Developing a plan
with your client: 8 Steps

Every smoker is unique and one cessation method will not work for everyone!

Common Cessation Aids are:

1. Non-Pharmacological Cessation Strategies: (Remember to let the client chose the method that is most suitable for them)
   Tapering - Cut down the number of cigarettes smoked each day until the client finds they are no longer smoking. Tapering involves counting the number of cigarettes smoked each day and then reducing that amount by a fixed number over a given amount of time. For example if you smoke 20 cigarettes each day (one pack) the client may decide to smoke 2 less each day (smoking 18 a day) for a given amount of time (one week) then four less the second week until they find they are no longer smoking. This method involves setting a quit date by which the client will have tapered down to the point that they are no longer smoking.

   Cold Turkey - Abruptly stopping all smoking. Best for clients who smoke two packs of cigarettes a day or less. Cold turkey is the simplest and, for most people the easiest way to quit.

   Nicotine fading - Smokers switch to cigarette rated lower in tar and nicotine, without changing the number of cigarettes smoked each day. Nicotine fading can lower the body's level of nicotine, making it easier to quit. This method can help prepare for complete cessation and give the client the confidence necessary to control their smoking addiction.

2. Pharmacological Methods: Pharmacological methods are primarily used in pre-conceptual service and with post-partum (non-breast feeding) mothers. The physician and patient must consider the potential risks of the different pharmacological methods of smoking cessation. For example, a number of studies have proven that nicotine itself presents risks to the fetus including neurotoxicity, and bupropion SR has been shown to cause seizures in 1 out of 1,000 patients treating tobacco use and dependence (U.S. department of Health and Human Services, p.94). The effects of these therapies during pregnancy are unknown at this time.
   Nicotine Patch - (transdermal nicotine system) provide a measured dose of nicotine through the skin. Patches can be purchased without a prescription.
   • Several types are available: 16-hour works best for light to average smokers. Does not provide nicotine overnight, so it is not helpful for relief of early morning withdrawal symptoms. 24-hour provides a steady dose of nicotine, therefore helping relieve early morning withdrawal symptoms. There may be an increased amount of side effects with the 24 hour patch.

   • Side effects of the 16 & 24 hour patches: skin irritations, racing heartbeat, sleep problems, and headache.

   Nicotine Gum - (nicotine polacrilex) fast acting where nicotine is absorbed through the mucus membrane of the mouth. It can be purchased over the counter in 2 mg or 4 mg strength. One advantage of the nicotine gum is that it allows the client to control the dose as needed.

   • Side effects: bad taste, throat irritation, mouth ulcers, hiccups, nausea, jaw discomfort, and racing heartbeat.

   Nicotine Inhaler - available only by prescription. There is a plastic rod with a nicotine plug on top, that when puffed on releases a nicotine vapor. Unlike other inhalers, which deliver medication to the lungs this inhaler delivers most of the medication to the mouth.

   • Side effects: coughing and throat irritation.

   Zyban - this is a prescription anti-depressant in an extended release form that helps reduce symptoms of nicotine withdrawal. Zyban can be used alone or in combination with other nicotine replacement therapies.