Support to stop smoking
If you’re thinking about stopping tobacco use, there are some helpful tools available from Fondation Cancer, Ligue Médico-Sociale and Ministry of Health in Luxembourg.
Figures from a study produced for Fondation Cancer in 2021 show that 28% of people in Luxembourg smoke (about 147,500 people), although only about 19% smoke daily (about 100,000 people). 2020 to 2021 saw an increase in smokers of all age groups but a 37% increase in smokers aged 25-34 years and 68% increase in those aged 18-24 years over the past five years. Some 34% smoke shisha.
More than half of smokers want to give up, and studies show that professional support increases your chances of quitting.
Tobacco contains about 70 carcinogens, and a third of cancer is caused by smoking. It can also result in heart attacks and strokes. There are some 1,000 deaths due to smoking every year in Luxembourg.
The Santé website on smoking cessation points out that motivation and will are essential to quitting tobacco, but says that there is no one-size-fits-all method for giving up and treatment should be personalised around your lifestyle and the strength of your addiction.
Physical addiction and psychological dependence
Ligue HMC’s website says that tobacco dependence is both a physical addiction to nicotine and a psychological one based around habits and associations. Both Ligue Médico-Sociale and Fondation Cancer encourage you to take the Fagerström test to look at your physical dependence. It asks how many cigarettes you smoke per day and the nicotine level in them, if you smoke more in the morning, when you have your first cigarette of the day, and if you smoke even when you are ill or feel like doing so in situations where you can’t such as at the cinema or on a train.
Fondation Cancer suggests you assess your psychological dependence too, such as if you need to smoke to relax or think, or whether you turn to it from stress, boredom or anger. These associations can take longer to overcome than the pure physical addiction. Do you smoke to take a break from work or when drinking coffee or alcohol?
Advice on its website and that of Santé is to keep a smoker’s diary before you quit stating the time, place and your activity when you smoke and the level of craving, to assess whether its essential or just pleasurable. This will help you to make a strategy for quitting, which might include temporarily avoiding certain situations that tempt you to smoke, such as being around other smokers or going out to a bar. You can also plan for ways to compensate for cravings, such as drinking water, chewing gum, going for a walk or phoning a good friend.
You can evaluate your motivation to quit on the Santé website using the Demaria-Grimaldi test, which looks at how much your want to stop smoking and if you are self-motivated and influenced by your family or medical conditions, if you’ve quit before or have a reason to quit such as pregnancy, and if you have a stable weight. If you score less than seven points, then now might not be the time to quit. A score of 13 or more and you have a good chance of success. Anything in between and you should try, but it expect it to be challenging.
Planning to quit smoking
When it comes to the actual giving-up part, online advice suggests the following:
- Choose a specific date which could be immediately, or in a few weeks’ time (make sure it’s not a stressful period in your life)
- Decide on the medication or nicotine replacement therapy and have it ready
- List the benefits and tell friends and family to support you
- Change your routine and avoid situations or places that will tempt you to smoke
- Think of divergent strategies to use if you are craving a cigarette, such as exercise, or taking a shower as soon as you wake up to avoid the craving for the first cigarette of the morning
Side-effects of quitting
The good news is that within 24 hours your body will have eliminated all the carbon monoxide from smoking, and within 48 hours your sense of taste and smell will improve. Unfortunately quitting nicotine does have side-effects, which include feeling irritated or agitated, having trouble sleeping, constipation, an increased appetite, and sometimes depression and anxiety.
You can combat much of this through relaxation exercises, a healthy diet where you focus on three meals a day (and take time to eat them), avoiding fats and sugars, keeping low calorie snacks around, eating plenty of fruit and vegetables, and taking up a sport or just walking. In some cases, where you feel depression or anxiety, it’s advised you visit your doctor as you may need to temporarily take medication for this.
You’ll also cough, but this eases the longer you stay off the cigarettes and are your lungs way of clearing out the debris from smoking.
Where to get support
Consultations are given by the Ligue Medico-Sociale with the support of specialist doctors, nicotine therapists, dieticians and psychologists and you can contact them at Luxembourg City, Ettelbruck and Dudelange. Sessions are free and your expenses are reimbursed according to the Smoking Cessation Assistance Programme run by the Ministry of Health.
You can also join this programme by visiting your doctor or a specialist doctor if you are insured with the CNS. You will get regular consultations with a doctor of your choice for up to eight months. If necessary, withdrawal medication or nicotine replacement will be prescribed. Your consulting physician will need to register a form of consent at the first consultation, which will be reimbursed 100% by the CNS. After the final consultation you send this together with invoices for medication to the Department of Health for validation and they will send this on to the CNS for reimbursement. Withdrawal medication or nicotine replacement will only be reimbursed 50% to a maximum of €100 by the CNS.
Nicotine replacement and other medication
To wean you off nicotine addiction you can try nicotine replacement products such as patches, gum, nasal sprays and lozenges. These are sold at pharmacies without a prescription, but if you join the smoking cessation programme, you will be reimbursed 50% up to the value of €100 by the CNS.
In some cases, a doctor or specialists might prescribe smoking cessation medication that affects the nicotine receptors in the brain, such as varenicline (a 12-week treatment) or Bupropion (and eight-week treatment). Whilst these reduce your urge to smoke, they also have side effects such as insomnia and abnormal dreams and tend to be recommended only in certain circumstances when nicotine replacement has not worked (and are not available if you are pregnant).
Whilst e-cigarettes are not considered an effective way to quit smoking as you don’t break the psychological habit, it is considered better to “vape” than smoke. The electronic cigarette vaporises a liquid which you then inhale, producing artificial smoke which can be flavoured as tobacco, fruit or sweets. It may or may not also contain nicotine, but it does not contain tobacco and therefore no carbon monoxide or carcinogenic substances in significant quantities. There are no long-term scientific studies, but e-cigarettes are probably a reduced risk compared to tobacco.
Cognitive behavioural therapy and e-coaching
CBT or psychological therapy can help you change your behaviour including habits you associate with smoking and give you alternative ways to manage stress. You can also download a smartphone app for e-coaching and support, often offering free personalised advice once you have defined your profile.
There are also other tactics including hypnosis, acupuncture, mesotherapy, homeopathy and soft laser treatment, but these have not been scientifically proven.
Go for it!
Finally, Fondation Cancer advises anyone who has quit, or is planning to, not to fear failure. Even if you don’t succeed the first time, you will be far better prepared for the next time. On average it takes people at least four attempts to stop smoking permanently. If you do succumb to smoking one cigarette or smoke for one evening, see it as a relapse and carry on the next day after evaluating why you gave in and trying to find a solution.
You can find information on mindfulness, relaxation and yoga to help you curb your cravings here.