Frequently Asked Questions
I went to your YouTube channel, which led me to your website. I’ve been trying to quit smoking for a year but somehow always go back to smoking. Can you please tell me how I can truly quit?
Thank you for contacting us. It’s wonderful to know you want to quit smoking! We could put you in touch with someone who can assist and possibly send you nicotine replacement products. There are also free programs available online visit (https://smokefree.gov/) and by phone (1-877-937-7848 press 8 for Spanish). You can also check out https://smokefree.gov/tools-tips/apps for a free app to help you quit. For more information please see the documents below.
Why is quitting smoking so hard?
The short answer is because the nicotine in tobacco is highly addictive. When people begin to use tobacco products, they quickly develop a tolerance to nicotine and need to use more products to get the desired effect. After a period of time, the person becomes used to having a certain level of nicotine and if the person doesn’t get that level of nicotine, then they experience withdrawal symptoms and have strong cravings – so they use more tobacco products. To better understand how our bodies become addicted to nicotine and why it is so hard to quit, watch this video.
How soon can I see benefits after I quit smoking?
Many people, even if they are relatively young, believe it is too late to quit smoking and they have already harmed their body beyond repair. For the vast majority of people, your body will recover very quickly and reverse much of the damage that cigarettes have caused and it doesn’t take long to see the positive results. For example, people typically see an increase in lung function and are able to take full deep breaths about 6 weeks after quitting smoking. To view a list of the benefits of quitting smoking, visit the American Cancer Society website or watch our video on the benefits of quitting smoking.
What are some first steps I can take to quit?
The fact that you are reading this information is a significant first step! You are learning about what it takes to quit and why it is so hard. Continue to do research and begin to develop a quit plan (view quit plan examples). Visiting or calling the Texas Tobacco Quitline (www.yesquit.org or 1-877-YES-QUIT) is a great next step. There are many resources available at www.smokefree.gov to guide you through these steps. Ultimately, you will want to set a quit date and continue to move forward from that point, even you have a slip or start smoking again.
Can I use an e-cigarette to quit smoking?
Electronic cigarettes or vape pens are currently being researched by the Food and Drug Administration (FDA), which has not regulated or approved their use as nicotine replacement therapy (NRT), and they contain known toxins and carcinogens. For this reason, we do not recommend their use in this manner. Only FDA-approved NRT (e.g., patches gum, lozenges) or prescription medications like Chantix (Varenicline) or Wellbutrin (Bupropion) should be used to quit tobacco use. For more information about e-cigarettes, please visit: https://www.consumernotice.org/products/e-cigarettes/.
If nicotine is in tobacco products, why would I use medication that has nicotine in it? Won’t that give me cancer too?
The nicotine in tobacco causes addiction. Other than being addictive, nicotine has few negative health effects. It may raise your heart rate and blood pressure a little, but other than that, it doesn’t really harm your body. Nicotine does not cause cancer. The thousands of other chemicals found in tobacco products are what’s harmful to your health.
NRT helps reduce withdrawal symptoms, which makes it easier to quit. There’s only a small chance someone will become addicted to NRT.
We know quitting tobacco is hard and may feel overwhelming. But with the right resources and support, you can do it.
Can I use more than one nicotine patch at a time?
Yes, people can use more than one nicotine patch at a time. A person would need to wear multiple nicotine patches at the same if they are smoking more than one pack of cigarettes per day. Nicotine patches are available in three strengths: 7 mg, 14 mg, or 21 mg. The best way to determine which patch(es) you should wear is to count how many cigarettes you typically smoke per day. For every cigarette you smoke, you inhale about 1 mg of nicotine. So if you smoke 20 cigarettes per day (one pack), you would need to use one 21 mg patch per day. If you smoke 30 cigarettes per day (pack and a half), you would use one 21 mg AND a 14 mg patch. If you smoke 40 cigarettes per day (2 packs), you would need to use two 21 mg patches at the same time.
It is important that you are getting the same amount of, or a little bit more, nicotine from the nicotine patch(es) as you were receiving from your cigarettes. You can taper down on your dosage over time. If you are not getting enough nicotine from the nicotine patch(es), you will likely experience withdrawal symptoms (irritability, anxiety, nervousness, etc.) and will most likely choose to go back to smoking. Many people relapse because they were not receiving enough nicotine from the nicotine patch(es) to eliminate or lessen the withdrawals and cravings.
Is it dangerous to combine nicotine replacement therapies, like using both a patch and a lozenge at the same time?
As mentioned above, not only is safe to use multiple patches at the same time, it is safe to use a nicotine patch and the nicotine gum or nicotine lozenge at the same time. In fact, combining the medications works very well and is strongly encouraged. As mentioned in the previous question, you will want to gauge the amount of nicotine you are receiving from the NRT based on how many cigarettes you are smoking per day.
As an example for a person who smokes 20 cigarettes per day, you could use a 14 mg patch and chew three or four pieces of 2 mg nicotine gum. This combination would give you approximately 20 mg of nicotine, which would be similar to smoking a pack of cigarettes. If a person is smoking 30 cigarettes per day, you use a 21 mg patch and suck on three or four 2 mg nicotine lozenges throughout the day.
If you prefer to have something in their mouth throughout the day, you could use a lower dose patch and chew/suck on more pieces of nicotine gum or lozenges during the day. The gum and lozenges provide people with a quicker hit of nicotine and work well for high trigger/stress times or locations during the day.
Do I need a prescription to get nicotine replacement therapy?
There are five FDA-approved NRT. Three of the NRT products can be purchased over-the-counter without a prescription. These products are the nicotine patch, nicotine gum, and nicotine lozenge. You must be over 18 years old to purchase these products and they can be found at any pharmacy or large retail store.
The nicotine nasal spray and nicotine inhaler require a prescription to purchase. We encourage you to speak with your personal care provider if you wish to explore these NRT options.
I’m worried that having my client focus on quitting smoking will jeopardize their substance use treatment recovery. Should I wait to address their tobacco use until after they recover from their substance use?
Research has shown that people who have a substance use disorder (SUD) see a decrease in depression, anxiety, stress levels, and substance use after they quit using tobacco. These decreases are actually greater than or equal to the effect that antidepressants have for depressive and anxiety disorders. However, it is important to recognize that symptoms of withdrawal from nicotine often mimic those of psychological disorders (e.g., increased agitation, anxiety, restlessness) and can be confused as exacerbating psychological conditions. Clients should be educated that these are temporary nicotine withdrawal symptoms that will resolve within 2-4 weeks if they abstain from tobacco use. Additionally, clients quitting smoking who are on certain medications should inform their prescriber about their quit attempt for potential dosage changes, which may be necessary based on how smoking affects drug metabolism. NRT or combination NRT therapies can help to address some of these withdrawal symptoms and should be used as long as needed to make this critical period easier for the client.
For people receiving services for chemical dependency, quitting smoking increases the likelihood of long-term abstinence by 25%. It could be said that it is counter-therapeutic to refrain from assisting clients with quitting tobacco when research shows that 1 out of every 2 people with a SUD, who continue to smoke, will likely die from a tobacco-related illness.
Why should my behavioral health clients quit smoking? Smoking is one of the things that helps their stress. We shouldn’t take that away from them, right?
Individuals with behavioral health needs represent one-fifth of the US population, but consume about half of all cigarettes sold in the US – with smoking rates five times higher than the general population. Moreover, about 25% of their income is spent on cigarettes and other tobacco products. Consequently, these individuals account for about half of the deaths attributable to tobacco use a year; on average, they also die earlier… about 20-25 years earlier… than those who do not use tobacco. The toll of tobacco use on individuals with behavioral health issues is great, and it is costing them their lives.
Many providers believe that helping clients quit will lead to disastrous outcomes, including suicidal behavioral and aggression – or, that they will get hit by cars when attempting to smoke off of the workplace grounds. However, research does not support these negative outcomes, nor does our experience in working with over half of the behavioral health treatment centers in the state. Rather, research supports that individuals with behavioral health issues who successfully quit smoking experience many benefits relative to those who do not – including reduced depression, anxiety, and stress. They also report improved quality of life. In fact, one study indicated that the effects of quitting smoking were equivalent to or greater than the effects of anti-depressant treatment for mood and anxiety disorders! And this is not to even mention the money that can be saved from not smoking.
There are many benefits to quitting that should be explored with clients to prevent the spread of misinformation. Quitting is difficult – yes, but there are also many evidenced-based ways to help you get there with the cooperation of your health provider. And, remember, motivation to quit can wax or wane: It is important for providers to keep offering tobacco cessation services, even when they have been turned down before. You never know when will be the right time for any one individual to take the step of agreeing to receive help.
Our center passed a smoke-free/tobacco-free policy already but people still use it on the grounds all the time. Can these policies be effectively enforced?
Yes, the policies can be enforced. Effective enforcement includes visible, permanent tobacco-free signage prominently displayed inside and outside buildings. Early and often communication with staff and clients about the policy and training all staff, including new staff, on how to talk with a person who is violating the policy is also crucial. Most importantly, it is the responsibility of all staff to talk with people who are violating the policy. If only a few people address violations, the policy will not be effective. The enforcement responsibility must be shared by all staff.
I thought it is my right to smoke. Isn’t it against the law to prohibit people from smoking?
Everybody was born a non-tobacco user and people who use tobacco products are not a protected class. There is no constitutional right to use tobacco and therefore prohibiting the use of tobacco products is legal. No one is preventing clients from smoking; the policy only places legal limitations on where smoking can occur; it can no longer occur on treatment center property.
Does prohibiting clients from using tobacco on the treatment center grounds negatively impact treatment outcomes?
No, as we mentioned above, research has shown that people who have a SUD see a decrease in depression, anxiety, stress levels, and substance use after they quit using tobacco; prohibiting tobacco on the grounds can actually help clients quit using tobacco! For example, cigarette smoke serves as a visual and olfactory (i.e., smell) cue that can trigger cigarette cravings. Therefore, a client trying to quit smoking who encounters cigarette smoke on your grounds might be more prone to slip. By eliminating these cues, you are helping clients who want to quit using tobacco, and ultimately encouraging long-term decreases in behavioral health symptoms and substance use.
TTTF recommends that tobacco-free workplace policies include e-cigarettes. Is the aerosol from the electronic cigarettes/vape pens harmful?
The 2016 Surgeon General’s report on E-Cigarette Use Among Youth and Young Adults summarizes, “E-cigarette aerosol is not harmless ‘water vapor,’ although it generally contains fewer toxicants than combustible tobacco products.” The aerosol created by e-cigarettes can contain ingredients that are harmful and potentially harmful to the public’s health, including: nicotine; ultrafine particles; flavorings such as diacetyl, a chemical linked to serious lung disease; volatile organic compounds such as benzene, which is found in car exhaust; and heavy metals, such as nickel, tin, and lead.