One in five of Ireland's smokers plans to kick the habit next month.Dr Muiris Houston sets out the options for giving up

New Year is a time when many people contemplate giving up smoking. About 20 per cent of Irish smokers intend to quit next month, according to a recent survey, compared with 12 per cent of smokers in Britain and 11 per cent in Italy. That's double the number of Irish smokers who said they wanted to quit four years ago, suggesting that the imminent ban on smoking in pubs, hotels and restaurants is concentrating people's minds. Having, within the next eight weeks or so, to leave premises to smoke in the street is clearly being seen as antisocial option and a hassle that people can do without.

The ban was originally meant to start next week, of course. One of the good things about the delay in implementing it until late February or early March is that it lets smokers resolve to quit but then gives them a few weeks to work up to putting their pledge into practice. This enhances their chance of success, because of the psychological process they must first work through, and gives them an opportunity to deal with practical issues that could otherwise thwart their efforts later on.

Many smokers who intend to give up their habit next month will probably have tried about five previous times. Despite this, more than half of people planning to give up smoking say they will rely on will power alone. It does not have to be this difficult.

According to Dr Fenton Howell of ASH Ireland, the antismoking group, "it is worrying to see how many are still trying to quit cold turkey. Smokers should avail of help. Using nicotine-replacement therapy can double your chances of quitting successfully".

So what help is available if you would like to give up tobacco in the new year? And is there any evidence that one method is better than the next? Your options range from the orthodox - conventional medical and pharmacological - to the complementary in the form of hypnotherapy and acupuncture (see panels). Some methods, such as laser therapy, are relatively new and untried. Many books give advice, such as a new Irish one, called Write Way To Stop Smoking, by Joe Armstrong. Allen Carr's self-suggestive approach, which he describes in his book Packing It In The Easy Way, appears to have a good success rate, but it has yet to be subjected to the rigorous scientific review that others have.

Smoking is essentially an addiction. Nicotine, the drug involved, is comparable to cocaine and opiates in its ability to make people dependent on it. But quitting is possible, and about half of smokers have stopped for at least some time. Most relapses occur within three months of stopping smoking; 50 per cent of people relapse within the first two days, emphasising the need to choose a method that offers you support and follow-up within days rather than weeks of quitting.

You also have to face up to what is likely to happen once you stop smoking. You can expect to put on between 9 lbs and a stone. Anxiety, sleeplessness, irritability and an inability to concentrate are also all part of withdrawal. This is quite apart from the severe cravings for tobacco. A frequently asked question is whether it is better to quit gradually rather than abruptly. Most people do better with an abrupt attempt; having said that, it suits some personality types to take a slower approach.

Getting advice to quit smoking definitely works, whether the advice is given by doctors, counsellors or nurses. The more intensive the stop-smoking advice the better the results, although brief intervention techniques improve quitting rates when compared with going solo.

Interestingly, people at high risk of disease respond better to antismoking advice. In a Danish study of the effects of smoking cessation and surgery, it was found that people who quit smoking before surgery had fewer complications. In the experiment, patients waiting at least eight weeks for hip or knee surgery were divided into two groups, one of which received intensive smoking-cessation counselling and an offer of free nicotine-replacement therapy. The other group was offered no intervention.

When the patients were reassessed after surgery, those in the group that was encouraged to give up smoking before joint replacement had fewer wound-related complications and had to spend less time in the hospital's intensive care unit after their operations.

Dr Ann Moller, an anaesthetist at Bispebjerg University Hospital, in Copenhagen, where the research was carried out, says: "Patients found that impending surgery was a motivating factor to give up cigarettes." She suggests that GPs offer smoking-cessation advice when they refer patients for elective surgery (perhaps a somewhat utopian ideal in the Irish system).

Nicotine-replacement therapy involves taking nicotine in the form of chewing gum, a lozenge, an inhaler, a nasal spray or a skin patch. Research trials show that almost twice as many smokers were still off tobacco after six months compared with other quitters. The method of delivery does not affect the outcome, so feel free to choose the form that suits you.

How and when to stop nicotine- replacement therapy are important issues that you should discuss in detail with your doctor or nurse. Various strengths of therapy are available, for example, so you can wean yourself off gradually. Combining the therapy with cigarettes can result in nausea and palpitations.

Bupropion is an antidepressant that has been shown to increase the odds of quitting. You do not have to be depressed to choose this option. Its side effects include insomnia, dry mouth and nausea, however, and it is unsuitable for some people. Seizures have been reported in about one in 1,000 people taking the drug.

Acupuncture has been shown to help initially, but a systematic review of its effectiveness found no evidence that it helped people to stay off tobacco for more than a year. There is good evidence that hypnosis reduces anxiety and panic disorder, but there is as yet no scientific evidence for its efficacy in helping people to stop smoking.

To maximise your chances of success in giving up cigarettes it is probably a good idea to combine formal advice from a healthcare professional with nicotine-replacement therapy. Many people find that adding complementary treatment in the form of acupuncture or hypnotherapy increases initial success rates.

The Department of Health and Children, in conjunction with the Irish Cancer Society, runs a national "quitline", to promote smoking cessation. When you call the quitline you will be offered an advice pack; if you require more support you will be referred to a team of counsellors at the Irish Cancer Society. The number for the quitline is 1850-201203; it is open every day from 8 a.m. until 10 p.m.

With the smoking ban imminent the new year is an ideal time to think about stopping. Best of luck with your efforts.

Hypnotherapy

Hypnotherapy is a complementary therapy, not an alternative to seeking medical care. Suggestion hypno- therapy, one of two main forms, treats problems such as giving up smoking, weight control, bed wetting in children and pre-exam nerves.

"I had been smoking cigarettes since I was 13," says one 44-year-old mother of three who used it to quit. "I smoked 30 cigarettes a day, and cigarettes were really my thing, because I don't drink alcohol. I had tried giving them up with will power - which didn't work because I have no will power - and then using the Allen Carr method, a self-suggestive technique . . .

"When I went to the hypno- therapist I was aware of everything that was going on, although I was deeply relaxed. After the first session I thought it hadn't worked, but in fact I have never smoked since. The hypnotherapist asked me to throw my cigarettes in the bin after the session, which I did. I thought: this is a waste, because I will want a cigarette when I get to the car. I didn't. Then I thought: I will want one when I get home. I didn't.

"I listened to the tape the hypno- therapist gave me every morning and night for two weeks. I have had cravings, but they haven't lasted for long. Each time I think of smoking or see people smoking, the idea goes out of my mind soon afterwards. I went back for a second session, and for a long time I didn't believe I had given up. It was just too easy."

A number of doctors practise hypnotherapy. Ask your GP for a referral to a colleague with an expertise in smoking-cessation hypnosis or log on to www.icgp.ie for more information.

• Adapted from Test-Driving Complementary Therapies by Sylvia Thompson

Acupuncture

Deirdre Courtney, a Dublin-based acupuncturist, regularly treats people who are attempting to quit smoking.

"Acupuncture de-stresses the body," she says. "When a patient stops smoking they get uptight and suffer with anxiety and irritability. Acupuncture relieves these feelings, and it also helps prevent food craving."

Acupuncture is a branch of Chinese medicine that uses fine needles placed at specific points on nerve pathways.

Acupuncture for smoking cessation usually involves one treatment session a week for three weeks. Occasionally a fourth session is needed.

During the first consultation, the smoker is asked about his smoking history and the psychological aspects are discussed.

Courtney advises her clients not to broadcast the fact that they are quitting; in her experience this leads to added pressure in the form of repeated questioning about their progress.

She puts the acupuncture needles in the cleft and outer edge of the ear. She also gives clients studs to place in their ears for four days after the session. This continues the stimulation of the acupuncture points.

Courtney says that, in her experience, between 70 and 75 per cent of clients stop smoking after four weeks. The only side effect is occasional nausea from the studs.

• Deirdre Courtney (01-2835566) practises at the Priory Clinic in Stillorgan, Co Dublin

You Family Doctor

Most family doctors in the Republic are up to date on ways to help you stop smoking. They can therefore explain exactly what you need to do, offering far more than just a quick prescription for nicotine patches.

If you seek help from your GP, what should you expect? As you have approached the doctor, you have identified yourself as someone who is contemplating a lifestyle change.

The doctor will explore your beliefs about the risks of smoking and the benefits you are looking for by stopping, as well as trying to help you identify obstacles you see in your path.

One of the key decisions you will be helped to make is to set a suitable date to begin. It's probably best to avoid particularly stressful times, such as when you are involved in a major project at work or in the run-up to the anniversary of the death of a close family member. You must also work through the "danger times" ahead: going out for a drink, after meals and during tea breaks at work.

You can expect maximum support and motivation from your doctor and the practice nurse, including follow-up appointments and the offer of support if you are finding it hard going or if you relapse. You will be given information leaflets and offered relaxation tapes.

Nicotine-replacement therapy is now available in many forms (see main article). It has been proven to double your chance of success, so you will be offered a formulation of your choice. It is available free to medical-card holders.