A Doctor’s Word--Tips to Escape the Smoking Trap
New America Media, Commentary, Erin Marcus, M.D., Posted: Oct 20, 2009
Editor's Note: In the debut of A Doctor's Word, Dr. Erin Marcus wrote about an African-American man's effort to quit smoking cigarettes. This week, she offers practical advice for all who would like to kick the habit. Dr. Marcus is associate professor of clinical medicine at the University of Miami Miller School of Medicine.
In my first column, I shared the story of Lawrence Jones, a 55-year-old man who smoked for 35 years until July, when he decided to quit. In his words, he was “sick and tired of being sick and tired.” Giving up the addictive habit of tobacco is extremely difficult, and Jones’ success depended on the help of a counselor, smoking cessation classes, nicotine replacement patches, and the support of a friend. Here are some things that helped Jones, as well as tips I’ve garnered over the years as a primary care physician.
To succeed at quitting, you first have to decide that this is something you really want to do. Medicine and classes won’t work unless you have made a commitment. In Jones’ case, a graphic video that his counselor played at his first stop smoking class made him resolve to quit. It showed pictures of smokers that he could not forget: a man missing an eye and part of his nose from mouth cancer, and people breathing through tracheotomies – holes that doctors surgically cut in their throats when cancer prevented them from breathing. “You have to be willing to give it your all,” Jones said. “But the pros outweigh the cons.”
If you can, join a stop smoking group. This can be difficult to do, as often these are held during working hours. But if you can find one at a time convenient for you, these groups can be very helpful in providing support and strategies and keeping you focused on your goal. Jones attended seven hour-long classes and describes them as crucial to his success. Call your local county health department or hospital and ask if they offer or know of a local smoking cessation program. The American Lung Association is a national organization that can direct you to smoking cessation classes in your region: 1-800- lung USA, or www.ffsonline.org
Set a quit date and prepare in advance for what you will do once you quit. This includes changing your environment by removing ashtrays and other smoking-related items from your home. It also includes telling your friends and loved ones about your plan and asking for their support. The first few weeks you will probably be the most tense and irritable. Plan to alleviate the stress through activities such as exercise, meditation, using a stress ball, or sharing your feelings with a friend.
Get medication in advance of your quit date. Yes, we all know people who quit “cold turkey” and succeeded. But research shows that your odds of succeeding are much higher if you use medication. There are three different medications: varenicline, brand name Chantix, which helps treat nicotine withdrawal as well as smokers’ cravings for tobacco after they quit; bupropion, or Zyban, which reduces cravings; and nicotine replacement, sold in the form of patches, inhalers and gum. Varenicline can be used alone, while bupropion and nicotine replacement are often used together. Jones has been using patches alone with success.
If you’re paying for these medications entirely out of pocket, be aware that they aren’t cheap. At my local pharmacy, bupropion costs $87 a month, nicotine replacement runs between $40 and $50 monthly, and varenicline costs $182 a month. But it’s important to remember how much you will save by not buying cigarettes, which cost up to $10 a pack.
Varenicline and bupropion require prescriptions, and they can have side effects. Some state Medicaid programs and insurance plans cover these medications. For more information, check the American Lung Association website (www.ffsonline.org) link called “state tobacco cessation coverage.” Very rarely, free or discounted medication is available through some state telephone quit lines. Call 1-800-QUIT NOW for more information.
If you can, find a “sponsor,” or a friend, who will be there for you when you are trying to quit. For some smokers, this is someone who listens when they feel frustrated; for others, it’s someone who can be empathetic as they mourn the ending of a lifelong habit, which can feel like losing an old friend. In Jones’ case, his sponsor was a non-smoking friend who rationed his cigarettes when he was tapering down and listened to him when he was withdrawing. “He was a good sponsor – he didn’t cut any corners or do me any favors,” Jones said. “In the beginning I would get aggressive, and he was somebody who was willing to be yelled at and ignored.”
Know your smoking triggers, and take steps to avoid them or to develop a way to cope with them. For Jones, being alone and isolated prompted him to smoke, so when he feels isolated, he talks to his sponsor. He also has been in touch with friends and family and has avoided places that he fears would make him go back to his old habits, such as the apartment in which his late girlfriend lived.
Be aware that most people make many attempts to quit before succeeding. If you have tried before and failed, you aren’t alone, and that doesn’t mean you should give up. It takes five to seven attempts, on average, before succeeding. Some smokers are able to succeed with far fewer attempts; others, many more. In the words of Mark Twain, “Quitting smoking is easy. I’ve done it a thousand times.”
Remember the Five D’s. These are outlined in the pamphlet “Pathways to Freedom,” which is referenced below. Jones’ smoking counselor, Mary Mites, recommends these to the people in her class. They are: Drink water – up to eight glasses daily, to cleanse your body of nicotine; Deep Breathe, to help relax; Do Something Else, to get your mind off smoking; Discuss, or talk about what you’re experiencing; and Delay – when you get the urge, count to 250. When Jones got the urge to buy a pack of cigarettes, he would stash the money in a jar –and after several weeks he had saved enough to buy an $80 pair of Stacy Adams shoes.
Put something in your mouth other than food. Many smokers miss the sense of something in their mouth when they are quitting. Jones uses gum when he gets a craving (go sugar-free if you are going to do that). Some people find the plastic sticks used to stir coffee to be helpful.
Quit lines may help. These are toll-free telephone lines, organized by the National Cancer Institute, that provide telephone counseling free of charge. Some have criticized these lines for not having a diverse staff of counselors, but Jones found the lines very helpful when, in his words, he was “searching for ways to not focus on picking up a cigarette.” The numbers are: 1-877-44U-QUIT and 1-800-QUIT NOW.
Information sources that I find useful are: Pathways to Freedom, a guide for African Americans developed by the U.S. Centers for Disease Control in collaboration with churches and community organizations; it’s available at http://www.cdc.gov/TOBACCO/quit_smoking/how_to_quit/pathways/index.htm
The government website http://www.smokefree.gov/ is also replete with useful information, as is that of the American Lung Association: www.ffsonline.org.
Related Articles:
A Doctor’s Word -- Black Americans Can Escape the Smoking Trap
A Doctor's Word: Regular Flu Shots Easier Sell in Time of Swine Flu
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User Comments
smokefree on Oct 22, 2009 at 20:24:35 said:
agree with pat. Electronic Cigarettes helped me cut down a LOOOOOT!.
no more wheezing.no stinking breath.no secondhand smoke, and much more.
greensmoke.com/vaporcigs
Nick Sullivan on Oct 20, 2009 at 16:30:15 said:
It's a shame that so many doctors, including Dr. Marcus, recommend pharmaceuticals as part of their default plan for beating cigarette addiction, even while acknowledging their high price and the significant risk of severe side effects. No authority claims that a single plan is best for all smokers, or that any plan has a reassuringly high success rate. That being so, surely the best rule is to start with the least costly, least invasive plan, and only in the face of repeated failures move on to the costlier, more invasive, medical alternatives.
Cold turkey, is certainly the fastest and cheapest way to quit, and some people can actually stand it, so my advice to any smoker is to start there. If it works, the problem is solved, and the cost is zero. The next simplest method, and one with a much better prospect of success, is tapering. Commenter Anna's description of a smoker's psychology rings very true with my experience, and gives an important clue as to how a tapering program should be constructed: in brief, the number of cigarettes should decline "asymptotically" - approaching but never reaching zero. (See the gottakickit.com website to read much more about a tapering approach of this type, designed by me, that uses mobile devices - such as the iPhone - to monitor and regulate cigarette intake.) Only after these gentler alternatives have been tried should medical interventions be considered.
anna on Oct 20, 2009 at 14:54:48 said:
I quit smoking, but it took me years. I didn't find the smoker's group helpful -- mostly because they were very militant about the evils of cigarettes and how terrible it "felt" to smoke. I found it more helpful to acknowledge how pleasurable smoking was for me. Knowing triggers was also a big one for me. I spent a number of weeks not trying to quit but recording my cigarettes and the "types of smokes" they were (e.g. after meals, in company of people, with a coffee, at a pub, a lovely solitary one on the porch listening to blue jays ... but smokers know what I mean). Then, I categorized them ITO their importance to me, and SLOWLY began to eliminate the daily cigarettes that were more superfluous. One by one. This process actually took years to complete, the last two or three, being down to 2 or 3 cigarettes a day that were simply sacred to me. Say what?, you say. Listen, it took a long time, but I quit, didn't I. On ocassion, I still get an urge, whereupon, I don't conjure up mental images of cancerous lungs, but I breath and remember how delicious that cigarette was, feel a moment or two of regret and loss ... we're all different, of course, but this is what worked for me. After trying a number of things (including cold turkey) and for many years. Oh, I also increased my exercise program, which helps too (or just starting one). There are a lot of other "tricks" each person can find for themselves.
Pat Goldbloom on Oct 20, 2009 at 11:17:13 said:
Ya know, I don't know why more smokers don't switch to e-cigarettes. They're easy to find at whitecloudecigoutlet.com.
These things don't have tobacco or second-hand smoke, i still get my need for nicotine satisfied, and I haven't smoked a tobacco cigarette now for over a year. And when people ask me if I smoke, I say 'No' because the things I smoke contain no smoke or tobacco.
Pat Goldbloom on Oct 20, 2009 at 11:10:37 said:
Ya know, I don't know why more smokers don't switch to e-cigarettes. They're easy to find at whitecloudecigoutlet.com.
-->These things don't have tobacco or second-hand smoke, i still get my need for nicotine satisfied, and I haven't smoked a tobacco cigarette now for over a year. And when people ask me if I smoke, I say 'No' because the things I smoke contain no smoke or tobacco.