Q. I've been trying to quit smoking. Why is it so difficult to quit, and can you recommend any natural methods to help me?

A. As a smoker, you may feel ostracized these days. Once considered socially acceptable, even sophisticated, smoking has become just the opposite and is banned in many public places.

We know smoking contributes to lung cancer, but it's also a major risk factor in heart disease and strokes. According to the American Lung Association, every year smoking-related diseases claim about 430,700 lives and cost the United States approximately $97.2 billion in healthcare costs and lost productivity.

Secondhand smoke has been classified by the Environmental Protection Agency as a known human carcinogen, responsible for roughly 3,000 lung cancer deaths in nonsmokers annually. Most smokers get hooked before they're 21 years old, in part due to targeted advertising by tobacco companies.

Although we know how unhealthy smoking is, smokers find it difficult to quit because of nicotine, the addictive drug in cigarettes. It has been estimated that people who smoke try to quit at least 12 times before they succeed.

Nicotine mimics the effects of a nerve chemical, acetylcholine, which acts on the nervous system and imparts a feeling of alertness and wellness. It also increases the flow of another nerve chemical, dopamine, which creates pleasurable feelings and a craving to keep nicotine in the blood stream. When people withdraw from nicotine they experience sleeping problems, brain-wave disturbances, depression, anxiety and changes in heart rate and blood pressure.

Some people use nicotine-containing patches and gums to help them kick the habit, but a combination of acupuncture and herbal medicine can be highly effective.

A study published in Preventive Medicine in 2001 found that acupuncture treatments can help smokers quit by affecting their taste of tobacco and desire to smoke. Another study, published in the American Journal of Public Health in 2002, found that acupuncture combined with education on smoking cessation significantly reduced smoking.

The herb St. John's wort can help people quit smoking because of its antidepressant effects, according to a British study published in The Pharmaceutical Journal in 2000. The recommended dose is 300 milligrams (containing .3 percent hypericin) three times daily. Nicotine withdrawal induces depression in some people, but St. John's wort acts as a natural antidepressant, enhancing critical neurotransmitters in the brain. (Note: St. John's wort should not be taken with certain prescription medications. Consult your physician before taking.)

Laurie Steelsmith is a naturopathic physician, licensed acupuncturist, and author of "Natural Choices for Women's Health" (Three Rivers, 2005). Reach her and read her past columns at www.drsteelsmith.com. This column is for information only. Consult your health provider for medical advice.