Prevention
HOW TO STOP SMOKING As a former smoker, I have some strong opinions about why we smoke and what it takes to stop.
We probably all started smoking for social reasons. We imitated people that we admired or else became associated with a group of people and took the same habits and dress that the group had. The reasons that we continue to smoke are very different from the ones which led us to start.
Among us are two groups of people: smokers and nonsmokers. Some of us can smoke for years and then for some reason be motivated to stop and have no difficulty whatsoever in stopping, as it were, in mid-cigarette. They are probably basically nonsmokers. Some of us became so locked into smoking that stopping becomes a major life project. There is probably an inherited metabolic defect in which some component of the smoking is activating, feeding biochemical hunger. Every time we smoke we both satisfy that biochemical hunger and increase the drive for the next cigarette. For people who have this metabolic lock on the cigarette, smoking stops being an issue of pleasure and certainly is no longer a moral or character logical issue. We don't smoke because we are too weak to quit, we smoke because our lock is so strong.
A metabolic addict has a dreadful time stopping. The strategy that (I believe) works best is substitution. Without substitution, the metabolic drive will eventually overcome what willpower is being used. It has been my observation that the drive to smoke, and probably the associate enzyme pathways, take about one year to reach a manageable level. During this period, food is the only substitute powerful enough to block the drive generated by smoking dependence. Dedicated quitters should give themselves permission, on behalf of eliminating this powerful dependence, to gain up to twenty pounds during the course of one year. The average weight gain is about fourteen pounds. I recommend purchasing clothing at the start, for temporary use, which will accommodate the weight gain. No diet or weight control program should be contemplated for one year. My experience has been that most people fall back to smoking within six to nine months, and that is why the period of one year must be allowed for this project.
Addiction always speaks to us. We usually find ourselves telling ourselves this is not a good day to stop and make a deal for a day in the future.
The next rationalization is the acknowledgment that we should stop; we postpone the project because of some upcoming "stressful" event. Nicotine is an upper. A dose of nicotine increases anxiety, and never reduces it. This excuse is the addiction talking.
Later, we note that we had fewer sore throats, nasal discharge, and less coughing while smoking. This response effect represents the wearing off of the local anesthetic effect of the smoking. When we smoke, we kill the pain from the damage we caused when last we smoked. This is part of the reason that we keep picking up one cigarette after another. When we stop smoking, we regain sensation in our airways and begin to feel the damage, even as it is healing. Again, it has been the addiction talking.
At about six to eight months, we have the sensation that we are beginning to be quite independent of smoking. We become proud of ourselves. We feel that when we see cigarettes we can either take them or leave them. Of course, we take them, and within a day or two are back to where we started from. This, again, was the addiction to nicotine talking to us.
None of this is moral weakness and none of it indicates a personality defect. This is an ingrained metabolic affliction. Realizing this should not make one conclude that one cannot stop smoking because of the strength of one's metabolic lock. This, too, would be the nicotine speaking.
A realistic attitude, plus reasonable substitute behavior can get us through the period of time it takes to allow the hunger to extinguish.
As physicians, we help with some pharmacological tricks which help with the first few weeks of intense craving. Behavioral modification techniques and hypnosis have an important, but a temporary, role in getting us through the initial period of high metabolic demand for smoking.
Commitment on the part of the smoker is all that is required in order to stop. It is that simple. Being simple, I don't mean to say that it is easy. The problem becomes only one of when to start. There is nothing wrong with right now. Any argument against right now is the addiction talking.
Remember, confession of addiction doesn’t substitute for stopping. The best time to stop is right now. The only cigarette to avoid is....the one you’re about to light.
If you haven’t stopped yet, take reasonable health precautions. Get an annual chest x-ray and an annual examination of the oral cavity and voice box. This is a poor substitute for quitting but seems to be the most prudent course since smoking itself will mask danger signals.