Cold turkey can give you cold feet

For those addicted to their daily fix of nicotine, stopping smoking is as difficult as giving up heroin. But help is at hand. Sarah Lonsdale surveys the options

Nicotine is a highly addictive drug. Withdrawing from it is physiologically as intense as withdrawing from heroin. If, in a drunken flash of optimism, you yesterday vowed to give up with no planning or preparation, I give you until the end of the week.

I should know. I had been trying to give up smoking for years and had used every method from nicotine chewing gum and patches to hypnotherapy and self-help books. Each time I failed because I was unprepared. It was like planning a difficult hike up Snowdon when in fact I was about to attempt the southern ascent of Everest.

"Smokers are drug addicts," says Robert Brynin, author of Stop Smoking for Good. "Heroin addicts are supported medically through withdrawal. Smokers are expected to kick the habit overnight. No wonder the success rate is so low."

I finally succeeded, for two reasons: I read a book explaining word by word to me what I was embarking on, and I became pregnant.

It is a rare person who can throw away cigarettes, lighters and ashtrays and go cold turkey with no planning or support. Even after the physical cravings have abated, the psychological ones remain. Smokers often stop for six months or more and return to the habit because of stress or because they become overconfident. "What the hell," you say, glass of wine in hand, "I've got it under control now, just one won't hurt." Gradually, each mental barrier falls: you have smoked one at a party, so why not after dinner? Then, "I can't keep scrounging off people. I'll just buy one packet." Often, the most successful quitters have lost someone to lung cancer or emphysema, or their doctors have given them the fright of their lives. For those who feel they ought to stop for the reasons they know off by heart (each year 100,000 people die from smoking-related diseases; each year we spend pounds 10bn on smoking, pounds 1,000 a year for an average 20-a-day person; smokers are social pariahs) it is a much taller order.

But which of the various methods on offer will you choose? All are promoted at this time of year by firms eager to cash in on the 80 per cent of smokers who say they want to give up.

Hypnotherapy

All hypnotherapists will tell you that it is no good going to them unless you really want to stop smoking. If, however, you really do, they claim about a 75 per cent success rate. Nicola Martin (who was unsuccessful with me, but has had other successes) operates in a fairly standard way. The consultation will last about an hour and a half, half of which time will be taken up by discussing your individual habit. The hypnotherapist will then tailor your "trance" to suit you. The average price you can expect to pay is pounds 60-pounds 100.

It did not work for me simply because I was not ready, or willing, to give up. Even when I was deep in my trance and heard the words: "You do not want to smoke again," I was thinking: "Oh yes I do." I lit up as soon as I was outside her door.

Call the Institute of Clinical Hypnotherapy on 0181-675 1598 for a registered hynotherapist in your area.

Acupuncture

Not for wimps. Acquaintances who have successfully given up by acupuncture say it is helpful not just to beat the physical cravings, but also to cope with the after-effects, such as months of chest problems. Again, practitioners say there is no point seeing them if you do not really want to give up. "I can usually tell within five minutes of an initial consultation whether someone really wants to give up or not," says Joseph Goodman, chair of the British Acupuncture Council and a practising acupuncturist. "If they don't, I tell them to stop wasting my time and their money."

Whether needles are inserted or pressure points simply stimulated with fingers depends on your consultation and general health. Acupuncturists claim about an 80 per cent success rate for those who are truly committed to quitting and usually reckon on about six sessions, each costing between pounds 30 and pounds 60.

Contact the British Acupuncture Council on 0181-964 0222.

Nicotine Replacement Therapy: patches, nasal spray or chewing gum. Official success rate: about 20 per cent, according to the medical journal the Lancet.

The two main brands, Nicotine and Nicorette, have similar products, the patch being the most popular method. It comes in three sizes: 15mg (pounds 16 for seven days' supply); 10mg (pounds 15); 5mg (pounds 13).

The 15mg patch, worn from morning to night, delivers the equivalent of about 22 medium-tar cigarettes during the day; the 10mg patch is the equivalent of about 15; the 5mg patch, around four or five.

Patches succeed in the short term because they remove the craving to smoke. I managed to stop smoking for three months on a combination of the 15mg and 10mg patches. But when I dropped to 5mg, the cravings kicked in and before I knew it I was smoking and wearing the patch together, giving a slightly sickening sensation.

It is at the 5mg stage that most smokers fail. There is a simple explanation for this: you need to smoke only six cigarettes a day to remove all cravings. Six cigarettes a day keep your nicotine intake at "addiction level", the amount you need so as not to get withdrawal symptoms. Unless you know this one basic fact, the moment you drop to a 5mg patch you will encounter problems.

Self-help: books, helplines

The cheapest and often most successful method, and the one that got me nine-tenths of the way to being a non-smoker - until the little blue line on the pregnancy indicator did the rest. There are plenty of books on the market, the two best-known being Alan Carr's The Easy Way to Stop Smoking (Penguin, pounds 7.99) and Stop Smoking For Good by Robert Brynin (Coronet, pounds 4.99). The latter helped me, simply by providing two pieces of information: that giving up smoking is as hard as heroin withdrawal and that you only need six cigarettes a day to avoid withdrawal symptoms. I cut down from 20 to six a day within the week.

Mr Brynin, director of National Health Association Research, a non-profit- making organisation researching nicotine addiction, is a proponent of one of the two main schools of thought on stopping smoking: the "cut back gradually" school or the "cold turkey" school. "In the book we draw up a long plan of slow cutting back, from 20 a day to one and then none over three months. In my view, if you go cold turkey, you will almost always fail. It is highly traumatic. Taking the time to understand your addiction, then planning your recovery is the kindest and therefore the best way," he says.

The government-funded Quitline, a free telephone helpline staffed by counsellors is available 9am to 11pm. Geoff Moon, counsellor for the Quitline, believes it is best to stop overnight. He quotes figures to show that three-quarters of all successful ex-smokers did it by going cold turkey. 'But," he adds, "that isn't to say that giving up smoking shouldn't be planned meticulously first." He advises callers to write down their reasons for giving up smoking and to keep this list at all times to refer to during difficult moments.

Quitline: 0800 00 22 00

NHA Helpline: 01273 22 00 55

Whichever method you choose, here are some useful tips:

The first two days will be relatively easy, because you will still have nicotine in your system. Day three is the worst.

Each craving impulse lasts four minutes. This is the crucial time, so give yourself something to do: breathing exercises, the crossword.

Know that you will become ill with chest and nasal infections as your cilli (fine hairs lining your bronchial tubes) grow back and begin to waft years of tar back up to the surface. It is recommended that you take 3,000mg of vitamin C daily over the first three months of giving up smoking.