQ and other nicotine replacement systems offers customized plans to help you quit smoking, using its products.