Congratulations on stopping smoking! This is the single most important thing you can do to protect your health. The following pages suggest strategies to avoid starting smoking again. Your chances of staying an ex-smoker will be higher if you use these strategies as much as you can.

Four crucial bits of advice

1- Do not give up!

When quitting smoking, the first times are the most difficult ones; this is when most relapses happen. The urge to smoke and other withdrawal symptoms decrease with time. The more time passes, the greater your chances of success become!

2- Absolutely refrain from taking even one cigarette

Very often, the fact of taking one cigarette leads to a relapse. It is VERY IMPORTANT to avoid taking even just a drag of a cigarette. It is much easier to refuse the first cigarette than to refuse the second.

3- Prepare an "emergency plan" in case you pick up some cigarettes again

If it happens, act immediately:

• Above all, avoid starting smoking regularly. Do not buy cigarettes and throw away the cigarettes in your possession.
• Look back; analyze the reasons why you smoked some cigarettes again.
• Remind yourself of your decision not to smoke.
• Consider this accident as a learning experience, and not like a failure.
• Do not chastise yourself. Avoid making yourself feel guilty.
• Seek the help of your friends or of a specialist in smoking cessation.

These products double or triple your chances of becoming an ex-smoker. The nicotine nasal spray and the nicotine inhaler are fast-acting products which immediately relieve withdrawal symptoms. The nicotine chewing gum prevents and attenuates these symptoms. The patch is a slow-diffusion product that prevents the appearance of withdrawal symptoms and reduces their force. Read the arguments in favor of these products in the next pages. Ask your doctor or pharmacist for advice on using these products.

How can you prevent a relapse?

Many ex-smokers start smoking again after a while. In fact, as much as eighty percent of people who make a serious attempt to quit smoking will have relapsed to smoking within one year. Stay on guard: your personal mission is to prevent a relapse. You can do it, we will show you how. Three types of situations favor a relapse:

1. When feeling the urgent need to smoke
2. When you are stressed, nervous, depressed, annoyed, or overwhelmed with problems.
3. When you are in the company of smokers.

The urgent need to smoke can occur a long time after you have stopped smoking. Consider it a signal that tells you that you need to react immediately. Answer the following questions then take heed of the strategies that will allow you to resist the urge to smoke.

List 2 situations where you may feel the urge to smoke: ___________________________ ___________________________

What is your strategy to resist the urge to smoke in these situations? __________________________ __________________________

Confidence (1-4)*  _______ _______

* Degree of confidence in your capacity to resist the urge to smoke in this situation:

1 = not at all confident, 2 = a little confident, 3 = moderately confidence, 4 = completely confident

Wait until it passes

The urge to smoke usually lasts only a few minutes. These urges will be strongest for the first 3 to 5 days after you first quit smoking. Following this time, they decrease in number, duration and intensity. >Immediately use distracting thoughts or activities

• Drink something (water, fruit juice).
• Always have some sugarless chewing gum, candy or toothpicks (Unwrapping a piece of chewing gum somewhat replaces the act of lighting a cigarette).
• Eat a fruit.
• Brush your teeth.
• Breathe several times deeply and slowly.
• Change places or activities; leave where you are.
• Keep your hands busy (e.g., play with a pencil, write, etc.).
• Take a walk, do some sports or some other physical activity.
• Take a shower.
• Focus yourself on anything else than cigarettes. Think about your work.

Remind yourself of the displeasure of cigarettes (smell, breath). Tell yourself: "If I wait for another 5 minutes, the urge to smoke will disappear." "I am stronger than cigarettes." "Is my urge to smoke really that strong?"

Remind yourself your decision not to smoke

Try to convince yourself. Remake a list of your reasons why you stopped smoking. Remind yourself of how difficult the first hours and the first days were, after you stopped smoking, when the urge to smoke was the strongest. Tell yourself that if you smoke, you will regret it, and that it would be a pity to jeopardize the effort you already made.

After a meal

• To avoid being tempted to smoke, leave the table immediately after you finish your meal and brush your teeth. Find another activity (e.g., take a walk or wash the dishes).
• Remind yourself that cigarettes do not make the meal better. On the contrary, by destroying the senses of taste and smell, they interfere with your full enjoyment.

If you have the urge to smoke when you first wake up, find a distracting activity such as taking a shower or preparing breakfast.

Use nicotine-containing products

Nicotine is a drug that causes a physical dependence and unpleasant withdrawal symptoms when you stop absorbing it. Nine out of ten daily smokers are dependent on nicotine and will feel these symptoms when they quit smoking.

By reducing withdrawal symptoms, or even by eliminating them altogether, nicotine-containing products increase your chances of successfully quitting by 2 to 3 times. Many scientific studies have demonstrated the effectiveness of these products. We strongly recommend that you use them. They will render your attempt to quit much more comfortable.

These products exist in 5 different forms. Depending on the country where you live, all forms are not available and some forms are available only with a prescription from a doctor.

• The patch diffuses nicotine slowly through the skin all day long. Use it for the entire time recommended, between 6 and 12 weeks.
• Chewing gums are effective if you follow the instructions strictly (chew with the specified technique, take the number of pieces specified, use for the entire time recommended).
• Nasal sprays immediately relieve withdrawal symptoms and make the need to smoke disappear.
• Inhaler replaces the smoking rituals (gestures and inhalation).
• Sublingual tablets melt slowly under the tongue.

Here are the reasons given by participants of our survey as to why they prefer not to use these products, as well as responses that we gave to them:

"I do not like the idea of using a medication to help me quit smoking."

• It is not shameful to use a medication to free yourself from a drug - like nicotine - that causes physical dependence.

"These products do not work."

• Though many scientific studies have shown these products are effective, they do not guarantee success. The use of these products does not free you from the efforts of changing your habits.

"I can stop smoking just fine without these products. Willpower is enough."

• A poorly placed sense of pride can lead you to a relapse. These products can double to triple your chances of success. Have as many winning cards on your side as possible!

"These products cost too much."

• It is true that these products are expensive (The patch costs 180 Swiss francs per month). It is, however, much less than what you spend each year to smoke.

"I'm afraid of the side effects of these products."

• These products have very few side effects, and the effects are banal. The patch can trigger itching or temporary, localized reddening of the skin. The spray can cause temporary irritation of the nasal membranes. It is important to know that the nicotine patch, nasal spray, inhaler, sublingual tablet and chewing gum are not dangerous to your health. In particular, the risk of cardiovascular accident is not increased for people who use these products. This also applies to patients with heart disease.

"I'm not dependent on the nicotine."

• These products increase your chances of success even if you smoke only 10 cigarettes per day. Start by accepting the idea that if you smoke more than 5-10 cigarettes per day, you will be dependent on the nicotine. A good way to see if you are dependent is to stop smoking for 24 hours. People who feel absolutely no withdrawal symptoms in the course of these 24 hours are probably not very dependent. Others will benefit a lot from using nicotine-containing product.

"My problem is not the physical dependence, but getting rid of an old habit."

• It will be easier for you to attack the other aspects of your smoking habit if the problem of physical dependence is resolved by using products that contain nicotine.

Very often, a relapse happens when ex-smokers are stressed, nervous, bothered, worried about something, arguing or depressed. Respond to the following questions to prepare yourself to resist the urge to smoke in each situation:

List 2 situations where you be tempted to smoke because you feel stressed, depressed, or in a bad mood: __________________________ __________________________

What is your strategy to resist the urge to smoke in these situations? _________________________ _________________________

Confidence (1-4)*  _____ _____

* Degree of confidence in your capacity to resist the urge to smoke in this situation:

1= not confident at all, 2= a little confident, 3= somewhat confident, 4= completely confident

Here is some advice to avoid relapsing in a similar case:

Slow down

Breathe deeply several times, slowly. Relax by listening to some music, talking to someone, reading a newspaper or a book, by playing some sports, by exercising or any other activity that you enjoy. Get enough sleep. Take a nap.

Deal with your issues calmly

Avoid making yourself annoyed. The first after stopping smoking, avoid argumentative people and situations if possible. Remind yourself that cigarettes do not solve your problems.

Warn people around you

After quitting smoking, some people will become irritable. Warn the people around you and ask them to try to understand and have patience with you for a while..

Express your feelings

Emotions are easier to manage if you talk about them. Express what you feel openly and calmly. Call your friends on the telephone. Go to see them.

Always have something to do

Plan your activities, in order to avoid moments of boredom during which the urge to smoke can creep up on you.

Practice a relaxation technique

This can help you manage your stress better. Perhaps call a specialist (doctor), or take a yoga or sophrology course.

Manage your time better

Instead of just doing tasks as they present themselves, establish priorities. Get to know your productive hours and dedicate this time to high priority tasks. Control interruptions (telephone calls, visits..). Learn to say "no". Avoid perfectionism. Plan relaxing activities to "recharge your batteries."

In case of depression

As nicotine is a stimulant, some people may feel depressed when they stop smoking. Like the other withdrawal symptoms, this feeling passes with time. If the depression does not pass, take it seriously and do not hesitate to make a call to a doctor.

Attack at the root of the stress

Try to understand the cause of your stress, then attack at its root. It is true that this can take some time. For this, find ways to respond to stress other than by smoking. The questionnaire below can help you to think about this.

Many people relapse when they are around other smokers. Responding to the following questions may help you to think of ways to resist the urge to smoke in such situation:

* Degree of confidence in your capacity to resist the urge to smoke in this situation:

1 = not at all confident, 2 = a little confident, 3 = somewhat confident, 4 = completely confident

Avoid the company of smokers

The first days after quitting smoking, avoid places where people smoke. Spend more time with your non-smoking friends than with the smoking ones. Get into conversations with nonsmokers preferentially. On the train or in a restaurant, locate yourself in the non-smokers' section. It may be difficult to resist the temptation to smoke when you smell the tobacco or when you see someone light a cigarette.

Do not drink too much alcohol or coffee

Do not let yourself be swayed by people who are jealous of your success and who would like to see you pick up cigarettes again. Remember that many of these smokers would like to quit themselves. Affirm your new identity as an ex-smoker. Write here what you will answer to people who encourage you to smoke or who doubt of your ability to refrain from smoking:

_________________________________________________________________

_________________________________________________________________

Rehearse the scene like an actor

Rehearse the scenes in advance where you refuse a cigarette you are offered, as well as one in which you respond to a person who doubts your ability to refrain from smoking. Prepare responses that use humor to diffuse these tense situations and disarm quite some sarcasm.

Other effective strategies to prevent a relapse

Also use the following strategies, as they can increase your chances of success.

Do more sports or exercise

Sports release tensions and allow the urge to smoke to dissipate. Doing sports increases your self-esteem and will reinforce your new identity as a person who takes care of your health. Doing sports generates endorphine, the pleasure hormone. This is a pleasant and effective way to prevent a relapse!

Be active

Practice activities that you particularly like. To avoid moments of boredom during which the urge to smoke can creep up on you, always have projects (e.g., some work to do, an interesting book to read, a sports activity, a movie, etc.).

Change your environment

Avoid keeping things around that can remind you of smoking and can provoke the urge to smoke. Toss your packets of cigarettes and store the ashtrays and lighters. Do not carry cigarettes with you, avoid asking smokers to give you some. Wash your clothes to get rid of the smell of smoke.

Look to your friends and family for support

You can increase the chances of your successfully quitting by asking for the support of people you trust. Let them know that you have stopped smoking and ask them to help you. Do not hesitate to speak with someone who you can trust about your efforts at quitting smoking. Be on guard for certain smokers, who - jealous of your success - may urge you to pick up cigarettes again.

Ask for professional help

Professional help increases your chances of success. You can:

• Ask your doctor. He or she can help you or show where to go.
• Ask a specialist in smoking cessation.
• Participate in a group-support program (e.g., The 5-day Plan).

Together one can share experiences and help each other. Even more, if your partner stops smoking, this will just increase your chances of success.

Be proud of yourself!

By stopping smoking, you have won a battle and found your freedom again. Be proud of your success. Be aware of the fact that your success valorizes you in the eyes of those who do not succeed in stopping smoking. These positive thoughts can help you stay an ex-smoker.

Reward yourself

Buy yourself a little present with the money you saved on cigarettes. You deserve it! Some rewards do not cost anything, like saying to yourself positively ("I am very proud that I have succeeded at quitting smoking "), going to see friends or taking some time off. These rewards encourage you to continue and compensate you for the lost pleasures of smoking. Moreover, why not offer a gift to your friends and family, who may have had to deal with your irritability as an ex-smoker?

List of the rewards that you will give yourself for not smoking:

______________________   _____________________   ___________________

Keep 2 lists with you

In the course of each day, do the following experiment: keep 2 lists with you and consult the lists whenever the urge to smoke hits you. This will replace the action of reaching for your pack of cigarettes:

1. the list of the reasons why you stopped smoking,
2. the list of your personal techniques for resisting the urge to smoke.

You may feel the urge to smoke even quite some time after you stop smoking. Do not consider these urges like a failure. Instead, see them like warning signals, telling you that it is time to use the coping strategies and techniques described in this brochure.

Dealing with weight gain

• Above all, avoid driving yourself into the ground with an all-or-nothing regime, because this will be too much at once. Keep stopping smoking your number-one priority.
• Avoid fatty foods, eat more fruits and vegetables.
• Do more exercise and sports.
• There are many books on ways to lose weight. Ask for help in a good bookstore.
• Ask for the help of a professional (doctor, pharmacist, dietician).
• Ask for the advice of a doctor before you use drugs to lose weight, since many of these drugs are ineffective. 

Here is what some ex-smokers told us about their experience of quitting.

- "I spend less money."

- "I feel younger." "I have more energy." "I'm in better shape."

- "I have rediscovered tastes and smells."

- "I feel so much better." "I breathe better." "I am quite proud of myself."

- "I have better breath." "My clothes are not smoky any more"

- "I do not have to be preoccupied with my lungs."

- "I do not cough anymore." "I do not have headaches anymore." "I'm less nervous."

- "You impose less on those around you." "My family thinks quite a bit more of me." "My family is very pleased."


If doubt gets the better of you

Prepare a response that will allow you to avoid picking up a cigarette:

If you think...	...remind yourself:
I am just going to have one	This strongly risks my relapsing into smoking again. I have made it so far, it would be a shame to just throw it all away.
I am absolutely unbearable when I try to quit	Irritability is a normal symptom of withdrawal. This will pass. To manage my irritability, I will use a nicotine-containing product.
I feel a craving for cigarettes all the time	Nicotine replacement products attenuate the cravings.

" I picked up a cigarette!"

The fact hat you picked a cigarette does not mean you have failed for good. If this happens, immediately put your "emergency plan" to work. Do not scold yourself and avoid feeling guilty. These thoughts do not help you to progress. Calmly analyze the circumstances under which you picked up a cigarette, so that next time you will know how to better resist in similar situations. Re-read your lists of high-risk situations and either identify the techniques that you can use to better resist cigarettes in these situations - or just try to avoid these situations in the future. Think of all the efforts that you have already made and which will be lost if you start smoking again.

" I started smoking regularly again!"

Do not be discouraged. Instead, look at it as a positive thing. Remind yourself that your attempt to quit has allowed you to acquire experience. This will increase your chances of really quitting the next time around. On average, ex-smokers attempt to quit smoking 4 times before actually quitting for good. Slipping several times is perfectly normal.

Having restarted smoking does not mean that you are incapable of quitting. It only means that you encountered a situation and did not manage it adequately. Think very carefully about the circumstances of your relapse. What could you do to better resist cigarettes under similar circumstances in the future? Thinking about this may help you to succeed the next time:

Circumstances under which I started smoking again:

___________________________________________________________________

___________________________________________________________________

Why could I not resist the urge to smoke under these circumstances?

____________________________________________________________________

____________________________________________________________________

The next time, how will I resist under similar circumstances?

_____________________________________________________________________

_____________________________________________________________________

You are just as capable of quitting smoking as anyone else. Plan your next attempt to stop smoking now. Try repeatedly to stop smoking, and your efforts will finally be rewarded. Read our brochure entitled, "I started smoking again". In it you will find advice that can build your motivation and help you correctly prepare for your next attempt to quit. And the next time, use the methods that you have not used previously: professional help, nicotine products, bupropion, etc.

What now?

We know it is not easy to stop smoking. But do not let your guard down. Follow the advice found in this brochure and in our brochure entitled, "Ex-smokers, persevere."

Just like a million Swiss, 8 million French and 36 million American citizens, you are completely capable of becoming and then remaining an ex-smoker!

If you would like, we can give you individualized advice to help you with it. For this, you should respond to a questionnaire and return it to us. In return, you will receive an evaluation that contains a report of your personal characteristics. If you would like, you can receive a series of evaluations, updated from time to time. You can order this questionnaire from the address in the first page. If you have access to the Internet, you can obtain the questionnaire, the individual evaluation report and the other brochures of this series from the following address: http://www.stop-tabac.ch. All of this material is free of charge.

To everyone, good luck!

• Individualized advice given by a system-expert: http://www.stop-tabac.ch
• The Center for Disease Control's Tobacco Information and Source Page is put out by the Office on Smoking and Health.
• The QuitNet is an online resource and support center for smokers struggling to quit and for those ex-smokers working to stay quit. http://www.quitnet.org/
• Nicotine Anonymous offers meeting information, a twelve step program, and motivational slogans. A great thing is that there are no fees for joining. http://rampages.onramp.net/~nica/

• Tobacco BBS
• Smoking From All Sides
• NicNet: Nicotine and Tobacco Network
• A Capsule History of Tobacco

• The Centers for Disease Control and Prevention
• CDC Tobacco Use and Prevention Information
• Food and Drug Administration
• American Cancer Society
• American Lung Association
• American Lung Association: Smoking and Tobacco Control

• CourtTV Tobacco Cases
• Tobacco Control Archives - The Brown & Williamson Collection
• Tobacco Litigation (The Wilmington Institute)
• Andrews' Publications: Tobacco Industry Litigation Reporter
• Tobacco on Trial: The Newsletter of the Tobacco Control Movement

• The Master Anti-Smoking Page
• The Foundation for a Smoke-free America
• Nicotine Anonymous
• Americans for Nonsmokers' Rights
• ASH - Action on Smoking and Health
• National Center for Tobacco Free Kids

• alt.smokers
• alt.support.stop-smoking
• alt.support.non-smokers
• alt.support.non-smokers.moderated

• Major Depression Linked To Stages Of Smoking - MHN Reading Room
• Psychiatrists use Antidepressants to Treat Smoking Addiction - MHN Reading Room
• Smoking As Drug Dependence - The Harvard Medical School Mental Health Letter
• Smoking Contributes to Mental Decline in Elderly - MHN Reading Room
• Smoking Found to Increase Sight Risk - USA Today

• LifeSign - Smoking cessation program.
• The Quit Smoking Company
• Quit'em - Stop smoking focus cards

• Smoke Free Stats - Free software to help you quit cigarettes.

• Addiction Alternatives - Dr. Marc Kern
• Neighborhood Tobacco Recovery Network - Calgary, Alberta, Canada

• Message to Youth - A NEW VIDEO
• Straight Talk About Tobacco, a live talk by Patrick Reynolds, was recently made available on video. Filmed before 2,000 middle and high school students, this powerful, multimedia presentation helps motivate youth to stay tobacco free, and to resist the onslaught of tobacco advertising and peer pressure.

• Most smokers pass through 5 steps (or stages) before they become confirmed ex-smokers.
• We have designed a brochure for each of these 5 stages, as well as a brochure for those who have restarted smoking after trying to quit (relapse).
• These brochures can be ordered from the address located on the first page.
• If you are in the Action stage (you have quit smoking less than 6 months ago), this is the brochure you should read first.
• You get the most out of these brochures if you make notes on them, if you underline the important passages and if you take note of the main points.

This brochure was created at the Institute of Social and Preventative Medicine of the University of Geneva, with the support of the Swiss Cancer League, the Swiss National Science Foundation, the Swiss-Romande Lottery, the Geneva Department of Social Action and Health, the Swiss Federal Office of Public Health, The Swiss Foundation for Health Promotion, Pharmacia & Upjohn, the Swiss Pulmonary League, the Cipret-Genève and the Jura Canton Health Service. We thank the Swiss Association for Smoking Prevention (at) for it help and support.

Copyright (c) Jean-François Etter 1999. All rights reserved.

Author: Jean-François Etter

Translated from French into English 1 March, 1999 by MCART.org

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Last modified Aug. 15, 2000 by J.-F. Etter