Research suggests that pairing medication with group, individual, or telephone counseling can boost abstinence rates by 40 to 70 percent over using either one alone. The 2008 guidelines recommend four or more counseling sessions of at least 10 minutes each; the longer and more intense the counseling, the better the result. Emphysema patient Wesley Derey, 59, smoked two packs a day for more than 40 years, losing precious lung function. But 30 days of Chantix and many calls from several smoking cessation telephone services have kept him smoke free for more than six months. Every state now has a free telephone quit-line, accessible by calling 1-800-QUIT-NOW.
There are other weapons in the quitter's arsenal. "I think the most important thing people can do is change the social environment," says Stanton Glantz, director of the Center for Tobacco Control Research and Education at the University of CaliforniaSan Francisco. Two of Hommen's smoking buddies—her husband and a sister—quit with Chantix several months after she did, buttressing her with solidarity and support.
Hommen also set physical and athletic goals, such as tackling the Chicago marathon later this year. Running and cycling got her away from a social environment steeped in the cigarette smoke of family, friends, and coworkers. In vulnerable moments, reminding herself of these goals dulls the pangs, she says. In a 2008 review of various studies by the Cochrane Collaboration, exercise was shown to reduce the desire to light up and ease psychological withdrawal, and it may improve quitters' perception of their coping abilities and their self-esteem.
Road rage. Patients need to recognize the thoughts or behaviors that trigger that conditioned reach for a cigarette, says Jorenby—sipping the morning coffee, walking the dog, feeling sad or stressed. Individualized distractions to overcome specific urges can help break the cycle. One of Jorenby's patients smoked only in his car. The distraction that worked for him was to yell at what he called an "all idiots, all the time" talk radio station.
Even a faceless online peer network can be effective. Logging onto the American Lung Association's Freedom From Smoking message board is what finally worked for Heidi Norie, a 46-year-old mother of three from Vista, Calif. Having smoked for 30 years—at times more than two packs a day—she has been an ex-smoker since March of 2008. "When you're jonesing like crazy, there's almost always somebody there," she says. She recalls once typing "I don't think I can do this" with tears streaming down her face. The 15 posts she received in response got her through the moment. Norie also used Chantix for six weeks to help her quit, but she says, "I attribute my success more to the program than the medicine."
Now, Norie fights complacency, aware that smoking alters the brain—by developing more nicotine receptor sites, for example—which makes relapse a lifelong possibility. Recently, she says, two longtime ex-smokers returned to the message board because they had started up again. "They had moved on and stepped away from the board," Norie says. "It's scary." So, she visits her peers daily—often late at night if she can't sleep—to encourage newbies who are struggling. And to remind herself how far she's come.