There are two peaks in the year when people decide to give up smoking. The first is in January, a product of New Year health resolutions. The second is on Ash Wednesday, which has the additional public health title of National No Smoking Day.
One in four adults smokes. This figure has stabilised in the last couple of years, although it masks gender differences and higher levels of smoking in deprived sections of society. Studies show that two-thirds of smokers want to quit. About one-third will try, - with only two per cent succeeding. There are many ways to look at smoking: psychologically, socially, medically. According to a landmark report from the Royal College of Physicians in London published last month, cigarette smoking should be seen first and foremost as a manifestation of nicotine addiction and every bit as addictive as "hard" drugs such as heroin. The report says that all actions aimed at curbing smoking should flow from this recognition of nicotine's central role in the compulsion to smoke.
The modern cigarette, developed and fine-tuned by the tobacco industry, is a highly efficient nicotine delivery device. It delivers the optimum dose of nicotine rapidly to the dependent brain. With the help of additives, the smoke of the cigarette is made even more pleasant and the task of giving up more difficult for the well-intentioned smoker.
It is now accepted that tar and nicotine levels and especially labels such as "mild" and "light" are clever tobacco industry marketing tools. They do not reflect individual smoking habits, such as deeper and longer inhalations, holding smoke in the lungs and covering the perforations around the filter, all of which make a nonsense of so-called nicotine yields.
If smoking is primarily a nicotine addiction, then nicotine replacement therapy (NRT) must be the central plank in "treating" smokers. There are many trials showing that nicotine replacement therapy doubles quit rates. Nor is the cost effectiveness of NRT in question. Remarkably, however, nicotine replacement is not available free to medical card holders in this country.
There are many formulations of nicotine replacement (see panel). When compared with the cigarette, smokers tell us that all forms lack the feel of "the real thing". NRT must be made more effective as a consumer item if it is to rival cigarettes in the minds of smokers.
How does NRT work? Basically, it aims to deliver steady amounts of nicotine into the body in a formulation that allows the ex-smoker to gradually reduce his body's exposure to the drug.
There is, of course, much more to stopping smoking than the pure medical model of nicotine addiction. Psychological factors such as identifying your place in the "quitting cycle", and weighing up the pros and cons of continuing to smoke are important elements in planning to quit. The Smoking Target Action Group (STAG) has been training family doctors in smoking cessation techniques, so your doctor will not only prescribe NRT but will be able to offer a structured programme to help you stop. If you are planning to give up cigarettes this week, good luck!
Further Information from the Irish Cancer Society Quitline, phone 1850 201203; the Western Health Board's "Smoke Free Dining" Website at www.selectireland.com/smokefree; the six-week Stop Smoking course at St Vincent's Hospital, starting this week; phone 2094958.