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Smoking Cessation

Mari Alschuler, PH.D., LISW-S
Counselor, Insight Clinical Counseling and Wellness, LLC

There is one goal many of us make every January 1st: stop smoking or vaping. Whether you started smoking/vaping due to peer pressure, stress, or other reason, it’s never too late to cut down and stop.

According to the Cleveland Clinic, 16 million Americans live with a disease caused by smoking. Every year, roughly 480,000 people die from smoking-related diseases. That means that for every person who dies from smoking, at least 30 others live with a serious smoking-related illness (clevelandclinic.org).

Smoking is the number 1 cause of preventable death in the U.S. Tobacco contains not only nicotine but more than 5,000 chemicals, including cancer-causing agents into your blood, lungs, and internal organs. Smoking Increases the risk of cardiovascular diseases like heart attack and stroke; diabetes; cataracts; lung diseases like chronic obstructive pulmonary disease (COPD) and emphysema; and cancers of the lung, mouth, and throat. E-cigarettes (vapes) differ from traditional tobacco products as they deliver more concentrated nicotine than cigarettes in a smokeless inhaled mist (vapor). Health risks from vape products range from asthma to COPD and cancer. Smoking while pregnant places their fetuses at risk; possible effects include low birth weight, ectopic pregnancy, miscarriage, stillbirth, and birth defects like cleft palate.

Why is it so hard to cut down or stop? Tobacco’s primary chemical is nicotine. Nicotine attaches to the brain’s pleasure center, the nucleus accumbens, which enables the release of the neurotransmitter dopamine. Dopamine causes improved mood and feelings of pleasure—which reinforces continued tobacco use. Nicotine dependence occurs when you need nicotine and can’t stop using it. Each time you smoke or vape, the pleasurable effects are temporary. So you reach for another cigarette. Once you become addicted, your pleasure center expects to receive its hit of nicotine and will urge you to smoke/vape repeatedly.

Signs that you may be addicted include an inability to stop despite numerous attempts to cut down or quit. With addiction comes tolerance: needing more nicotine to get the pleasure or relief sought. The more you smoke, the more nicotine you need to feel good. When you try to stop, you experience unpleasant mental and physical changes. Symptoms of nicotine withdrawal include strong cravings to use, anxiety, irritability, restlessness, difficulty concentrating, depressed mood, frustration, anger, increased hunger, insomnia, constipation, or diarrhea; smoking despite health problems; and giving up on social activities where perhaps smoking isn’t permitted (mayoclinic.org).

Regardless of how long you’ve smoked, stopping can improve your health. It isn’t easy but you can break your dependence on nicotine. Many effective treatments are available (mayoclinic.org). According to the Center for Tobacco-Free Living, you should work with your provider to develop a care plan that may include one or more of these treatment options: medications like Bupropion (which raises levels of dopamine and norepinephrine), or Varenicline (which binds to nicotine receptors, reducing withdrawal symptoms); nicotine replacements (gum, patches); and psychological interventions (hypnosis, cognitive-behavioral therapy, behavior modification, group therapy).

I’m not ready to quit. Can’t I just cut down? Cutting down or decreasing usage (called ‘harm reduction’) sounds easier than quitting. Harm reduction means that if you use a substance less frequently and use less of it, there may be a result of a decreased health risk.

I’m not sure I can quit cold turkey. What steps might I take to slowly quit? When I work with a client who is ready to cut down or quit smoking or vaping, I use various techniques including cognitive-behavioral therapy (CBT), behavior modification, guided imagery, relaxation or mindfulness training; and clinical hypnotherapy. Tobacco cessation is covered by many insurance companies.

Additional resources include:


The US Quitline at 1-800-QUIT-NOW (1-800-784-8669) is a toll-free number run by the National Cancer Institute (NCI) that will connect you to your state’s tobacco quitline.

Download the QuitStart app from your app store.


SMOKEFREETXT: Get daily text messages with encouragement, advice, and tips to help you quit smoking. To sign up, text CDC to 47848.

For an appointment with one of our counselors for smoking cessation, please call 330-397-6007.

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