How To Quit Smoking...And Quit For Keeps

How To Quit Smoking...And Quit For Keeps


U.S. Department of Health and Human Services Public Health Service National Institutes of Health

INTRODUCTION

This guides you from thinking about stopping through actually doing it - from the day you quit to quitting for keeps. It gives tips on fighting temptation - and what to do if you give in - and on avoiding weight gain (a handy Snack Calorie Chart is included). By telling you what to expect, it can help you through the day-to-day process of becoming and remaining a nonsmoker.

Here you'll find a variety of tips and helpful hints on kicking your smoking habit. Take a few moments to look at each suggestion carefully. Pick those you feel comfortable with, and decide today that you're going to use them to quit. It may take a while to find the combination that's right for you, but you can quit for good, even if you've tried to quit before.

Many smokers have successfully given up cigarettes by replacing them with new habits, without quitting "cold turkey," planning a special program, or seeking professional help.

The following approaches include many of those most popular with ex-smokers. Remember that successful methods are as different as the people who use them. What may seem silly to others may be just what you need to quit - so don't be embarrassed to try something new. These methods can make your own personal efforts a little easier.

Pick the ideas that make sense to you. And then follow through - you'll have a much better chance of success.

PREPARING YOURSELF FOR QUITTING...

  • Decide positively that you want to quit. Try to avoid negative thoughts about how difficult it might be.
  • List all the reasons you want to quit. Every night before going to bed, repeat one of the reasons 10 times.
  • Develop strong personal reasons in addition to your health and obligations to others. For example, think of all the time you waste taking cigarette breaks, rushing out to buy a pack, hunting for a light, etc.
  • Begin to condition yourself physically: Start a modest exercise program; drink more fluids; get plenty of rest; and avoid fatigue.
  • Set a target date for quitting - perhaps a special day such as your birthday, your anniversary, or the Great American Smokeout. If you smoke heavily at work, quit during your vacation so that you're already committed to quitting when you return. Make the date sacred, and don't let anything change it. This will make it easy for you to keep track of the day you became a nonsmoker and to celebrate that date every year.

 
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KNOWING WHAT TO EXPECT...

  • Have realistic expectations - quitting isn't easy, but it's not impossible either. More than 3 million Americans quit every year.
  • Understand that withdrawal symptoms are TEMPORARY. They usually last only 1-2 weeks.
  • Know that most relapses occur in the first week after quitting, when withdrawal symptoms are strongest and your body is still dependent on nicotine. Be aware that this will be your hardest time, and use all your personal resources - willpower, family, friends, and the tips in this booklet - to get you through this critical period successfully.
  • Know that most other relapses occur in the first 3 months after quitting, with situational triggers - such as a particularly stressful event - occur unexpectedly. These are the times when people reach for cigarettes automatically, because they associate smoking with relaxing. This is the kind of situation that's hard to prepare yourself for until it happens, so it's especially important to recognize it if it does happen. Remember that smoking is a habit, but a habit you can break.
  • Realize that most successful ex-smokers quit for good only after several attempts. You may be one of those who can quit your first try. But if you're not, DON'T GIVE UP. Try again.

INVOLVING SOMEONE ELSE...

  • Bet a friend you can quit on your target date. Put your cigarette money aside for every day, and forfeit it if you smoke. (But if you do smoke, DON'T GIVE UP. Simply strengthen your resolve and try again.)
  • Ask your spouse or a friend to quit with you.
  • Tell your family and friends that you're quitting and when. They can be an important source of support, both before and after you quit.

WAYS OF QUITTING...

Switch brands

  • Switch to a brand you find distasteful.
  • Change to a brand that's low in tar and nicotine a couple of weeks before your target date. This will help change your smoking behavior. However, DO NOT smoke more cigarettes, inhale them more often or more deeply, or place your fingertips over the holes in the filters. All of these will increase your nicotine intake, and the idea is to get your body used to functioning without nicotine.

Cut down the number of cigarettes you smoke

  • Smoke only half of each cigarette.
  • Each day, postpone lighting your first cigarette 1 hour.
  • Decide you'll smoke only during odd or even hours of the day.
  • Decide beforehand how many cigarettes you'll smoke during the day. For each additional cigarette, give a dollar to your favorite charity.
  • Change your eating habits to help you cut down. For example, drink milk, which many people consider incompatible with smoking. End meals or snacks with something that won't lead to a cigarette.
  • Reach for a glass of juice instead of a cigarette for a "pick-me-up."
  • Remember: Cutting down can help you quit, but it's not a substitute for quitting. If you're down to about seven cigarettes a day, it's time to set your target date and get ready to stick to it.

Don't Smoke "Automatically"

  • Smoke only those cigarettes you really want. Catch yourself before you light up a cigarette out of pure habit.
  • Don't empty your ashtrays. This will remind you of how many cigarettes you've smoked each day, and the sight and smell of stale butts will be very unpleasant.
  • Make yourself aware of each cigarette by using the opposite hand or putting cigarettes in an unfamiliar location or a different pocket to break the automatic reach.
  • If you light up many times during the day without even thinking about it, try to look in a mirror each time you put a match to your cigarette - you may decide you don't need it.
Make smoking inconvenient

  • Stop buying cigarettes by the carton. Wait until one pack is empty before you buy another.
  • Stop carrying cigarettes with you at home and at work. Make them difficult to get to.
Make smoking unpleasant

  • Smoke only under circumstances that aren't especially pleasurable for you. If you like to smoke with others, smoke alone. Turn your chair toward an empty corner and focus only on the cigarette you are smoking and its many negative effects.
  • Collect all you cigarette butts in one large glass container as a visual reminder of the filth smoking represents.

JUST BEFORE QUITTING...

  • Practice going without cigarettes.
  • Don't think of NEVER smoking again. Think of quitting in terms of 1 day at a time.
  • Tell yourself you won't smoke today, and then don't.
  • Clean your clothes to rid them of the cigarette smell, which can linger a long time.

ON THE DAY YOU QUIT...

  • Throw away all your cigarettes and matches. Hide your lighters and ashtrays.
  • Visit the dentist and have your teeth cleaned to get rid of tobacco stains. Notice how nice they look, and resolve to keep them that way.
  • Make a list of things you'd like to buy for yourself or someone else. Estimate the cost in terms of packs of cigarettes, and put the money aside to buy these presents.
  • Keep very busy on the big day. Go to the movies, exercise, take long walks, go bike riding.
  • Remind your family and friends that this is your quit date, and ask them to help you over the rough spots of the first couple of days and weeks.
  • Buy yourself a treat or do something special to celebrate.

IMMEDIATELY AFTER QUITTING...

  • Develop a clean, fresh, nonsmoking environment around yourself - at work and at home. Buy yourself flowers - you may be surprised how much you can enjoy their scent now.
  • The first few days after you quit smoking, spend as much free time as possible in places where smoking isn't allowed, such as libraries, museums, theaters, department stores, and churches.
  • Drink large quantities of water and fruit juice (but avoid sodas that contain caffeine).
  • Try to avoid alcohol, coffee, and other beverages that you associate with cigarette smoking.
  • Strike up a conversation instead of a match for a cigarette.
  • If you miss the sensation of having a cigarette in your hand, play with something else - a pencil, a paper clip, a marble.
  • If you miss having something in your mouth, try toothpicks or a fake cigarette.

Avoid temptation

  • Instead of smoking after meals, get up from the table and brush your teeth or go for a walk.
  • If you always smoke while driving, listen to a particularly interesting radio program or your favorite music, or take public transportation for a while, if you can.
  • For the first 1-3 weeks, avoid situations you strongly associate with the pleasurable aspects of smoking, such as watching your favorite TV program, sitting in your favorite chair, or having a cocktail before dinner.
  • Until you're confident of your ability to stay off cigarettes, limit your socializing to healthful, outdoor activities or situations where smoking isn't allowed.
  • If you must be in a situation where you'll be tempted to smoke (such as a cocktail or dinner party), try to associate with the nonsmokers there.
  • Try to analyze cigarette ads to understand how they attempt to "sell" you on individual brands.

Find new habits

  • Change your habits to make smoking difficult, impossible, or unnecessary. For example, it's hard to smoke when you're swimming, jogging, or playing tennis or handball. When your desire for a cigarette is intense, wash your hands or the dishes, or try new recipes.
  • Do things that require you to use your hands. Try crossword puzzles, needlework, gardening, or household chores. Go bike riding; take the dog for a walk; give yourself a manicure; write letters.
  • Enjoy having a clean-mouth taste and maintain it by brushing your teeth frequently and using a mouthwash.
  • Stretch a lot.
  • Get plenty of rest.
  • Pay attention to your appearance. Look and feel sharp.
  • Try to find time for the activities that are the most meaningful, satisfying, and important to you.

When you get the crazies

  • Keep oral substitutes handy - try carrots, pickles, sunflower seeds, apples, celery, raisins, or sugarless gum instead of a cigarette.
  • Take 10 deep breaths and hold the last one while lighting a match. Exhale slowly and blow out the match. Pretend it's a cigarette and crush it out in an ashtray.
  • Take a shower or bath if possible.
  • Learn to relax quickly and deeply. Make yourself limp, visualize a soothing, pleasing situation, and get away from it all for a moment. Concentrate on that peaceful image and nothing else.
  • Light incense or a candle instead of a cigarette.
  • Never allow yourself to think that "one won't hurt" - it will.

About gaining weight

Many people who're considering quitting are very concerned about gaining weight. If you're concerned about gaining weight, keep these points in mind:

  • Quitting doesn't mean you'll automatically gain weight. When people gain, most of the time it's because they eat more once they've quit.
  • The benefits of giving up cigarettes far outweigh the drawbacks of adding a few extra pounds. You'd have to gain a very large amount of weight to offset the many substantial health benefits that a normal smoker gains by quitting. Watch what you eat, and if you're concerned about gaining weight, consider the following tips:

Tips to help you avoid weight gain...

  • Make sure you have a well-balanced diet, with the proper amounts of protein, carbohydrates, and fat.
  • Don't set a target date for a holiday, when the temptation of high-calorie food and drinks may be too hard to resist.
  • Drink a glass of water before your meals.
  • Weigh yourself weekly.
  • Chew sugarless gum when you want sweet foods.
  • Plan menus carefully, and count calories. Don't try to lose weight - just try to maintain your prequitting weight.
  • Have low-calorie foods on hand for nibbling. Use the Snack Calorie Chart to choose foods that are both nutritious and low in calories. Some good choices are fresh fruits and vegetables, fruit and vegetable juices, low-fat cottage cheese, and air-popped popcorn without butter.
  • Take time for daily exercise, or join an organized exercise group.

SNACK CALORIE CHART

SNACKS/CALORIES*
BEVERAGES
Carbonated (per 8-ounce glass)
Cola-type 95
Fruit flavors (10-13% sugar) 115
Ginger ale 75

Fruit drinks (per 1/2 cup)
Apricot nectar 70
Cranberry juice 80
Grape drink 70
Lemonade (frozen) 55

Fruit juices (per 1/2 cup)
Apple juice, canned 60
Grape juice, bottled 80
Grapefruit juice, canned, unsweetened 50
Orange juice, canned, unsweetened 55
Pineapple juice, canned, unsweetened 70
Prune juice, canned 100

Vegetable juices (per 1/2 cup)
Tomato juice 25
Vegetable juice cocktail 20

Coffee and tea
Coffee, black 3-5
with 1 tsp. sugar 18-20
with 1 tsp. cream 13-15
Tea, plain 0-1
with 1 tsp. sugar 15-16

CANDY, CHIPS, AND PRETZELS
Candy (per ounce)
Hard candy 110
Jellybeans 105
Marshmallows 90
Gumdrops 100

Chips (per cup)
Corn chips 230
Potato chips 115

Popcorn (air-popped, without butter) 25

Pretzels
Dutch, 1 twisted 60
Stick, 5 regular 10

CHEESE (PER OUNCE)
American, processed 105
Cottage, creamed 30
Cottage, low-fat (2%) 25
Swiss, natural 105

CRACKERS
Butter, 2-inch diameter 15
Graham, 2 1/2 inches square, 2  55
Matzoh, 6-inch diameter 80
Rye 45
Saltine 50

FRUITS (RAW)
Apple, 1 medium 80
Apricots, fresh, 3 medium  50
Apricots, dried, 5 halves  40
Banana, 1 medium 105
Blackberries, 1/2 cup 35
Blueberries, 1/2 cup 40
Cantaloupe, 1/4 melon 50
Cherries, 10   50
Dates, dried, 3  70
Fig, dried, 1 medium 50
Grapefruit, 1/2 40
Grapes, 20   30
Orange, 1 medium 60
Peach, 1 medium 35
Pear, 1 medium 100
Pineapple, 1/2 cup 40
Prunes, dried, 3  60
Raisins, 1/4 cup 110
Strawberries, 1 cup 45
Watermelon, 1 cup 50

NUTS (PER 2 TABLESPOONS)
Almonds 105
Brazil nuts 115
Cashews 100
Peanuts 105
Pecans, halves 95

VEGETABLES (RAW)
Carrots, 7 1/2 X 1 1/8 inch 30
Carrots, 1/2 cup grated 25
Celery, 5-inch stalks, 3   10
Pickle, 1 15-20

*Data from published sources. References are available upon request.

WHAT HAPPENS AFTER YOU QUIT SMOKING...

Immediate rewards

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

Within a few days, you'll probably begin to notice some remarkable changes in your body. Your sense of smell and taste may improve. You'll breathe easier, and your smoker's hack will begin to disappear, although you may notice that you still cough for a while. And you'll be free from the mess, smell, inconvenience, expense, and dependence of cigarette smoking.

Immediate effects

As your body begins to repair itself, instead of feeling better right away, you may feel worse for a while. It's important to understand that healing is a process - it begins immediately, but it continues over time. These "withdrawal pangs" are really symptoms of the RECOVERY process (see "Withdrawal Symptoms and Activities That Might Help).

Immediately after quitting, many ex-smokers experience "symptoms of recovery" such as temporary weight gain caused by fluid retention, irregularity, and dry, sore gums or tongue. You may feel edgy, hungry, more tired, and more short-tempered than usual and have trouble sleeping and notice that you're coughing a lot. These symptoms are the result of your body clearing itself of nicotine, a powerful addictive chemical. Most nicotine is gone from the body in 2-3 days.

It's important to understand that the unpleasant after-effects of quitting are only temporary and signal the beginning of a healthier life. Now that you've quit, you've added a number of healthy productive days to each year of your life. Most important, you've greatly improved your chances for a longer life. You've significantly reduced your risk of death from heart disease, stroke, chronic bronchitis, emphysema, and several kinds of cancer - not just lung cancer. (Cigarette smoking is responsible every year for approximately 130,000 deaths from cancer, 170,000 deaths from heart disease, and 50,000 deaths from lung disease.)

WITHDRAWAL SYMPTOMS AND ACTIVITIES THAT MIGHT HELP*

SYMPTOM ACTIVITY

Dry mouth; sore throat, Sip ice-cold water or fruit juice, or gums, or tongue chew gum

Headaches Take a warm bath or shower. Try relaxation or meditation techniques.

Trouble sleeping Don't drink coffee, tea, or soda with caffeine after 6:00 p.m. Again, try relaxation or meditation techniques.

Irregularity Add roughage to your diet, such as raw fruit, vegetables, and whole- grain cereals. Drink 6-8 glasses of water a day.

Fatigue Take a nap. Try not to push yourself during this time; don't expect too much of your body until it's had a couple of weeks.

Hunger Drink water or low-calorie liquids. Eat low-fat, low-calorie snacks (see Snack Calorie Chart).

Tenseness, irritability Take a walk, soak in a hot tub, try relaxation or meditation techniques.

Coughing Sip warm herbal tea. Suck on cough drops or sugarless hard candy.

*Adapted from "Quitting Times: A Magazine for Women Who Smoke," funded by the Pennsylvania Department of Health; prepared by Fox Chase Cancer Center, Philadelphia.

QUITTING FOR KEEPS...

Congratulations

Now you're ready to develop a new habit - not smoking. Like any other habit, it takes time to become a part of you; unlike most other habits, though, not smoking will take some conscious effort and practice. This section of the booklet can be a big help. You'll find many techniques to use for developing the nonsmoking habit and holding on to it.

By reading this section of the booklet carefully and reviewing it often, you'll become more aware of the places and situations that prompt the desire for a cigarette. You'll also learn about many nonsmoking ways to deal with the urge to smoke. These are called coping skills. Finally, you'll learn what to do in case you do slip and give in to that urge.

Keep your guard up

The key to living as a nonsmoker is to avoid letting your urges or cravings for a cigarette lead you to smoke. Don't kid yourself - even though you've made a commitment not to smoke, you WILL sometimes be tempted. But instead of giving in to the urge, you can use it as a learning experience.

First, remind yourself that you've QUIT and you're a NONsmoker. Then, look closely at your urge to smoke and ask yourself:

  • Where was I when I got the urge?

  • What was I doing at the time?

  • Whom was I with?

  • What was I thinking?

The urge to smoke after you've quit often hits at predictable times. The trick is to anticipate those times and find ways to cope with them - without smoking. Naturally, it won't be easy at first. In fact, you may continue to want a cigarette at times. But remember, even if you slip, it doesn't mean an end to the nonsmoking you. It does mean that you should try to identify what triggered your slip, strengthen your commitment to quitting, and try again.

Look at the following list of typical triggers. Does any of them ring a bell with you? Check off those that might trigger an urge to smoke, and add any others you can think of:

  • Working under pressure

  • Feeling blue

  • Talking on the telephone

  • Having a drink

  • Watching television

  • Driving your car

  • Finishing a meal

  • Playing cards

  • Drinking coffee

  • Watching someone else smoke

If you're like many new nonsmokers, the most difficult place to resist the urge to smoke is the most familiar: home. The activities most closely associated with smoking urges are eating, partying, and drinking. And, not surprisingly, most urges occur when a smoker is present.

How to dampen that urge

There are seven major coping skills to help you fight the urge to smoke. These tips are designed for you, the new nonsmoker, to help you nurture the nonsmoking habit.

1. Think about why you quit - Go back to your list of reasons for quitting. Look at this list several times a day - especially when you're hit with an urge to smoke. The best reasons you could have for quitting are very personally yours, and these are also your best reasons for staying a nonsmoker.

2. Know when you're rationalizing - It's easy to rationalize yourself back into smoking (see "Common Rationalizations"). Don't talk yourself into smoking again. A new nonsmoker in a tense situation may think, "I'll just have one cigarette to calm myself down." If thoughts like this pop into your head, stop and think again! You know better ways to relax - nonsmokers' ways, such as taking a walk or doing breathing exercises.

Concern about gaining weight may also lead to rationalizations. Learn to counter thoughts such as "I'd rather be thin, even if it means smoking." Remember that a slight weight gain is not likely to endanger your health as much as smoking would (cigarette smokers have about a 70-percent higher rate of premature death than nonsmokers). And review the list of healthy, low-calorie snacks that you used when quitting.

3. Anticipate triggers and prepare to avoid them - By now you know which situations, people, and feelings are likely to tempt you to smoke. Be prepared to meet these triggers head on and counteract them. Keep using the skills that helped you cope in cutting down and quitting:

  • Keep your hands busy - doodle, knit, type a letter.
  • Avoid people who smoke; spend more time with nonsmoking friends.
  • Find activities that make smoking difficult (gardening, washing the car, taking a shower). Exercise to help knock out that urge; it will help you to feel and look good as well.
  • Put something other than a cigarette in your mouth. Chew sugarless gum or nibble on a carrot or celery stick.
  • Avoid places where smoking is permitted. Sit in the nonsmoking section in restaurants, trains, and planes.
  • Reduce your consumption of alcohol, which often stimulates the desire to smoke. Try to have no more than one or two drinks at a party. Better yet, have a glass of juice, soda, or mineral water with a celery stick to nibble on.

4. Reward yourself for not smoking - Congratulations are in order each time you get through the day without smoking. After a week, give yourself a pat on the back and a reward of some kind. Buy a new record or treat yourself to a movie or concert. No matter how you do it, make sure you reward yourself in some way. It helps to remind yourself that what you're doing is important.

5. Use positive thoughts - If self-defeating thoughts start to creep in, remind yourself again that you're a nonsmoker, that you don't want to smoke, and that you have good reasons for it. Putting yourself down and trying to hold out through willpower alone are not effective coping techniques. Mobilize the power of positive thinking!

6. Use relaxation techniques - Breathing exercises help to reduce tension. Instead of having a cigarette, take a long deep breath, count to 10, and release it. Repeat this five times. See how much more relaxed you feel?

7. Get social support - The commitment to remain a nonsmoker can be made easier by talking about it with friends and relatives. They can congratulate you as you check off another day, week, and month as a nonsmoker. Tell the people close to you that you might be tense for a while, so they know what to expect. They'll be sympathetic when you have an urge to smoke and can be counted on to help you resist it. Remember to call on your friends when you're lonely or you feel an urge to smoke. A buddy system is a great technique.

Not smoking is habit-forming

Good for you! You've made a commitment not to smoke, and by using this booklet, you know what to do if you're tempted to forget that commitment. It's difficult to stay a nonsmoker once you've had a cigarette, so do everything possible to avoid it.

If you follow the advice in this booklet and use at least one coping skill whenever you have an urge to smoke, you will have quit for keeps!

Relapse: If you do smoke again

If you do smoke again - and many successful ex-smokers relapse at least once before they quit for good - here's what to do:

  • Recognize that you've had a slip. A slip means you've had a SMALL setback and smoked a cigarette or two. But your first cigarette or two didn't make you a smoker to start with, and a small setback doesn't make you a smoker again.
  • Don't be too hard on yourself. One slip doesn't mean you're a failure or that you can't be a nonsmoker, but it's important to get yourself back on the nonsmoking track IMMEDIATELY.
  • Identify the trigger: Exactly what was it that prompted you to smoke? Be aware of the trigger and decide NOW about how you'll cope with it when it comes up again.
  • Know and use the coping skills described above. People who know at least one coping skill are more likely to remain nonsmokers than those who don't know any.
  • Sign a contract with yourself to remain a nonsmoker.
  • If you think you need professional help, see your doctor. He or she can provide extra motivation for you to stop smoking. Your doctor also may prescribe nicotine gum as an alternative source of nicotine while you break the habit of smoking.

MARKING PROGRESS...

  • Each month, on the anniversary of your quit date, plan a special celebration.
  • Periodically, write down new reasons you're glad you quit, and post these reasons where you'll be sure to see them.
  • Make a calendar for the first 90 days. Cross off each day and indicate the money you saved by not smoking.
  • Set other, intermediate target dates, and do something special with the money you've saved.

COMMON RATIONALIZATIONS*

Rationalization Response

I'm under a lot of stress, Your body's used to nicotine, so you and smoking relaxes me. naturally feel more relaxed when you give your body a substance it's come to depend on. But nicotine really is a stimulant - it raises your heart rate, blood pressure, and adrenaline level. Most ex-smokers feel much less nervous just a few weeks after quitting.

Smoking makes me more Trouble concentrating can be a short- effective in my work. term symptom of quitting, but smoking actually deprives your brain of oxygen.

I've already cut down Cutting down is a good first step, to a safe level. but there's a big difference in the benefits to you between smoking a little and not smoking at all. Besides, smokers who cut back often inhale more often and more deeply - negating many of the benefits of cutting back. After you've cut back to about seven cigarettes a day, it's time to set a quit date.

I smoke only safe, low-tar These cigarettes still contain harm- low-nicotine cigarettes. ful substances, and many smokers who use them inhale more often and more deeply to maintain their nicotine intake. Also, carbon monoxide intake often increases with a switch to low-tar cigarettes.

It's too hard to quit. Quitting and staying away from I don't have the willpower. cigarettes is hard, but it's not impossible. More than 3 million Americans quit every year. It's important for you to remember that many people have had to try more than once, and try more than one method, before they became ex-smokers, but they HAVE done it, and so can you.

I'm worried about gaining Most smokers who gain more than weight. 5-10 pounds are eating more. Gaining weight isn't inevitable - there are certain things you can do to help keep your weight stable. (See "Tips To Help You Avoid Weight Gain".)

I don't know what to do That's a common complaint among with my hands. ex-smokers. You can keep your hands busy in other ways - it's just a matter of getting used to the change, of not holding a cigarette. Try holding something else, such as a pencil, paper clip, or marble. Practice simply keeping your hands clasped together. If you're at home, think of all the things you wish you had time to do, make a list, and consult the list for alternatives to smoking whenever your hands feel restless.

Sometimes I have an This is a common feeling, especially almost irresistible urge within the first 1-3 weeks. The to have a cigarette. longer you're off cigarettes, the more your urges probably will come at times when you smoked before, such as when you're drinking coffee or alcohol or are at a cocktail party where other people are smoking. These are high-risk situations, and you can help yourself by avoiding them whenever possible. If you can't avoid them, you can try to visualize in advance how you'll handle the desire for a cigarette if it arises in those situations.

I blew it, I smoked a Smoking one, or even a few, cigarette. cigarettes doesn't mean you've "blown it." It does mean that you have to strengthen your determination to quit, and try again - harder. Don't forget that you got through several days, perhaps even weeks or months, without a cigarette. This shows that you don't need cigarettes and that you CAN be a successful quitter.

FOR FURTHER INFORMATION...

The National Cancer Institute operates a toll-free Cancer Information Service (CIS) with trained personnel to help you. Call 1-800-4-CANCER* to reach the CIS office serving your area, or write: Office of Cancer Communications, National Cancer Institute, National Institutes of Health, Building 31, Room 10A24, Bethesda, MD 20892.

The following organizations also can help you. Contact them to learn more about quitting for keeps.

American Cancer Society**
3340 Peachtree Road, NE
Atlanta, GA 30026
(404)320-3333

The American Cancer Society (ACS) is a voluntary organization composed of 58 divisions and 3,100 local units. Through "The Great American Smokeout" in November, the annual Cancer Crusade in April, and numerous educational materials, ACS helps people learn about the health hazards of smoking and become successful ex-smokers.

American Heart Association**
7320 Greenville Avenue
Dallas, TX 75231
(214)750-5300

The American Heart Association (AHA) is a voluntary organization with 130,000 members (physicians, scientists, and laypersons) in 55 state and regional groups. AHA produces a variety of publications and audio-visual materials about the effects of smoking on the heart. AHA also has developed a guidebook for incorporating a weight-control component into smoking cessation programs.

American Lung Association**
1740 Broadway
New York, NY 10019
(212)245-8000

A voluntary organization of 7,500 members (physicians, nurses, and laypersons), the American Lung Association (ALA) conducts numerous public information programs about the health effects of smoking. ALA has 59 state and 85 local units. The organization actively supports legislation and information campaigns for non-smokers' rights and provides help for smokers who want to quit, for example, through "Freedom From Smoking," a self-help smoking cessation program.

Office on Smoking and Health
U.S. Department of Health and Human Services
5600 Fishers Lane
Park Building, Room 110
Rockville, MD 20857

The Office on Smoking and Health (OSH) is the Department of Health and Human Services' lead agency in smoking control. OSH has sponsored distribution of publications on smoking-related topics, such as free flyers on relapse after initial quitting, helping a friend or family member quit smoking, the health hazards of smoking, and the effects of parental smoking on teenagers.

*In Hawaii, on Oahu call 524-1234 (call collect from neighboring islands). Spanish-speaking staff members are available during daytime hours to callers from the following areas: California, Florida, Georgia, Illinois, New Jersey (area code 201), New York, and Texas.

**Consult your local telephone directory for listings of local chapters.

National Cancer Institute (NCI)

NIH Publication No. 89-1647 Revised April 1988 February 1989

*Adapted from "Clinical Opportunities for Smoking Intervention - A Guide for the Busy Physician", National Heart, Lung, and Blood Institute. NIH Pub. 86-2178, August 1986.

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