Time To Stop Part II

There are some aids for the wannabe non-smoker. Here's one.

Cigarette smokers must be the bravest people in the world, to be able to continue doing something that is approximately as lethal as Russian roulette with bullets in five of the six chambers.

You can not be scared out of smoking. In fact, we have had patients so frightened at the prospect of their smoking-abetted demise they are seen shakily lighting up as they leave the office! Except for local ordinances against it in certain places, smoking isn't illegal, and people who smoke are not necessarily either good or bad because of their habit. Smoking, unlike illicit drugs and alcohol, does not adversely influence one's behavior, just one's health.

Smoking is almost the perfect addiction - legal, easily available, with no immediate consequences. There are some fortunate current smokers who could quit today, never miss it and never look back. For every one of these there are ten thousand others who quit, last three days or less, re-start, quit again, etc.

Serious commitment to the project of quitting smoking is essential. To that end, we suggest you print and post the following bits of "commitment enhancing" information side-by-side on your refrigerator. (That will allow you to make comparisons easily between the features of the two. Decide which has the more important elements.)

A. Reasons to stop: Cigarette smoking is known to cause or accelerate the following disease states: Major and minor (TIA) strokes, multiple-stroke dementia, macular degeneration, cancer of the mouth and throat, cancer of the larynx, most lung cancers, chronic bronchitis and emphysema, esophageal cancer, peptic ulcers, bladder cancer, coronary artery disease including angina, heart attacks and heart failure, aortic aneurysm and rupture, all peripheral vascular disease (worst in diabetics), osteoporosis and fractures of hips and spine, impotence, and wrinkling of the facial skin. (OK so far?)

B. Reasons to continue smoking: "I enjoy it". "If I quit I'll get fat", "It's too late". "What I do is none of your business" (Hmm, a Libertarian, are you?), "I've tried and failed several times", "You gotta die of something," "Who cares, anyway?" (Well, lots of people care, including many who love you.)

Let's assume that the commitment is there, all that's needed is a shove in the right direction. In that context, here's the first push: Know yourself, and identify the reasons why it is necessary for you to smoke. Let's say that there are about ten, ranging from "first thing in the morning" or "always on coffee break with a friend" to "whenever my mother-in-law calls." Let's also assume that your average daily cigarette "consumption" is a pack (that's still 20, isn't it?)

The next step is to rate these twenty smokes in order of their importance, with the more important ones at the top of the list. At the bottom will be the ones we're going to deal with first.

Anyone can smoke less, and there is little question that less is better, so that will be our first goal. We're going to drop from 20 down to 15 per day, and the word "quitting" will not interest us at the moment. What we need is a success, achievable by establishing a realistic goal. At the beginning of each day, set out the number of cigarettes needed to cover the essential smoking episodes, realizing that the most stressful times will still be covered. The five (or two, or three) situations on the bottom of the list can now be crossed off. It may take a few days to get it right, but you will have plenty of cigarettes left for the critical times. After adjusting to the lowered level, take another step down.

It is obvious that this method involves tapering down one's habit though the use of a gimmick. The gimmick requires expenditure of time and thought. Why not just take a pill and quit all at once? Because, if you try to quit "cold-turkey" from a heavy-duty habit, even though you take a pill or a patch, your chance of success is minimal, and the probability of relapse is immense. What we're aiming for is a re-education of smokers, to gain knowledge of why they smoke, and minimize the need to do so.

Nicotine patches and Zyban may be helpful, and are OK for the time when the now 5 or fewer / day (former 20 / day) smoker stops cold. This will be the subject of the next, and last, smoke-ending column.

Next: Is there life after cigarettes?