[Like many of you, I've been surprisingly saddened by Peter Jennings' passing. Not that it was unexpected... the good ones tend to go fast with cancer. This diary is my attempt to deal with those feelings, and offer some experience to Kossacks who are struggling with smoking. Give us your ideas too.]
"Did you ever smoke?"
That's the common response when I challenge my patients to quit smoking. No, I answer, but I've been trying to get people to quit for the past 20 years or so: probably about as long as you've been trying to quit. In those decades, I've evolved an approach to the subject which is slightly different than the usual. I've gotten quite a few smokers to quit who haven't been able to any other way.
Read this. Check out other resources. It doesn't matter how you quit, it matters that you quit. Don't give up. You can do it. Millions already have.
Follow below the fold if this is of interest. (Warning: it's long, but I've tried to make it digestible in bites.)
The Two Problems for Would-be Ex-smokers
1. Smokers are nicotine addicts. Nicotine is a highly addictive substance, perhaps the most addictive legally-available chemical. Quitters must therefore overcome strong cravings for nicotine. They must also suffer withdrawal symptoms, including irritability, food cravings, headaches, nausea, insomnia, fatigue, and all the rest. (Add your own symptoms here _____.) Withdrawal symptoms can continue for up to three months, with gradually decreasing but variable severity. They're a bitch.
Fortunately, addiction is relatively easily overcome these days. Nicotine delivery systems are available as patches, gum, or inhalers. They give quitters an alternative source of their drug of choice while they're kicking tobacco. Bupropion (Zyban, Wellbutrin) is also aimed at withdrawal symptoms: an antidepressant, it has the happy side effect of reducing nicotine withdrawal symptoms significantly for most people. While it's not for everybody, this prescription medication can help many quitters.
2. Smoking is a collection of habits. Most smokers readily admit that smoking is a habit. Actually, it is a series of habits that occur regularly through the day. Smoking is, for most smokers, a very stereotyped behavior. A pack-a-day smoker probably has between 6 and 10 smoking habits.
The first couple of cigarettes with coffee in the morning are a habit. The cigarette in the car on the way to work is a habit. Cigarettes during the morning coffee break, lunch, and midafternoon are habits. The one on the way home is a habit. The cigarette at the table after dinner is a habit. The 3 or 4 blogging in the evening are a habit. Weekends have their own habits.
Every situation during the day in which a smoker ritually lights up is a separate habit. These habits are different than--though reinforced by--nicotine addiction. It is vital to distinguish between nicotine addiction and habitual behavior when trying to quit, because they have very different solutions. Most quitters of my acquaintance have had far more difficulty with their habits than their addiction, mainly because the habits tend to go unrecognized and unaddressed.
Changing Habits: The Most Important Step in Quitting
You want to quit smoking? You gotta break your habits. It might be easier than you think. You can't change behavior until you become conscious of what it is, and most smoking is unconscious behavior. It's not a choice, it's automatic. It's governed by habit. So the most vital task is gain control of your habits.
Sit down with three pieces of paper. You're going to make three lists:
- Write down every cigarette you smoke in the day. From the first one you light up after the alarm clock to the last one you stub out before turning out the light. When during the day do you light up each one? What are you doing? This won't be hard: you probably smoke the same cigarettes every day. So write them down. Don't forget weekends; they may be a separate list.
- Figure out what your smoking habits are. Not quite the same as page 1. For instance: with coffee in the morning; in the car; during breaks at work; after meals; while watching the tube; while blogging. Each of your cigarettes on page 1 are probably explained by a habit.
- Generate change strategies for each habit. Your habits will each have to be tackled individually. There are two strategies that are generally effective: avoidance, or staying away from a smoking situation (e.g. Friday night at the pub); or substitution, putting a new habit in place of the old one. Substitution is much more widely applicable. Come up with a couple of ideas about how to change each habit you've listed on page 2. Ideally, they shouldn't all involve calories, so you don't gain weight. Write them down.
Finished? Congratulations. You've just done the hardest part. Next, putting it into action. Pick your approach:
4. One toe first. Look at your list of habits on page 2. Pick the one that looks like it would be easiest to break. Grab the low hanging fruit. Now, start. Put your change strategies into action, for that one habit. Don't worry about the others.
Work on that one habit until you've got it licked. Don't worry about how long it takes. You're learning how to change habits: it takes time. Keep trying changes until you've got it licked. Now congratulate yourself and cross it off the list. Now go back to page two and pick the next easiest habit. Keep it up until you've got them all crossed off the list.
Quitting smoking one habit at a time breaks an awesome task down into bite-sized pieces. It teaches you how to change your habits, and gradually reduces your nicotine consumption. As you work through your list of habits, you get better at changing them, and you become gradually less addicted to nicotine. Withdrawal symptoms are generally not a problem, because you don't reduce your consumption too much at once.
5. Dive right in. Some people can't take a gradual approach. They are powerless, in the 12-step sense. That's OK. Make your lists. Pick your nicotine replacement of choice (see above). Visit your doctor to talk about bupropion. Review your change strategies. Pick a date. Use all the ideas below that sound good to you. And have at it!
Stress Management and Smoking
Why do people go back to smoking after quitting? There seem to be two main reasons: unresolved habits, and major stresses. Quitting by changing habits, as outlined above, helps to prevent old habits from coming back to bite you on the ass. Stress is another matter.
Almost all smokers use cigarettes as stress releasers. When the going gets tough, the tough go outside and light up. But most smokers smoke differently when they're stressed. I see it all the time: folks who go outside, gaze off into the distance, light up slowly, take a big drag and blowwwwww the stress away. Thing is, this is all great stress management technique, except the cigarette. Nicotine is a stimulant, not a tranquilizer. But leaving the stressful situation, gazing into the distance and emptying the mind, slow deep breathing... those are not far from meditation.
If you give up cigarettes you need a new stress releaser, otherwise a situation will someday arise you don't know how to handle. Next thing you know you'll be at the corner 7/11 buying a pack and smoking it greedily.
If you don't have another reliable stress releaser, practice this: go outside and smoke, but don't bring your cigarettes. Look off at the mountain in the distance, pantomime lighting up, take a drag off that imaginary cigarette, and watch the invisible smoke blow your stress away. I promise you, you'll get the same release. You don't need the cigarette. Keep doing it, and drop the silly smoking pantomime. It's a great technique; you just don't need to smoke to do it.
Other Ideas for Quitters:
If you want to quit, give yourself every advantage you can. Play every angle that works. Following are some techniques that are very helpful for some people:
- Keep your motivation fresh. Make a list of all the reasons you want to quit. Attach pictures of the kids or grandkids. Make copies, and post them where you'll see them: the refrigerator, the bathroom mirror, the cubicle wall, the passenger seat in your car, wherever you might need reminding.
- The piggy bank. Just for fun, add up the amount of money you spend in a month on cigarettes. Prepare to be scandalized. If your budget is a little tight, try this one: every day, drop the amount of money you'd spend on cigarettes into a piggy bank. You won't miss it--you're already spending it. Tell yourself that when you've been a non-smoker for 6 months, you get to buy yourself a present. Don't blow it on the light bill, make it something you really want, but maybe can't afford. This can be a wonderful reward for quitting--as if your health and your sense of smell weren't enough--and can be a fantastic motivator for some.
- Vanity. Think back to last Thanksgiving, when you last saw your aunt Tillie. You know, the one who's smoked two packs a day for 40 years. Remember how her face looked like a piece of unironed washed linen? Cigarette smoke dramatically ages the skin of the face, creating those fine lines that multiply and deepen and make people look much older. If you care about your appearance, ponder this deeply.
- Shame is your friend. Tell all your friends, family, and coworkers you're quitting smoking, in your cockiest voice. When they scoff, be self-assured. Offer to bet them, even. That way, if you're ever tempted to backslide, the thought of all the "I told you so's" that go unsaid but not unthought will deter all but the hardiest recidivist.
- Be responsible for yourself. "I'd like to quit smoking, but my husband [wife, partner, son, mother, cat...] smokes. I can't do it alone." BS. Sure you can. It's great if you can get other smokers in your house to quit with you, but you can't hold your success hostage to theirs. If you smoke together, that's a habit. Deal with it. If you get no cooperation, that makes it harder. You just have to try that much harder. Once you're a pain-in-the-ass ex-smoker, maybe you'll nag your loved one into joining you.
You've Made It This Far?
Wow, you must really want to quit! Well, good. That's the one necessary requirement. Quitting is hard; it's not impossible. You've really got to want to do it to succeed. If you're reading this sentence, you obviously do. You can quit. Believe, and make it so.