LIKE many ex-smokers, Tonya Guess, 33, of Chesapeake, Va., tried just about everything to quit. There were hundreds of nicotine patches, an online support group, a prescription for an antidepressant and another prescription for Chantix, a drug that helps quell nicotine cravings.  Luke Sharrett/The New York Times  Thomas Glynn is the director of cancer science and trends and director of international cancer control at the American Cancer Society.  Jim Wilson/The New York Times  Studies indicate that at any one time at least one-third of smokers want to quit, especially around this time of year when New Year’s resolutions are still fresh.  Finally, after several false starts, a long period of quitting with a relapse, and a new baby daughter, Ms. Guess quit again. She has not smoked for two years. “I’m so relieved,” Ms. Guess said. “It’s so great to be free and not be controlled by cigarettes anymore.”  Another thing Ms. Guess was relieved about: Her insurance paid for most of her quit-smoking aids. “It can really add up,” she said. “Fourteen patches used to cost as much as $40.”  Indeed, experts say, sometimes the costs associated with smoking cessation can provide their own psychological barrier to quitting.  There are 45 million adult smokers in the United States, but even more  47 million  former smokers, according to Cheryl Healton, chief executive of the American Legacy Foundation, an antismoking, nonprofit group financed by tobacco litigation settlement money.  Studies indicate that at any one time at least one-third of smokers want to quit, especially around this time of year, when New Year’s resolutions are still fresh.  And yet, it takes most smokers eight to 11 tries to quit for good, Ms. Healton says. Paying for treatments that may not work or aren’t right for you in the first place only adds to the frustration. “It’s a form of denial, but often smokers will balk at the upfront cost of quitting and say ‘forget it,’ ” Ms. Healton said.  So this column is meant to help you, or a smoker close to you, sort through the options for quitting. And look at it this way: No matter what you spend, it will probably never add up to more than the cost of continuing to smoke.  “If you’re paying about 10 bucks a day for a pack of cigarettes in New York City, that adds up to about $6,000 over two years,” said Thomas Glynn, director of cancer science and trends at the American Cancer Society. “You could check yourself into the in-patient program at Mayo Clinic for that.”  And that doesn’t begin to count the extra health care costs of smoking.  WHAT’S RIGHT FOR YOU? If you are intent on giving up smoking, evidence suggests that a combination of mood-altering drugs, nicotine replacement therapy and counseling can be three times as effective as simply trying to go cold turkey.  But there is an overwhelming range of no-smoking products and treatments, so it’s important to figure out what might work best for each individual. To learn more about your options, call your state’s toll-free telephone quit line. (To find the number in your state, log onto the North American Quitline Consortium map at www.naquitline.net.)  In most states a counselor will ask you a series of questions, like “How much do you smoke?” and “What are your five favorite cigarettes of the day?” The aim is to help determine what type of smoker you are and what regimen will best help you quit.  You’ll learn, for instance, about the various nicotine replacement products, which experts say are crucial to successful smoking-cessation efforts.  Nicotine patches, gums and lozenges are all available over the counter. Nicotine nasal sprays and inhalers, both of which deliver nicotine to your system faster than the other methods, are available by prescription only. But at a cost of about $400 a month, inhalers are considerably more expensive than other nicotine replacement products.  Nicotine patches work best for someone looking for convenience  you put them on once a day.  Nicotine gum, lozenges, sprays and inhalers work better for smokers who want to control when they get that “hit” of nicotine  after dinner, for instance, or during a coffee break. Sometimes, heavy smokers with serious cravings will need to supplement the patch with gum or a lozenge during particularly tough moments.  The counselor will also talk to you about prescription medicines. Several antidepressants are now commonly prescribed “off label” to smokers to help them deal with the irritability and anxiety that nicotine withdrawal can cause. Chantix, a newer drug that reduces nicotine cravings and which Ms. Guess used successfully, is also available by prescription.  CHECK WITH YOUR DOCTOR Once you get guidance from a smoking-cessation counselor, you’ll need to check with your doctor for more advice on what type of stop-smoking method will work best with your general health. Some of the prescription drugs, for instance, may not be right for you if you have health problems.  And the Food and Drug Administration last year warned that patients taking Chantix or Zyban, a smoking-cessation form of the antidepressant Wellbutrin, should be watched for signs of potential mental problems. But the agency said those concerns should not stop people from trying the drugs.  Mr. Glynn says it’s a matter of proceeding with caution, “The percentage of patients who experience extreme symptoms is minuscule,” he said. “Still, patients taking these drugs must be carefully monitored.”  Even the nicotine replacement therapies have side effects that you should discuss with your doctor.  BEWARE THE UNPROVEN “Everyone knows someone who went to the hypnotist or the acupuncturist and never smoked again,” Mr. Glynn said. And for those people, for whatever reason, it really did work, he added.  But there is little hard clinical data to suggest that either acupuncture or hypnosis is an effective way to help quit smoking, he said. And they are costly; single sessions can cost $100 or more.  Electronic cigarettes, which dispense nicotine and mimic the act of smoking, are not approved by the F.D.A. Worse, some have been found to emit harmful toxins. Mr. Glynn advises staying away from these gizmos.  Also watch out for expensive smoking-cessation programs that administer drugs or make promises that are too good to be true. “Often, these are fly-by-night operators,” Mr. Glynn said.  With any tobacco-cessation program, always ask for details about success rates. For instance, is a person considered a success if they have quit smoking by the end of the program? Six months afterward? A year? For more details on smoking-cessation methods, including the pros and cons, see the American Cancer Society’s Guide for Quitting Smoking at www.cancer.org.  CHECK YOUR INSURANCE For Ms. Guess, the fact that her insurance covered much of the cost of her smoking-cessation regimen definitely contributed to her success, she says.  Many insurers are willing to cover the therapies for obvious reasons: nonsmokers file far fewer medical claims than smokers. It’s always a good idea to read your policy carefully to find out what your insurer offers.  LOOK FOR DISCOUNTS If you decide on a regimen that includes over-the-counter nicotine replacements, be sure to check Wal-Mart, Costco and other big discounters. They often offer patches and other products for significantly less than pharmacies and drugstore chains.  USE SUPPORT GROUPS Sometimes nothing can substitute for good old-fashioned support, Ms. Guess said. “The combination of support and medicine is what finally worked for me,” she added.  Ms. Guess used Mary Quits, one of the many online support groups. Others include the American Lung Association’s Freedom from Smoking Online and becomeanex.org, which the American Legacy Foundations helps sponsor. Another is Quitnet.com.  Your local hospital, or a local chapter of the American Cancer Society or American Lung Association may also sponsor free in-person support group meetings in your area. Check with your doctor’s office for more information. Or, try a local Nicotine Anonymous group.  And always check with your employer’s human resources department. Big companies often sponsor on-site groups to help employees stop smoking.
Another new year, another resolution to stop smoking. Here are a variety of options to help smokers quit.