Neil Perlman,MD, The Quit Doctor

Frequently Asked Quitting Questions

Here are Neil Perlman’s responses to the most commonly asked Quitting Questions.

If you do not see the answer to your question, have any personal insight into these issues, or would like back-up or clarifications, please contact Neil Bradford Perlman, M.D. by e-mail at

Frequently Asked Questions

  1. Why a watch?
  2. What’s the best way to quit smoking? “Cold turkey” or gradually?
  3. How many people who quit begin smoking again?
  4. Why is nicotine so addictive?
  5. What if I only decrease my habit from, say, two packs to one pack a day?
  6. Is chewing tobacco more or less addictive than cigarettes? And what about cigars?
  7. I don’t inhale, so I’m OK. Right?
  8. Why is it so hard to quit smoking?
  9. I’ve quit. How long until I start seeing any improvements to my health and what will they be?
  10. Does smoking really cause cancer?
  11. I’ve been smoking for over 20 years. Should I even bother quitting?
  12. I’m over 50 and I have emphysema. I might as well keep smoking. Right?
  13. I quit smoking after my heart attack. Will I live longer?
  14. What if I cheat while quitting?
  15. How many times do I try to quit and fail before I’m wasting my time even trying?
  16. How long does it take to get the nicotine out of my body?
  17. What is NRT? Should I use it?
  18. I pressed the 'cigarette' button by accident. What do I do?

Q: Why a watch?

A: The short answer: because people are constantly looking at their watches.

Let me explain. To quit smoking, half the battle is breaking the physical nicotine addiction. The other half is the psychological smoking habit. These challenges are not the same.

After ten years of working as a physician, I know that patients are more successful in quitting smoking when the physical act of quitting is paired with some type of psychological therapy – whether it’s provided by a physician, a pharmacist, a smoking cessation class, or even a personalized message mailed to the smoker. These personal observations have been affirmed time and time again by clinical studies.

However, very few people attend support groups or consult professionals on a consistent basis.

Providing ongoing psychological reinforcement works but until now, no one has developed a way to provide this reinforcement on a long term, continuous, and cost effective basis. That’s why I thought of a watch. Because most people already wear a watch, it would be unobtrusive. Since people look at their watches regularly, I could put a message – as well as other helpful features – where and when people need them most.

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Q: What’s the best way to quit smoking? “Cold turkey” or gradually?

A: The ‘best way’ to quit is cold turkey. Flush your cigarettes down the toilet and resist the temptation to ever light up again.

However, it’s rarely that easy. You should do whatever works for you. Try cold turkey first and if that doesn’t work, keep trying methods until you find one that does.

In my experience, I have seen the highest level of success from ‘combination’ therapy.

Cold Turkey – The good news here is that the nicotine withdrawal (cravings) will only last a week. The bad news is that very few people manage to quit and stay quit from the cold turkey approach.

Nicotine Replacement Therapy (NRT) – Patches, gums, and sprays fall into this category. Instead of getting your nicotine from a cigarette, you get it from another source – in increasingly smaller and smaller doses.

Medications – The most common drug combats your brain’s desire for dopamine in order to fight cravings and minimize nicotine withdrawal symptoms.

Counseling – Medical and lifestyle therapists – even acupuncturists and hypnotists – try to strengthen your willpower and provide – one hopes – positive feedback.

Combination Therapy – Multiple studies have shown that combining several therapies works much better then any one alone. Overall, medications and nicotine replacement therapies have shown better results when combined with each other and/or counseling.

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Q: How many people who quit begin smoking again?

A: Far too many. While it depends on the program, most studies show that at least 50% of the people who successfully quit smoking will begin were smoking again within 6 months. Some of the studies show relapse rates over 90%.

This high relapse rate is the major reason for continuing supportive therapy long after a person quits smoking. This can be done through monthly physician visits, regularly attending smoking cessation classes, or some other form of follow-up care.

This is also the major reason I invented the QT-Watch.

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Q: Why is nicotine so addictive?

A: Inhaled nicotine is rapidly absorbed into a smoker’s blood stream. The absorbed nicotine then causes the brain to increase its level of the neurotransmitter dopamine. This causes a pleasurable sensation.

After prolonged cigarette use, the brain will come to expect and desire a higher level of dopamine. If a person stops smoking, the level of dopamine falls, causing a craving for nicotine.

The more you smoke, the higher the brain sets your dopamine level and the more you will crave nicotine.

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Q: What if I only decrease my habit from, say, two packs to one pack a day?

A: Do it.

The less you smoke, the less damage you are doing to your body. It will slow the progression of emphysema and lower the amount of carbon monoxide in the body. Studies show that 1 pack per day smokers have a slightly lower rate of cancers than a 2 pack per day smokers.

Additionally, the less you smoke, the easier it will be to eventually break your smoking habit. If you smoke a pack a day or less, you can – with commitment and assistance – break the habit. If you smoke two packs a day you still can quit, but it will be far, far harder. As a doctor, I have had much less success breaking the habits of patients who smoke more than one pack a day.

So if you can smoke less, do so. Smoking one pack a day vs. two packs is a good start. You’ll feel better, decrease your odds of cancers, be less harmful to the people around you, and are more likely to be able to quit entirely.

Since there is a considerable decrease in the risk of cancer by going from a 1 pack a day smoker to nothing. That should be your ultimate goal.

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Q: Is chewing tobacco more or less addictive than cigarettes? And what about cigars?

A: Like cigarettes, chewing tobacco contains nicotine. The nicotine is absorbed though the cheeks and gums, instead of through the lungs like from cigarettes. Don’t fool yourself thinking chewing tobacco is less addictive. It is not. You are simply trading one nicotine delivery method for another.

You didn’t ask about cancer, but I will tell you anyway. Since chewing tobacco releases no smoke, you have less of a chance of developing lung cancer then smokers who inhale. However, you will increase your risk of developing mouth and gum cancer.

Cigars are basically overly-large cigarettes, and therefore each cigar contains far more nicotine than a single cigarette. While you may smoke fewer in a day – perhaps even a single one after dinner – you are still creating the same addiction.

When it comes to nicotine, there is no good choice

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Q: I don’t inhale, so I’m OK. Right?

A: Wrong. You are breathing in your own second-hand smoke and, though somewhat less-efficiently, are still getting more than enough nicotine into your blood stream to become addicted.

And as far as cancer goes, studies clearly show that second-hand smokers (this would be you as the non-inhaler – as well as those around you) have shown higher rates of cancers then non-smokers.

Here’s a test you can take: Don’t smoke a cigarette for a full day. If you can do this, then you are a non-smoker and should stay that way – while you still have the choice. If the cravings are too bad and you cannot stop yourself from lighting up, then you are an addicted smoker – whether you inhale or not – and should quit.

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Q: Why is it so hard to quit smoking?

A: Because smoking cigarettes is a powerful combination of drug addiction and social activity. You need to break both the social habit and the craving (called ‘nicotine withdrawal’) in order to quit and stay quit.

The nicotine addiction can be overcome by gradual reduction, nicotine replacement, or the cold turkey method.

The other problem is the psychological addiction. This can be treated with a strong desire to quit plus, positive reinforcement. I believe that a major reason for failure is that other smokers wittingly or unwittingly encourage the recently quit smoker to start up again.

If your partner or best friend smokes, convince that person to quit at the same time and you will have a far easier time of it.

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Q: I’ve quit. How long until I start seeing any improvements to my health and what will they be?

A: After the first day, the effect nicotine has on your blood pressure resolves.

After 2 days, your senses of smell and taste will start to improve.

After one week the amount of carbon monoxide in your body will start to decrease and the level of oxygen in your blood will increase.

After 1 year your risk of heart disease goes to half normal.

After 5 years your risk of a stroke returns to normal.

After 10 years your risk of lung, mouth and throat cancer returns to normal.

After 15 years, your risk of heart disease returns goes back to normal.

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Q: Does smoking really cause cancer?

A: A big yes.

Smoking has been directly linked to cancers of the lungs, larynx, esophagus, mouth, and bladder. In addition, smoking contributes to cancer of the cervix, pancreas, and kidneys. On average, smoking causes 430,000* deaths each year, in the United States. (That’s one every 82 seconds!) 155,000 of these deaths are cancer related and 79% of these are from lung cancer.

Every four and a half minutes, in the United States alone, someone dies from lung cancer caused by smoking.

* AVERAGE ANNUAL NUMBER OF DEATHS, 1990-1994, CDC, MMWR Mar. 3 1999; 48; 131-38

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Q: I’ve been smoking for over 20 years. Should I even bother quitting?

A: Yes.

Assuming you are an average smoker, you started smoking at the age of 18 and now smoke a pack of cigarettes a day. This would make you 38 years old with a “20 pack year” history of smoking.

A “pack year” is the number of years you have smoked multiplied by the number of packs of cigarettes per day (20 years x 1 pack per day = 20 pack years).

Since emphysema does not usually develop until someone has accumulated 50 pack years, quitting today may prevent you from ever getting emphysema.

Also, since most men do not start having heart attacks until their mid 40’s, stopping cigarettes should delay or prevent your risk of heart attacks. Furthermore, should you quit now, by the time you are 50 years old, not only will your risk of dying from a heart attack decrease, but so will your risk of lung, throat and esophageal cancers.

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Q: I’m over 50 and I have emphysema. I might as well keep smoking. Right?

A: Wrong. Even if you have emphysema, you will benefit by quitting.

Smoking will make your emphysema much worse. I see patients that have lost 60% of their lung capacity due to emphysema. While these patients can still go to work, drive a car and even walk up one flight of stairs, every percent of lung capacity is precious to them. Which is why I try the hardest to get these patients to quit.

Every percent decline in your lung capacity will significantly decrease your quality of life. If you quit right now, you might save yourself from requiring oxygen or becoming housebound in the very near future.

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Q: I quit smoking after my heart attack. Will I live longer?

A: Most likely.

If you have had a heart attack, your biggest risk of dying is the next heart attack. By quitting smoking, that risk is significantly decreased.

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Q: What if I cheat while quitting?

A: There is a big difference between cheating and failing, yet repeated cheating will lead to failure.

The goal of smoking cessation therapy is to alter a person’s daily routine for the better. A plan must be specifically designed for each individual, since one plan will not work for everybody. If an occasional cigarette is smoked beyond what the plan called for, that may be called cheating. If this is a one-time occurrence, no long-term harm is done. However, if “cheating” is frequent, the plan could be considered a failure.

The QT-Watch was designed to help people quit, even if they begin to “cheat”. When you begin using your QT watch, you will establish your goals for quitting. The QT watch will then monitor how well you stick to your plan, and will assign you a “Quitting Score” based on your level of success. If you begin to “cheat”, your “Quitting Score” will decrease and the messages you receive from the QT watch will adjust accordingly. Different groups of messages are designed for different stages of success in the smoking cessation program. All of the messages have the ultimate goal of long-term smoking cessation.

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Q: How many times do I try to quit and fail before I’m wasting my time even trying?

A: Keep trying until you succeed. You are never wasting your time when you try to quit smoking.

On average, a person will try seven times before they ultimately succeed in quitting smoking. That’s on average, meaning many of people have succeeded after a dozen or more attempts, while others find success more quickly.

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Q: How long does it take to get the nicotine out of my body?

A: Nicotine is processed very quickly- it will exit your body within a day of its consumption. However, this rapid metabolism also causes nicotine withdrawal symptoms to start the day you quit. Fortunately, these symptoms can be controlled with nicotine replacement therapy or will resolve on their own within a week.

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Q: What is NRT? Should I use it?

A: NRT stands for ‘Nicotine Replacement Therapy’. If NRT is what it will take you to quit smoking, then you should try it.

NRT is the provision of nicotine by a means other then a tobacco product. Currently available methods are a nicotine patch, nicotine gum, nicotine nasal inhaler and nicotine lung inhaler.

NRT provide a way of reducing nicotine withdrawal symptoms by gradually weaning the amount of nicotine consumed each day. When studied, about 1/3 of all people using NRT have been able to quit smoking. The type of NRT to select is an individual choice. The gum is tougher to chew then regular chewing gum. It is just chewed a few times, releasing a burst of nicotine. Then it is held between the cheek and gum again until needed again. The nasal inhaler is used as needed instead of a cigarette. The lung inhaler is shaped like a cigarette and inhaled to replace a cigarette. Although 1/3 of people using NRT report success, many of not most of these people start smoking again within one year. That is why follow-up therapy with a physician, smoking cessation class or the QT-Watch should be continued long after you quit.

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Q18: I pressed the 'cigarette' button by accident. What do I do?

A. If you press the cigarette button by accident, it is OK. Simply do not press the button the next time you have a cigarette and you will be back on schedule. Please do not smoke an extra cigarette.

If you are already in "non-smoking mode" (that is, you have successfully stopped smoking) the QT-Watch will think you smoked and give you a factual and motivational messages tomorrow.

The following day the QT-Watch will reset back to non-smoking mode. Although your time from last cigarette will be decreased, your amount saved will only be minimally affected.

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