Smokers Jessica Hammond and her husband went cold turkey for Lent in 2006. He hung in for about six months; she stayed smoke free through the birth of the Damascus, Md., couple's first child in February. But last July, when her father suddenly became ill and died, the 26-year-old, who started her daily half-pack habit as a college freshman, lost her resolve. Breaks from the hospital bedside vigil meant going outside with family members who would promptly light up. "My breath of fresh air was their cigarette smoke," says Hammond, who joined them. Motivated by her baby daughter, she intends to try again this year: "It's such a nasty habit," she says. "I want to quit now before Amaya even recognizes what a cigarette is."
At any age, quitting can avert or blunt myriad health hazards and might avoid heartache for would-be parents—smoking can hamper conception in women and reduce sperm count in men. The earlier a smoker grinds out that last cigarette, the greater the gain. Male doctors who ditched the habit before age 35 had nearly the same life expectancy as did a matched group of physicians who never picked it up, according to a 2004 study in the British Medical Journal.
But most smokers know perfectly well they should quit, and 7 out of 10 say they want to. The challenge is how to break free of nicotine's suffocating grip for good. Just 2 to 4 percent of those who try are smoke free—with no slip-ups—a year later.
Pure willpower is the usual strategy, says Douglas Jorenby, director of clinical services at the University of Wisconsin's Center for Tobacco Research and Intervention, and it rarely works. "Tobacco dependence is a chronic disease," he says, so over the long term, "the odds are very great that you'll relapse."
Addictive potential. Most experts agree that smoking is a drug habit with a tenacious clutch. "It's about the same as heroin," says Ivan Montoya, an addiction expert at the National Institute on Drug Abuse. And nicotine, unlike heroin, is legal, available everywhere, promoted by billion-dollar marketing campaigns, and associated with enjoyable—and still widely accepted—social behavior.
That's why smokers need help, says Jorenby. The 2008 federal guidelines for treating tobacco use and dependence strongly recommend tools known to help smokers change their puffing ways, including medications that decrease the craving for nicotine, dampen the reward felt from smoking, or both. But only 22 percent of those attempting to quit try medication.
A vaccine that discourages backsliding could be one answer. Montoya has been a medical officer for NIDA-funded clinical trials of such an inoculation. The idea is to spur the body to make antibodies that latch on to nicotine molecules, which are then too big to cross the blood-brain barrier—thus never reaching the brain's pleasure centers. Montoya says the vaccine won't be available for at least two or three years.
But even effective drugs can overcome only part of the problem. Rituals are hard to break, and smoking is entangled with many of them. Andrea Hommen enjoyed them all—the flick of the lighter, bonding with a coworker over drags. "I loved smoking," says the nurse's assistant from Madison, Wis. "I still miss it." A pack-a-day smoker for 15 years, Hommen, 36, made many unsuccessful efforts to undo her habit—with the nicotine patch, lozenges, and nasal spray, all of which deliver nicotine at a lower dose and slower rate than cigarettes.
Then, in May 2007, Hommen tried Chantix, which she got free through her employer's smoking-cessation program. The drug does not contain nicotine. It works by diminishing cravings and withdrawal symptoms and by dulling the pleasure if a cigarette is smoked. Its success at keeping smokers off cigarettes for six months is about 70 percent—around 20 percentage points better than a placebo.
Transformed. But breaking with nicotine can be hellish. The initial period without her smokes was "probably the worst five days of my life," says Hommen. She called in sick with flulike symptoms. Nausea, a common side effect of the drug, lasted the entire five weeks she took it. Nor is Chantix completely safe. Earlier this year, the Food and Drug Administration issued a warning that Chantix can worsen existing psychiatric illness or cause anxiety, depression, or suicidal thoughts. The FDA advised careful monitoring by a physician. But Hommen had none of those problems, and the drug helped her begin a transformation from smoker to triathlete.