Kicking the Habit

The latest information on smoking cessation can help you quit for good.

Nobody likes a quitter. Unless, of course, we’re talking cigarettes.

Gone is the era when smoking was held up as a symbol of glamour (think Bette Davis and Humphrey Bogart), rebellion (à la James Dean) and feminist empowerment (You’ve come a long way, baby).
These days, quitting is in: Just 14 percent of adults in California currently light up on a regular basis, down by an impressive one-third since 1988, when voters passed a ballot initiative that jump-started the state’s groundbreaking anti-tobacco program. (Only Utah boasts a lower smoking rate.)

For the majority of the 4 million adults in the state who still smoke, however, kicking the habit remains an elusive goal. The intense nicotine cravings, the deep-seated rituals associated with smoking, the influence of family and friends who smoke (and the nagging pleas of those who don’t)&emdash;all conspire against even the most earnest attempts to give up cigarettes.

As anyone addicted to nicotine will tell you, tobacco’s grip can be mighty. It begins innocently enough, usually as a youthful attempt to forge a personal identity or a relaxing puff while socializing with friends. But for many individuals, enjoying the occasional cigarette can evolve into a helpless submission to a few dried leaves rolled in a tiny slip of paper. Making matters worse, from 1998 to 2004, there was a 10 percent increase in the amount of nicotine in cigarettes, according to a recently released study by the Massachusetts Department of Public Health.

Of course, not all smokers want to give up their Marlboros. Whether serving as a stress reliever, appetite suppressant or simple pleasure, smoking offers benefits that for some people outweigh the obvious risks.

Unfortunately, those risks are nothing to sniff at. First, there are the health dangers. Smoking increases a person’s risk not only of lung cancer, but of cancers of the mouth, esophagus, bladder, kidney and stomach. Smoking increases the risk of emphysema, heart disease, stroke and chronic bronchitis. Roughly half of all smokers who continue to smoke will end up dying from a smoking-related illness; a staggering 43,000 Californians will die prematurely this year alone, according to the California Department of Health Services.

If the thought of a laryngectomy or even early death doesn’t faze smokers, you’d think an appeal to vanity would. Simply put, smokers stink. Their breath, their clothes, their hair, their fingernails&emdash;they reek with a stale, bitter odor that can’t be masked with mints or cologne. Smoking also causes premature wrinkling of the skin that even a gallon-size jar of La Mer can’t fix.  

Then there are the social drawbacks. Widespread bans on smoking in the workplace and public spaces like restaurants and bars have marginalized smokers and placed smoking firmly outside the social norm. These public policy changes have resulted in fewer and fewer places where smokers feel comfortable lighting up. And with evidence of the harmful effects of secondhand smoke mounting, nonsmokers feel empowered to scorn anyone lighting up within a hundred-foot radius of them.

Chip Powell, an information technology specialist from Sacramento, gave up cigarettes eight years ago and is glad to be free of the social stigma. I don’t feel like a social pariah, says Powell. In my family, nobody smokes. In my wife’s family, nobody smokes. When you smoke and you’re in that environment, you feel like a criminal. 

MarcyJ Nichols, a senior health educator and cessation programs coordinator with Kaiser Permanente in Sacramento, confirms that the social pressures facing smokers are real. I think the pendulum has definitely swung, at least in California, to where smoking is considered unacceptable or undesirable by a lot of people. She repeatedly encounters smokers in her cessation classes who decide to quit in large part to escape the stigma. 

It’s not surprising, then, that the vast majority of smokers would prefer to join the ranks of ex-smokers. Most smokers have tried to quit at least once in their lives, some even dozens of times, according to studies done by the Centers for Disease Control and Prevention.

Virtually all adults who smoke cigarettes are well aware of their negative effects, but the chains of addiction are sometimes too strong to break&emdash;at least on one’s own. 

Smokers trying to quit now have a wide arsenal of methods at their disposal: nicotine-replacement gums, patches and inhalers; prescription medications; 12-step groups; phone- and web-based help lines; behavior modification classes; acupuncture; hypnosis. In other words, it’s a good time to be a quitter.

Studies indicate that most people who are successful at quitting combine methods: for example, using a nicotine replacement in addition to attending a cessation class. We definitely encourage our folks to combine the behavioral with the medical interventions, says Nichols. Often, medical aids are covered by health insurance. 

If you smoke and want to quit, before choosing the best path for you, experts say it’s important to consider all the components of cigarette addiction: physical, psychological, social and behavioral. Nicotine is a powerfully addictive substance, but simply weaning yourself off it is often not enough to break your ties to cigarettes for good. Most smokers have deep emotional and ritualistic links to smoking that must be addressed in order to quit successfully.

Jeff Myers of West Sacramento recently underwent hypnotherapy&emdash;a process of deep relaxation aimed at opening your mind to behavioral change&emdash;to break his two-pack-a-day addiction. While his nicotine cravings seem to have subsided, he says the routines associated with smoking still linger.

There are certain behavioral patterns that you develop. Like in my case, when I finished a meal, I went to the garage, sat down in a chair and had a cigarette after dinner, says Myers. Well, now I get done with a meal and I still go out in the garage and sit in my chair. It’s just that I’m totally unsure at times why I’m there.

Powell, who used a nicotine-replacement patch to break the physical part of the addiction, took advantage of a bout with the flu that coincided with an out-of-town work assignment to shake up his smoking routine.

I recognized that a lot of my smoking had to do with daily rituals: after breakfast, after dinner, being at my house on the porch, he says. I figured, great, I’m sick, I’m going out of town. This will be an opportunity to remove myself from all my triggers, my comfortable environment, everywhere I’m used to smoking.

Tom Higgins, a 49-year-old former legislative staffer who smoked for most of his life, quit three years ago with the help of nicotine-replacement gum, which works by delivering nicotine to your brain to help you overcome physical cravings. Higgins is among the 20 percent of gum users who continue chewing it well after giving up cigarettes.

Although the gum satisfies his body’s desire for nicotine, he is mindful of the social triggers that could cause him to relapse. I’m a pretty social person, and being around smokers is a good way for me to fall right off the wagon, Higgins explains.

Before succeeding with the gum, Higgins estimates he tried to quit hundreds of times, but never for long periods. He believes firmly that no single approach works for everyone. I would say to explore the alternatives. There are a lot of them out there. Recognize that it’s a very personal thing, he says, adding that exercise has helped him a lot on his quest to stay smoke-free.

Smoking cessation experts say you’re more likely to quit successfully if you have a quit plan in place. It need not be anything elaborate, but a plan can keep you honest when the temptation to put off quitting inevitably arises.

Nichols is a big proponent of planning ahead. The quit plan is designed to leave nothing to chance, she explains. If you don’t have a plan or have some quit activities in place ahead of time, when that moment comes, the addiction is going to take over pretty quickly.

The Quit Plan

First, make a firm decision to quit and set a quit date. The Great American Smokeout, held each year on the third Thursday in November, is a popular time to quit. If joining a cessation class or support group is part of your strategy, be sure to sign up before your quit date.

Second, establish a plan that addresses all aspects of the addiction. Really having a plan for all those components is critical, says Nichols. If you’re accustomed to taking a smoking break with a friend at work, for example, Nichols suggests you consider what am I going to do so that I can still get all the social benefits from smoking without smoking. Instead of a cigarette break, go for a walk together.

Third, learn to deal with the withdrawal from nicotine. Overcoming cravings is essential to making the transition from smoker to nonsmoker. Nicotine replacement therapies can help, but avoiding or managing triggers such as people, places and activities that tempt you to smoke can be just as important. If you feel a craving coming on, stall until it subsides. 

Fourth, make plans to avoid relapses and stay off cigarettes. After a few weeks or months away from them, it’s easy to feel overly confident about your success. Prepare for how you will manage triggers such as stress or the temptation to enjoy just one puff.

• Occasionally, of course, there are smokers who manage to say farewell to cigarettes without any fanfare. Ken Burnett, a musician from Citrus Heights and a smoker for 35 years, gave up cigarettes two years ago cold turkey. Although the technique doesn’t work for most people, Burnett is one of the lucky few who were able to stick with it.

Burnett recalls smoking the last cigarette in a pack when an unexpected feeling overcame him. I wadded the pack up and threw it in the garbage can, and something kind of clicked in me where I said, ‘I’m not a smoker anymore,’ and I never smoked again.

Despite his success, Burnett doesn’t necessarily advocate the cold-turkey approach. I don’t think it will work for other people like it worked for me, he says, adding that overcoming cravings was the hardest part of quitting. For that, he developed his own coping mechanism. I kind of go minute by minute. If I have a craving, I’ll go, ‘I’ll just wait a minute, I’ll just wait a minute,’ until the craving goes away. 

While the process isn’t easy, like others who have quit, Burnett reports that life is much better as a nonsmoker. I can sing a lot better. I’ve got more lung power, he says, adding that his sense of smell has also improved. I just wish I would have thought about quitting 25 years ago.

Powell also has experienced an improved quality of life since giving up cigarettes. Today, he exercises (he’d never figured smokers could exercise) and is proud to be setting a better example for his children. Plus, the social barriers he experienced as a smoker have vanished. I feel like I’m totally in the world of the nonsmokers, he beams. It feels good. I feel like I can be at a family event and I don’t have to think about, ‘How am I going to get that cigarette, when would that be appropriate?’ And I don’t have to smell like smoke when I come back.

For Higgins, quitting has had countless rewards, not the least of which is a new identity as a nonsmoker. It feels good not to smoke. I know so clearly that I don’t want to be a smoker, he says emphatically. There are no benefits from it.

Although candid about his experience, Higgins describes his addiction to cigarettes as very personal and not something he’s proud of. I get it that it’s bad, and that’s why I’m embarrassed, says Higgins. It feels stupid to admit to lying to yourself and being self-destructive.

Thankfully, those bad feelings are mostly behind him. And he feels physically healthier, too. I can breathe better. I get a lot fewer colds. I used to get five pretty good colds every winter, and now sometimes I can go a year without a cold. And that’s really nice. 

Indeed, life is better once the smoke clears. But cessation expert Nichols offers a gentle caution to well-meaning nonsmokers who want to help their tobacco-addicted loved ones. Rather than doling out advice, she says, instead ask quitters if and how you might assist them in their quest. Don’t nag, obviously, says Nichols. Everybody’s going to want a different kind of support. Everybody gets ready to quit in a different time and way, so the best thing you can do is to ask them what you can do to be helpful.

And remember, even failing has its rewards. As Nichols puts it, We know that every time a person tries to quit, they learn something even through their failure, so to speak. They figure out some things along the way. So get busy quitting.

Promising Pill&emdash;The anti-smoking medication varenicline (Chantix) was approved by the Food and Drug Administration in May. The twice-daily pill, available by prescription, mimics the effects of nicotine on the brain.

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