Smoking Cessation

Change happens. The issue is not if things will change over time, or, if we will change. Rather, it's whether we want to try to take some control over the direction in which our lives and our health will change.

I am of the belief that any day, or any time is an opportunity for change. However, for many people, the New Year is the time to put thoughts into action. We make resolutions. We want to eat better, be more organized, exercise or lose weight. Or perhaps we want to give up an unhealthy habit, like smoking.

The method I use to help my clients quit smoking is one that incorporates ideas from many teachers, programs and philosophies. The following is a brief list of things to consider when you want to stop smoking. By no means is this list complete. There are many resources and many ways to go about it. Please check out the links that follow.

Readiness: How ready are you to quit smoking entirely? Be honest with yourself. People who want to make changes in their lives go through different stages: from having no desire to make a change, to thinking about it, to being ready to take action. In this case from having "no desire to quit smoking", through "consideration of quitting", to "being ready to quit". Don't worry if you feel you aren't ready to quit. You can still learn more about why you smoke and there are still steps you can take to reduce the harm that your smoking is doing to you. These changes will also help you quit fully if and when you decide to do that.

Ambivalence: Don't equate ambivalence with not being ready to make a change. Nearly everyone has some level of doubt and anxiety about making changes. Usually people are concerned about what they are giving up and whether they have the strength to follow through. It's important to listen to the doubting voices in your head. Try to learn as much about your anxiety and concerns as you can, so that you can try to make plans to address them. Are you concerned about gaining weight? Do you feel you need cigarettes to help you clear your head or calm you down? Try to shift your approach from what you are giving up to what you are gaining.

Motivation: Why do you want to stop smoking? Make a list of the reasons why you want to stop. Include all the negative impact that smoking has on your life. List your short term and long term goals, such as improved health, being a role model for your children, or saving money. Then make a list of the reasons why you might want to continue smoking. Smoking serves some purposes in your life. It's important to understand what they are so that you can devise other means of addressing them. Make a list of all of the words that you might use to complete the following sentence: “When I smoke I feel ______.” Some might use words like: "calm," "focused," "attractive" or even "guilty."

Awareness: Learn about your smoking. Some of your smoking may simply be habitual. Other times, you may smoke to be social, to relax, or in a response to a nicotine craving. Learn your triggers. What places, situations, or events often provoke you to light up? Keep a piece of paper and pen wrapped around your cigarette pack with a rubber band. Every time you reach for a cigarette write down where, when, why, and score on a scale of 1-5 just how badly you want it. Are there situations in which you would never smoke? In church? In the office? What is special about these situations that enable you to forgo smoking?

Mindfulness: Pay attention to your smoking. In our fast paced society we tend to multi-task and often do things without paying any attention to them. When we are engaged in other activities we can smoke or eat without even the awareness of having done so. You look down and see butts in the ashtray, but can't even recall having smoked them. Chances are that many of the cigarettes you smoke are disappearing without your having any real awareness of them. If you are going to smoke, you should at least be conscious of what you are doing. Don't smoke mindlessly or while doing other things like driving, working at the computer, watching TV, talking on the phone or eating. If you feel you have to have something in your hands or mouth, then be prepared to use something else.

Preparation: Start to cut back on your smoking. Now that you've learned a little about your smoking let's start to make some small shifts. Start breaking your habits. Don't light up any un-necessary, 'habitual,' cigarettes. Delay lighting up in response to a craving. Can you wait 5 minutes, 20 minutes or an hour? Don't inhale as deeply. Don't finish the cigarette. Make it a little more burdensome and annoying to smoke. Pull over and stop the car. Get out. Then smoke.

Planning: What method will work for you? Have you tried to quit before but failed? What can you learn from your past experience? Some people can just go 'cold turkey' but many benefit from medication. You might wish to consult with your doctor to discuss medication options* to help you to stop. Nicotine is a very addictive substance that you have exposed your body to on a regular basis, most likely for years. Studies show that smokers who use a nicotine replacement product are more often successful at quitting than those who don't. There are a variety of forms of nicotine replacement that can help reduce cravings. There is a new medication that works to block nicotine withdrawal at the nicotine receptor in the brain and another that can help manage the issue of the addictive craving. In addition there are alternative, "natural" products or techniques such as hypnosis or acupuncture.

Help: What resources do you want to use to help you to quit? There is no need to do this alone. People who utilize other resources will have an easier time quitting than those without help. There are many useful internet sites** devoted to quitting smoking, as well as some toll-free help lines with people ready to assist you. Your place of work may be a resource, ask your EAP department if they have smoking cessation programs. Consider a support group such as Nicotine Anonymous. Many hospitals have clinic-based smoking cessation programs that use a multi-tiered approach to helping people quit

Support: Create your own support group. Tell as many people as you can ahead of time of your plan to quit and tell them you'd like support in getting through this. Part of their support will be in understanding the stress that you and your body will be going through when you first stop and any irritability you might be feeling. But be mindful that not everyone might want you to quit. If you have a partner that smokes or an office smoking-buddy, they might want to keep your company and might unconsciously sabotage your efforts with offers of cigarettes or invitations to go out on a smoking break with them.

Timing: Pick a date. It's highly unlikely that there will ever be a perfect stress-free time in your life when you can quit. But certain times may be easier and other times worse. Trying to go on a diet or quitting smoking during the holidays may be a recipe for failure. Yet New Years day might be a very good time to start. Or perhaps you'll have better success if you quit while away from your routine and your stressors, like when you're on vacation. Prepare your home, office, car or other spaces. Get rid of all of your stashes of cigarettes. Remove ashtrays and try to clean up some of the cigarette smell from objects in your home.

Quitting: When it's time to stop smoking. You've learned about your smoking, triggers and habits. You've cut back. You've done your research, created your plan and formed a support group. Now it's your quit date. Here are some things to help you succeed.

Changes: Alter your routine. Minor changes in your routine that enable you to avoid your triggers (those people, places and things associated with smoking) can be helpful. This may be as simple as changing where you eat (a different place in your home or apt?), or what you eat, or changing your commute route, if buying a package of cigarettes from a certain store is on the way to work or home.

Rewards: Be good to yourself. This can be a difficult process and one that may cause you to feel unsettled and irritable. Make sure you take time and do something nice for yourself. If your teeth are stained you might feel renewed by getting a cleaning. Or get a manicure so that you can enjoy what your hands look like without a cigarette. A bubble bath is a less expensive alternative. Knitting can be relaxing and can occupy your hands. Consider a massage.

Health: Eat well and exercise. You may feel that you have just 'given up' smoking. But perhaps you can reconsider this as embracing a healthier lifestyle. I am a strong proponent of nutrition and exercise as a way to reduce stress and promote health. If you don't already have an exercise program, start one. You should consult with your physician to assess how ready your body is for exercise. It's OK to start small. Try to pick something you like and which is suited to you. If you don't like the gym try a dance class, golf, bowling or walking. Or consider yoga, which is my personal favorite as it focuses on breathing, relaxation, flexibility, strength and balance. Any exercise will be an important tool to help your lungs and body to recover. Expect some difficulty at first. Chances are you'll be doing a lot of coughing and it won't be pretty. This is the result of your lungs reawakening from your smoking and clearing out the gunk that has been accumulating. Try, at least during the early phase of your non-smoking to avoid alcohol. Chances are you've associated drinking with smoking. In addition, alcohol can reduce your will power to remain smoke free.

Stress: Reducing tension and anxiety. For those people who used cigarettes to help them to relieve stress it's important to think about the pressures you feel in your life and put into place different ways of addressing them. Chronic stress is unhealthy for your mind and body may be a signal that you need to make some other changes in your life. Consider reaching out to a mental health professional to help you identify the stressors in your life and address them in a healthier and more productive manner.

Belief: Don't lose hope if you have a slip. If you're feeling a particularly strong, craving reach out and call someone in your support group. However if you do slip and have a cigarette, don't interpret this as a failure and therefore a reason to give up on yourself and your plan. Rather, forgive yourself. Be patient and compassionate. View your slip as an opportunity to learn more about yourself, your addiction, your triggers and to beef-up your plan to better prepare yourself the next time a similar situation arises. Believe in yourself. With confidence, support and a plan, you are likely to succeed.

*Prescription and Over-the-Counter Tobacco Cessation Medications (from CDC website, revised)

Type Form Common Brand Name(s) Availability
Nicotine Replacement Therapy Gum Nicorette® Over-the-counter (OTC)
Patch Nicoderm®, Habitrol®,Prostep®, Nicotrol® OTC and prescription
Inhaler Nicotrol® Prescription
Nazal Spray Nicotrol® Prescription
Lozenge Commit® OTC
Bupropion SR Pill Zyban®, Wellbutrin® Prescription
Varenicline Pill Chantix® Prescription

**Useful Links (from American Cancer Society Website)

American Heart Association

American Cancer Society: Quitline® phone counseling program ACS at 1-800-ACS-2345 or 1-800-227-2345

Centers for Disease Control and Prevention: Office on Smoking & Health Telephone: 1-800-CDC-INFO or 1-800-232-6237

National Cancer Institute: Cancer Information Service Telephone: 1-800-4-CANCER 1-800-422-6237

Nicotine Anonymous: Telephone: 1-415-750-0328 (Online materials, including info on state telephone-based programs) Telephone: 1-800-QUITNOW or 1-800-784-8669

Very useful booklet with steps to quitting smoking

Smoking Cessation Leadership Center: Telephone: 1-800-QUITNOW or 1-800-784-8669

Dr. Elizabeth Getter received her undergraduate degree from Brown University and medical degree from the University of North Carolina at Chapel Hill. Dr. Getter has lectured on and worked extensively with the problem of addictions as well as the psychiatric problems of persons with HIV and AIDS. She is an Assistant Clinical Professor of Psychiatry & Behavioral Sciences at Albert Einstein College of Medicine of Yeshiva University and currently has a private practice in psychiatry in New York City.