My

Tobacco

Cessation

Workbook

A Resource

for Veterans
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My

Tobacco

Cessation

Workbook

A Resource

for Veterans
Acknowledgements

The provider manual Primary Care & Tobacco Cessation and the accompanying My Tobacco

Cessation Workbook were developed by Julianne Himstreet, Pharm.D., BCPS. The author’s

primary goal was to develop materials promoting tobacco cessation interventions, based on

published principles of evidence- and consensus-based clinical practice, for use by primary

care providers treating patients who use tobacco.

With permission from the HIV and Smoking Cessation (HASC) Working Group, several materials

used in the Primary Care & Tobacco Cessation provider manual were modified from HIV

Provider Smoking Cessation Handbook. The U.S. Public Health Service Clinical Practice

Guideline (Fiore, 2000) and the treatment model described by Richard Brown (2003) provided

the foundation for their work and therefore indirectly ours as well.1

Many thanks to Kim Hamlett-Berry, Director of Tobacco & Health Policy in Clinical Public

Health, Office of Public Health, for supporting this project and Leah Stockett for editing

the manual and the workbook. In addition, much appreciation needs to be given to Dana

Christofferson, Kim Hamlett-Berry, Pam Belperio, and Tim Chen for their editing and content

contributions.1

1 Brown, R. A. (2003). Intensive behavioral treatment. In D. B. Abrams, R. Niaura, R. Brown, K. M. Emmons, M. G. Goldstein, & 

P. M. Monti, The tobacco dependence treatment handbook: A guide to best practices (pp. 118-177). New York, NY: Guilford Press.

Fiore, M. C., Bailey, W. C., Cohen, S. J., Dorfman, S. F., Goldstein, M. G., Gritz, E. R., Heyman, R. B., Jaén, C. R., Kottke, T. E., 

Lando, H. A., Mecklenburg, R. E., Mullen, P. D., Nett, L. N., Robinson, L., Stitzer, M. L., Tommasello, A. C., Villejo, L., & 

Wewers, M. E. (2000). Treating tobacco use and dependence. Clinical practice guideline. Rockville, MD: U.S. Department of Health

and Human Services, Public Health Service.
Table of Contents

CHAPTER 1: Introduction ...............................................1

Why Do I Want To Quit Tobacco? ............................3

Why Do I Use Tobacco Products? ............................4

Barriers To Quitting ...........................................5

CHAPTER 2: Why Do I Use Tobacco? ..................................7

Tobacco Use Is Linked To Other Habits .....................8

A Challenge For You: Addressing Your Triggers ............9

CHAPTER 3: Nicotine Addiction ...................................... 17

What Is Nicotine? ............................................ 18

Coping With Nicotine Withdrawal ......................... 19

How Tobacco Affects Your Body ........................... 23

Secondhand Smoke .......................................... 25

Recovery Of Your Body After Stopping Tobacco ......... 26

CHAPTER 4: Medications To Help You Quit Tobacco .............. 29

Types Of Tobacco Cessation Medications ................. 30

Nicotine Replacement Therapy (NRT) .................... 31

Bupropion (Zyban®, Wellbutrin®)........................... 35

Varenicline (Chantix®) ....................................... 37

Medications Affected By Smoking ......................... 39

CHAPTER 5: Getting Ready For Quit Day! .......................... 41

Set Your Quit Day ............................................ 42

Planning For Quit Day ....................................... 43

Stress And Tobacco Use ..................................... 46

Cravings For Tobacco: What Do I Do? ..................... 47

Get Help From Family And Friends ........................ 48

CHAPTER 6: Quit Day ................................................. 51

What To Do On Quit Day .................................... 52

Handling Nicotine Cravings ................................. 53

i
Exercise....................................................... 53

Healthy Eating ............................................... 55

CHAPTER 7: The First Two Weeks After Quit Day ................. 57

Benefits Of Quitting ......................................... 58

Reward Yourself ............................................. 59

CHAPTER 8: How Do I Stay Off Tobacco? ........................... 63

Watch Out For Triggers ..................................... 64

Resist The Urges ............................................. 64

Planning For The Future .................................... 65

Slip Prevention ............................................... 66

CHAPTER 9: Living As A Nonsmoker................................. 71

Stay Tobacco Free ........................................... 72

Dealing With Stress .......................................... 74

CHAPTER 10: Appendices ............................................. 77

Appendix A: Deep Breathing Exercises ................... 78

Appendix B: Progressive Muscle Relaxation

 And Body Scan ................................ 80

Appendix C: Tobacco Cessation Resources ............... 82

Appendix D: Frequently Asked Questions ................ 84

Table of Contents (cont.)

ii
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Introduction

Why Do I Use Tobacco?

Nicotine Addiction

Medications To Help You

Quit Tobacco

Getting Ready For Quit Day!

Quit Day

The First Two Weeks After Quit Day

How Do I Stay Off Tobacco?

Living As A Nonsmoker

Appendices

1

2

3

4

5

6

7

8

9

10
CHAPTER 1: Introduction

1. Why Do I Want To Quit Tobacco?

2. Why Do I Use Tobacco Products?

3. Barriers To Quitting

1
CHAPTER 1: Introduction

Congratulations on taking the first step to quitting tobacco products. Whether you

smoke cigarettes, cigars, pipes or use chewing tobacco, VA’s Primary Care Tobacco

Cessation Program can help you quit. Smoking is the number one cause of preventable

illness in the United States. Smoking increases your chance of heart attacks and strokes 

and it can damage your lungs and in many cases, lead to emphysema. Smoking can also 

cause cancer of the lungs, bladder, kidney, and pancreas as well as in the mouth and

throat.

If you have tried to quit before and have not been successful, don’t give up! Research

has shown that it takes an average of 6-8 quit attempts for a smoker to quit for good.

Think of this as a chronic disease like high blood pressure or high cholesterol...you will

need to work at it to become a nontobacco user.

So what is the best way to quit tobacco? People ask this question all the time and there 

are multiple ways you can stop. The best way to stop tobacco is to use behavioral 

techniques to help you break the habit and develop new behaviors, along with

medications to manage nicotine withdrawal symptoms. This manual, written specifically 

for Veterans, will assist you in changing your daily behaviors that up until now have 

resulted in your use of tobacco products.

2

CHAPTER 1: Introduction
WHY DO I WANT TO QUIT TOBACCO?

The first step in quitting any addictive drug, including nicotine, is to determine why you

want to quit.

Mark off the reasons you want to quit tobacco products:

£ Breathe better

£ Reduce my risk of cancer

£ Reduce my risk of emphysema/chronic bronchitis, chronic obstructive pulmonary 

disease (COPD)

£ Improve circulation of blood to my legs and arms

£ Reduce my risk of heart attack and stroke

£ Smell better

£ Improve my sense of smell and taste

£ Save money

£ Set a good example for my children/grandchildren

£ Have more control over my life

What are other reasons you want to quit? Write these reasons below:

CHAPTER 1: Introduction

3
WHY DO I USE TOBACCO PRODUCTS?

The next step is to look at why you smoke or chew tobacco. It is okay to admit that you like 

it. Most people who use tobacco like something about it, whether it is the feeling when the 

nicotine hits your brain, or the taste or smell.

Mark off the reasons you use tobacco products:

£ Reduces stress

£ Relieves boredom

£ I just do it!

£ I like it

£ Something to do during break time

£ Reward for completing a task

£ Celebrating something

£ Socializing

£ Relieves anxiety

£ I have nightmares or difficulty sleeping

What are other reasons you use tobacco? Write these reasons below:

Now look at your reasons for using tobacco and the reasons why you want to quit. Do the 

reasons to quit outweigh the reasons to continue tobacco use? If the answer is yes, then you 

are ready to head to the next step: preparing to quit tobacco.

CHAPTER 1: Introduction

4
BARRIERS TO QUITTING

Have you tried to quit tobacco in the past? If the answer is yes, then think about what caused 

you to relapse. This could be a barrier you may need to address in this quit attempt. Think 

about your barriers to quitting like a “speed bump” that may get in your way of quitting

successfully. If you are able to address these barriers, you can increase your chances of

quitting tobacco. These barriers can sometimes become a “backdoor” that you leave open 

to justify your return to tobacco. To stop for good, it is important to close all of these

backdoors so you have no reason to return to tobacco.

Check each of the following barriers you may have to stopping tobacco:

£ I tried to quit in the past, but it never worked

£ I live with other people who are still using tobacco

£ I am concerned about weight gain

£ I don’t know what to do without a cigarette or a chew

£ How will I socialize with my friends who still smoke/chew?

£ I am worried about how I will handle stress

£ I have a cigarette with my coffee. I am not sure if I can enjoy coffee without 

a cigarette.

£ I usually have a cigarette when I have a beer. It is hard to separate the two.

£ I smoke when I am bored

£ I am afraid it will make my stress, anxiety, or mood worse

£ I can’t get back to sleep unless I smoke one

£ It is the only vice I have left...I have quit everything else

£ I don’t know how to say “no”

Write in other barriers you have to quitting tobacco:

CHAPTER 1: Introduction

5
Introduction

Why Do I Use Tobacco?

Nicotine Addiction

Medications To Help You

Quit Tobacco

Getting Ready For Quit Day!

Quit Day

The First Two Weeks After Quit Day

How Do I Stay Off Tobacco?

Living As A Nonsmoker

Appendices

1

2

3

4

5

6

7

8

9

10
CHAPTER 2: Why Do I 

Use Tobacco?

1. Tobacco Use Is Linked To Other Habits

2. A Challenge For You: Addressing

 Your Triggers

7
CHAPTER 2: Why Do I Use Tobacco?

TOBACCO USE IS LINKED TO OTHER HABITS

Tobacco use is associated with several different behaviors that are very closely related. 

Tobacco use is a learned behavior, meaning you learned this from your family, friends, 

magazine ads, television, movies, or during your military service. When you were in

the military, you may have heard someone say “Smoke ‘em if you got ‘em.” Who helped 

you learn your tobacco habit?

Think about how often you “puff” or “drag” on a cigarette in a day. If you smoke one 

pack of cigarettes a day and each cigarette takes 10 puffs, that’s 200 puffs a day. Over 

the course of 40 years, you would take approximately three million puffs!

Table 1. My Tobacco Use

Example My Experience

If you smoke 1 pack per day  I smoke ____ packs/cigarettes per day

Estimate 10 puffs on each cigarette  Estimate 10 puffs on each cigarette

10 puffs/cigarette x 20 cigarettes/day

= 200 puffs each day

 10 puffs/cigarette x ___cigarettes/day

= ____ puffs each day

Tobacco use is also a triggered behavior, meaning certain activities or times of day may 

make you think about having a cigarette or chewing tobacco.

Check off some of your triggers for using tobacco:

£ Waking up in the morning

£ After meals

£ During breaks

£ Driving

£ Talking on the phone

£ Working on the computer

£ Drinking coffee

£ Drinking alcohol

£ After sex

£ Before bedtime

£ Waking up during the night, having 

nightmares

£ Stress

£ Pain

8

CHAPTER 2: Why Do I Use Tobacco?
£ Feeling anxious, angry or impatient

£ Seeing someone else smoke

£ Feeling bored

£ Watching TV

£ After completing a task

Write down other triggers you may have:

A CHALLENGE FOR YOU: ADDRESSING YOUR TRIGGERS

Try not smoking during one of your triggers. For example, you might pick after eating 

breakfast as the trigger. Starting tomorrow, try not smoking for 10 minutes after breakfast. 

Wait 20 minutes to smoke after breakfast the next day. Wait 30 minutes the day after that. 

Add another 10 minutes each day. By the end of the week you will be waiting one hour 

between the trigger and smoking. Once you have tackled one trigger, try adding another 

trigger until you have a few of them managed. By adding time between the trigger and the 

action of using tobacco, the trigger becomes weaker. This will help when you get to your 

quit day. If you use chewing tobacco, you can do the same thing by looking at your triggers 

to put in a new dip. To help you avoid using tobacco, come up with a few things you can do 

rather than use tobacco.

Some examples would be:

 Going for a walk

 Using a substitute like chewing gum or candy

 Doing deep breathing exercises

A more complete list of substitute behaviors can 

be found under DEADS Strategy on p.47.

CHAPTER 2: Why Do I Use Tobacco?

9
Write down 3 of your triggers and what you will do instead of using tobacco:

1. Trigger:

Instead of smoking, I will:

2. Trigger:

Instead of smoking, I will:

3. Trigger:

Instead of smoking, I will:

Lastly, tobacco use is also an automatic behavior, meaning you may find you smoke without 

thinking about it. You may recall times when you lit a cigarette and then noticed you already 

had one lit.

There are a few ways to help reduce this automatic behavior:

Tip #1 Move your tobacco to a different location

 If you carry your cigarettes in your front pocket, put them on the kitchen counter. If

you smoke outside, take one cigarette with you instead of the whole pack. You will 

need to physically walk to the pack to smoke the next cigarette. This leads you to 

think about smoking that cigarette and possibly consider whether you really need it 

or if you can wait longer to have the next one.

 If you use chewing tobacco, try placing the can on the kitchen counter or another

location in the house, rather than in your pocket. You will need to walk to the 

location of the tobacco can before putting in a new plug of chew.

CHAPTER 2: Why Do I Use Tobacco?

10
Tip #2 Keep track of your cigarettes as you smoke them

 It may be difficult to track all of your cigarettes but try to for 1-2 days. Keeping track

of the cigarettes helps you work on the automatic behavior of smoking. You can see 

if changes in your mood cause you to smoke more or less. Many people find that 

they smoke more when they are unhappy, while others might find they smoke more 

when they are bored. Times of celebration might be another time when your tobacco

use might increase. You may find that you smoke more when you are around certain 

friends who also smoke.

 If you use chewing tobacco, you can use the same method to track the number of 

dips you take in a day.

 Try using Table 2: Tobacco Tracker found on p.13. Use the star rating scale 

to show how much you needed each cigarette or dip. You can also fold the sheet 

and put it in your pack of cigarettes to remind you to keep track of how much you

are smoking.

CHAPTER 2: Why Do I Use Tobacco?

11
Rating Scale

- Mood is happy, feeling good, may be celebrating

. Mood is bored or tired

/ Mood is unhappy or angry, may be feeling pain, anxiety, panic, 

or irritability

Little need for a cigarette, just smoked it

 More of a need for a cigarette, perhaps feeling stress or anxiety,

or maybe just a need for celebration

 High need for a cigarette, may have needed more than

one cigarette

CHAPTER 2: Why Do I Use Tobacco?

12
Table 2. Tobacco Tracker

Cigarette (C) or 

Dip of Chew (D)

Time of 

Day

Mood

Happy Bored/TIred Unhappy/Angry

Need for

Cigarette/Chew

Low

Medium

High

CHAPTER 2: Why Do I Use Tobacco?

13
Cigarette (C) or 

Dip of Chew (D)

Time of 

Day

Mood

Happy Bored/TIred Unhappy/Angry

Need for

Cigarette/Chew

Low

Medium

High

CHAPTER 2: Why Do I Use Tobacco?

14
CHAPTER 2: Why Do I Use Tobacco?

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15
Introduction

Why Do I Use Tobacco?

Nicotine Addiction

Medications To Help You 

Quit Tobacco

Getting Ready For Quit Day!

Quit Day

The First Two Weeks After Quit Day

How Do I Stay Off Tobacco?

Living As A Nonsmoker

Appendices

1

2

3

4

5

6

7

8

9

10
CHAPTER 3: Nicotine 

Addiction

1. What Is Nicotine?

2. Coping With Nicotine Withdrawal

3. How Tobacco Affects Your Body

4. Secondhand Smoke

5. Recovery Of Your Body After

 Stopping Tobacco

17
CHAPTER 3: Nicotine Addiction

WHAT IS NICOTINE?

Nicotine is a substance found naturally in tobacco that causes feelings of pleasure,

relaxation or stimulation, and stress reduction. Nicotine is the addictive part of tobacco, 

but is not by itself harmful to your body. The other substances found in tobacco and

substances formed when tobacco is burned harm your body. There are more than 7,000

chemicals in tobacco smoke and at least 69 that are harmful to humans and can cause

cell damage, cell death and cancer. Some of the more harmful chemicals include the

following:

 Carbon monoxide

 Hydrogen cyanide

 Ammonia

 Lead

 Cadmium

 Polonium-210

 Arsenic

 Benzene

 Formaldehyde

Even though it is not burned, smokeless tobacco also contains some of these harmful

chemicals. Other products and devices that deliver nicotine, including the electronic

cigarette, may also be harmful to you. Some products with nicotine can help you

quit using tobacco, like nicotine replacement therapy (nicotine patch, nicotine gum,

and nicotine lozenges). It is important to only use nicotine products to quit that are

approved by the U.S. Food and Drug Administration (FDA).

18

CHAPTER 3: Nicotine Addiction
COPING WITH NICOTINE WITHDRAWAL

Nicotine is one of the most addictive substances on earth and this is why it is so hard to

quit. You feel a need for a cigarette when the level of nicotine in your body starts to drop.

If you go for long periods of time between cigarettes, such as sleeping through the night,

you will have a strong craving to smoke. This is because the amount of nicotine in your body

has dropped. Since your body is used to having nicotine, it will want more.

You might feel the following effects when you are low on nicotine:

 Irritability, frustration, anger

 Anxiety

 Difficulty concentrating

 Restlessness

 Depressed mood

 Difficulty sleeping

 Increased appetite

 Coughing

 Runny nose

 Cravings/urges

Most of these symptoms start the first or second day you are off tobacco. They are at their 

worst in the first week and get better with time. Most symptoms disappear after 2-4 weeks, 

but the urge to smoke can stay with you for a long time. The urge to use tobacco will be 

stronger when you first quit and seem to last minutes. However, after the first 2-4 weeks, 

the urges will become shorter. For most people the urge lasts only seconds after they have 

been off tobacco for a month or longer. Nicotine withdrawal symptoms can be managed by 

certain medications and behavioral coping strategies. These medications are discussed in 

detail in Chapter 4.

CHAPTER 3: Nicotine Addiction

19
Table 3. Behavorial Strategies for Coping with Nicotine Withdrawal Symptoms

Withdrawal Symtoms What Can I Do About It?

Irritability

 Avoid stress

 Practice relaxation techniques

 Exercise

Depressed mood

 Do something fun

 Get support from family and friends

 Discuss with your medical provider

Difficulty concentrating

 Avoid stress

 Plan your work accordingly

Dizziness  Get up slowly from sitting position

Chest tightness  Practice relaxation techniques

Fatigue

 Get more sleep

 Take naps

 Don’t push yourself

Hunger

 Drink lots of water

 Eat low-calorie snacks

Stomach pain, constipation, gas

 Drink fluids

 Eat fruits and vegetables

Cough, dry throat, runny nose

 Drink fluids

 Eat sugar-free candy

 Use cough drops

Difficulty sleeping  Reduce caffeine consumption 

(e.g., reduce daily intake by 50%)

CHAPTER 3: Nicotine Addiction

20
Withdrawal Symtoms What Can I Do About It?

Stress

 Practice relaxation techniques

 Avoid stressful situations

 Exercise

 Plan work accordingly

Craving for tobacco

 Practice DEADS Strategy (see p.47)

 Use nicotine replacement therapy

CHAPTER 3: Nicotine Addiction

21
This test can help you determine if you are addicted to nicotine. Most people who smoke 

every day are addicted to nicotine.

Table 4. Fagerström Test for Nicotine Dependence

Points Your Points

1. How soon after you wake 

up do you smoke/use your

first cigarette/chew?

 Less than 5 

minutes 3

 6-30 minutes 2

 31-60 minutes 1

 After 1 hour 0

2. Do you smoke/chew more 

frequently in the hours 

after waking than during 

the rest of the day?

 Yes 1

 No 0

3. Do you find it difficult not

to smoke/chew?

 Yes 1

 No 0

4. Which cigarette/chew 

would be the hardest to

give up?

 First one in 

the morning 1

 Any other 0

5. How many cigarettes do

you smoke in a day?

 10 or less 0

 11-20 1

 21-30 2

 31 or more 3

6. Do you smoke when you’re

so sick that you’re home 

in bed?

 Yes 1

 No 0

CHAPTER 3: Nicotine Addiction

22
NICOTINE DEPENDENCE SCORE (Points): Your Score: _______

0–2 points: Very low dependence

3–4 points: Low dependence

5 points: Medium dependence

6–7 points: High dependence

8–10 points: Very high dependence

*

Note. Adapted and used with permission from “The Fagerström Test for Nicotine Dependence: a revision of the Fagerström 

Tolerance Questionnaire,” by T. F. Heatherton, L. T. Kozlowski, R. C. Frecker & K. O. Fagerström, 1991, British Journal of 

Addiction, 86(9), 1119-1127. Copyrighted.

HOW TOBACCO AFFECTS YOUR BODY

Tobacco can be harmful to almost every part of your body. Many of these problems can be

completely or almost completely reversed if you stop tobacco. Here is a list of the most

common problems of tobacco use going from your head to your toes:

Head

 Stroke (blockage or breaking of a blood vessel in the brain) 

 Mouth and throat cancers

 Cavities and loss of teeth

 Bad breath

 Decreased night vision

 Yellow staining of skin and teeth

 Nose congestion and infections

CHAPTER 3: Nicotine Addiction

23
 Wrinkles

Lungs

 Cancer (up to 85% of all lung cancers are from smoking)

 Emphysema and chronic bronchitis 

 Worsening of asthma

 Lung infections 

Heart

 Congestive heart failure

 Heart attacks

 Increased blood pressure and heart rate

Stomach/intestines

 Cancers

 Ulcers

 Heartburn

Pancreas

 Cancer

Circulation in arms, legs and feet

 Reduced circulation in arms, legs

and feet that sometimes leads to

amputations in severe cases

Bones

 Increased bone thinning leading to a

higher risk of broken bones

Genitals/urinary system

 Cancers in kidneys, bladder and reproductive organs

CHAPTER 3: Nicotine Addiction

24
 Erectile dysfunction in men

 Sexual dysfunction in women

SECONDHAND SMOKE

Secondhand smoke comes from a burning cigarette and exhaled smoke from the person

smoking that cigarette. Secondhand smoke is harmful for people and pets.

Adults exposed to secondhand smoke may:

 Have more breathing problems

 Get colds or flu more easily

 Have higher chances of heart disease and cancer

 Die younger than people not exposed to secondhand smoke

Children exposed to secondhand smoke may have:

 More breathing problems like asthma

 More ear infections

 More lung infections like pneumonia

 More dental problems like cavities

Pregnant women and infants exposed to secondhand smoke may have:

 A higher risk of giving birth to a low birth-weight baby

 A higher risk of sudden infant death syndrome (SIDS)

Pets exposed to secondhand smoke may have:

 Higher risk of oral cancer, lung cancer and lymphomas (cats)

 Higher risk of lung and nasal cancers (dogs)

 Higher risk of lung cancer (birds)

 A fatal nicotine overdose if your pet eats a cigarette

CHAPTER 3: Nicotine Addiction

25
RECOVERY OF YOUR BODY AFTER STOPPING TOBACCO

After you quit using tobacco products, your body will start to heal and you will start seeing 

many improvements. It is never too late to quit. You will start seeing benefits the very 

first day you quit using tobacco and these benefits will increase the longer you remain 

tobacco free.

20 minutes after you quit

Reduction in your heart rate and blood pressure; the temperature of your hands and feet

will start returning to normal.

12 hours after you quit

Carbon monoxide level in your blood drops.

24 hours after you quit

Anxiety and irritability may start due to withdrawal from nicotine. These symptoms get

better the longer you are off tobacco.

2—3 days after you quit

Nerve endings in your body start to regenerate and you may notice a return in your taste 

and smell. Anger, anxiety and irritability from nicotine withdrawal may be at the worst 

level during this time. Nicotine replacement with nicotine gum or lozenges may help this. 

Breathing may be easier now.

1 week after you quit

Tobacco cravings and urges may be less frequent and shorter in duration.

2 weeks after you quit

Blood circulation in your gums and teeth are similar to a nonsmoker. You should no longer 

have anger, anxiety and irritability from nicotine withdrawal. Cravings and urges should be 

shorter and less frequent.

1—3 months after you quit

Your heart attack risk has started to drop and your lung function is improving. The blood 

circulation in your body has improved and walking might be easier. Give walking a try 

and see if you can go farther than when you were smoking. If you had a cough when you 

smoked, the cough should be gone now.

1—9 months after you quit

Smoking-related nasal congestion, fatigue, and shortness of breath should be improving. 

Cilia (little hairs in the lungs, throat and nose) have re-grown in your lungs and can clean

your lungs to remove irritants and mucous, and reduce infections.

1 year after you quit

The risk of cardiovascular disease, heart attack, and stroke has dropped to less than half

that of a smoker.

CHAPTER 3: Nicotine Addiction

26
10—15 years after you quit

Your risk of having a stroke or heart attack has dropped to a similar rate as a nonsmoker.

Your risk of lung cancer is 30-50% less than a continuing smoker’s risk. Your risk of death 

from lung cancer is one-half of the risk if you were an average smoker (one pack per day).

Your risk of pancreatic cancer is similar to a person who has not smoked and your risk of 

mouth, throat, and esophageal cancer has reduced significantly.

Your risk of tooth loss has decreased to a rate similar to someone who has never smoked.

20 years after you quit (women)

Your risk of death from smoking-related causes, including cancer and lung disease, is the

same as a person who never smoked.

20 minutes to 20 years...

Benefits of quitting smoking

last a lifetime

CHAPTER 3: Nicotine Addiction

27
Introduction

Why Do I Use Tobacco?

Nicotine Addiction

Medications To Help

You Quit Tobacco

Getting Ready For Quit Day!

Quit Day

The First Two Weeks After Quit Day

How Do I Stay Off Tobacco?

Living As A Nonsmoker

Appendices

1

2

3

4

5

6

7

8

9

10
CHAPTER 4: Medications To

Help You Quit Tobacco

1. Types Of Tobacco Cessation

 Medications

2. Nicotine Replacement Therapy

3. Bupropion

4. Varenicline

5. Medications Affected By Smoking

29
CHAPTER 4: Medications To Help You

Quit Tobacco

TYPES OF TOBACCO CESSATION MEDICATIONS

There are many types of medications used to help people quit tobacco. Some of these

medications provide nicotine to help you slowly reduce the nicotine level in your

body when you quit tobacco. Medications that provide nicotine are called nicotine

replacement therapy (NRT). NRT reduces your cravings for nicotine and helps reduce

nicotine withdrawal symptoms. There are also two medicines, bupropion (Zyban®) and

varenicline (Chantix®), which do not contain nicotine, but can help you have fewer

cravings for nicotine.

All medications are effective in increasing your chances of stopping for good. The

medications listed below are available through VA. Contact your primary care provider

or mental health provider if you are interested in using medications to help you quit

tobacco.

1. Nicotine replacement therapy (NRT)

• Nicotine patch

• Nicotine lozenge

• Nicotine gum

2. Bupropion (Zyban®, Wellbutrin®)

3. Varenicline (Chantix®)

Some of these medications can be used together to help you stop tobacco. Many

studies have shown that these combinations are effective and can work better than

using one medication alone.

Combination therapy:

 Nicotine patch + Nicotine gum

 Nicotine patch + Nicotine lozenge

 Nicotine patch + Bupropion

30

CHAPTER 4: Medications To Help You Quit Tobacco
 Nicotine gum + Bupropion

 Nicotine lozenge + Bupropion

Note: Varenicline is not used in combination with any other medication for quitting tobacco.

You may be wondering “What works best?” when it comes to quitting tobacco. At this time,

it appears that combination therapy using the medications listed above along with behavioral 

strategies have the highest success rates. For most patients, the choice of medication will

be based on your medical history, which you can discuss with your medical provider.

NICOTINE REPLACEMENT THERAPY (NRT)

Nicotine Patch

Q:How is nicotine delivered into the body?

 Through the skin by wearing the patch

Q:How much do you use?

 If you smoke 10 cigarettes or more a day:

A 21 mg patch daily for 4-6 weeks and possibly longer if you need more time

then a 14 mg patch daily for 2 weeks

then a 7 mg patch daily for 2 weeks

 If you smoke less than 10 cigarettes a day:

A 14 mg patch daily for 6-8 weeks and possibly longer if you need more time

then a 7 mg patch daily for 2 weeks

Q:Where do I apply the patch?

 Apply to the skin on the upper arm, upper chest or upper back

 Press the patch down firmly to get it to stick to your skin

 Do not use lotion on your skin before applying the patch

 If your skin is oily, first use a cotton ball with rubbing alcohol to clean the area,

then apply the patch when the skin is dry

CHAPTER 4: Medications To Help You Quit Tobacco

31
Q:Can I smoke when using the nicotine patch?

 You should try to avoid smoking when wearing the nicotine patch

 If you have a slip and smoke a few cigarettes, continue to use the nicotine patch. 

If you are also using nicotine gum or nicotine lozenges, try to use these when you 

have a craving for tobacco rather than smoking. If you do not have nicotine gum or

nicotine lozenges and would like to try these, call your tobacco cessation course 

instructor or your primary care provider at the VA. Other strategies that may 

help you to avoid using tobacco can be chewing gum, eating carrot sticks, deep 

breathing, going for a walk or drinking water. Give these a try.

 If you have a relapse and are back to your original smoking habit, it may be 

Q:What are the possible side effects of the patch?

 Itching or rash on the area where patch is placed

• If this happens, try to put the patch on a different area of skin each day

 Nausea, dizziness if the strength is too high

 Difficulty sleeping or nightmares

• If this happens, try removing the patch before you go to sleep

Nicotine gum

Q:How is nicotine delivered into the body?

 Through the lining of the inside of your mouth, similar to the area where chewing 

tobacco is placed

Q:How much do you use?

 If you are using nicotine gum only:

• If you smoke your first cigarette within 30 minutes of waking, use 4 mg gum

Ò Chew one piece of gum every 1-2 hours for weeks 1-6

◦ You should use at least 10 pieces of gum a day

CHAPTER 4: Medications To Help You Quit Tobacco

32
• Chew one piece of gum every 2-4 hours for weeks 7-9

Ò You should use about 4-8 pieces of gum a day

• Chew one piece of gum every 4-8 hours for weeks 10-12

Ò You should use about 1-3 pieces of gum a day

• Smoking less than one pack a day use 2 mg gum

Ò Follow the same schedule as the 4 mg gum above, but use the 2 mg gum

 If you are using nicotine gum in combination with nicotine patches or bupropion

(Zyban®, Wellbutrin®):

• Chew one piece of gum (2 mg) when you have a craving for tobacco or at times

when you know you have strong cravings

Ò For example, when you first quit tobacco you may find the cravings are 

strong in the morning. One way to help reduce the cravings is to use a piece 

of nicotine gum when you first wake up.

• Try to use no more than 6-10 pieces of gum a day when using the nicotine gum 

in combination with the nicotine patch

Ò The longer you have been off tobacco, the less you will need the gum

Ò Substitute sugar-free gum, mints, or candy between doses of the 

nicotine gum

Q:How do you use nicotine gum?

 Use the “bite and park” method. Place a piece of gum in your mouth and bite it 

two or three times until you get a peppery taste or feel a tingling sensation. Park 

the gum in the inside of your cheek and leave it there until you no longer have the

peppery taste or the tingling. Then repeat the bite-and-park method several times

until there is no longer a peppery taste to the gum. Then throw out the gum.

 Avoid chewing nicotine gum like regular chewing gum. Using nicotine gum this way

will not allow the nicotine to be absorbed through the lining of your mouth. You 

will swallow the nicotine, which may cause you to feel sick to your stomach and to

have heartburn. In addition, your nicotine craving will not go away since nicotine 

will not be absorbed from your stomach. Avoid combining regular chewing gum 

with nicotine gum since this will reduce the absorption of the nicotine from the 

NRT gum.

Do not drink or eat for 15 minutes before using the gum, while using the gum, and 

for 15 minutes after. Avoid acidic beverages like coffee, juices, soda, and alcohol 

during these times since this will reduce the absorption of nicotine from the gum.



CHAPTER 4: Medications To Help You Quit Tobacco

33
Q:What are the possible side effects of the gum?

 Irritation of the mouth

 Nausea and heartburn if chewed quickly and swallowed

Nicotine lozenge

Q:How is nicotine delivered into the body?

 Through the lining of the inside of your mouth, similar to the area where chewing

tobacco is placed

Q:How much do you use?

 If you are using nicotine lozenges only:

• If you smoke your first cigarette within 30 minutes of waking, use a

4 mg lozenge

Ò Dissolve one lozenge every 1-2 hours for weeks 1-6

◦ You should use at least 9 lozenges a day

Ò Dissolve one lozenge every 2-4 hours for weeks 7-9

◦ You should use about 4-8 lozenges a day

Ò Dissolve one lozenge every 4-8 hours for weeks 10-12

◦ You should use about 1-3 lozenges a day

• If you smoke your first cigarette more than 30 minutes after waking, use a

2 mg lozenge

Ò Follow the schedule for the 4 mg lozenge above, but use the 2 mg lozenge

 If you are using nicotine lozenges in combination with nicotine patches or

bupropion (Zyban®, Wellbutrin®):

• Use one lozenge (2 mg) when you have a craving for tobacco or at times when

you know you have strong cravings

Ò For example, when you first quit tobacco you may find the cravings are

strong in the morning. One way to help reduce the cravings is to use a 

nicotine lozenge when you first wake up.

• Try to use no more than 6-10 lozenges a day when using nicotine lozenges in

combination with the nicotine patch

Ò The longer you have been off tobacco, the less you will need the lozenge

CHAPTER 4: Medications To Help You Quit Tobacco

34
Ò Substitute sugar-free gum, mints, or candy between doses of the

nicotine lozenge

Q:How do you use the nicotine lozenge?

 Place a lozenge in your mouth and put it in the inside of your cheek and leave it 

there. You may rotate the place in your cheek where you put the lozenge in order

to reduce irritation to your mouth.

 Do not chew or bite the lozenge. It must dissolve completely to release the entire

dose of the nicotine.

 Do not drink or eat for 15 minutes before using the lozenge, while using the 

lozenge, and for 15 minutes after. Avoid acidic beverages like coffee, juices, soda, 

and alcohol during these times since this will reduce the absorption of the nicotine

from the lozenge.

Q:What are the possible side effects of the lozenge?

 Irritation of the mouth

 Nausea and heartburn if chewing or swallowing the lozenge

BUPROPION (ZYBAN®, WELLBUTRIN®)

Q:How does bupropion work?

 Bupropion reduces nicotine cravings by increasing dopamine in the brain. Dopamine

is involved in the addiction to nicotine. Bupropion does not contain nicotine, 

so you may still have some nicotine withdrawal symptoms. Bupropion is also an 

antidepressant, which can be beneficial for some people who use tobacco and have

a history of depression.

Q:How do you take bupropion?

 Bupropion is a tablet that is swallowed whole. Do not cut or break the tablet.

 Dosing:

• Bupropion 150 mg sustained release (SR) tablet: one tablet in the morning

for 3 days then one tablet twice a day for up to 12 weeks (as advised by 

your provider)

Ò When taking bupropion twice a day, have at least 8 hours between doses

Ò Take the second dose before 6:00 pm to reduce the risk of insomnia

(difficulty sleeping)

CHAPTER 4: Medications To Help You Quit Tobacco

35
• Bupropion is started 7-14 days before quit day so set your quit day about a week

or so after you start taking bupropion

• Bupropion is used for 8-12 weeks, but can be used longer if necessary

Table 5. Sample schedule of bupropion usage for the first 2 weeks

Day 1-3 Day 4-7 Day 8-14 Quit Day* After Day 14*

9 AM 150 mg pill 150 mg pill 150 mg pill 150 mg pill

5 PM 150 mg pill 150 mg pill 150 mg pill

*

Set your quit date between day 8 and day 14. Continue taking bupropion for 8-12 weeks as advised by your provider.

Q:Who should NOT use bupropion?

 If you have a history of seizures, bupropion can increase your seizure risk

 If you currently have an eating disorder like anorexia or bulimia, bupropion can

increase your seizure risk

 If you drink more than two servings of alcohol a day (one serving is 12 ounces of 

beer, six ounces of wine, or one ounce hard alcohol), bupropion can increase your

risk of seizures if you quit alcohol abruptly

 If you are currently taking medication for depression, bipolar disorder, or other 

mental health disorder, you should discuss with your psychiatrist or primary care

provider if bupropion will work with your current medications

Q:Can bupropion be used in combination with other medications to help quit tobacco?

 Bupropion can be used in combination with nicotine patches, nicotine lozenges, or

nicotine gum

Q:What are the possible side effects when using bupropion?

 Most common

• Difficulty sleeping

• Nervousness

• Dry mouth

 Less common

• Rash or swelling

CHAPTER 4: Medications To Help You Quit Tobacco

36
• Mood changes, depression, suicidal or homicidal thoughts

**CONTACT YOUR DOCTOR IF YOU EXPERIENCE ANY OF THESE SIDE EFFECTS**

If you are in crisis, call 1-800-273-TALK (1-800-273-8255) and press 1 to talk to 

someone now. www.veteranscrisisline.net

VARENICLINE (CHANTIX®)

Q:How does varenicline work?

 Varenicline blocks the receptor in the brain where nicotine binds. This blocks the

effect of nicotine when you smoke or chew tobacco. Varenicline also acts like a 

weak form of nicotine, which can help reduce nicotine withdrawal symptoms.

Q:How do you take varenicline?

 Varenicline is a tablet that is swallowed. This tablet can be split if necessary.

 Dosing:

Varenicline 0.5 mg: One tablet in the morning for 3 days then increase to

Varenicline 0.5 mg: One tablet twice a day for 4 days, then increase to

Varenicline 1 mg: One tablet twice a day for a time period advised by your

medical provider

Always take varenicline with a full glass of water and with food to decrease the risk

of stomach upset and vomiting

• Varenicline is started 7-14 days before your quit day

• Varenicline is used for a total of 12 weeks, but can be used for an additional

12 weeks if you have successfully quit tobacco and need longer use of 

the medication

• The safety of using varenicline for longer than 24 weeks is not known at this

time, so it is recommended to stop varenicline after 24 weeks

• VA hospitals and clinics will provide varenicline in a 28-day supply with no 

refills to ensure that everyone receiving varenicline will be monitored by their 

provider for mood changes and suicidal or homicidal ideation prior to receiving

additional prescriptions

CHAPTER 4: Medications To Help You Quit Tobacco

37
Table 6. Sample schedule of varenicline usage for the first 2 weeks

Day 1-3 Day 4-7 Day 8-14 Quit Day* After Day 14*

9 AM 0.5 mg pill 0.5 mg pill 1 mg pill 1 mg pill

5 PM 0.5 mg pill 1 mg pill 1 mg pill

*

Set your quit date between day 8 and day 14. Continue taking varenicline for 12-24 weeks as advised by your provider.

Q:Who should NOT take varenicline?

 If you have a history of depression, bipolar disorder, PTSD, or other mental health

disorders, you will need to discuss with your psychiatrist or primary care provider

about whether varenicline will be safe for you

• There have been reports of mood changes, depression, anger, irritability, and

most importantly, suicide and violent acts in people using varenicline

 If you have had a history of suicidal or homicidal thoughts or acts in the past

12 months, varenicline would not be appropriate for you

Q:Can varenicline be used in combination with other medications to help quit tobacco?

Varenicline is not used in combination with nicotine replacement therapy (NRT) or 

bupropion. NRT is not expected to be effective since varenicline blocks the nicotine

receptors. Varenicline has not been studied in combination with bupropion.

Q:What are the possible side effects of varenicline?

 Most common

• Upset stomach, nausea, vomiting

• Headache

• Difficulty sleeping, dream disturbances

 Less common

• Depression, anger, irritability, suicidal thoughts, homicidal thoughts

**IF ANY OF THESE SIDE EFFECTS HAPPEN AFTER STARTING VARENICLINE, STOP 

THE MEDICATION AND CONTACT YOUR MEDICAL PROVIDER OR GO TO THE 

EMERGENCY DEPARTMENT**

If you are in crisis, call: 1-800-273-TALK (1-800-273-8255) and press 1 to talk to

someone now. www.veteranscrisisline.net

CHAPTER 4: Medications To Help You Quit Tobacco

38
List the medication(s) you will be using to help you quit tobacco:

MEDICATIONS AFFECTED BY SMOKING

Q:Did you know some of your medications may be affected by smoking?

Tobacco smoke affects how some medications are used and removed from your 

body. This means there may be lower amounts of medicine in your body when you 

are smoking so they might not work as well. As a result, your doctor may need to 

increase the dosage of certain medications. Conversely, when you stop smoking, your

body will remove the medications slower and you may need a lower dosage. Talk to 

your doctor or pharmacist if you have more side effects from your medications after 

you quit smoking.

Some types of medications that can be affected by smoking:

 Antidepressants

 Anti-anxiety medications

 Antipsychotic medications

 Blood thinners like warfarin (Coumadin)

 High blood pressure medications

 Medications for heart rhythm problems (arrhythmias)

Caffeine is also removed from your body faster when you smoke, so you might need 

less caffeinated coffee, tea, or soda after you quit. It is good to reduce your caffeine

intake by half when you quit tobacco.

CHAPTER 4: Medications To Help You Quit Tobacco

39
Introduction

Why Do I Use Tobacco?

Nicotine Addiction

Medications To Help You

Quit Tobacco

Getting Ready For

Quit Day!

Quit Day

The First Two Weeks After Quit Day

How Do I Stay Off Tobacco?

Living As A Nonsmoker

Appendices

1

2

3

4

5

6

7

8

9

10
CHAPTER 5: Getting Ready

For Quit Day!

1. Set Your Quit Day

2. Planning For Quit Day

3. Stress And Tobacco Use

4. Cravings For Tobacco: What Do I Do?

5. Get Help From Family And Friends

41
CHAPTER 5: Getting Ready For Quit Day!

SET YOUR QUIT DAY

As your quit day approaches, there are several things you might want to do to get

ready.

First, write down your quit day...this date is very important!

MY QUIT DAY

Month_______ Day________ Year________ Time_________

42

CHAPTER 5: Getting Ready For Quit Day!
PLANNING FOR QUIT DAY

Now get your home, car and workplace ready for quit day by following the tips below:

1. Plan out your tobacco usage so you will run out by your quit day. Make sure you 

remove all tobacco from your home. Look in jacket pockets, kitchen drawers, the 

freezer, your garage, or other frequent tobacco storage sites. Also check inside 

your car for any stashes of tobacco. Considering that the average craving for 

tobacco lasts 2-3 minutes, removing nearby tobacco products will keep you from 

being tempted. For most folks, the urge may pass before you can get in the car 

and go to a store to buy tobacco.

2. Remove all ashtrays and lighters. These can be triggers for tobacco use once you

get to quit day. Since your plan is to quit, do you really still need them? Remove 

ashtrays and lighters in the car as well.

3. Clean up your smoking area. If you smoke in one room (e.g., porch, garage) or 

in the car, clean up these locations as they can be triggers for you to smoke. 

Remove cigarette butts, wash down furniture, and spray upholstery with an odor 

neutralizer to help remove the smoke smell. Getting your car cleaned or detailed 

may help. You may find you have trouble spending time in these areas for a while.

That is ok, just take a break and come back when you have a few weeks of being 

tobacco free.

4. Go to the store and stock up on some tobacco substitutes. Sugar-free gum, 

sugar-free mints or candies, carrot and celery sticks or other vegetables, 

toothpicks, straws, and cinnamon sticks. These items can be helpful when you

are having a craving.

5. Think about hobbies or other interests you have to fill up your day. Some hobbies

and interests to consider would be puzzles, games, reading, exercise, fishing, 

woodworking, painting, drawing, and cooking. Make sure it is a hobby not 

associated with tobacco use.

Some interests I will try include:

CHAPTER 5: Getting Ready For Quit Day!

43
Pack up an emergency kit for your first long car trip or other adventure that is coming up.

Such a kit would contain:

 Sugar-free candy

 Sugar-free gum

 Toothpicks

 Straws

 Vegetables and fruit

 Water

 Cinnamon sticks

 Throat lozenges

 Stir sticks

When you are planning to quit, it is first good to look at your habits and patterns of using 

tobacco. You can use Table 2. Tobacco Tracker (see p.13) to review your pattern of use. 

Pick three times you use tobacco and write these down. Write an activity you can do or 

a substitute you could use instead of using tobacco. For example, if you use tobacco after 

meals, brush your teeth instead of smoking.

Examples of activities and substitutes are:

 Chewing sugar-free gum

 Using sugar-free candy

 Chewing on a straw or toothpick (don’t swallow pieces of toothpick)

 Eating carrot sticks or celery sticks

 Drinking water

 Going for a walk

CHAPTER 5: Getting Ready For Quit Day!

44
 Doing chair exercises

 Deep breathing

 Talking to a friend

 Reading a book

 Working on a crossword puzzle

 Playing computer games

 Brushing your teeth

1. I usually smoke when:

Instead of smoking at that time, I can:

2. I usually smoke when:

Instead of smoking at that time, I can:

3. I usually smoke when:

Instead of smoking at that time, I can:

CHAPTER 5: Getting Ready For Quit Day!

45
STRESS AND TOBACCO USE

Most Veterans who use tobacco say that stress is their biggest trigger. You may notice when 

you are under more stress you smoke more or inhale deeper. It is important to discover a 

way to handle stress without turning to tobacco. While you might feel more relaxed after 

using tobacco, nicotine is not a true relaxant. Nicotine is a stimulant and increases your 

heart rate and blood pressure very quickly after you use it. Because of this, the high level 

of nicotine from smoking a cigarette may cause you more physical stress. The feeling of 

relaxation you may experience when you use tobacco is usually from the nicotine treating 

the withdrawal symptoms you may have between cigarettes or chewing tobacco. 

What situations cause you to experience stress? Write them down:

Here are some tips you can try to help you deal with stress without using tobacco. Try

several of these before your quit day in order to see what works for you.

Stress Reduction Tips:

 Deep breathing: Inhale deeply through your nose or mouth, hold the breath for four

counts, and then slowly exhale the breath. Repeat this 4-5 times.

 Go for a walk or a jog: Walk or jog around the block, to the mailbox, or around your

house. It does not matter how far you go, just get up and get moving!

 Do chair exercises: If you cannot walk, sit in your chair and get your arms moving.

You can do this with just your hands, or put a canned food (same weight) in each 

hand and do arm curls or arm lifts to the front and side.

 Drink water: Cold water can reduce a craving and also fill you up so you don’t fill 

up on other foods. Water also helps remove tobacco’s toxic substances from your 

body faster.

 Take a break: If a situation is causing you stress, take a break and go outside or to 

another room. If you are driving, pull over at a rest stop or parking lot and take a 

break. Try some deep breathing to feel better without using tobacco.

CHAPTER 5: Getting Ready For Quit Day!

46
 Listen to relaxing music: Relaxing music can reduce your stress and improve 

your mood.

CRAVINGS FOR TOBACCO: WHAT DO I DO?

Almost all people have tobacco cravings when they quit. You may even dream about smoking 

or chewing tobacco. This is normal and should not be thought of as a relapse. Remember, if 

you have cravings this does not mean you will not be able to quit for good.

What can you do about tobacco cravings? Try the DEADS Strategy:

D-Delay

The most important thing to remember is that an urge will go away whether you smoke 

or not. Waiting out an urge, especially if you begin to do something else, is easier than 

you may expect. Believe it or not, the urge will fade after about 5-10 minutes, even if 

you don’t smoke. It also helps if you have a positive attitude about the urge disappearing.

Think “This won’t last, the urge will go away” or “I would like a cigarette, but I am not 

going to have one, because I don’t need one.”

E-Escape

Remove yourself from the situation or event that led to the urge. If you’re in a room 

where others are smoking and an urge hits, get up and take a short walk. You can 

walk around the building or outside until you feel ready to re-enter the situation 

without smoking.

A-Avoid

Avoid situations where you’ll be tempted to smoke. This will be particularly important 

in the first days and weeks after you quit. For example, if you regularly go places where 

there’s a lot of smoking, it’s best to avoid them for a little while to allow you to get used 

to not smoking.

D-Distract

Get busy and get back to what you were doing before the urge hit. There may be 

other things you enjoy doing that are incompatible with smoking. You can try working

in the yard, reading a book or magazine, walking, taking a shower, or working on a 

crossword puzzle.

S-Substitute

When you feel you want a cigarette, substitute something else for a cigarette. Try 

sugar-free candy or sugar-free gum, especially if you are watching your weight. You could 

also eat a piece of fruit or drink a glass of water. Chew on something like a straw or a 

toothpick. The trick is to come up with something you like that can be easily substituted 

for a cigarette.

CHAPTER 5: Getting Ready For Quit Day!

47
GET HELP FROM FAMILY AND FRIENDS

Choosing to quit is a tough decision. You must do it for yourself, but you don’t have to do

it alone. Asking for help is a key part of the quitting process. Think about who can help 

you quit. Consider family members and other people with whom you spend a lot of time. 

Also consider getting support from former smokers who have successfully quit. Try calling

a quitline or using a supportive text messaging service. There are also smartphone apps 

and quit information online. Don’t be afraid to ask for help.

To help yourself quit, you can:

 Tell everyone that you’re quitting and your quit day

 Ask family, friends and roommates to smoke outside

 Ask a friend or spouse to quit with you

 Make a list of people who can give you support (fill in Table 7. My Support People)

 Call the VA national quitline: 1-855-QUIT VET (1-855-784-8838) to speak with a

smoking cessation counselor and receive free telephone counseling

 Sign up to receive text message tips and support from SmokefreeVET to your cell 

phone. Text the word VET to 47848 or visit www.smokefree.gov/VET

 Use an app on your smartphone – try VA’s Stay Quit Coach:

http://mobilehealth.va.gov/app/stay-quit-coach

 Access online information: www.publichealth.va.gov/smoking

Q:How can your support person help you?

 Listen when you want to talk

 Call to see how you are doing

 Offer to help you with chores, errands, childcare, shopping and other things

 Talk about problems and how to solve them

 Cheer you on

CHAPTER 5: Getting Ready For Quit Day!

48
Q:How can you help your support person?

 Let them know what will help you

 Let them know when you will be quitting tobacco

 Set up a time to talk after quit day

 Plan fun activities that can keep you from thinking about tobacco

 Teach your support person about quitting tobacco, especially if they have not used

tobacco themselves

 If you are keeping your quit attempt a secret, let your support person know this

 Thank your support person for helping you quit tobacco

Table 7. My Support People

Name Phone Number Email Address

CHAPTER 5: Getting Ready For Quit Day!

49
Introduction

Why Do I Use Tobacco?

Nicotine Addiction

Medications To Help You

Quit Tobacco

Getting Ready For Quit Day!

Quit Day

The First Two Weeks After Quit Day

How Do I Stay Off Tobacco?

Living As A Nonsmoker

Appendices

2

1

3

4

5

7

8

9

10

6
CHAPTER 6: Quit Day

1. What To Do On Quit Day

2. Handling Nicotine Cravings

3. Exercise

4. Healthy Eating

51
CHAPTER 6: Quit Day

WHAT TO DO ON QUIT DAY

It is finally here, your quit day. This is the day you stop using tobacco for good. Take a

moment and say: “I can quit smoking...” or “I can quit chewing and today is the day!”

Do you have a plan for today? The most important thing is to make your quit day a 

positive experience. Try not to schedule too many events for today. You want to stay 

busy, but not feel rushed or under stress. Keep your emergency kit handy. Drink plenty 

of water, try deep breathing for relaxation, go for a walk, or do other exercises.

It is time to make some changes:

DO

 Change your routine

 Switch the order of your morning

 Be active — take a walk

 Have your morning coffee in a

new mug

 Drink less caffeine

 Drive to work on a new route

 Take your work break inside

 Get up from the table as soon as

you finish eating

 Sit in a different chair to watch TV

or read the newspaper

KEEP BUSY

 Do something fun like see a movie

 Exercise for 20-30 minutes a day

 Wash your clothes and sheets 

 Use substitutes to keep your

mouth busy

 Meet with friends who don’t smoke

 Go to nonsmoking places like

the library

 Drink more water

 Stay away from places where

you smoked

52

CHAPTER 6: Quit Day
DON’T

 Feel like smoking has been taken 

away from you, remember you are

better off without it.

 Test yourself by trying a cigarette.

This can lead to a full relapse.

 Forget there will be difficult times 

when you stop smoking: be proud of

how well you are doing!

 Drink alcohol and go to bars for a 

while; this can be too tempting and

you may want to smoke.

 Forget to bring nicotine lozenges or 

nicotine gum with you when you need 

to go places or do things where you 

used to smoke.

HANDLING NICOTINE CRAVINGS

This is the one nicotine withdrawal symptom that can stay with you forever. The cravings

will seem more intense the first week and will slowly reduce in intensity and frequency.

After the first month, the cravings might only last a few seconds. You can make the cravings

go away by using a substitute like gum or sugar-free candy, starting an activity, doing deep

breathing, or any of the other activities listed above. Remember to review the DEADS

Strategy from Chapter 5.

EXERCISE

Exercise can be helpful when you are quitting tobacco. Our body produces a substance called 

endorphins that make you feel better. When you exercise, you produce more endorphins and

they can help with cravings for tobacco.

Q:How much exercise do you need to do?

Everyone has limitations on how much exercise they can do. You will have to look at 

yourself and determine where to start. In the military, exercise consisted of running 

and doing sit-ups and push-ups. If you have not been running lately, then don’t 

expect to do it now, or at least not yet.

If you have not been exercising, you can start with walking or using a stationary 

bike for 5 minutes a day. Try to increase by 2-3 minutes a week until you can go for 

30 minutes a day. The 30-minute session can be split into two 15-minute sessions if 

you are unable to exercise for longer than 15 minutes. If you are using a stationary 

bike or another type of cardiovascular equipment, do not start at a high resistance 

setting. You are exercising at the right intensity if you are lightly panting, but can 

still hold a conversation while doing the exercise. If you cannot hold a conversation 

when exercising, then turn down the resistance or slow down your pace.

CHAPTER 6: Quit Day

53
Activities to consider:

 Walking or jogging

 Tennis

 Dancing

 Golfing without a cart

 Aerobic exercise classes

 Cycling

 Gardening and pushing a lawn mower

 Yoga

 Swimming

 Water walking

 Weight machines

 Aqua aerobics

You may find exercise easier once you quit smoking. This is because you may be breathing

better and the circulation of blood in your body has improved. Keep exercising and it will

be easier each day.

If your activity is limited and you are unable to walk, try doing chair exercises. This consists

of using light weights and doing arm exercises in a chair. An alternative to the weights is

to use cans of food (just make sure to use the same type of canned food so the weight is

similar). Any type of body movement is good, so work within your limitations. If your doctor

limits your exercise due to health reasons such as heart problems, please talk with them

before you start exercising.

CHAPTER 6: Quit Day

54
HEALTHY EATING

Try adding healthy food choices to your meals and snacks by:

 Eating more fresh fruits and vegetables. If you cannot afford fresh fruit/vegetables,

then try buying them frozen.

 Drinking more water, which will help you feel more full and help reduce weight gain

 Eating carrot sticks and celery sticks to help with the hand-to-mouth habit

from smoking

 Eating crunchy foods like pretzels, rice cakes, or air popped popcorn, so your mouth

has to work

 Eating a small square of dark chocolate or low fat frozen yogurt if craving a sweet

 Eating smaller meals, but more often. If you eat snacks in between meals, you are

less likely to overeat. This can help prevent weight gain as well.

CHAPTER 6: Quit Day

55
Introduction

Why Do I Use Tobacco?

Nicotine Addiction

Medications To Help You

Quit Tobacco

Getting Ready For Quit Day!

Quit Day

The First Two Weeks

After Quit Day

How Do I Stay Off Tobacco?

Living As A Nonsmoker

Appendices

2

1

3

4

5

8

9

10

7

6
CHAPTER 7: The First Two

Weeks After Quit Day

1. Benefits Of Quitting

2. Reward Yourself

57
CHAPTER 7: THE FIRST TWO WEEKS AFTER

QUIT DAY

BENEFITS OF QUITTING

Congratulations for quitting tobacco. This is a very challenging task, but you will be

rewarded in many ways. In the first few weeks you may notice:

 Improved breathing

 More energy

 Improved sense of taste and smell

 The yellow staining almost gone from your fingers and sides of your mouth

 Feeling like you are in control instead of the cigarette being in control of you

 More money!

List some improvements you have noticed since your quit day:

List some benefits you are looking forward to in the next few weeks:

58

CHAPTER 7: The First Two Weeks After Quit Day
REWARD YOURSELF

By quitting tobacco, you are doing a great thing for your body. This can be challenging and

you may feel that it is hard to keep your resolve. Try making a list of rewards and see if this

helps keep you motivated during this challenging time.

Rewards could be:

 Buying yourself something special to celebrate quitting

 Splurging on a massage or dinner at a new restaurant

 Seeing a movie or sporting event

 Starting a new hobby

 Beginning exercising

 Using your savings to pay off your bills

 Going on a nice trip after being a non-smoker for six months

To start saving money for your rewards you can put the money you spend each week on

tobacco into a piggy bank or savings account. This way you can see the savings accumulate

and this can be a reward on its own. You will be amazed at how fast the money you used to

spend on tobacco adds up and how soon you will be able to buy your rewards.

Calculate how much money you will save from quitting tobacco products:

• I smoke _________ packs/cigarettes per day

• 1 pack of cigarettes costs: $_________

• I spend $_________ per day

• $ _________ per day on tobacco x 365 days = $_____________ per year

CHAPTER 7: The First Two Weeks After Quit Day

59
My Rewards

After 1 week without tobacco, I will reward myself with:

After 2 weeks without tobacco, I will reward myself with:

After 1 month without tobacco, I will reward myself with:

After 3 months without tobacco, I will reward myself with:

After 6 months without tobacco, I will reward myself with:

After 12 months without tobacco, I will reward myself with:

CHAPTER 7: The First Two Weeks After Quit Day

60
The example is based on smoking one pack per day at $5.00 per pack.

Table 8. My Savings Calculator

Days Without Tobacco Example Savings My Savings

1 Day $5.00

1 Week $35.00  $ (1 Day) x 7 = 

1 Month $150.00  $ (1 Day) x 30 = 

1 Year $1,825.00  $ (1 Day) x 365 = 

10 Years $18,250.00  $ (1 Year) x 10 = 

20 Years $36,500.00  $ (10 Years) x 2 = 

CHAPTER 7: The First Two Weeks After Quit Day

61
Introduction

Why Do I Use Tobacco?

Nicotine Addiction

Medications To Help You

Quit Tobacco

Getting Ready For Quit Day!

Quit Day

The First Two Weeks After Quit Day

How Do I Stay

Off Tobacco?

Living As A Nonsmoker

Appendices

2

1

3

4

5

9

10

8

6

7
CHAPTER 8: How Do I Stay

Off Tobacco?

1. Watch Out For Triggers

2. Resist The Urges

3. Planning For The Future

4. Slip Prevention

63
CHAPTER 8: How Do I Stay Off Tobacco?

WATCH OUT FOR TRIGGERS

Go back to your list of triggers on p. 8-9.

What triggers are the most common now that you have quit?

How have you kept from using tobacco when you have a trigger?

RESIST THE URGES

REMEMBER, THE URGE TO USE TOBACCO WILL GO AWAY WHETHER

YOU SMOKE/CHEW OR NOT.

TRY TO AVOID USING TOBACCO AND THE URGES WILL SLOWLY LOSE

THEIR POWER OVER YOU.

Go back to p.45 when you were planning for quit day. On that page you wrote down

what you could do instead of smoking when you had a craving for tobacco. Have these

strategies worked?

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CHAPTER 8: How Do I Stay Off Tobacco?
Make a new list if your strategies are not working.

Instead of using tobacco I could:

Ideas: Go for a walk, chew gum, use a sugar-free mint or candy, talk to a friend, listen to

music, play with your dog/cat, or try deep breathing.

NO MATTER WHAT, DON’T THINK “JUST ONE WON’T HURT”... YES IT CAN 

HURT AND CAUSE YOU TO GO BACK TO SMOKING DAILY. YOU HAVE WORKED

SO HARD!

Keep things simple. Work through this one day at a time.

PLANNING FOR THE FUTURE

It is time to start looking at your calendar and seeing if there are any big events coming up

that might be a trigger for you to use tobacco.

Examples of some events that could cause triggers:

 Weddings

 Holidays

 Anniversaries

 Birthdays

 Family or group events

 Sporting events

 Hunting season

 Fishing season

CHAPTER 8: How Do I Stay Off Tobacco?

65
List some upcoming events where you might be triggered to use tobacco:

What could you do instead of smoking at these events?

SLIP PREVENTION

What is a slip? This is when you smoke a couple cigarettes and then go back to not smoking.

This is not a full relapse, but can lead to a relapse if not corrected quickly.

To prevent slips:

 Be aware of triggers—during these times you will crave tobacco more often

 Do not get overconfident—you may think that you can smoke just one and go back to 

being a nonsmoker. Many people relapse and go back to full-time smoking after just 

one cigarette.

 Think about the benefits you have experienced and feel good about your progress

To continue your success, try to:

 Be aware of your triggers

 Not get discouraged if you slip and stay the course of becoming tobacco free

 Stay positive and praise your achievements

 Focus on the benefits of quitting and beginning a healthier lifestyle

Q:What if I have slipped?

Don’t get discouraged! One cigarette is better than smoking a whole pack.

Get back on track quickly:

 Slips can quickly lead to a relapse

CHAPTER 8: How Do I Stay Off Tobacco?

66
 If you bought a pack, throw it away and destroy it so you will not be tempted to

dig it out of the garbage 

 Continue to use medications as prescribed

Figure out what caused the slip:

 If you can identify what caused the slip you can try to prevent this from happening

in the future

 If stress is the cause, review your stress reduction strategies such as:

• Deep breathing

• Going for a walk

• Removing yourself from the stressful situation

• Using nicotine lozenges or nicotine gum if you were prescribed these 

medications. If you were not prescribed these, ask your provider if these would

be appropriate for you.

Don’t let one slip take you back to smoking again!

Q:What if I am back to daily smoking?

If you go back to daily smoking then this is called a relapse.

If you relapse, get back on track as soon as you can.

 Stop your medications until you are ready to quit again

 Set a new quit day in the next two weeks

 Review what led you to start smoking again

 Plan out your cigarettes so you will not have any left once you get to your new

quit day

 Throw out ashtrays and lighters on quit day

 Talk to your provider about the medication you used for stopping tobacco 

• You might want to consider a change in medication if the medication did not 

seem to help you or if you had adverse effects from the medication

• If the medication did help you, then you can retry the same medication

CHAPTER 8: How Do I Stay Off Tobacco?

67
Don’t tell yourself negative messages like:

 “It’s no use, I can’t quit. I may as well give up because I smoked!”

• In reality, it takes people on average 6-8 tries to quit for good

 “I smoked because I’m weak and don’t have the willpower.”

• This is not about willpower. It’s more about learning from the relapse to make 

sure you don’t fall back again. You learn more about your addiction and the best

way for you to quit the more times you try.

 “I’m too old to quit smoking; it is too late for me anyway.”

• Everyone can benefit from stopping smoking no matter their age or current

health status

• Even people with very severe lung disease can see improvements by

stopping smoking

CHAPTER 8: How Do I Stay Off Tobacco?

68
CHAPTER 8: How Do I Stay Off Tobacco?

69

This page intentionally left blank.
Introduction

Why Do I Use Tobacco?

Nicotine Addiction

Medications To Help You

Quit Tobacco

Getting Ready For Quit Day!

Quit Day

The First Two Weeks After Quit Day

How Do I Stay Off Tobacco?

Living As A Nonsmoker

Appendices

2

1

3

4

5

10

9

6

7

8
CHAPTER 9: Living As A 

Nonsmoker

1. Stay Tobacco Free

2. Dealing With Stress

71
CHAPTER 9: LIVING AS A NONSMOKER

STAY TOBACCO FREE

You have made it and are ready to stay tobacco and nicotine free. Congratulations on

your success in meeting this goal. If you have not completely quit, try going back to

Chapter 1 and restarting the program when you are ready to try to stop tobacco again.

If you have quit, the challenge now is to stay off tobacco for good. Here are some ways

to do this:

 Avoid smoking and chewing

• Smoking or chewing even one time can lead to relapse. Sometimes you

might think that “it is only one” but many people have relapsed from 

“just one.”

• Avoid cigars also, this can lead you back to smoking or chewing and cause

a relapse.

 Try to be around people who do not smoke

• It can be challenging to stay off tobacco when you are around people who 

still smoke. Try to be around nonsmokers if you can do this. If you must be

around people who smoke, let them know you have quit smoking and ask 

them not to offer you any tobacco. You can also be around them in places 

where they can’t smoke.

• Bring your emergency kit and other items to help distract you from

wanting to use tobacco.

 Continue to use substitutions and distractions

• Use your emergency kit or some sugar-free candy or gum

• Have a book, the newspaper, or a puzzle book to do when you have extra

time on your hands

 Don’t be afraid to ask for help

• If you have been working with your primary care provider or tobacco 

cessation counselor to quit, contact them if you are struggling to remain

off tobacco

• Ask for help from friends and family 

• Call the VA tobacco quitline at 1-855-QUIT VET (1-855-784-8838), available

Monday through Friday, 8am through 10pm Eastern time

72

CHAPTER 9: Living As A Nonsmoker
• Get supportive text messages from SmokefreeVET, text the word VET to 47848

• Use the Stay Quit Coach, an app on your smartphone, to stay off tobacco

• Use online resources: www.publichealth.va.gov/smoking

 If you have been using medication to help you quit, take it for the entire course

• You may feel ready to quit the medication early, but try not to do this. The

medication may work better if you finish the entire course.

• If you need the medication for a longer period of time, talk to your primary care

provider or tobacco cessation counselor.

 Congratulate yourself every day

• You have done an amazing job and you deserve it!

If you feel like using tobacco again, remember why you quit. Go back to p.3 and look at

your reasons for quitting tobacco.

Check off the things you are enjoying now that you have quit tobacco:

£ I have more energy

£ I can breathe better

£ I am not wheezing

£ I sleep better

£ I can walk farther

£ I have saved money

£ I don’t have to stand outside

to smoke

£ I can say I am a nonsmoker

£ I am setting a good example for my

£ I smell better

£ I can taste my food

£ I have lowered my risk of cancer

£ I have lowered my risk of heart

£ I have less stress since I quit tobacco

£ I am in control now

£ I am proud of myself

CHAPTER 9: Living As A Nonsmoker

73
DEALING WITH STRESS

Here are more tips on how to deal with stress. We all have stress, so remember that there

are ways to deal with stress other than using tobacco.

Do what is best for you

 Give yourself extra time to get to work or appointments

 Make time to do things you want to do

 Learn to say “no” to things you don’t want to do or don’t have time to do

 Eat healthy foods

 Get enough sleep

 Reward yourself

Have fun

 Enjoy your hobbies

 Go for a walk, go swimming, or get on your bike

 Go to a movie

 Play with your pet

 Go outside

Spend time with others

 Visit or call a friend

 Go out to eat

 Spend time with family members

 Cook a special meal for your spouse or friend

 Go to a fun event

CHAPTER 9: Living As A Nonsmoker

74
Keep busy

 Go dancing

 Work on your yard

 Fix or build something

 Clean your home

 Listen to music

Find time to relax and have quiet time

 Read a book or magazine

 Listen to music

 Take a bath

 Practice deep breathing

 Meditate

 Daydream

 Take a yoga class

CHAPTER 9: Living As A Nonsmoker

75
Introduction

Why Do I Use Tobacco?

Nicotine Addiction

Medications To Help You

Quit Tobacco

Getting Ready For Quit Day!

Quit Day

The First Two Weeks After Quit Day

How Do I Stay Off Tobacco?

Living As A Nonsmoker

Appendices

2

1

3

4

5

10

6

7

8

9
CHAPTER 10: Appendices

A. Deep Breathing Exercises

B. Progressive Muscle Relaxation And

 Body Scan

C. Tobacco Cessation Resources

D. Frequently Asked Questions

77
Appendix A

DEEP BREATHING EXERCISES1

 What is deep breathing?

Deep breathing involves using your diaphragm muscle to help bring about a state

of physiological relaxation. The diaphragm is a large muscle that rests across the

bottom of your rib cage. When you inhale, the diaphragm muscle drops, opening

up space so air can come in. When watching someone do this it looks like their

stomach is filling with air. This type of breathing helps activate the part of your

nervous system that controls relaxation. It can lead to decreased heart rate,

blood pressure, and muscle tension; and an overall feeling of relaxation. It is also

something you can do quickly and easily, almost anywhere.

 Why be concerned with how I’m breathing?

• To increase your awareness of the role breathing plays in increased physical

tension and your body’s response to stress.

• To lower your level of stress-related arousal and tension.

• To understand how to take calm, relaxing breaths that will break the cycle

of increasing arousal during stressful situations.

 What is the best way to use deep breathing exercises?

• Use these exercises frequently.

• Take deep breaths at the first signs of stress, anxiety, physical tension, or

other symptoms.

• Schedule time for relaxation.

My scheduled time for deep breathing will be __________________________.

 Instructions

• Find a comfortable position, either sitting or lying down. It is sometimes 

easier to first learn deep breathing while lying on your back as it makes it

easier to feel the correct stomach motion.

• Place one hand, palm side down, on your chest. Place the other hand,

palm side down, on your stomach.

• Breathe in through your nose to a slow count of 3 or 4. Notice the motion 

of each hand. When you breathe in and out, the hand on your chest should

1

 Hunter, C. L., Goodie, J. L., Oordt, M. S., & Dobmeyer, A. C. (2009). Integrated behavioral health in primary care: 

Step-by-step guidance for assessment and intervention, Washington, DC: American Psychological Association. Adapted from 

the Center for Integrated Healthcare (a VA Office of Mental Health Services’ Center of Excellence), Deep Breathing patient 

handout (Version 1.0), March 2010. 

78

CHAPTER 10: Appendices
move very little, and the hand on your stomach should push out significantly 

on your inhale, and go back down on your exhale. Your abdomen should gently

expand as if you are filling a balloon in your stomach each time you inhale.

• Exhale through your nose and continue to notice the motion of your hands. 

Alternately, you can exhale through your mouth while making a sighing sound.

• Start with just a few deep breaths and stop if you feel light-headed. 

With practice, you can increase the number of deep breaths without

becoming light-headed.

CHAPTER 10: Appendices

79
Appendix B

PROGRESSIVE MUSCLE RELAXATION AND BODY SCAN12

 What is progressive muscle relaxation (PMR)?

We all carry tension in different parts of our bodies. This tension may become

so habitual that we don’t even realize our muscles are tense. PMR not only helps

release tension from muscles, but it also helps you become more aware of your

muscles. This exercise involves sequentially tightening and relaxing various

muscle groups.

 Instructions

• Sit in a chair with eyes closed and your hands loosely in your lap. Take a

few slow, deep breaths.

• Extend your right arm in front of you and tense your fist to the point of

pressure but not of strain. Hold the tension for 5-7 seconds, and then 

let your hand relax back into your lap. Let your hand and arm relax for 

10-20 seconds.

• Repeat the previous step, tensing and relaxing your right fist for a

second time.

• Continue alternating tension with relaxation for each of the remaining 

muscle groups. Remember to keep breathing as you tense your muscles. 

After you have tensed and relaxed one muscle group, move on to the next.

• Below you will find a sample sequence of muscles to tense and relax, but 

PMR can be done with a fewer number or greater number of muscle groups

as well. For example, you may choose to tense just one fist at a time, both

fists at the same time, or perhaps even tense your entire arm along with 

the fist in the first step. You may also choose to spend more time with an 

especially tense muscle before moving on to the next muscle.

• It is not important that you tense your muscles in a certain way. Do this 

in whatever manner is comfortable for you. You should never tense to 

the point of pain. Try to keep any muscles not currently being tensed in a

relaxed state. Practice once per day, if possible. It is an acquired skill and

you will get better at it with practice.

 Possible PMR muscle sequence

• Hands – clench each fist

• Upper arms – bend elbows and tense your upper arms (i.e., make a muscle)

2

 Adapted from the Center for Integrated Healthcare (a VA Office of Mental Health Services’ Center of Excellence), 

Progressive Muscle Relaxation (PMR) and Body Scan patient handout (Version 1.0), March 2010.

80

CHAPTER 10: Appendices
• Shoulders – lift your shoulders towards your ear

• Neck – let neck drop to your chest

• Forehead and scalp – raise eyebrows

• Face – scrunch up face

• Tongue – press tongue against roof of mouth

• Chest – tighten chest muscles

• Upper back – pull shoulders forward

• Lower back – roll head and upper back down and forward, stretching the lower

back (like touching your toes while sitting in a chair)

• Buttocks – squeeze buttocks

• Abdomen – tighten stomach muscles

• Thighs – while sitting with knees bent at 90 degree angle, tense thigh muscles or

press upper legs together from knees to hips to create tension 

• Calves – lift toes off ground towards your shins

• Feet - gently curl toes down so they are pressing into the floor

When you have finished tensing and relaxing each muscle group, sit quietly for another

minute or two. Use your imagination to further relax your muscles. Focus on one

muscle group at a time. Going from one to the next, visualize the muscles spreading

out; getting long, loose, and more deeply relaxed. Sit quietly for a few more minutes

and feel the relaxation.

To finish this exercise, gently stretch and slowly open your eyes.

 Body scan instructions

During a body scan, you mentally “scan” your muscles looking for areas of tension. Close

your eyes. Start with your head and move down your body. Ask yourself, “Where am

I tense?” Scan your muscles looking for signs of tension. Ask yourself, “Is my forehead

relaxed? Is my jaw relaxed?” and so forth. Scan your face, neck, shoulders, arms,

hands, chest, back, stomach, buttocks, legs, and feet. Whenever you discover an area

of tension, gently move the muscle to loosen it, and then relax it. In a body scan, you

do not necessarily need to tense the muscle before you relax it.

CHAPTER 10: Appendices

81
Appendix C

TOBACCO CESSATION RESOURCES

WEB AND TELEPHONE RESOURCES

 VHA Tobacco & Health

www.publichealth.va.gov/smoking

 Quit VET, Veterans Smoking Quitline

1-855-QUIT VET (1-855-784-8838)

8am-10pm, Monday-Friday (ET)

Counseling is available in Spanish

 SmokefreeVET Text Message Program

Text the word VET to 47848 or sign up online:

www.smokefree.gov/VET

SmokefreeVET en Español

Envie la palabra VETesp al 47848

www.smokefree.gov/VETespanol

 Stay Quit Coach smartphone app

http://mobilehealth.va.gov/app/stay-quit-coach

 Smokefree.gov

www.smokefree.gov

 Women.smokefree.gov

www.women.smokefree.gov

 Womenshealth.gov

www.womenshealth.gov/smoking-how-to-quit

 My HealtheVet

www.myhealth.va.gov

 Centers for Disease Control and Prevention

www.cdc.gov/tobacco and

www.cdc.gov/tobacco/data_statistics/sgr/2010/consumer_booklet

82

CHAPTER 10: Appendices
 U.S. Department of Health and Human Services

www.ahrq.gov/consumer/tobacco/helpsmokers.htm

 Office of the Surgeon General

www.surgeongeneral.gov/tobacco

 Healthfinder Tobacco Resources Page

www.healthfinder.gov/scripts/SearchContext.asp?topic=860

SPIT TOBACCO RESOURCES

 Spit Tobacco: A Guide to Quitting

www.nidcr.nih.gov/OralHealth/Topics/SmokelessTobacco/

SmokelessTobaccoAGuideforQuitting.htm

 U.S. Food and Drug Administration

www.fda.gov/TobaccoProducts/ucm173429.htm

 Center for Disease Control and Prevention

www.cdc.gov/tobacco/basic_information/smokeless

CHAPTER 10: Appendices

83
Appendix D

FREQUENTLY ASKED QUESTIONS

 Does nicotine cause cancer?

Nicotine does not cause cancer but is the addictive chemical in tobacco that

makes it so hard to stop smoking. Tobacco smoke has more than 7,000 chemicals

and more than 69 of these chemicals are cancer causing. Nicotine in the form of

a patch, gum, or lozenge doesn't contain any of the cancer-causing agents that

are found in cigarettes. These products give you a reduced amount of nicotine

to help calm your cravings and irritability so you can focus on the emotional and

behavioral aspects of your habit.

 Can I stay on nicotine gum indefinitely? What are the risks if I can't kick the 

gum habit?

Typically, people use nicotine replacement therapy for about four to six months.

The recommended course of therapy for nicotine gum is 12 weeks and you should 

use it for the full 12 weeks to improve your chances of success. In one clinical

trial, gum was used for as long as one year without any negative effects. Beyond 

one year, the long-term effects of nicotine exposure aren't clear. If you are

having difficulty giving up the gum try to gradually reduce your dependence by 

substituting regular or sugar-free gum. If that doesn't work, you may want to seek 

assistance from a smoking-cessation expert who can help guide you through a

behavioral program to change the habit part of your nicotine gum use. Work out a 

plan to wean yourself off of nicotine gum, and be willing to do the work it takes

to achieve your goal.

 What is the best way to quit smoking?

There is no one way to quit smoking, but we do know that a combination of 

behavioral counseling and the use of FDA-approved smoking cessation medications 

are the most effective elements of any treatment plan. Behavioral counseling 

may include a brief session on how to quit from your primary care providers or 

a number of sessions through a smoking cessation clinic or telephone counseling. 

But the combination of both counseling and medication appears to be the key. 

We also know that the greater the number of behavioral counseling sessions, the 

more likely you will be successful in quitting.

 I have tried quitting before and I failed. How do I know if I will be more 

successful this time?

It’s important to keep in mind that it takes even the most motivated smoker

several quit attempts before he or she is able to quit for good. To increase your 

chances of being successful this time, have a plan. Talk with your health care

84

CHAPTER 10: Appendices
provider about quitting and ask about getting a prescription for smoking cessation 

medications such as nicotine replacement therapy or bupropion or a combination of 

medications. Set a quit date and plan to throw away all cigarettes in your home, 

workplace, and car. Tell your friends and family about your plan and let them know 

that you will need their help and support. Think about the ways your health will 

improve and think about all the money you will save by quitting smoking. Try to think 

about what worked or helped you the last time you tried to quit and think about the 

challenges that you faced as well.

 Are “light” or “low tar” or “natural” cigarettes less harmful than regular cigarettes?

No and in fact, there are new regulations that will prevent cigarette manufacturers 

from making these claims. They are all still harmful and carry the same health risks 

as “regular cigarettes.” Quitting is the only way to reduce your risk of smoking-related 

illnesses and premature death.

 I only smoke occasionally, like when I am at parties or at a bar. What are the health 

risks of occasional smoking?

Even occasional smoking carries health risks and there really is no safe amount to 

smoke. Anytime you inhale cigarette smoke (even that from someone else smoking), 

the smoke enters the lungs and damages tissue in the lungs. Cigarette smoke can also 

restrict blood flow to the heart and increase your risk for heart attack. Many people 

who are casual or occasional smokers also convince themselves that they can quit 

whenever they want, but many of them find themselves becoming regular smokers. 

Again, there is no safe amount to smoke.

 Can hypnosis help me to quit?

There have been a lot of studies looking at just this question and the majority have 

found that hypnosis alone isn’t effective in helping smokers quit. It is still important to 

make sure you receive behavioral counseling and use FDA-approved smoking cessation 

medications as part of your quit attempt. Hypnosis or meditation or other therapies 

may help you with reducing or managing the stress of quitting smoking, but they often 

aren’t enough by themselves.

 What about e-cigarettes or electronic cigarettes? Can they help me quit?

There has been a lot in the news about e-cigarettes or electronic cigarettes and you 

may have seen them on the internet. However, there are no studies to show that these 

are effective in helping smokers quit. In addition, there are international concerns 

about the safety of these products as they are currently not regulated. The FDA has 

published updates to consumers about potential safety concerns. They are not the 

same as FDA-approved smoking cessation medications, which are known to be safe and 

effective in helping smokers quit.

CHAPTER 10: Appendices

85
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Sponsored by

U.S. Department of Veterans Affairs

Veterans Health Administration

Clinical Public Health

U.S. Department of Veterans Affairs

Veterans Health Administration

Washington, DC 20420

My Tobacco Cessation Workbook: A Resource for Veterans

Revised June 2014

IB 10-564; P96621