No one says that quitting tobacco is easy. But if you smoke and want to quit, you can draw on more sources of help than ever before.

According to the American Lung Association, over 44 million Americans have quit. Most of them tried several times before they succeeded. But they quit for good.

Dr. Michael Fiore, director of the Center for Tobacco Research and Intervention at the University of Wisconsin Medical School in Madison, has treated more than 5,000 smokers who want to quit. That experience, he says, made him "acutely aware of both the powerfully addictive nature of tobacco and the enormous differences among people who smoke and want to quit."

Even so, the range of medical treatments and self-help strategies has increased over the last five years. Fiore headed an expert panel that summarized those options in "Treating Tobacco Use and Dependence," the most recent clinical guidelines for health care professionals.

Among the options are nicotine replacement therapies -- ways to deliver carefully controlled doses of nicotine that take the edge off cravings. These come in the form of nicotine sprays, gums, patches and inhalers. Other medications -- including bupropion (Zyban), an antidepressant -- can help you manage mood changes that come with quitting.

Be sure to support medication with counseling. Quitting tobacco means learning a host of new skills, such as coping with stress and the cravings to smoke. Counseling offers a way to acquire those skills. According to the recent clinical guidelines, the more counseling you have, the better your chances of quitting.

You can also learn those skills in a group setting, along with other people who are trying to quit. Examples include stop-smoking classes from the American Cancer Society and American Lung Association. Your doctor can recommend others as well, such as Nicotine Anonymous, a fellowship of men and women helping each other to live free of nicotine. NA is a mutual-help group that uses the Twelve Steps as a foundation for recovery.

The most intense form of help for smokers is a residential treatment program. Only a handful of these exist, including a seven-day Your Next Step program offered by Hazelden; an eight-day program from the Mayo Clinic's Nicotine Dependence Center in Rochester, Minn.; and the Nicotine Addiction Program at St. Helena's Hospital in Deer Park, Calif.

Outpatient tobacco recovery programs are an option as well. Yet there's evidence that residential programs -- where participants live together in a retreat setting -- offer a greater benefit.

A study at Mayo's Nicotine Dependence Center found that 45 percent of people treated in its residential program were tobacco-free one year after treatment. In contrast, only 23 percent of outpatients managed to abstain during that period. "The most important factor that accounts for the more favorable outcomes for the residential group was the intensity of the inpatient intervention," said Dr. Richard Hurt, head of the center.

Barry McMillen, director of Nicotine Dependence Treatment Services at Hazelden, notes a unique feature of Hazelden's Your Next Step program: It does not provide nicotine replacement therapy. "Our thinking is that we have seven days to get people off nicotine and develop strategies to remain tobacco-free for the rest of their life," said McMillen. "If they use nicotine replacement, then theyre going to walk out of here still addicted to the drug."

McMillens comment echoes the Twelve Step philosophy of Nicotine Anonymous, the basis of Hazelden's program. Drugs such as alcohol and tobacco are "cunning, baffling, and powerful." In the end, you either use a drug or you don't. Total abstinence offers the best prospect for staying tobacco-free.

For information about ways to quit tobacco, contact the:

• American Heart Association, (800) 242-8721, http://www.americanheart.org/
• American Cancer Society, (800) 320-3333, http://www.cancer.org/
• American Lung Association, (800) 586-4872, http://www.lungusa.org/
• National Cancer Institute, (800) 422-6237, http://www.nci.nih.gov/
• Nicotine Anonymous, (415) 750-0328, http://www.nicotine-anonymous.org/

--Published November 19, 2001