Two women sitting on a couch and one is breaking a cigarette in half. Two women sitting on a couch and one is breaking a cigarette in half. Two women sitting on a couch and one is breaking a cigarette in half.

Quitting chewing tobacco

So, you are a dipper and you'd like to quit. Maybe you have already found that quitting dip or chew is not easy, but you can do it! We want to help you make your own plan for quitting. Quitting smokeless tobacco is a lot like quitting smoking. Both involve tobacco products that contain addictive nicotine, and both involve the physical, mental and emotional parts of addiction. There’s no one right way to quit, but there are some important things that need to get done. It's important to develop your own recipe for willpower. Some key steps for quitting are covered here. This guidance is the result of advice from chewers and dippers who have canned the habit.

Dip, chew, snuff, snus, chaw, twist — there are many names for smokeless tobacco products. Note that we also call it spit tobacco, instead of smokeless tobacco, because it is a harmful habit. Smokeless tobacco is the term preferred by the tobacco industry. It makes the products sound safe; they aren't.

The dangers of dip and chew

You probably know some of the health-related reasons to quit, but you must find your own personal reasons for quitting. They can motivate you more than the fear of health consequences. Health risks should be a big motivator, however. Here are some of the dangers:               

  • It’s addictive — nicotine is absorbed through the mouth tissues directly into the blood, where it goes to the brain. There is higher concentration of nicotine in smokeless products than in cigarettes.
  • Holding an average-size dip in your mouth for 30 minutes gives you as much nicotine as smoking three cigarettes. A two-can-a-week snuff dipper gets as much nicotine as a 1-1/2-pack-a-day smoker does.
  • At least 28 chemicals in smokeless tobacco have been found to cause cancer, and smokeless tobacco specifically has been found to cause oral cancer, esophageal cancer and pancreatic cancer.
  • Chewing tobacco speeds up your heart rate and increases your blood pressure. This then increases your chances of heart problems and circulatory diseases.
  • Sugar in spit tobacco causes decay in exposed tooth roots.
  • Dip and chew can cause your gums to pull away from the teeth in the place where the tobacco is held. The gums do not grow back.
  • Leathery white patches, called leukoplakia, are common in dippers and chewers and can turn into cancer.
  • Oral cancer is one of the toughest cancers to treat. Surgery needed to treat oral cancer is often difficult and disfiguring. The disease can spread quickly. On average, only half of those with mouth cancer will survive more than five years.

Possible signs & symptoms of oral cancer

  • A sore, irritation, lump or thick patch in your mouth, lip or throat
  • A white or red patch in your mouth
  • A feeling that something is caught in your throat
  • Difficulty chewing or swallowing
  • Trouble moving your jaw or tongue
  • Numbness in your tongue or other areas of your mouth
  • Swelling of your jaw that causes dentures to fit poorly or become uncomfortable
  • Pain in one ear without hearing loss
  • Be on the lookout for any change

Setting goals and preparing to quit

Are you ready to make a serious try at quitting? Kicking the spit or chew habit can be tough, but it can be done, and you can do it. The best way to quit spit tobacco is to have a quit date and plan. These methods make it easier. Try what you think will work best for you. Once you decide to quit:

  • Pick your quit date, but don’t wait longer than a month and make a strong personal commitment to keep it. You may get psyched up for quitting by tapering down before you quit, but on your quit date —quit! Not even a pinch!
  • Know your reasons for stopping. You have to want to quit to make it through those first few weeks off tobacco. Don't let outside influences or peer pressure get in your way.
  • Focus on all you don't like about dipping and chewing. Do you really believe that the benefits of quitting outweigh the benefits of continuing to use tobacco?
  • Support should be a key part of your plan. Web-based quit programs, telephone quit lines, Nicotine Anonymous meetings, self-help materials, such as books and pamphlets, and quit counselors can be a great support. Also tell your family, friends and co-workers that you are quitting. They can give you help and encouragement, which increases your chances of quitting for good.
  • Talk to your physician or dentist for advice and assistance. Nicotine replacement gums, lozenges or prescription drugs may be helpful.
  • There is no "ideal" time to quit, but low-stress times are best. Having a quit date in mind is important, no matter how far off it is. But it's best to pick a date in the next month, so you don't put it off too long.

Cut back before you quit dip

Some people are able to quit spit tobacco "cold turkey." Others find that cutting back makes quitting easier. There are many ways to cut back:

  • Taper down. If you usually carry your tin or pouch with you, try leaving it behind, as you try scaling back to half of your usual amount before you quit. Carry substitutes instead, like sugar-free chewing gum, hard candies or sunflower seeds. During this period, you might also try a mint-leaf snuff.
  • Cut back on when and where you dip or chew. Notice when your cravings are strongest. What events trigger dipping or chewing for you? Go as long as you possibly can without giving into a craving, at least 10 minutes. Try to go longer and longer as you approach your quit day. Now, pick three of your strongest triggers and stop dipping or chewing at those times.
  • Notice what friends and co-workers who don't dip or chew are doing at these times. This will give you ideas for dip or chew substitutes. It's a good idea to avoid your dipping and chewing pals while you are trying to quit. That will help you avoid the urge to reach for a can or chew.
  • Switch to lower nicotine snuff. This way, you cut down your nicotine dose while you are getting ready to quit. This can help to prevent strong withdrawal, when you quit.
  • Don't switch to other tobacco products like cigarettes or cigars! In fact, if you already smoke, this is a good time to quit smoking. That way you can get over all your nicotine addiction at once. Talk to your physician or dentist about nicotine substitutes. (List some types of forms of options of these substitutes without name brand names.)

Tips to help you quit chew

  • Make your quit day special right from the beginning. You are doing yourself a huge favor.
  • Change daily routines to break away from tobacco triggers. When you eat breakfast, don't sit in the usual place at the kitchen table. Get right up from the table after meals.
  • Make an appointment to get your teeth cleaned. You will enjoy the fresh, clean feeling and a whiter smile.
  • Keep busy and active. Start the day with a walk, run, swim or workout. Aerobic exercise will help you relax. Plus, it boosts energy, stamina and all-around fitness and curbs your appetite.
  • Chew substitutes. Try sugar-free hard candies, cinnamon sticks, gum, mints, or sunflower seeds. Carry them with you and use them whenever you have the urge to dip or chew.

Nicotine withdrawal

Withdrawal symptoms don't last long. Symptoms are strongest the first week after you quit. The worst part is over after two weeks. After a month, you will feel better than when you dipped or chewed. Symptoms of nicotine withdrawal include:

  • Cravings and urges to dip, especially in the places you used to dip the most
  • Feeling irritable, tense, restless, impatient or angry
  • Anxiety and/or depression
  • Constipation/irregularity
  • Hunger and weight gain
  • Desire for sweets
  • Headaches

What can I do about withdrawal symptoms?

  • Remember they will pass
  • Avoid situations and people that you associate with chewing
  • Chew on carrots, apples, celery or sugar-free gum, as alternatives to dip
  • Practice deep breathing and relaxation techniques
  • Ask your doctor about nicotine replacement products

What can I do about weight gain?

Nicotine speeds up metabolism, so quitting spit tobacco may result in a slight weight gain. Dippers usually gain fewer than 10 pounds after quitting. To limit the amount of weight you gain, try the following:

  • Eat well-balanced meals and avoid fatty foods
  • Consume small pieces of fruit to satisfy your cravings for sweets
  • Keep low-calorie foods handy for snacks; consider trying popcorn, sugar-free gums and mints, and fresh fruits and vegetables
  • Drink 6 to 8 glasses of water each day
  • Work about 30 minutes of daily exercise into your routine

What can I do about depression and anxiety?

Depression and anxiety are common nicotine withdrawal symptoms that will subside after two weeks. You may feel unusually sad and lethargic or agitated and tense. Here are some tips for dealing with anxiety and depression while you are quitting:

  • Identify events, places and activities that cause depression and anxiety. What about those things makes you feel anxious or depressed? Address these issues.
  • Spend time with a friend or loved one
  • Spend time in a quiet, relaxing environment
  • Reduce caffeine intake
  • Exercise to lift your mood and lower anxiety
  • Practice relaxation techniques like deep breathing, yoga or meditation
  • If anxiety or depression persists for more than a month, contact your doctor. They can offer information about prescription medications or other interventions that can help you cope with these symptoms.

Know your triggers

In addition to physical symptoms of nicotine withdrawal, people, places and activities in your daily life may trigger an urge to dip. Triggers can be anything that ignites an urge to use chew. Knowing your triggers in advance can help you make coping plans for when you encounter them. Triggers may include:

  • Being in places where you dipped or chewed the most
  • Being around other people who dip
  • Stress or boredom
  • Drinking coffee or alcohol
  • Starting the day

Dealing with triggers

Anyone quitting chew is best equipped to deal with their triggers when they know what they are. Here are some tips for identifying and beating your triggers:

  • Write down events, situations and people who might trigger you. Create a plan for how you will navigate them ahead of time.
  • Create a list of things you can do when you feel a strong urge to chew. This may include going for a walk, chewing gum, brushing your teeth, or having a healthy snack.
  • Avoid alcohol, a common trigger for tobacco quitters

What about tobacco cessation medications?

There are many types of medications used to help people quit tobacco. Some of these medications provide nicotine to help you slowly reduce the nicotine level in your body when you quit. These medications, called Nicotine replacement therapy (NRT), will reduce your cravings for nicotine and help withdrawal symptoms. These include gum, lozenges and patches, which are available over the counter, and nasal sprays and inhalers, which must be prescribed. There are also two prescription FDA-approved medications, bupropion (Zyban®, Wellbutrin®) and varenicline (CHANTIX®), that do not contain nicotine but can help reduce your nicotine cravings. Most of the research on these medications is related to smoking cessation, however, there is some evidence of effectiveness for smokeless tobacco cessation. Before you decide to include any medications in your plan, talk to your physician or dentist. With a growing number of options available, doctors are now able to create personalized treatment plans tailored to an individual tobacco user’s needs and preferences.

 

 

Sources:

Making a Plan to Quit Smokeless Tobacco. American Cancer Society. 2017 https://www.cancer.org/healthy/stay-away-from-tobacco/guide-quitting-smoking/deciding-to-quit-smokeless-tobacco-and-making-a-plan.html  Accessed July 2018.

Smokeless Tobacco Use and the Risk of Head and Neck Cancer: Pooled Analysis of US Studies in the INHANCE Consortium

 Wyss AB, Hashibe M,  Lee YCA, Chuang SC, et.al. Am J Epidemiol. 2016 Nov 15; 184(10): 703–716.

Ways to help people stop using smokeless tobacco (including chewing tobacco, snuff and snus). Ebbert JO,  Elrashidi MY, Stead LF. Cochrane Collaboration. 2015 https://www.cochrane.org/CD004306/TOBACCO_ways-help-people-stop-using-smokeless-tobacco-including-chewing-tobacco-snuff-and-snus  Accessed July 2018.

Use of Varenicline in Smokeless Tobacco Cessation: A Systematic Review and Meta-Analysis. Schwartz J, Fadahunsi O, Hingorani R et. Al. Nicotine Tob Res. 2016 Jan;18(1):10-6.

Association of Noncigarette Tobacco Product Use With Future Cigarette Smoking Among Youth in the Population Assessment of Tobacco and Health (PATH) Study, 2013-2015. Watkins SL, Glantz SA, Chaffee BW. JAMA Pediatr. 2018;172(2):181–187.

U.S. government programs sponsored by the National Institutes of Health. National Cancer Institute. U.S. Veteran’s Administration: 

Smokeless Tobacco A Verteran’s Guide for Quitting. U.S. Department of Veterans Affairs – 2017. https://www.publichealth.va.gov/docs/smoking/Smokeless_Tobacco_A_Guide_for_Quitting_Workbook_508.pdf  Accessed July 2018.

Tobacco Quitline: Call 1-855-QUIT-VET (1-855-784-8838) to talk with a trained counselor who can help you come up with a quite plan that work for your life. He or she can also give you support to stay smoke free. 

How to Quit Smokeless Tobacco. Smoke free vet. National Cancer Institute. Accessed July 2018. https://smokefree.gov/veterans/quit-smokeless-tobacco/how-quit-smokeless-tobacco

Explore Quit Methods. National Cancer Institute.  https://smokefree.gov/explore-quit-methods-no-js  Accessed July 2018.

Telephone counseling and support is available for free by calling 1-800-QUIT-NOW.

Internet based quitting programs: Available online at http://smokefree.gov, http://women.smokefree.gov, http://teen.smokefree.gov, and http://espanol.smokefree.gov

Ways to help people stop using smokeless tobacco (including chewing tobacco, snuff and snus). Ebbert JO,  Elrashidi MY, Stead LF. Cochrane Collaboration. 2015 https://www.cochrane.org/CD004306/TOBACCO_ways-help-people-stop-using-smokeless-tobacco-including-chewing-tobacco-snuff-and-snus  Accessed July 2018.

Use of Varenicline in Smokeless Tobacco Cessation: A Systematic Review and Meta-Analysis. Schwartz J, Fadahunsi O, Hingorani R et. Al. Nicotine Tob Res. 2016 Jan;18(1):10-6.

Association of Noncigarette Tobacco Product Use With Future Cigarette Smoking Among Youth in the Population Assessment of Tobacco and Health (PATH) Study, 2013-2015. Watkins SL, Glantz SA, Chaffee BW. JAMA Pediatr. 2018;172(2):181–187.

U.S. government programs sponsored by the National Institutes of Health. National Cancer Institute. U.S. Veteran’s Administration: 

Smokeless Tobacco A Verteran’s Guide for Quitting. U.S. Department of Veterans Affairs – 2017. https://www.publichealth.va.gov/docs/smoking/Smokeless_Tobacco_A_Guide_for_Quitting_Workbook_508.pdf  Accessed July 2018.

Tobacco Quitline: Call 1-855-QUIT-VET (1-855-784-8838) to talk with a trained counselor who can help you come up with a quite plan that work for your life. He or she can also give you support to stay smoke free. 

How to Quit Smokeless Tobacco. Smoke free vet. National Cancer Institute. Accessed July 2018. https://smokefree.gov/veterans/quit-smokeless-tobacco/how-quit-smokeless-tobacco

Explore Quit Methods. National Cancer Institute.  https://smokefree.gov/explore-quit-methods-no-js  Accessed July 2018.

Telephone counseling and support is available for free by calling 1-800-QUIT-NOW.

Internet based quitting programs: Available online at http://smokefree.gov, http://women.smokefree.gov, http://teen.smokefree.gov, and http://espanol.smokefree.gov

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