DR. JAMIE OSTROFF, MEMORIAL SLOAN KETTERING CANCER CENTER, ON ADDICTION AND OVERCOMING IT:

Addiction is a complex behavioral and physical process of which people become dependent on smoking.

Addiction is sort of the medical term or is a complex term that we use for when you feel like you have to smoke, that you're hooked; and we know that it involves both psychological and biological factors that explain addiction. We know that one of the many chemicals that are in cigarettes is nicotine. And we know that nicotine is a dependent producing chemical. Nicotine is a drug and it's one of the many chemicals in tobacco smoke. Essentially when you're addicted to cigarette, you've kind of lost control.

Teen smoking has not been as well studied as it has for adult smoking. But what happens, when people report when they stop smoking abruptly, are a number of physical and emotional symptoms. The most common one is cravings. That feeling you've just got to have a cigarette. Some other common things have to do with being irritable, being in a bad mood, being easily frustrated or upset.

Having difficulty sleeping, having difficulty concentrating. And also changes and increased appetite and sometimes headaches and stomach upsets as well. So nicotine withdrawal is really very powerful. And which is why, when you stop smoking abruptly, teens often describe feeling crummy. In fact that is one of the things that cues them to go back and smoke more and more. To try to turn off that withdrawal which is really uncomfortable.

Yet the urge to smoke passes whether or not you smoke. Now it happens more, it happens frequently but it's absolutely true that that urge to smoke will pass whether you smoke. One of the things, though, that we recommend for people that are trying to quit, is not just to sort of be passive and sort of ride out that uncomfortable feeling. That's where some of the common strategies for dealing with cravings come in. So, for instance, chewing gum or hard candies or having a drink of water from a water bottle, those are some of the things that we know can help people have that craving at least pass more easily.

There's no one right way for everybody to quit but we know that there are some very helpful ways to be more comfortable. When you're in the midst of a craving and one of the easier ways to remember them is that there's 4 D's. So the first one is to distract yourself. If you're in a situation where you typically smoke, change your setting, hang with someone else, do something else. So the first D is distraction. The second one is to drink water ‘cause again it's a big substitute for smoking. Delay, as you said. Let it ride and pass. The craving will pass. One of the reasons why some kids smoke is to deal with stress. Deep breathing. Taking slow deep breaths is a really helpful way to have a craving pass, particularly, when it's in the situation where you're anxious about something. A test coming up or giving a concert, or a presentation or a sport event at school. If you find yourself in that kind of situation, you just take in slow deep breaths...will often help that craving to pass.

One of the physical effects of nicotine is that we know that it does have a calming influence…There are lots of healthy ways to deal with stress besides smoking. In fact, what happens is teenage smokers don't have as good an opportunity to learn really effective healthy ways of dealing with stress so they're less prepared for when they get to college or when they get to their first job. Because they've never really had to learn how to cope with stress, they've relied on smoking instead.

It's been shown that quitting takes practice and that, in fact, the first time you quit often you're not prepared for what you're gonna experience, both physically and psychologically. So the next time you're smarter...and you have an opportunity to be more prepared. So in fact quitting does take practice and you learn from each successive attempt until you get it right.

One of the ways to prepare is to set a goal and look at a calendar and think well, I'm gonna set my quit date and maybe I'm gonna cut down. If you're a daily smoker, maybe you want to cut down a cigarette or two a day, so that by the time your quit date comes, you've kind of cut them out and down to size, you've sort of cut the problem down to size a little bit. And you'll find it easier to quit and deal with withdrawal symptoms.

By the time a smoker is eighteen, 80 percent of them have tried to quit at least once, unfortunately set between 75 and 80 percent of those smokers resume.

Only 1 out of 3 teenagers quit smoking for good the first time. The rest need to be practicing and working on it until they get it right. The longer you wait to quit smoking the harder it'll be.

DR. WILLIAM CAHAN, MEMORIAL SLOAN-KETTERING CANCER CENTER, ON THE PHYSICAL ASPECTS OF SMOKING AND TOBACCO:

When the cigarette is lit and the tobacco is burned, hundreds of chemicals result. At least forty of which can cause cancer. So…the smoke carries these chemicals into their mouth. When you take a drag, it goes by your voice box, which is in your neck, into your main bronchial tubes and then out into your lungs. Now when it gets to the lung, it does several things. First of all, the ingredient called nicotine passes through the lung into the circulation, and it may either give somebody a stimulation that blood pressure goes up, that pulse rate goes up. And this is circulating in their blood. However all the chemicals also go through the lung and circulate in the blood, going to all parts of the body. Some of which are the arteries that go to the brain into your legs, into your heart, are narrowed by that particular process and it really is something that becomes almost a permanent part of you. So that later on in life it keeps adding certain amounts of, shall we say, plaques they call them. Little areas of thickening in the lung, in the arteries. And finally sometimes they close off. You get strokes, you get heartaches, you get all sorts of problems. Little droplets of tar are deposited and stay in the lung...they're the ones that cause the cancer.

Tar is one of the ingredients of the tobacco smoke. Tar is a phrase used because when tobacco burns, you get substances that are easily volatile, that go through the lung. But some of them, cigarette tar, connects. And it’s called tar because it looks like tar. That is the substance which when painted on the backs of animals repeatedly caused cancer on their skin. That was the original research done to show a connection between smoking and cancer. This is the cancer forming element in smoke...tar...the cigarette tar resulting from the burning of the tobacco.

The residue goes down through your mouth when you take a drag, passed your voice box. And some of it is deposited there, down your windpipe and out into your lungs and there it remains. And as it keeps repeating and repeating, it’s very much as if you were painting tar on the backs of the animals except you’re painting it on your own lungs or on your own voice-box....so you get cancers.

And there's so many that are related to smoking now. For example, there is one where the cancer passes from the mouth. Some of the deposits forms on the vocal cords and we get a cancer. An operation must be done to take out that larynx, which means that the person will forever have a hole in their neck where their windpipe, their voice box used to be. And they have to talk with a machine held along side of their neck, to make themselves audible. Now there are other cancers that go on besides the lung. Most often people think of it only in terms of the lung, but there is the larynx, the gullet, the kidney, the pancreas, the cervix, and the bladder…these are places that one gets cancer related to smoking.

Emphysema is a result of much scarring of the lung. The lungs are frequently irritated by the deposit of smoking. And there are little sacs around called alveoli from which you take carbon dioxide out of your system and breath oxygen in. You breath in, they open up, you breath out they contract. With frequent smoking, there's scarring of these little sacs, these little alveoli. As a result of it, they begin to stiffen; instead of being elastic they begin to get scarred and inelastic. They lose their ability to contract and expand as you breath. As a result, the carbon dioxide in your system doesn't get expelled and the oxygen doesn't get in and you begin to get shorter and shorter breath.

If you smoke, several things happen to you from the cosmetic point of view. The smell permeates your hair and your clothes. It also yellows your teeth; it yellows your finger where you hold the cigarette in your hand, and of course you get a lot of burn holes in your clothes from the ashes dropping on them. So we have really a messy arrangement and it certainly doesn't seem to be worthwhile and it certainly is not glamorous.

The expense of smoking. At the present rate let's say - two dollars and 25 cents. One pack a day. That amounts to almost nine hundred dollars a year. Can you imagine what you can do with nine hundred dollars for clothes, for bracelets, for going to shows, for taking athletic courses, for going to the theater, the opera, you name it. Nine hundred dollars. And that's every year. By the way, at which time you will end up in the hospital with the expenses of a doctor. But in the addition to which, if you took that money and you put it into a mutual fund each day at the current rate of interest, at the end of 65 years you will have 450 thousand dollars and you won't be in the hospital with an oxygen mask on your face.