Chris Cullen realized he was addicted to cigarettes when he found himself thinking about visiting a bar at 2 p.m., just so he could light up.

“I was a situational smoker,” explains Cullen, a former Navy pilot. “I told myself that the only time I would smoke was when I was enjoying a bottle of beer. But one day after leaving work around 2 in the afternoon, I saw a bar and thought seriously about going in. I didn’t want a beer; I wanted a cigarette. That’s when it occurred to me that this wasn’t my choice anymore—I was addicted on a cellular level and had been lying to myself. I realized then I had to get this addiction out of my system.”

Cullen, who is now vice president of Marketing, Communication, and Policy for the American Legacy Foundation, the organization behind the award-winning Truth anti-smoking campaign, decided to quit cold turkey—not an easy feat for a man who at one time had been a pack-a-day smoker. He admits to falling off the wagon a couple of times at the beginning, but now has been tobacco free for five years.

“At some point in your life people start to look up to you, whether it’s your younger siblings, your children, or maybe some friends,” Cullen says. “One of the reasons I quit was because I realized I was creating a poor example for the younger people in my life relative to smoking.”

Kicking the tobacco habit is one of the most common New Year’s resolutions—and one of the most difficult to keep, experts say. But it’s not impossible. With the right tools and a strong desire, you can quit cigarettes forever.

Health hazard

Despite nearly four decades of government warnings, an estimated 46 million Americans still smoke, according to Loretta Braxton, Ph.D., director of the Stop Smoking Clinic at the VA Medical Center (VAMC) in Durham, N.C. “That’s a lot, but the number has actually reduced by about 50 percent since 1965.”

The fact that many VAMCs now have smoking cessation clinics should come as no surprise considering the long relationship between smoking and military service. During World War I, for example, soldiers actually were encouraged to smoke because military officials found that soldiers in the trenches who smoked were more alert, says Dr. Amy Rosenthal, a primary care physician at the VAMC in Durham. And during World War II, cigarettes were a common part of soldiers’ kits, provided free by the government. After getting hooked on the battlefield, many World War II veterans continued to smoke when they returned home.

Before the 1960s, the dangers of smoking were seldom acknowledged and little reported. Today, however, tobacco’s many adverse health effects are well known—and provide good incentive to quit.

“The bottom line is that smoking has absolutely no redeeming properties,” says Braxton, a 12-year smoker who quit 20 years ago. “More than 400,000 people die from smoking-related health issues each year, and smoking is a major risk factor for several kinds of cancer as well as heart disease, lung disease, leukemia, erectile dysfunction, and even cataracts. Smoking is not just a lung issue—it affects every part of your body.”

And women who smoke face some unique issues, adds Braxton. They might find it more difficult to get pregnant, and those who continue to smoke during pregnancy run the risk of losing their baby or delivering a child with serious health issues, including low birth weight and an increased risk of sudden infant death syndrome.

Monkey on your back

Nicotine is addictive because it contains chemicals that stimulate pleasure centers in the brain—hence the so-called “smoker’s rush.” But tobacco affects everyone differently. For some, it’s a calming drug; for others, it acts as a stimulant.

There also are the social and emotional components of smoking, the pure habit of lighting a cigarette and pulling the smoke deep into your lungs. “For many people, smoking is like a friend,” Braxton says. “It’s there when you’re happy; it’s there when you’re sad. It’s one of the constants in a smoker’s life, and that’s why it’s often so difficult to stop.”

To be successful, a smoker must be motivated to quit, says Susan Zafarlotfi, Ph.D., clinical director of the Breath and Lung Institute at Hackensack University Medical Center in Hackensack, N.J. “You will be more successful if you truly want to quit than if you are doing so because your spouse has nagged you or forced an ultimatum,” she says. “Often you become a [closet] smoker, smoking in hiding away from your spouse.”

Sometimes, however, gentle encouragement from family members can prove helpful. Darren G. Boch, a public relations account executive in Parsippany, N.J., and a captain in the New Jersey Army National Guard, says he quit because his 5-year-old son begged him to. “He would say, ‘Daddy, please don’t smoke because I want you to live,’” Boch says. “So I quit more for my family than for myself. You need to think about those around you who love and depend upon you.”

Once motivated, smokers must make an honest assessment of the environments that trigger their urge to smoke, says Mark Ketterer, Ph.D., professor of psychiatry and neuroscience at Henry Ford Hospital in Detroit. “Typically people will say, ‘I smoke after a meal or I smoke in a bar.’ So for the first year they are trying to quit, I recommend that they don’t do that,” Ketterer says. “Rather than sitting at the table after a meal they need to get up and do something because the longer they sit there, the more difficult it will be to resist the urge to smoke.”

Ketterer also encourages his patients who want to quit smoking to go on a regimen of SSRI antidepressants in the weeks before they begin their smoking cessation program. “It makes people calmer, it helps them sleep, and studies have shown that antidepressants decrease the possibility of a relapse by about 30 percent,” he says.

Cessation aids such as nicotine gum, patches, nose sprays, and lozenges can be effective at curbing the inevitable symptoms of nicotine withdrawal, addiction experts say. Social support also helps, so try to enlist the aid of friends, family, and coworkers.

“Tell everyone to please bear with you if you’re a little grouchy because you’re quitting smoking,” Zafarlotfi says. “Also, tell your smoking buddies that you are trying to quit and ask them to respect that. People who are smokers often try to pull others into the pool, so it’s important to emphasize the seriousness of your commitment. I once treated a couple who had been married for 40 years, and the wife had to quit smoking because of health reasons. Her husband had great trouble coping with that. He used to put cigarettes in her hand and say, ‘Please smoke. I don’t want to do it by myself.’”

The least effective way to quit smoking, according to Ketterer, is going cold turkey. “It rarely works,” he states, noting that people who try to quit without assistance have a one-year cessation rate of just 6 percent.

Zafarlotfi reports much better success with a step-down approach that gradually reduces the number of cigarettes you smoke in a day until you no long smoke at all. As for the oral cravings, she recommends drinking lots of water; eating healthful snacks, such as carrot sticks, celery, or pretzels; and keeping a straw handy for those times when you simply have to have something in your mouth.

Most importantly, don’t become discouraged if you fail to quit the first time; the average smoker requires an average of six or seven attempts before succeeding, studies show. “It’s OK if you have a relapse,” says Zafarlotfi. “Just try again.”

Boch, who smoked for 21 years, says, “There’s no magic bullet. You just have to want to quit. If you don’t really want to, then don’t try. Wait until the desire is there or you’ll just end up a quitter at quitting.”