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July 9 2010

The Guilt-Free Guide to A Smoke-Free Life

Tom Ferguson, M.D.

Article Adapted from the book The No-Nag, No-Guilt, Do-It-Your-Own-Way Guide to Quitting Smoking

Finally a stop-smoking method that doesn’t nag, pressure, threaten or blame

Nonsmokers just don’t understand,” says one particular smoker. “I don’t need to be told smoking is bad for me. I know that. I don’t need to be told I ought to quit. What I need are some concrete, workable suggestions as to what my options are, support for the belief that I can do it, and lots of help when I do decide to make the final break.”

What follows is based on information gleaned from interviews with 200 health-concerned smokers conducted at the Center for Self-Care Studies in Austin, Texas. I started by asking what kinds of information the smokers would find most useful. I was astounded to find no one had ever thought to ask them that before.

Most of the smokers we interviewed told us if they could find a method that would make it possible for them to quit without experiencing the unpleasantness of withdrawal—while achieving the same or similar benefits of smoking—they would be much more likely to quit.

Here, then, is the solution those smokers asked for.

Why smokers smoke

“It’s like being in love with a man who’s no good. You know you’re a fool, but you just can’t help it.” anonymous smoker

Let’s imagine for a moment that scientists have just discovered a new drug that could:

  • Regulate moods.
  • Strengthen both attention and performance.
  • Help learning and memory.
  • Control anger and anxiety.
  • Reduce the effects of stress.
  • Dull the sensation of pain.
  • Provide a sense of control.
  • Produce a moderate state of euphoria.
  • Shed excess pounds—without dieting.

This may sound like a pharmaceutical company’s dream, but there is such a drug. In the United States alone users take well over 10 billion doses per day. The drug, of course, is nicotine.

Nicotine is the only known psychoactive ingredient in tobacco smoke. Addicted smokers smoke for one principal reason—to get their accustomed doses of nicotine. The respected British smoking researcher M. A. H. Russell wrote, “If it were not for the nicotine in tobacco smoke, people would be little more inclined to smoke cigarettes than they are to blow bubbles or light sparklers.”

Most smokers realize their habit is addictive and that, following cessation, they are likely to experience unpleasant reactions. But avoiding withdrawal symptoms is only a small part of the reason they smoke. They smoke primarily for the positive effects smoking provides.

The average smoker takes 10 puffs per cigarette. For the pack-a-day smoker, this works out to about 200 puffs per day. Each “hit” of nicotine reaches the smoker’s brain within seven seconds, about twice as fast as a syringeful of heroin injected into a vein.

Once nicotine enters the brain, it stimulates production of a number of the brain’s most powerful chemical messengers—among them norepinephrine (which regulates alertness and arousal), dopamine (which is part of the brain’s pleasure mechanism), and beta-endorphin (which reduces anxiety and pain). The net effect in addicted smokers is enhanced pleasure, decreased anxiety, and a state of alert relaxation. As a result of this positive reinforcement many dozens of times per day, smoking becomes thoroughly interwoven into every nook and cranny of a smoker’s life. This helps explain why the habit holds its victims in such a tenacious grip.

How to quit

“Sometimes I just sit in front of a mirror and watch myself inhaling that poison gas. If I was in a concentration camp and someone tried to make me do that, I’d want to kill them.” anonymous smoker

One of the biggest mistakes prospective quitters make is trying to let up without proper preparation. The successful ex-smokers I spoke with advised that the period of getting ready to quit may well be the most important time of all.

The first thing to remember is that quitting is a long-term process, so don’t be in too much of a hurry. Don’t try to quit before you’re ready, either. One way is to do all you can to reduce the stress in your life. High levels of stress are among of the most common reasons for failure. Therefore, don’t set a quitting date that occurs in a particularly high-stress time—moving, changing jobs, major deadline, ending or beginning a serious relationship, etc. Choose a quitting date you know will be followed by a relatively stable period of at least four weeks.

Good examples are: New Year’s Day, your birthday, the anniversary of a loved one’s death, while recuperating from an illness or injury, while experiencing a smoking-related symptom, or following the resolution of a major life difficulty. One ex-smoker told me several months after going through an excruciatingly painful divorce: “I decided to turn a bad experience into a good one by giving up cigarettes. When I succeeded in staying free from cigarettes for two months, I knew it was all going to be okay.”

Beware of relapse crises such as rationalizations, high-risk remarks and cigarette triggers that play a large part in inducing successful quitters to smoke again. Think through each relapse crisis before it occurs and devise a number of emergency coping mechanisms so you can respond immediately.

Rationalizations consist of such thoughts as “Just one cigarette won’t hurt me,” “I deserve a cigarette,” and “I can’t take it anymore.” High risk remarks from others include “One little cigarette won’t hurt you,” “Be sociable, have a cigarette,” and “You need a cigarette. You’ve been grouchy all day.” Cigarette triggers are situations that make you want a cigarette such as social get-togethers (especially where alcohol is served and others are smoking), interpersonal conflicts, periods of boredom or depression (especially when alone), relaxing after a meal, work pressure, driving, drinking coffee, talking on the phone, a deadline, and after sex.

If you do experience a slip, don’t fall victim to the so-called abstinence violation effect. In this all-too-common pattern of self-defeatist thinking, a single slip triggers a period of intense self-castigation, depression and negativity (“I’m no good,” “I have no will power,” “I wasn’t really cured anyway,” etc.). This in turn leads to a decreased sense of control, a drop in self-esteem.

A slip or two along the way doesn’t make you a failure. Accept the fact that you slipped, let it go, and allow yourself to return to your nonsmoking state. This “no-fault” approach will increase your chances of ultimate success. Many people who eventually succeed experience slips along the way. For more information on how to quit step-by-step, see “The 10 Stages of Quitting”.

Healthy ways to help you quit

“Exercise can’t counteract the damage being done to your body while you continue to smoke. What exercise can do is help you kick the habit.”Kenneth H. Cooper, M.D.

Undertaking healthier ways of eating, exercising, controlling tension, enlisting support of friends and the family are changes that would benefit anyone, smoker or nonsmoker. These same measures can greatly increase your chances of cutting down or eliminating smoking altogether.

Diet: Some researchers believe unhealthy eating habits may be responsible for nearly as many deaths as smoking. An American Cancer Society study suggests that eating fruit or drinking fruit juice regularly may “somewhat reduce the high risk of lung cancer incurred by cigarette smoking.”

The body’s defenses—against cancer and other diseases—require certain nutrients to function effectively. American Cancer Society and National Cancer Institute guidelines list vitamins A and C and fiber—all present in vegetables, fruits and grains—as the most important anticancer nutrients. Vitamin E, selenium and calcium have some protective effect, as may isothiocyanates and indoles (chemicals in foods). Of all the cancer-promoting nutrients, the most dangerous are probably fat and alcohol.

Exercise: Physical activity provides many of the same rewards as smoking: mental sharpening, an increased sense of control, and a greater ability to relax. Many successful ex-smokers have found they were able to reduce or eliminate smoking only after they started a regular exercise program. Kenneth H. Cooper, M.D., president of the Aerobics Center in Dallas and author of The Aerobics Program for Total Well-Being (Bantam, 1983), says, “I have received hundreds of letters from cigarette smokers telling me how they could never break the habit until they started exercising. Regular aerobic exercise seems to have given them an overall discipline and self-confidence they didn’t have before.”

Exercise can also help you lose weight. The smokers we interviewed told us that fear of weight gain was a major barrier to quitting. Since it’s difficult to quit smoking and start an exercise program at the same time, it’s probably best to begin exercising several months before you plan to quit smoking. [See Avoiding Weight Gain When You Quit Smoking]

Stress: Kenneth R. Pelletier, Ph.D., author of the stress classic Mind As Healer, Mind As Slayer (Peter Smith, 1984), says, “Successful stress managers have learned to provide themselves with periodic islands of peace—little daily ‘stress vacations’ that help them break the cycle of chronic stress. When [smokers] light up, all their worries, all the petty hassles of life, are temporarily set aside. It is this factor—in combination with the pharmacological actions of nicotine—that makes smoking such a valuable tool in dealing with stress. Smokers who wish to cut down or quit simply need to establish other islands of peace in their lives. After all, nonsmokers have found a thousand ways to break the stress cycle without having a cigarette.”

Support: Health-concerned smokers may find it particularly difficult to control their smoking habits unless they are able to arrange social support for the changes they wish to make. Forge strong bonds with the people who are most supportive of your efforts to control your smoking. Make yourself less vulnerable to the pressures from those who may be threatened or disturbed by this change. As one successful quitter told me: “I can practically guarantee that smokers who ignore the social dimension of smoking will have little luck in taking control of their habit.”

How to help a smoker quit

“If people don’t love themselves enough to cut down on their smoking, they may love someone else enough to do it.” —anonymous smoker

The smokers I interviewed gave very low marks to their friends’ and family members’ efforts to help them take control of their smoking. Most nonsmokers simply don’t know how best to help if a health-concerned smoker wants to quit.

“Coercive approaches or those based on excessive judgment, rationality and criticism have little place in a quit-smoking program,” advise researchers Arden Christen and Cooper. “‘Hard-sell’ approaches, which attempt to induce guilt or shame in smokers, should be avoided because they may overwhelm the ego rather than inform, assist or strengthen it. These approaches leave the smoker afraid, ashamed or guilt-ridden, and he or she may reach for another cigarette to soothe these painful feelings.”

The smokers I interviewed suggested the following guidelines for those wishing to support someone’s efforts to quit:

Don’t nag, insult or try to shame the smoker into quitting.

Separate the smoker from the smoking. Let the person know you will continue to care no matter what he or she does.

Try to envision the problem from the smoker’s point of view. Smoking can help you concentrate, relax and deal with stress; giving it up would be like losing a good friend.

Smoking is a powerful physical and psychological addiction. Quitting can be painfully difficult. A supportive relationship with someone caring and understanding can make the smoker feel more secure and can help provide the motivation for change.

Don’t tell smokers what to do; encourage them to do what they think is best. Progress can occur only when they want to do something about their smoking.

“The key to training a friend to cut down or quit is to totally ignore all the bothersome or offensive apects of his or her smoking behavior, while giving positive reinforcement for periods of nonsmoking,” says Karen Pryor, author of Don’t Shoot the Dog: How to Improve Yourself and Others through Behavioral Training (Bantam, 1985).

Love and understanding are particularly important in the days and weeks immediately after quitting. Here are 10 guidelines for supporting someone during this difficult time:

  1. “Adopt” the quitter by offering to provide whatever support you can (preparing food, cleaning house, doing laundry, etc.).
  2. Make yourself available as frequently as possible for those first few days. Be prepared for hostile or bizarre behavior.
  3. Arrange to see the person regularly for several weeks after he or she quits.
  4. Help your adoptee keep as far away from smokers and cigarettes as possible.
  5. Consider giving up something yourself—candy, dessert, coffee— for the first days or weeks of the person’s new life to show you care.
  6. Encourage the quitter to talk about feelings, and listen sympathetically and supportively without judging or offering advice.
  7. Send flowers or take the person out to dinner (no-smoking section, of course) to celebrate the first week or month.
  8. Offer direct or indirect rewards for continued abstinence ($50 to the quitter after 100 days or $50 to someone he or she loves).
  9. If you’re a smoker, promise that you won’t smoke in the person’s presence (the smell of smoke can tempt a recent quitter).
  10. Smoking together can be an important part of a friendship. Show your adoptee you care by working to develop other activities you can enjoy together.

After you quit

“Even with the best preplanning, quitting is an extremely unsettling experience. It may feel as if some body dropped a bomb on your life.” anonymous smoker

Physical and psychological symptoms of nicotine withdrawal vary widely from person to person, but they usually peak by the second or third day and diminish thereafter. Physical symptoms include an increased appetite, coughing, sweating, muscle aches and cramps, constipation or diarrhea, nausea, headaches, sleep disturbances, weight gain, forgetfulness, lack of concentration and of alertness. Psychological symptoms include irritability, restlessness, anxiety, depression, aggressive behavior, decreases in work performance and in sexual drive.

Happily, there are many positive physical and psychological effects to counterbalance the negative ones. In addition to the general euphoria at being free of cigarettes, the carbon monoxide level in your blood will return to normal within 12 hours, your pulse rate will slow, and your skin temperature will increase; cardiac function, circulation to your hands and feet, and fine motor coordination will improve within 24 hours; your heart will begin to improve within a few days and return to a nearly normal condition within a year; you should notice a difference in breathing in two or three weeks; your immune system will show improved functioning levels, and your stamina and vigor will improve within two to three months; your risk of heart disease will drop 90 percent within the first year; and within 10 to 15 years your risk of lung cancer will be roughly the same as if you had never smoked.

In addition, you will experience more oxygen to the brain and other parts of your body, a decrease in blood pressure, a return of your senses of smell and taste—and your home, office, clothes, hair, body and breath will smell better.

Quitting as opportunity

“The key is focusing on the positive. Build up the good things in your life and the smoking will go away by itself.” anonymous smoker

In the process of abdicating smoking, a great deal of energy and attention is released and is thus available to be placed elsewhere. Prospective quitters should plan in advance where they wish to invest it—in friends, family, an exercise program, a new project etc.

The period before, during and after quitting affords an opportunity to allow yourself to become more aware, more relaxed and more accepting of the way you really are and the way the world really is. It is a unique opportunity to be open to new life, to assume full power as a responsible adult and, in so doing, to allow yourself to live more fully.

As one successful ex-smoker explained: “Sure there were some tough times. There was a lot of anguish and a deep sense of loss. But there was a lot of richness and excitement, too, a tremendous feeling of rightness and relief, and an amazing sense of being reborn, of being given a second chance. Even at the hardest times I never doubted the whole thing was going to be a totally positive experience. The pain I was feeling was just the old, deadened parts of myself coming back to life again.”

This material, used by permission, is Copyright 1989 Tom Ferguson, M.D., and is adapted from his book The No-Nag, No-Guilt, Do-It-Your-Own-Way Guide To Quitting Smoking.

Read The 10 Stages of Quitting, adapted from this book.

About the Author

Tom Ferguson, M.D., is the author of The No-Nag, No-Guilt, Do-It-Your-Own-Way Guide To Quitting Smoking.