Positive Results Laser Rehabilitation Inc.

Joel Spitzer's
Never Take Another Puff

Author's Disclaimers and Use Authorization

Copyright © Joel Spitzer, 2007. This book or any portion thereof may be freely distributed in either electronic or print form so long as no charge is made for it, and so long as this notice remains with any significant portion of the book when distributed.

Joel Spitzer and www.WhyQuit.com are not affiliated with any product or service, nor do they endorse any service or product.

About the Author

Joel Spitzer has been a leading authority in the development and implementation of smoking cessation and prevention programs for over 30 years. Far from just following and teaching the commonly held beliefs of the day, he has been a visionary who recognized early on that nicotine was an addiction while the rest of the medical and scientific community contended it was simply a habit. His unique insight allowed him to develop and implement nicotine prevention and intervention strategies that were decades ahead of their time. Participants in his clinics have success in quitting at rates that far exceed the national average for such programs. Currently, he serves as a smoking prevention and cessation consultant to the Evanston and Skokie, Illinois Health Departments. He is conducting full 6-day clinics throughout the year as well as conducting monthly seminars. He also is currently co-managing an Internet based smoking cessation support group with over 3,000 members and serves as a technical advisor for another smoking prevention and cessation site http://www.whyquit.com/ that has over four million hits per year. His materials are being widely utilized on many Internet based quit sites. Mr. Spitzer has been providing smoking cessation and prevention services since 1972, first as a volunteer speaker and then a member of the professional staff of the American Cancer Society, and later as the smoking programs coordinator for the Rush North Shore Medical Center’s Good Health Program. He has conducted over 325 six-session stop smoking clinics to over 4,500 participants, including programs for major corporations, medium and small sized companies, universities, health departments and numerous hospitals in the Metropolitan Chicago area. Besides smoking cessation clinics, he has developed and presented smoking education seminars to both adult and school age groups. Since 1972, he has presented over 570 one-session seminars to over 92,000 people. He has been a main speaker on the physical, psychological, and social aspects of smoking at over 30 major conferences on smoking and health throughout Illinois. He has trained physician and lay speakers for the American Cancer Society. He has done many radio, television, newspaper and magazine interviews. He has written over 100 articles used as part of the follow-up reinforcement for participants of his Stop Smoking Clinics. He has been involved in other aspects of health promotion. He has done public speaking on lifestyle and fitness, weight control, drug abuse, cancer prevention and cancer early diagnosis. He personally designed and produced most of the audio-visual materials used in conjunction with these programs.

In September of 2000 he established Joel Spitzer, Ltd., where he is working as a private consultant providing smoking cessation and prevention programs in the Chicago area.

Preface

Never take another puff. It seems so simple. If you want to quit smoking all you need to do is to never take another puff. There you have it-a roadmap for breaking free from one of the deadliest scourges ever to hit mankind. Nearly five million people a year die from smoking. Many knew the dangers and wanted to quit but didn’t feel as if they knew how to break away from such a complicated and powerful addiction. Truth be known, this is not a complicated addiction and while on the surface it may seem powerful, in truth, it is not. Yes there are lots and lots of people who smoke until it kills them but it is not that they couldn’t quit. It’s that they didn’t have the understanding of what was needed to quit, and more importantly, what they needed to do to stay quit. Again, the answer to both is to never take another puff.

Anyone who goes through the trouble of reading this book is going to see that phrase a lot. While it may sound repetitive to the point of being annoying, it is the one key piece of information that will secure your quit. This series of short articles, exploring different smoking issues, was written over a twenty-two year period. They were not written to be a “how to” manual for quitting, but as follow-up reinforcement to support those who had already quit smoking through clinics I had conducted, to remind them of the importance of remaining vigilant in order to stay free. While they were not intended to be a “how to” manual, when compiled and organized as they are here, they may very well serve as an empowering tool to help you learn how to join the ranks of the millions of successful ex-smokers alive today. The more you read the more you will understand why you smoke and why you should quit. You will also begin to grasp how your life can change by quitting. After spending a few minutes reading any article that touches on some aspect of smoking pertinent to you, you will arrive at a sentence spelling out what you need to do to remain free today. Make it through to the end and you will have all the understanding and tools in place to make a commitment that can preserve your health and likely save your life. You will understand that all you need to do to stay smoke-free is to Never Take Another Puff!

Chapter 1 Why do people continue to smoke?

Junkie, burn-out, addict, drug abuser, drunk, alcoholic, smoke-a-holic

Some people would argue that smoke-a-holic is just a cute euphemism which should not be compared to what they consider degrading syndromes. Contrary to this belief, nicotine addiction can be equally as strong and deadly as any of these other conditions. In fact, if you total the number of people who die yearly of all these other conditions combined, they would not add up to the number of premature deaths attributed to cigarette smoking. Until recent times, the idea of nicotine being a physiologically addictive substance was controversial in the world-wide medical community. For a drug to be considered addictive, it must meet certain criteria. First, it must be capable of inducing physical withdrawal upon cessation. Nicotine abstinence syndrome is a well documented, established fact.

Second, tolerance to the drug usually develops. Increasingly larger doses become necessary to achieve the same desired effects. Smokers experience this phenomenon as their cigarette consumption gradually increases from what probably was sporadic occasional use to a required daily consumption of one or more packs. The third criterion is that an addictive substance becomes a totally consuming necessity to its user, usually resulting in what is considered by a society as anti-social behaviour. Many have argued that cigarette smoking fails to fulfill this requirement. True, most smokers do not resort to deviant behaviours to maintain their dependency, but this is because most smokers do manage to easily obtain the full complement

of cigarettes they need to satisfy the addiction. When smokers are deprived of easy accessibility to cigarettes, the situation is totally different. During World War II, in concentration camps in Germany, prisoners were not given enough food to fulfill minimum caloric nutritional requirements. They were literally starving to death. A common practice among smoking prisoners was to trade away their scarce supplies of life sustaining food for cigarettes. Even today, in underdeveloped countries, such as Bangladesh, parents with starving children barter away essential food for cigarettes. This is not normal behaviour. During the “stop smoking clinics” I conduct, numerous participants admit to going through ashtrays, garbage cans and, if necessary, gutters looking for butts which may still have a salvageable value of a few puffs when their own supplies are depleted due to carelessness or unforeseen circumstances. To them, it is sick to think that they ever performed such a grotesque act, but many realize that if they were currently smoking and again caught in a similar predicament, they would be fully capable of repeating the repulsive incident. Nicotine is a drug. It is addictive. And if you let it, it can be a killer. Consider this when you get the urge for a cigarette. One puff can and most often will reinforce the addiction. Don’t take that chance. Remember - NEVER TAKE ANOTHER PUFF!

I Smoke Because I Like Smoking!

Ask almost any current smoker why she continues to indulge in such a dangerous activity and she will normally reply, “Because I like smoking.” While she may say this in all honesty, it is a very misleading statement, both to the listener and to the smoker herself. She does not smoke because she enjoys smoking, rather she smokes because she does not enjoy not smoking. Nicotine is a powerfully addictive drug. The smoker is in a constant battle to maintain a narrow range of nicotine in her blood stream (serum nicotine level). Every time the smoker’s serum nicotine level falls below the minimum limit, she experiences drug withdrawal. She becomes tense, irritable, anxious and, in some cases, even shows physical symptoms. She does not enjoy feeling these withdrawals. The only thing that will alleviate these acute symptoms will be a cigarette. The nicotine loss is then replenished and, hence, the smoker feels better. She enjoyed smoking. A smoker must also be cautious not to exceed his upper limit of tolerance for nicotine or else suffer varying degrees of nicotine poisoning. Many smokers can attest to this condition. It usually occurs after parties or extremely tense situations when the smokers finds themselves exceeding their normal level of consumption. They feel sick, nauseous, dizzy and generally miserable. Being a successful smoker is like being an accomplished tightrope walker. The smoker must constantly maintain a balance between these two painful extremes of too much or too little nicotine. The fear which accompanies initial smoking cessation is that the rest of the exsmoker’s entire life will be as horrible as the first few days without cigarettes. What ex-smokers will learn is that within a short period of time, the physical withdrawal will start to diminish. First, the urges will weaken in intensity and then become shorter in duration. There will be longer time intervals between urges. It will eventually reach the point where the ex-smoker will desire a cigarette very infrequently, if ever. Those who continue to smoke will continue to be in a constant battle of maintaining their serum nicotine level. Included in this battle is the great expense of buying pack after pack and the dangerous assault on the smoker’s body of inhaling the poison nicotine along with over 4,000 other toxic chemicals which comprise the tars and gasses produced from the combustion of tobacco. These chemicals are deadly by themselves and even more so in combination. So the next time you think of how much you once seemed to enjoy cigarettes, sit back and take a serious, objective look at why you have such an idealization of this dangerous product. Consider all the consequences. You will probably realize that you feel physically and mentally better now than you ever did as a smoker. Consider all of this and - NEVER TAKE ANOTHER PUFF!

I Smoke Because I’m Self-Destructive!

Many Smokers believe they continue to smoke because of their self-destructive attitude. They actually want to get sick. Some say they are afraid of reaching old age. Others arrogantly vow to continue smoking until it kills them. While some people do have emotional problems which lead to self-destructive behaviour, I believe the majority of smokers with this attitude are not in this category. Most make these statements to hide their fears of not being able to give up cigarette smoking. Over the past years, I have had many people ravaged by smoking related illnesses come into smoking clinics. They often explain that they had made such excuses yet were shocked when they actually did become ill. Clinic participants who fail occasionally state that they just didn’t care enough about themselves to give up cigarettes. Unfortunately, some were later diagnosed of having cancer. Others have had heart attacks, strokes or other circulatory conditions. Many were discovered to have major breathing impairments from emphysema. None of them ever called me enthusiastically proclaiming, “It worked, it’s killing me!” On the contrary, they were normally upset, scared and depressed. Not only did they have a potentially deadly condition, but they knew that, to a major degree, they were responsible for its occurrence. An equally tragic situation is experienced by the survivors of people who die of smoking related illnesses. Many ex-smokers go back to smoking through the encouragement of family and friends. This usually happens to someone who is disease free and quits to stay healthy. Initially they are nervous and crabby (remember those days?). Soon the spouse, kids and others are saying, “If this is what you are like as a non-smoker, for heaven’s sake, smoke!” While it may seem to be a good idea at the time, consider how the relative feels when the smoker gets cancer or has a heart attack and dies. The guilt is tremendous. Some beliefs or statements made by smokers sound irrational, as if they have a real death wish. Often, there is really nothing wrong with the person - it is a drug effect. Fear of withdrawal or of being unable to cope with life without cigarettes results in a defence mechanism to justify dependency. Once off smoking these excuses simply disappear, leaving a physically and psychologically healthier individuals who will have a good chance of remaining this way by following one simple procedure - NEVER TAKE ANOTHER PUFF!

You Smoke Because You’re A Smoke-a-holic!

Some smokers say they smoke because they are nervous. Others say they smoke to celebrate. Some think they smoke for energy. Many smoke to look sexy. Yet others smoke to stay awake or to sleep. Some think they smoke to think. One truly unique smoker once told me she smoked to breathe better. Another once said she returned to smoking when experiencing chest pains. She figured the fear of a heart attack is enough to make anyone smoke. None of these reasons satisfactorily explains why people continue smoking. However, the answer is, in fact, quite simple. Smokers smoke cigarettes because they are smokers. More precisely, smokers smoke cigarettes because they are smoke-a-holics.

A smoke-a-holic, like any other drug addict, has become hooked on a chemical substance. In the cigarette smoker’s case, nicotine is the culprit. He is at the point where the failure to maintain a minimum level of nicotine in his blood stream leads to the nicotine abstinence syndrome, otherwise known as drug withdrawal. Anything that makes him lose nicotine makes him smoke. This concept explains why so many smokers feel they smoke under stress. Stress has a physiological effect on the body which makes the urine acidic. Whenever the urine becomes acidic, the body excretes nicotine at an accelerated rate. Thus, when a smoker encounters a stressful situation he loses nicotine and goes into drug withdrawal. Most smokers feel that when they are nervous or upset cigarettes help calm them down. The calming effect, however, is not relief from the emotional strain of the situation, but actually the effect of replenishing the nicotine supply and ending the withdrawal. It is easy to understand why smokers without this basic knowledge of stress and its nicotine effect are afraid to give up smoking. They feel that they will be giving up a very effective stress management technique. But once they give up smoking for a short period of time, they will become calmer, even under stress, than when they were smokers. The explanation of how physiological changes in the body make smokers smoke is difficult for some smokers to believe. But nearly all smokers can easily relate to other situations which also alter the excretion rate of nicotine. Ask a smoker what happens to their smoking consumption after drinking alcohol, and you can be sure they will answer that it goes up. If asked how much their consumption rises, they will normally reply that it doubles or even triples when drinking. They usually are convinced that this happens because everyone around them is smoking. But if they think back to a time when they were the only smoker in the room, they will realize that drinking still caused them to smoke more. Alcohol consumption results in the same physiological effect as stress - acidification of the urine. The nicotine level drops dramatically, and the smoker must light one cigarette after another or suffer drug withdrawal. It is important for smokers considering quitting to understand these concepts because once they truly understand why they smoke they will be able to more fully appreciate how much more simple their life will become as an ex-smoker. Once the smoker stops, nicotine will begin to leave his or her body and within two weeks all the nicotine will be gone. Once the nicotine is totally out of the body, all withdrawal will cease. No longer will they experience drug withdrawal states whenever encountering stress, drinking, or just going too long without smoking. In short, they will soon realize that all the benefits they thought they derived from smoking were false effects. They did not need to smoke to deal with stress, or to drink, socialize, or work. Everything they did as a smoker they can do as a non-smoker, and in most cases they will now do these activities more efficiently and feel better during them. They will become a more independent people. It is a good feeling and a major accomplishment to break free from this addiction. But no matter how long they are off smoking and how confident they feel, the ex-smoker must always remember that he or she is a smoke-a-holic. Being a smoke-a-holic means that as long as they don’t take a single drag off a cigarette, cigar or pipe, or chew tobacco, or inject it into their bloodstream with a syringe, they will never again become hooked on nicotine. If, on the other hand, they do make the tragic mistake of experimenting with any nicotine product, they will reinforce their addiction. This will result either in returning to their old level of consumption or experiencing a full fledged withdrawal process. Neither situation is fun to go through. So, once off of smoking, the ex-smoker must always remember just who and what he is - a smoke-a-holic for the rest of his life. Remembering this, you can remain truly independent from nicotine by following one simple practice - Never Take Another Puff!

Why Do I Smoke?

Most smokers spend countless hours during their smoking careers trying to satisfactorily answer this most perplexing question. Typically, answers they come up with are that they smoke because they are unhappy, unsatisfied, nervous, bored, anxious, lonely, tired or just frustrated without their cigarettes. Other reasons often quoted are that cigarettes keep them thin, make them better able to think, or that they are more sociable while smoking. Some claim that they smoke to celebrate the joyful times of life. Food, drink, fun and games, and even sex all seem to lose their appeal without an accompanying cigarette. After hearing all of these wonderful qualities attributed to cigarette smoking, I find myself amazed that over one billion of earth’s inhabitants have successfully given up smoking. What in the world is wrong with these ex-smokers? I can understand people who never smoked. They never knew or believed all of these wonderful benefits derived from smoking. What you never had you’ll never miss. But these ex-smokers, having given up such a marvellous chemical addiction with so many benefits, must be crazy. The fact is ex-smokers are not crazy. To the contrary, it was their ability to be rational which enabled them to successfully break free from cigarettes. They had the foresight to put themselves through the pain and agony encountered during the initial withdrawal from the nicotine addiction. It is both a powerful physical and psychological addiction which creates many irrational beliefs as defence mechanisms in order to perpetuate the smoking behaviour. Most of the reasons mentioned above of why smokers claim they smoke are such drug induced beliefs. All ex-smokers should be applauded for their great accomplishment in overcoming the many obstacles created by their addiction. Encountering the initial quitting process creates a state of emotional insecurity and self doubt. Will they ever be able to survive in our complicated world without their cigarettes? Once they become totally free of the grip which cigarettes exert upon them, they will be able to get a clear perspective of how many misconceptions they had about the benefits they thought they derived from smoking. Being drug free after years of enslavement brings a sense of relief and accomplishment that the smoker never anticipated. To their pleasant surprise, they discover the marvellous fact that there is life after smoking. It is a healthier, calmer and more pleasant life. They now have a choice as to whether or not they ever wish to smoke again. If they look honestly and objectively at the advantages and disadvantages, the logical choice is to remain exsmoker’s. Unfortunately, some don’t remember all of the consequences associated with their now arrested dependency, but only recall the infrequent good times they believe they had with their cigarettes. They think that they could once again enjoy just a few cigarettes. What must be understood by all ex-smokers is that they only have two options. They can smoke nothing or they can smoke at their previous level of consumption. There is no in-between. They are wasting their time contemplating how nice it would be to be an occasional social smoker. They can never again have that luxury. All ex-smokers must consider both options. Then if they choose to smoke, all they need do is take their first cigarette and again become trapped in the nicotine addiction. If they choose to remain free, all they need is to follow the simple practice - NEVER TAKE ANOTHER PUFF!

How would you deal with the following situations?

Your 2-year-old is having a temper tantrum because he wants a new toy.

Would you;

1. Leave him alone until he calmed down

2. Give into his demands

3. Give him a tranquilizer

Your 7-year-old is anxious about next week’s Little League tryouts.

Would you;

1. Assure him that he can do it

2. Practice with him and tell him to try his best

3. Give him a Valium every three hours until the game

Your 14-year-old is crushed when she is not asked to the sophomore

dance.

Would you;

1. Fix her up with one of your friend’s children

2. Tell her to go anyway

3. Give her cocaine to pick up her spirits

Your 15-year-old is self-conscious about being 5 pounds overweight.

Would you;

1. Cook lower calorie meals

2. Enroll her in a diet or exercise program

3. Put her on appetite suppressants

All of these young people are experiencing what adults would consider

“growing pains.”

A little time, patience and positive reassuring will help them overcome all of these difficult situations. The fact is, as long as anyone continues to develop physically, emotionally, intellectually, professionally or spiritually, they too will experience growing pains. Adults are prone to hurt, pain, sadness, depression and anxiety just as children are. These feelings are all necessary if we wish to continue to develop our minds and bodies. Without such growth, we would not experience happiness, satisfaction, contentment or purpose to their full extent. The third choice in each of the above situations was, of course, ridiculous. We would not subject our children to chemical hazards to overcome such trivial problems. However, as adults we are fully capable of practicing such dangerous behaviours for our own relief. Take cigarette smoking as an example. When you were still a smoker, how many times would you say you had to smoke because you were lonely and sad without your friendly cigarettes? How many times did you say that you had to smoke because of all the stress in your life? How many times did you tell yourself that many social activities were just not fun without your cigarettes? How many times did you say that you would gain too much weight if you quit smoking? All you were saying was that you needed nicotine, a drug, to overcome everyday life problems. It was not until you were off cigarettes that you realized you could overcome such problems without smoking, and in most cases more effectively than when you were a smoker. Once you had quit you realized just how much a source of stress dependence upon nicotine was to you. You were caught by a socially unacceptable and physically deadly addiction and were quite often aware of it. This is when you had the desire to give them up, but thought the pain of quitting too great to even attempt it. Even today, you probably still desire an occasional cigarette. It may be in a stressful situation, at a party after a few drinks, or at a time when you find yourself alone with nothing better to do. The fact is, there is nothing worse you can do than take a cigarette. One cigarette will not help you over the problem. In reality, it will create a new problem, a disastrous situation of a revived and reinforced addiction, with all the physical dangers and the dirty means of delivery that come with it. So, next time you have the desire for a cigarette, sit back and take a few moments to reflect upon what you are setting yourself up for. Do you need that drug? Do you want that addiction? If not, simply remember - NEVER TAKE ANOTHER PUFF!

I Have to Smoke Because of All My Stress!

Stress is considered a cause for smoking by many people. Actually, smoking is a cause of stress. Recent correspondence dealt with reasons people give for going back to smoking: social situations, parties, alcohol consumption and stress. This month I wish to amplify on stress. In January of 1979, Chicago and vicinity was devastated by a major blizzard. Heavy snows fell just after the New Year crippling the area. Additional snowfall continued throughout the week. During this time period I was barraged with phone calls from participants of the November, 1978 clinic claiming to be terribly nervous, upset and anxious from “not smoking.” Curiously, most of them were feeling well during the month of December. They had occasional urges which lasted only seconds and were quite easy to overcome. What they were experiencing in January was different. Many felt that they were on the verge of cracking up. To them life was “just no good” without their cigarettes. Was the anxiety they were now experiencing really a side effect from giving up smoking? To any outside observer the answer to the mysterious intensification of perceived withdrawal was obvious. In fact, if our ex-smokers listened to radio or television or read the front page of any newspaper, they would have encountered a story on cabin fever. By simply comparing their symptoms with those accompanying cabin fever they would understand what was happening.

Attributing the anxiety to smoking cessation was transference of blame. In fact, they were having a normal reaction to an abnormal situation - confinement due to the blizzard. They would have had the same anxiety whether or not they had given up cigarettes. The above story illustrates an atypical time period in which numerous people experience similar complaints. In everyday life inherent problems exist. Work, family, friends, and money can all contribute to daily distress. Ex-smokers often think that if they just take a cigarette during a stressful episode the situation will be solved. For example, consider a person who finds he has a flat tire in a parking lot during a freezing rain. When encountering this kind of misfortune, the ex-smoker’s first reaction often is, “I need a cigarette.” What will actually solve this problem is changing the tire, and driving off in a warm car. What would a cigarette do to help this situation? It only makes the person see the flat tire longer and freeze more. This adds up to greater frustration. The first puff will probably reinforce the addiction to cigarettes which is a much greater crisis than the flat tire ever was. In fact, taking the first puff almost always results in a bigger problem than the crisis that “caused” them to take the puff. Even in a real catastrophe, such as a death in the family, injuries, illnesses, flooding resulting in major property loss, bankruptcy and so on, a cigarette will not solve the problem. It will just add another major problem to the originally bad situation. Remember, smoking cannot solve problems of daily living. No matter what the problem, there is a more effective way of solving it than smoking. In fact, a smoker’s health risks are a real problem that can only be solved if they - NEVER TAKE ANOTHER PUFF!

I’ve Smoked for So Long and So Much, What is the Use in Quitting Now?

On the sixth night I called her to see if she had made it through the weekend all right. “I feel so bad,” she replied. “I had a terrible evening last night and I had a major problem dealing with a client at work this morning. I was just so upset from lack of sleep and frustration, I finally broke down and took a cigarette. I’ve been beating myself up for it ever since. I am more depressed now than I was before. Why am I beating myself up so, and what should I do now?” I said she had two options, quit right then and face a potential full three day withdrawal or go back to full fledged smoking all over again. If she didn’t make a decision, her body would automatically make the decision for her. Again she expressed the sentiment that she was beating herself up so badly and wanted me to explain why she was so upset with herself. She just couldn’t believe that one cigarette could be so important to be making such a big issue. A few minutes later, she told me the story of how her husband had once been off for three years. One day while they were in the car together, for one reason or another he bummed a cigarette from her. She raised the issue with him of what good would a cigarette be after all that time, but he convinced her it was no big deal. What right did she have to protest anyway, she thought, she was a chain smoker herself. He finally got his way. He never stopped smoking after that day. Four years later she got a call at work that her husband had collapsed at her mother-in-law’s home. By the time they got to him it was too late. He had died of a sudden and totally unexpected heart attack. She has little doubt that his last four years of smoking was a major contributing factor to his sudden and premature death. So why was she now making such a big deal out of a cigarette? Once again, her own personal history was giving her a more powerful answer than I could ever have expressed. One cigarette, in a car a number of years earlier helped to end her husband’s life. If he had known the implication that one cigarette would have had, he would never have considered the thought for more than a second. In retrospect, she had the opportunity to look back to that day and realize how a fleeting urge followed by poor judgment helped to end or shorten her husband’s life. With the kind of personal experiences she had witnessed associated with smoking, it is quite easy to see how she could be so hard on herself for what occurred earlier that day. She witnessed how smoking diminished the quality of her father’s life and almost brought on a premature death. Equally important, she saw how quitting smoking vastly improved his health and general feeling of well being. She also witnessed how her husband’s momentary lapse of judgment resulted in her suffering such a grave loss just a few years earlier. If he had the opportunity, he would surely have cursed the day he lit just one. She had the benefit of hindsight, which now was haunting her because she had made the same mistake that day he had made just a few years earlier. He never got the chance to quit again. She still had time to make a decision - and she was asking me what she should do now. Again, I feel her own personal experience and the immediate emotional reactions she was now experiencing were giving a more powerful answer to her question than I could. If she listened to her heart, I am sure it was telling her to - NEVER TAKE ANOTHER PUFF!

What A Relief, I Think I Have Cancer!

“Last night I was getting a burning sensation in my lungs. I actually thought I had lung cancer. I wasn’t scared, surprised, or even upset. I was actually happy. I can’t remember ever looking so forward to being diagnosed of having a terminal illness.” This unusual statement was made to me by a clinic participant on her fourth day without smoking. While it sounds like the ravings of a severely depressed or mentally ill individual, in fact she was nothing of the sort. To the contrary, she was smiling and laughing when she said it. What was the humour she saw in the statement? As soon as she said it to herself the night before, she realized the pain she was experiencing was the same complaints she heard three other people describe earlier that day at her clinic. It was a normal part of the healing process from quitting smoking. She also recognized the fact that she was not looking forward to a debilitating illness and an early demise. She was looking forward to taking a cigarette. When the pain started she rationalized that as long as she had lung cancer already, she might as well smoke. Then she realized she was looking forward to cancer. At that point she recognized just how morbid her thought processes had become. Not because she was quitting smoking, but because she was an addict was she capable of thinking in such depraved terms. Upon recognizing the absurdity of the situation, she laughed off the urge and went to bed. It is important to remember just how irrational your thoughts were when you too were a smoker. As a smoker you were constantly warned of the dangers through the media, physicians, family, friends who quit, and most importantly, your own body. Not a week went by when you were not being bombarded by the constant annoying message that smoking was impairing and killing you. But being the obedient addict you were, you disregarded these pestering outside influences to obey your true master-your cigarette. As Vic, the participant in my first clinic once stated, “Everywhere I turned I was being warned about cigarettes. Newspapers reports and magazines articles constantly reinforced that cigarettes were deadly. Even bill boards advertising cigarettes carried the Surgeon General’s warning signal. Every time I’d reach for my pack, a warning label stared me in the face. It was only a matter of time before I reached the only logical conclusion. I quit reading!” The control cigarettes exert on you when you are in the grip of the addiction is complete. It makes you say and do things that when observed by outside observers makes you look weak, stupid or crazed. At the same time it robs you of your money, health and eventually life. Once free of cigarettes you can recognize all these symptoms of your past addiction. To avoid ever living such a miserable existence - NEVER TAKE ANOTHER PUFF!

The Power of Advertising

The father sat reflecting on how much joy his two sons brought to him during the year. He decided to buy them both the present of their choice this holiday season. When he asked his older boy what he would like, the son replied, “Oh boy, I would like so many things. Maybe a bicycle, or new skis, or skin diving equipment. I wish I would have them all, but any one would make me happy.” That was fine with the father, he now had some good choices. Next, he turned to his younger son, who was only eight years old. The boy envied his brother for all the games he could play and all of the sports he could do so well. When asked what he would like, he made one simple request. “I would like a box of Tampax Tampons.” The father was shocked, “What in the world do you want a box of tampons for?” he demanded angrily. The poor boy, not knowing he had said something wrong, answered, “With Tampax, you can swim, ski, sky dive, horseback ride and play any sport you want.” This humorous story illustrates a serious point. Advertising promises can influence our desires for material products. The more naive we are, the more effective advertising will be. The claims ads promote are often misleading or exaggerations of the truth. No product abuses the truth more than cigarettes. Just as the young boy in our story expected great things from this marvellous unknown product, smokers have great confidence in the emotional benefits brought from inhaling burning weeds. To tell a smoker the truth about his cigarettes while he still is in the midst of the smoker’s psyche results in a state of denial and defiance. He cannot believe his cigarettes, his friends and allies, would in any way hurt him. They help him over trauma, they help him enjoy life to the fullest. Think of all the things he does with his cigarettes. He wakes in the morning to them, works with them, plays with them, eats and drinks, goes to the bathroom, reads the paper, watches television, socializes with all of his friends and even has them on his mind during sex. If any person hung around him that much, it would drive him crazy. But not his friendly cigarettes - they enhance everything. The advertisements even say they do. The advertisements do claim this, but the claim is not true. He does not smoke during all of these activities because he chooses to. He has to. Smokers are drug addicts. They cannot enjoy natural pleasures, no matter how good they are, until their serum nicotine level is raised. They are controlled by this product. Cigarettes are not friends, they are lousy acquaintances. Once you get rid of them, stay clear. Yes, they may call to you, and the ads may strike out at you. But you know the truth about cigarettes. Don’t let any smoker who is feeling inferior, or tobacco company or advertising agency which wishes to maintain its vast wealth at the expense of your life convince you of anything different. Life can be longer as an ex-smoker, and life is better as an ex-smoker. Consider this whenever external or internal forces call out to you. Remember this and - NEVER TAKE ANOTHER PUFF!

A Safer Way to Smoke

Smokers are always looking for ways to reduce the health risks of smoking. Unfortunately, most techniques used to reduce the risk don’t work, and, in many cases, may actually increase the dangers of smoking. Probably the most popular method of risk reduction is switching to low tar and nicotine cigarettes. If people only smoked to perpetuate a simple habit, low tar and nicotine cigarettes would probably reduce the dangers of smoking. Unfortunately, the necessity to smoke is not continuance of a habit but rather maintenance of an addiction. Switching to a low tar and nicotine cigarette makes it difficult for a smoker to reach and maintain his normal required level of nicotine. The smoker will probably develop some sort of compensatory smoking pattern. Compensatory behaviours include smoking more cigarettes, smoking them further down, inhaling deeper, or holding the smoke down longer. By doing one or a combination of these behaviours, the smoker will reach similar levels of tar and nicotine in his system as when he smoked his old brand, but, in the process, he may increase the amount of other potent poisons beyond what was delivered by his old cigarettes. Low tar and nicotine cigarettes often have higher concentrations of other dangerous poisons. By increasing consumption, substantially greater amounts of these poisons are taken into the system, thereby increasing his risk of diseases associated with these chemicals. One such poison, found in higher quantities in many low tar and nicotine cigarettes, is carbon monoxide. Carbon monoxide is one of the major factors contributing to the high incidence of heart and circulatory diseases in smokers. Also, to give flavour to the low tar and nicotine cigarettes, many additional additives and flavour enhancers are used. Tobacco companies are not required to disclose what the chemical additives are, but the medical community suspects that many of these additives are carcinogenic (cancer producing) and may actually be increasing the smoker’s risk of tobacco-related cancers. The filter at the end of cigarettes also may make a difference in how much poison a smoker takes in. Some filters are more effective than others, but, again, a smoker will generally alter the way he smokes rendering many of the protective actions of the filters useless. Some cigarettes have holes inserted around the perimeter of the filter permitting more air to be inhaled with the tars and gasses of the cigarette. Theoretically, this lowers the amount of the actual tobacco smoke being inhaled. But, a smoker will normally find these cigarettes difficult to inhale and cannot get the amount of nicotine necessary to satisfy the craving. In response, he may smoke more or may discover an even more innovative way to interfere with the filter’s protective action. Many times a smoker will learn how to put the cigarettes a little deeper into his mouth and seal his lips around the ventilation holes, thus decreasing the filter’s efficiency. I have even encountered smokers in clinics who put tape around these holes because they found the cigarette easier to inhale and generally tasted better. In the process, they inactivated the semi protective mechanism of the filter. Their attempts at making their smoking safer were simply an inconvenience and a waste of time. Filters could be developed that would take out all of the nicotine, but, unfortunately, in order to satisfy the addiction, most smokers would give themselves a hernia trying to inhale. One last method of risk reduction worth mentioning is vitamin supplements. The body’s ability to utilize Vitamin C is impaired by smoking. When some smokers learn this, they start taking supplemental Vitamin C. But vitamin C acidifies the urine, resulting in the body accelerating the excretion rate of nicotine. In response, the smoker may smoke extra cigarettes. In the process, he will probably destroy the extra vitamin C and increase his exposure to all of the poisonous chemicals found in tobacco smoke. Almost every method of making smoking safer is a farce. There is only one way to totally reduce the deadly effects of smoking, and that is, simply, not to smoke. Only then will your chances of diseases such as heart disease, cancer and emphysema be reduced to the level of non-smokers. And to keep your risk at these low levels, only one method is necessary— NEVER TAKE ANOTHER PUFF!

Are You Smoking More and Enjoying it Less

This creative slogan was once used by a cigarette advertiser trying to entice smokers of other brands to switch to their product. The slogan was a brilliantly conceived advertising tactic. Almost every smoker who had indulged for a significant period of time would instantly recognize him or herself in the slogan. He or she may even have tried smoking the other brand to recapture the pleasure and joy of earlier days of smoking. But to his or her dismay, even this cigarette failed to deliver that special feeling once derived from smoking. Why do cigarettes seem to lose that special appeal for the veteran smoker? Have cigarettes changed so drastically over the years? No, that is not the problem at all. Cigarettes haven’t changed, smokers have. For the longer an individual smokes, the more dependent the smoker becomes on his nicotine fix. In his early days of smoking, the smoker derived much pleasure from the pharmacological action of nicotine. It made him feel alert, energetic, or maybe even had a calming, relaxing effect. It helped in studying and in learning. Sometimes it made him feel more mature, confident, and more social. It pretty much did whatever he wanted it to, depending on the circumstances surrounding him while he smoked it. In these early days, he smoked maybe 5 to 10 per day, usually just when he wanted the desired effect. But gradually, something happens to the smoker. He becomes more dependent on cigarettes. He no longer smokes to solve a problem, to celebrate, or to feel great. He smokes because he NEEDS a cigarette. In essence he smokes because he is a smoker, or, more accurately, a smoke-a-holic. No longer does he get those special smoker highs now he smokes because not smoking makes him feel withdrawal. Not smoking means feeling nervous, irritable, depressed, angry, afraid, nauseous, or headachy just to mention a few effects. He grasps for a cigarette to alleviate these symptoms, all the time hoping to get that special warm feeling that cigarettes used to give him. But, to his dismay, all that happens is he feels almost normal after smoking a cigarette. And 20 minutes later the whole process starts up again. Once he quits smoking, life becomes nice again. No longer does he go into withdrawal 20 to 80 times per day. He can go anywhere any time he wishes and not have to worry about whether he will be able to smoke at his needed intervals. When he gets a headache or feels nauseous, he knows he is coming down with an infection, not feeling the way he does every day as a smoker from too much or too little smoking. In comparison to his life as a smoker, he feels great. But then something insidious starts to occur. He begins to remember the best cigarette he ever had in his life. It may be one he smoked 10, 20 or maybe even 40 years earlier. He remembers that special warm feeling of that wonderful cigarette. If he thinks about it long enough, he may even try to recapture the moment. Unfortunately, however, the moment will recapture him. Once again he will be in the grip of an addiction which will cause him to be smoking more and enjoying less. This time he may not get off. This wonderful cigarette will cost him his freedom, his health and eventually his life. Don’t make this mistake when you quit. Remember how cigarettes were the day you stopped, for that will be what they are like the day you go back, no matter how far apart those two days are. Remember the way they were and - NEVER TAKE ANOTHER PUFF!

“Quitting Smoking”: A Fate Worse than Death?

People sitting in at smoking clinics are amazed at how resistant smokers are to giving up cigarettes. Even smokers will sit and listen to horror stories of other participants in sheer disbelief. Some smokers have had multiple heart attacks, circulatory conditions resulting in amputations, cancers, emphysema and a host of other disabling and deadly diseases. How in the world could these people have continued smoking after all that? Some of these smokers are fully aware that smoking is crippling and killing them, but continue to smoke anyway. A legitimate question asked by any sane smoker or non-smoker is, “why?” The answer to such a complex issue is really quite simple. The smoker often has cigarettes so tied into his lifestyle that he feels when he gives up smoking he will give up all activities associated with cigarettes. Considering these activities include almost everything he does from the time he awakes to the time he goes to sleep, life seems like it will not be worth living as an ex-smoker. The smoker is also afraid he will experience the painful withdrawal symptoms from not smoking as long as he deprives himself of cigarettes. Considering all this, quitting smoking creates a greater fear than dying from smoking. If the smoker were correct in all his assumptions of what life as an ex-smoker were like, then maybe it would not be worth it to quit. But all these assumptions are wrong. There is life after smoking, and withdrawal does not last forever. Trying to convince the smoker of this, though, is quite an uphill battle. These beliefs are deeply ingrained and are conditioned from the false positive effects experienced from cigarettes. The smoker often feels that he needs a cigarette in order to get out of bed in the morning. Typically, when he awakes he feels a slight headache, tired, irritable, depressed and disoriented. He is under the belief that all people awake feeling this way. He is fortunate though, because he has a way to stop these horrible feelings. He smokes a cigarette or two. Then he begins waking up and feels human again. Once he is awake, he feels he needs cigarettes to give him energy to make it through the day. When he is under stress and nervous, the cigarettes calm him down. Giving up this wonder drug seems ludicrous to him. But if he quits smoking he will be pleasantly surprised to find out that he will feel better and be able to cope with life more efficiently than when he was a smoker. When he wakes up in the morning, he will feel tremendously better than when he awoke as a smoker. No longer will he drag out of bed feeling horrible. Now he will wake up feeling well rested and refreshed. In general, he will be calmer than when he smoked. Even when under stress, he normally will not experience the panic reactions he used to feel whenever his nicotine level fell below acceptable levels. The belief that cigarettes were needed for energy is one of the most deceptive of all. Almost any exsmoker will attest that he has more strength, endurance, and energy than he ever did as a smoker. And the fear of prolonged withdrawal also had no merit, for withdrawal symptoms would peak within three days, and totally subside within two weeks. If any smoker just gives himself the chance to really feel how nice not smoking is, he will no longer have the irrational fears which keeps him maintaining his deadly addiction. He will find life will become simpler, happier, cleaner, and most importantly healthier, than when he was a smoker. His only fear will now be in relapsing to smoking and all he has to do to prevent this is - NEVER TAKE ANOTHER PUFF!

Quitting by Gradual Withdrawal

Quitting by the gradual withdrawal method. I discuss this method quite extensively in my seminars. I always tell how if there is anyone attending who knows a smoker who they really despise they should actively encourage them to follow the gradual withdrawal “cut down” approach. They should call them up every day and tell them to just get rid of one cigarette. Meaning, if they usually smoke 40 a day, just smoke 39 on the first day of the attempt to quit. The next day they should be encouraged to smoke only 38 then 37 the next day and so on. Then the seminar participant should call these people every day to congratulate them and encourage them to continue. I must reemphasize, this should only be done to a smoker you really despise.

You see, most smokers will agree to this approach. It sounds so easy to just smoke one less each day. Thirty-nine cigarettes to a two pack a day smoker seems like nothing. The trick is to convince the person that you are only trying to help them. For the first week or two the one downside is you have to pretend to like the person and you have to talk to them every day. They won’t whine too bad either. When they are down to 30 from 40, they may start to complain a little. You really won’t be having fun yet. When the payoff comes is about three weeks into scam. Now you’ve got them to less than half their normal amount. They are in moderate withdrawal all the time. A month into the approach you’ve got them into pretty major withdrawal. But be persistent. Call them and tell them how great they are doing and how proud you are of them. When they are in their 35th to 39th day, you have pulled off a major coup. This poor person is in peak withdrawal, suffering miserably and having absolutely nothing to show for it. They are no closer to ending withdrawal than the day you started the process. They are in chronic withdrawal, not treating him or herself to one or two a day, but actually depriving him or herself of 35 to 40 per day. If you want to go in for the kill, when you got them down to zero, tell them don’t worry if things get tough, just take a puff every once in a while. If you can get them to fall for this, taking one puff every third day, they will remain in withdrawal forever. Did I mention you really should despise this person to do this to them? It is probably the cruellest practical joke that you could ever pull on anyone. You will undercut their chance to quit, make them suffer immeasurably and likely they will at some point throw in the towel, return to smoking, have such fear of quitting because of what they went through cutting down, that they will continue to smoke until it kills them. Like I said, you better really despise this person. Hopefully there is no one you despise that much to do this to them. I hope nobody despises themselves enough to do this to themselves. Quitting cold turkey may be hard but quitting by this withdrawal technique is virtually impossible. If you have a choice between hard and impossible, go for hard. You will have something to show at the end of a hard process, but nothing but misery at the end of an impossible approach. Quit cold and in 72 hours it eases up. Cut down and it will basically get progressively worse for weeks, months, years if you let it. I should mention, this is not a new technique. It has been around for decades. Talk to every long-term ex-smoker you know. Try to find one person who successfully used the cut down approach, gradually reducing to eventual zero over weeks or months. You will be hard pressed to find even one person who fits this bill. One other perspective that should help you see the flaw in the approach. Look at people here who had once quit for months or years and then relapsed. One day, after such a long time period, they take a drag and are smoking again. If one puff can do this after years or decades, guess what it will do after days or hours of being smoke free. It puts the smoker back to square one. All that any ex-smoker has to do to avoid relapse or chronic withdrawal is to - NEVER TAKE ANOTHER PUFF!

I Can’t Quit or I Won’t Quit

“I don’t want to be called on during this clinic. I am quitting smoking, but I don’t want to talk about it. Please don’t call on me.” This request was made by a lady enrolling in one of my clinics over 20 years ago. I said sure. I won’t make you talk, but if you feel you would like to interject at anytime, please don’t hesitate to. At that she got mad and said, “Maybe I am not making myself clear-I don’t want to talk! If you make me talk I will get up and walk out of this room. If you look at me with an inquisitive look on your face, I am leaving! Am I making myself clear?” I was a little shocked by the strength of her statement but I told her I would honour her request. I hoped that during the program she would change her mind and would share her experiences with the group and me but in all honesty, I wasn’t counting on it. There were about 20 other participants in the program. Overall, it was a good group with the exception of two women who sat in back of the room and gabbed constantly. Other participants would turn around and tell the two to be quiet. They would stop talking for a few seconds and then start right up again with just as much enthusiasm as before. Sometimes, when other people were sharing sad, personal experiences, they would be laughing at some humorous story they had shared with each other, totally ignorant of the surrounding happenings. On the third day of the clinic, a major breakthrough occurred. The two gossips were partying away as usual. There was one young woman, probably early twenties who asked if she could talk first because she had to leave. The two gossips in back still were not listening and kept up with their private conversation. The young woman who had to leave said, “I can’t stay, I had a horrible tragedy in my family today, my brother was killed in an accident.” Fighting back emotions she continued. “I wasn’t even supposed to come tonight, I am supposed to be helping my family making funeral arrangements. But I knew I had to stop by if I was going to continue to not smoke.” She had only been off two days now. But not smoking was important to her. The group members felt terrible, but were so proud of her, it made what happened in their day seem so trivial. All except the two ladies in the back of the room. They actually heard none of what was happening. When the young woman was telling how close she and her brother were, the two gossips actually broke out laughing. They weren’t laughing at the story, they were laughing at something totally different not even aware of what was being discussed in the room. Anyway, the young woman who lost her brother shortly after that excused herself to go back to her family. She said she would keep in touch and thanked the group for all of their support. A few minutes later I was then relating some story to the group, when all of a sudden the lady who requested anonymity arose and spoke. “Excuse me Joel,” she said loudly, interrupting me in the middle of the story. “I wasn’t going to say anything this whole program. The first day I told Joel not to call on me. I told him I would walk out if I had to talk. I told him I would leave if he tried to make me talk. I didn’t want to burden anyone else with my problems. But today I feel I cannot keep quiet any longer. I must tell my story.” The room was quiet. “I have terminal lung cancer. I am going to die within two months. I am here to quit smoking. I want to make it clear that I am not kidding myself into thinking that if I quit I will save my life. It is too late for me. I am going to die and there is not a damn thing I can do about it. But I am going to quit smoking.” “You may wonder why I am quitting if I am going to die anyway. Well, I have my reasons. When my children were small, they always pestered me about my smoking. I told them over and over to leave me alone, that I wanted to stop but couldn’t. I said it so often they stopped begging. But now my children are in their twenties and thirties, and two of them smoke. When I found out about my cancer, I begged them to stop. They replied to me, with pained expressions on their faces, that they want to stop but they can’t. I know where they learned that, and I am mad at myself for it. So I am stopping to show them I was wrong. It wasn’t that I couldn’t stop smoking- it was that I wouldn’t! I am off two days now, and I know I will not have another cigarette. I don’t know if this will make anybody stop, but I had to prove to my children and to myself that I could quit smoking. And if I could quit, they could quit, anybody could quit.” “I enrolled in the clinic to pick up any tips that would make quitting a little easier and because I was real curious about how people who really were taught the dangers of smoking would react. If I knew then what I know now- well, anyway, I have sat and listened to all of you closely. I feel for each and every one of you and I pray you all make it.” Even though I haven’t said a word to anyone, I feel close to all of you. Your sharing has helped me. As I said, I wasn’t going to talk. But today I have to. Let me tell you why.” Then she turned to the two ladies in the back of the room, who actually had stayed quiet during this interlude. Suddenly she flared up, “The only reason I am speaking up now is because you two BITCHES are driving me crazy. You are partying in the back while everyone else is sharing with each other, trying to help save each other’s lives. She then related what the young woman had said about her brother’s death and how they were laughing at the time, totally unaware of the story. “Will you both do me a favour, just get the hell out of here! Go out and smoke, drop dead for all we care, you are learning and contributing nothing here.” They sat there stunned. I had to calm the group down a little, actually quite bit, the atmosphere was quite charged with all that had happened. I kept the two ladies there, and needless to say, that was the last of the gabbing from the back of the room for the entire two-week clinic. All the people who were there that night were successful at the end of the program. At graduation, the two ladies who had earlier talked only to each other were applauded by all, even the lady with lung cancer. All was forgiven. The girl who lost her brother also came for the graduation, also smoke free and proud. And the lady with lung cancer proudly accepted her diploma and introduced one of her children. He had stopped smoking for over a week at that time. Actually, when the lady with cancer was sharing her story with us, she had not told her family yet that she had even quit smoking. It was a few days later, when she was off a week that she told her son. He, totally amazed said to her that if she could quit smoking, he knew he could and stopped at that moment. She beamed with joy. Six weeks later she succumbed to the cancer. I found out when I called her home just to see how she was doing and got her son on the line. He thanked me for helping her quit at the end. He told me how proud she was that she had quit and how proud he was of her, and how happy she was that he had quit also. He said, “She never went back to smoking, and I will not either.” In the end, they had both given each other a wonderful gift. He was proud her last breath was smoke free she NEVER TOOK ANOTHER PUFF!

Epilogue: I normally say you can’t quit for someone else, it has to be for yourself. This incident flies in the face of this comment to some degree. The lady with lung cancer was quitting smoking to save her children from her fate, to some degree undo the lesson that she had taught years earlier. The lesson that she “could not stop.” It was that at the time she “would not stop.” There is a big difference between these two statements. It holds true for all smokers. The lady in this story proved years later she could quit too late to save her life, but not too late to save her sons. Next time you hear yourself or someone else say, I cannot stop, understand it is not true. You can quit. Anyone can quit. The trick is not waiting until it is too late.

“Why Did I Start Smoking? Why Did I Quit?”

It is pretty funny. People often try to reflect on when and why they started smoking as if thinking that it would answer the daunting question of why they continue to smoke. In reality, the reason you start and the reasons you continue are not the same. Some people start because of peer pressure. But in society today, if peer pressure were going to be the influencing factor, it would be making people quit smoking , not continue to smoke. Some people took up smoking to look older and more mature. How many people in their 30’s, 40’s, 50’s or 60’s or beyond want to do everything in their power to look older than they already do? Others take up smoking out of a sense of rebellion. Their parents, teachers, doctors and other adults told them they couldn’t smoke. So to show them who was in control, they smoked anyway. Well, how many 60-year-old smokers are there who are smoking today so that they can snub their nose at their 80 to 90 year old parents saying, “you see, you still can’t tell me not to smoke.” People start for a variety of reasons, but they continue for just one – they became drug addicts, the drug-nicotine. It is interesting though because the same thing happens when the smoker quits. The initial reason that people quit smoking often become secondary in importance to reasons they eventually stay off. Some people quit to make others happy, or because of non-smoking policies issued at a place of employment. But after quitting, they find they feel better than ever, are calmer, have more energy, have more money, overall are happier and in more control of their own life. Their new reasons may have little bearing to their initial quit reason. In many ways they are better reasons and more lasting. Or, some people who quit for medical risks alone start to realize that not smoking is just a nicer way of life. Sometimes the quality of life becomes more important to them than the concept of length of life. Whatever your initial reason for quitting was, it is still valid. On top of that there are numerous benefits you may have noticed and some you haven’t even thought of yet which are still to be noticed. Some you will never think of but are real anyway. Keep focused on every good reason not to smoke. This becomes your ammunition to stay the course, and to ride out those annoying craves or thoughts that can pop out of nowhere. Whether or not you ever accurately remember why you started to smoke, as long as you remember why you quit and why you desire to stay free, you will keep your resolve strong enough to NEVER TAKE ANOTHER PUFF!

Copyright © Joel Spitzer, 2003. This book or any portion thereof may be freely distributed in either electronic or print form so long as no charge is made for it, and so long as this notice remains with any significant portion of the work when distributed.

Chapter 2 The Real Cost of Smoking

My Cigarette, My Friend

How do you feel about a friend who has to go everywhere with you? Not only does he tag along all the time, but since he is so offensive and vulgar, you become unwelcome when with him. He has a peculiar odour that sticks to you wherever you go. Others think both of you stink. He controls you totally. When he says jump, you jump. Sometimes in the middle of a blizzard or storm, he wants you to come to the store and pick him up. You would give your spouse hell if he or she did that to you all the time, but you can’t argue with your friend. Sometimes, when you are out at a movie or play he says he wants you to go stand in the lobby with him and miss important scenes. Since he calls all the shots in your life, you go. Your friend doesn’t like your choice of clothing either. Instead of politely telling you that you have lousy taste, he burns little holes in these items so you will want to throw them out. Sometimes, he tires of the furniture and gets rid of it too. Occasionally, he gets really nasty and decides the whole house must go. He gets pretty expensive to support. Not only is his knack of property destruction costly, but you must pay to keep him with you.

In fact, he will cost you thousands of dollars over your lifetime. And you can count on one thing, he will never pay you a penny in return. Often at picnics you watch others playing vigorous activities and having lots of fun doing them. But your friend won’t let you. He doesn’t believe in physical activity. In his opinion, you are too old to have that kind of fun. So he kind of sits on your chest and makes it difficult for you to breathe. Now you don’t want to go off and play with other people when you can’t breathe, do you? Your friend does not believe in being healthy. He is really repulsed by the thought of you living a long and productive life. So every chance he gets he makes you sick. He helps you catch colds and flu. Not just by running out in the middle of the lousy weather to pick him up at the store. He is more creative than that. He carries thousands of poisons with him which he constantly blows in your face. When you inhale some of them, they wipe out cilia in your lungs which would have helped you prevent these diseases. But colds and flu are just his form of child’s play. He especially likes diseases that slowly cripple you - like emphysema. He considers this disease great. Once he gets you to have this, you will give up all your other friends, family, career goals, activities - everything. You will just sit home and caress him, telling him what a great friend he is while you desperately gasp for air. But eventually your friend tires of you. He decides he no longer wishes to have your company. Instead of letting you go your separate ways, he decides to kill you. He has a wonderful arsenal of weapons behind him. In fact, he has been plotting your death since the day you met him. He picked all the top killers in society and did everything in his power to ensure you would get one of them. He overworked your heart and lungs. He clogged up the arteries to your heart, brain, and every other part of your body. In case you were too strong to succumb to this, he constantly exposed you to cancer causing agents. He knew he would get you sooner or later. Well, this is the story of your “friend,” your cigarette. No real friend would do all this to you. Cigarettes are the worst possible enemies you ever had. They are expensive, addictive, socially unacceptable, and deadly. Consider all this and - NEVER TAKE ANOTHER PUFF!

Smoking and Circulation

While most people equate smoking deaths to cancer and lung disease, in fact many more people will die from circulatory conditions from smoking than die from cancer or other lung diseases. Also, in general, they will die at much younger ages from these problems. We would have many more lung cancers than we do if smokers could live long enough to get them. When many people with fatal heart attacks or strokes are autopsied, there are often precancerous lesions found that indicate that if these people had a few more years to live they would have eventually succumbed to these smoking induced diseases.

As for heart and other circulatory diseases, the two chemicals in cigarette that stand out as the biggest problems are nicotine and carbon monoxide. Nicotine, besides being addictive, has very powerful effects on arteries throughout the body. Nicotine is a stimulant, speeding up the heart by about 20 beats per minute with every cigarette, it raises blood pressure, is a vasoconstrictor which means it makes arteries all over the body become smaller making it harder for the heart to pump through the constricted arteries and it causes the body to release its stores of fat and cholesterol into the blood. The heart has to work harder to overcome all of these effects. To work harder the heart, like every other muscle in the body, needs extra amounts of oxygen for the additional workload. The oxygen has to be transported through the blood. But carbon monoxide from tobacco smoke literally poisons the oxygen carrying capacity of the blood. So this results in the heart having to work harder to get more blood to itself to work harder, because it’s working harder. This is a circle. A vicious and deadly circle when it comes down to it. Below we see the cross section of a normal artery. Usually we have nice big openings in the artery to carry oxygen as well as all other nutrients to all the tissues of the body.

You can see the blood clotted blocking the blood flow to whatever organ or tissue this artery was leading to. Without being able to get circulation, that tissue will literally suffocate in a matter of minutes and basically be left as useless tissue. Sometimes the artery involved is a coronary artery, one that supplies the heart with the blood it needs to function. Below is a picture of a coronary artery attached to the heart...If we look at a close up view of the artery...

Here we see the blood clotted and blood flow to the section of the heart that this artery was supplying was cut off. What will result is that a portion of the heart muscle that was supposed to get that blood flow suffocates and dies within a matter of minutes. Above we see infarcted (dead) heart muscle (myocardial infarction). The tissue is literally brittle as illustrated by the cracking effect. Instead of being able to pump blood, this area whole section of muscle is no longer able to be utilized for its life sustaining function. Again, smokers get this much more often because of the effects of nicotine and carbon monoxide. Nicotine having all the direct effects on the heart itself, carbon monoxide robbing the oxygen supply, and both chemicals increasing clotting as well as clogging factors in the blood. If the section of the heart affected was larger enough the smoker would die from the first attack. Often smaller areas are affected and the patient can survive but has lost that specific section of the heart and may have permanent impairments from the now limited supply of heart tissue. Cigarette smoking increases risks of blood clots significantly. If the blood clots in an artery and blood can no longer get through, the tissue that is supposed to be supplied with blood has lost the source of its oxygen and nutrients and dies in minutes. But clots are not the only way these arteries can be blocked. Another way is by clogs.

As opposed to clots where the blood actually coagulates and becomes an obstruction, clogs are where deposits of fat gradually build up. In the first picture below you can literally see the start of an artery getting a fat buildup. Over time, this opening can get narrower and blood flow gets more and more impeded. This of course adds to the workload of the heart to pump through smaller arteries with increased resistance. But this clogging does not only happen to the coronary arteries, it literally happens all over the body. Remember, nicotine is not only a vasoconstrictor, making arteries go into constrictions every time it is administered, but it also causes the body to release its own stores of fat and cholesterol. Besides this, carbon monoxide has an effect that makes the fat stick to the arteries. The reason is carbon monoxide lowers the oxygen level of the blood (hypoxia) and hypoxia seems to have an effect making fat stick to artery walls.

Eventually over time arteries can become totally blocked with fat as seen in the slide below. As in the case with a clot, blood cannot get through and the body part that was contingent on that blood supply for survival is lost. If this artery lead to your heart as in the case of the clotted coronary arteries above, the result would be a heart attack with a loss of heart muscle that if large enough would be fatal. But the heart is not the only organ affected this way. Another common site of problems are the arteries leading to the brain. Below is a picture of the base of a healthy human brain.

The arteries to the brain are very small here and clear, very difficult to see in fact. The arrows are pointing them out. To see them clearer here is a close up shot of these arteries... Again note, these arteries are very thin and clear. Smoking increases the fat deposits to these arteries.

With the fat build up the arteries are much easier to see. But this build up if complete cuts off circulation to your brain and as is the case with the heart, the part of the brain that no longer gets circulation dies. This is what happens in the case of a stroke. Circulation gets cut off from the brain either through a clog or a blood clot. The section of the brain that gets cut off suffocates and dies. If this part of your brain controlled speech, you will not talk anymore, if it controlled some form of motor function, these abilities will be lost and leave the patient impaired or crippled. If the section of the brain affected controlled some life sustaining function, the patient will die, again, within minutes of when the circulation cut off is complete. The clogging and clotting effects of nicotine and carbon monoxide are the primary reasons why smokers are at such a higher risk of this condition. But this clogging/clotting effect is not limited to just major organs like the heart or brain. These chemicals affect arteries throughout the entire body. These affects may not be as deadly as cutting off circulation to the heart or brain, but in a real way they can show the true potential of the grip of the nicotine addiction. Peripheral circulation, arteries going to the extremities are also highly susceptible to the vasoconstrictor effects of nicotine as well as the increase of clots and clogging risks posed by smoking. Smoking is a primary cause of much of the peripheral vascular disease seen as well as a powerful aggravating factor for people who have other pre-existing conditions causing circulation problems to the extremities. One condition though stands out as being truly unique and in many ways, demonstrates the real addictive nature of nicotine better than any other cause. The condition is known as Buerger’s Disease (thromboangiitis obliterans.) Buerger’s Disease is a condition where there is a complete cutoff of circulation to the finger or toes, resulting in gangrene.

Once gangrene occurs the only course of action is to amputate the affected area. The most common age bracket that this disease strikes is in people between the ages of 20 to 40, normally young to get circulation problems that result in amputations. While it is much more common in men, women are affected to. What makes Bueger’s Disease unique is that it is a disease that is basically exclusive to smokers. There are almost no documented cases of this disease happening in a non-smoker. Smoking is the primary etiologic factor. This is a rare disease, but noteworthy because of this unique nature of happening only in smokers. If a smoker gets lung cancer, the person and other people can sometimes think, “well non-smokers sometimes get lung cancer too, maybe cigarettes didn’t cause it.” Same thing with heart attacks or strokes, non-smokers get them too, smokers just get them much more often. But again a certain level of denial can be exhibited and there is no way to conclusively prove that cigarette did it. But Buerger’s Disease, having no other known cause and basically never happening in non-smokers does not lend itself to such denials. When a doctor determines he or she is dealing with a Buerger’s Disease patient, a basic ultimatum is going to be delivered—quit smoking or lose your limb—your choice! If we were dealing with simply a “bad habit,” how many people given such an ultimatum and knowing it is true would continue doing the particular behaviour given such consequences?

While Buerger’s Disease is much more common in men, I have personally had two women who were Bueger’s Disease patients in my clinics. My first actual encounter with a Buerger’s Disease patient was with a woman who was 38 year old when I met her, which was about 24 years ago. Three years before I met her, at the age of 35 she was diagnosed with Buerger’s Disease. This is actually relatively late to first be diagnosed. Her doctor had told her she had to quit smoking, but she did not comply and within a few months she had her right leg amputated. The circulation in her left leg was also badly affected, and after the hospitalization from the amputation she did quit smoking and had no further circulatory complications for the next three years. Then one night at a party, a friend offered her a cigarette. She figured that since she had been off cigarettes for so long, she now had control over her dependency. If she liked the cigarette, she would smoke one or two a day. If she didn’t like the cigarette, she just wouldn’t smoke anymore.

Well, she took the cigarette. She didn’t particularly like the cigarette, but the next day she was up to her old level of consumption. Four days later she lost circulation in her left leg. She knew the reason. After three years with no problem and only four days after going back to smoking her circulation was affected. Her doctor told her that if she did not quit immediately, she would probably lose her other leg. This is when I met her. She enrolled in a smoking clinic that week and quit smoking. Almost immediately her circulation improved. The doctor took her off anti-coagulant drugs and vasodilators he had put her on a few weeks earlier to try to slow up the process even though they were highly ineffective at stopping the likelihood of gangrene and amputation. But once she quit smoking she no longer needed them. Soon, her circulation was back to normal. Nine months later, I called to ask her to serve on a panel. At that time, she sluggishly replied, “I can’t come. I have been in the hospital the last two months.” When I asked what had happened, she hesitantly replied, “I had my toes amputated.” She had gone back to smoking. She tried one because she just couldn’t believe she would get hooked again. She was wrong. She lost circulation, had her toes removed and eventually had her leg amputated. I have had other clinic participants with similar experiences, being told to quit smoking or lose limbs who did not quit smoking. The reason I talk about this particular woman again and again is about a year after she had the second amputation, she came back into a clinic I was conducting and told me she had quit again and was now off about 9 months. I told her I was surprised, I thought she had permanently lost control. After all, she had her leg removed, the toes from her other foot, and eventually her second leg. When I confronted her with that information she replied, “The doctor finally convinced me. He said, ‘You might as well keep on smoking, I’ll just take your arms off next.’” That scared her into quitting smoking. Her next comment to me was unbelievable. She looked me straight in the face, dead seriously, and said “I DIDN’T NEED A HOUSE TO FALL ON ME TO TELL ME TO QUIT SMOKING.”

I had periodic contact for the next 15 years at which time she moved away. She was fine over that whole time period. Whenever I brought up that conversation, we both found ourselves amazed that she could ever have made such an irrational statement. She happened to be a very rational, bright and inspirational individual. She would get around on wooden legs, socializes, and even occasionally would sing and dance on stage. Once she had broken free of the drug’s effects and the smoker’s psyche, she knew she could do anything. Frequently, I would encounter people who quit smoking on their own. When I ask how they did it, they tell me of this marvellous lady they met who told of how she used to be hooked on smoking. Hooked so bad, in fact, that she had her legs amputated from a smoking related illness. It usually turns out to be the same person. By spreading her story, she offers inspiration and hope to countless smokers to break the addiction before the addiction breaks them. Her story represents the real power of the addiction. She could not deny any where along the way smoking wasn’t the cause. Not only would every doctor and all the research she could do pinpoint smoking as what was causing her problem, but she had quit, was fine, relapsed and within days lost her circulation—twice! The second time she actually lost her toes and her foot and then her lower leg. There was absolutely no way she could deny the cause and yet it took another 9 months for her to quit again. Her continued smoking and ease of relapsing shows nicotine dependency at its worst. This overpowering nature of nicotine should not be lost on anyone here. You probably don’t have a condition that is obvious as to force you to make a decision almost immediately upon relapse. In many ways this is worse, for cigarettes are quietly and insidiously destroying you, sometimes with little warning, or at least ones you will acknowledge. The first symptom to many circulatory diseases caused by smoking is sudden death. You may get no second chance. Once you have a quit smoking, do everything in your power to make it last. You don’t know that you will have the desire, strength or worst of all, the opportunity to quit next time. A tragic and fatal disease may get you first. Always consider the full danger of smoking and power of the addiction and your likely choice will be to – NEVER TAKE ANOTHER PUFF!

Because Now it Really Hurts!

“I want to quit for my health. I have no pulse in my legs and my doctor says I’m going to need surgery. But he won’t even consider operating until I quit smoking. Besides this, I have had throat polyps removed and all of my doctors say I have to stop smoking.” This dramatic story was told to me on the third day of a recent Stop Smoking Clinic. When I asked the participant how long she had all of these smoking related problems she replied, “For many years.” Then I asked why she decided to quit now? She answered, “Because now it really hurts.” As opposed to fear, pain is a marvellous motivator for initiating a life-style change such as quitting smoking. Fear of something that might happen may make a person think about quitting. But fear can be bargained around. Thoughts like, “Maybe it won’t happen to me,” are often used as defence mechanisms protecting the smoker’s addiction to cigarettes. But pain is not so easily dismissed. It is here, it is now, and it hurts. While pain can be a powerful motivator in making positive change, it can also be responsible for preventing necessary changes from being successfully attempted. The participant in the above story is a good example of this. For years she knew that her cigarettes were slowly crippling and killing her. But any attempt to quit resulted in nicotine withdrawal symptoms. This discomfort results in taking a cigarette to help alleviate withdrawal. This inevitably results in relapse. So while the smoker may have solved the problem of withdrawal, the method used prolonged a much more serious problem – continuation of a powerful and deadly addiction. While some discomfort may be involved in giving up cigarettes, it is insignificant compared to the pain and suffering which can be caused by continuing smoking. Physical withdrawal from quitting will normally peak within three days, and totally subside within two weeks. Diseases such as emphysema, heart disease, other circulatory conditions and cancers involve months or even years of long term suffering. These pains are much more severe than anything encountered while quitting. The biggest difference, though, is that these diseases have the full potential of permanently crippling or killing their victims. Smokers are not only prone to have these major catastrophic illnesses. Due to the weakening of the body’s defence mechanisms, smokers are more frequently plagued by infectious diseases, such as colds, flu, and pneumonia. While most of these infections rarely result in permanent crippling or death, they do result in great inconveniences and discomfort. Not only does the smoker have a greater risk of these diseases, but when he does get one of them, it is more severe, and painful than it would have been if he didn’t smoke. No non-smoker would consider inhaling dry hot smoke into an already burning irritated throat. But no matter how intense the pain, the smoker will else he suffers withdrawal besides the cold. So any smoker who is afraid of experiencing the pain of withdrawal must consider the alternative. Continuing to smoke has the full potential of causing long-term suffering from causing and aggravating common infectious diseases. More significantly, smoking may eventually cause life-long, chronic suffering from diseases like emphysema, cancer, and circulatory diseases. And if the smoker waits too long, a smoking induced death may be the only relief. Don’t let fear of withdrawal stop you from quitting. Withdrawal is short, and mild in comparison to the suffering caused from continuing to smoke. Once you quit, you will never experience it again as long as you - NEVER TAKE ANOTHER PUFF!

Smoking’s Impact on the Lungs

Ex-smokers are often tempted when watching others smoke. Spending time with a specific friend and watching them smoke may be a trigger especially if it was the most time you had spend with the friend since you quit smoking. The first time you have any new experiences, even if smoking is not part of the ritual, the thought for a cigarette will seem like a natural part of the ritual. Another factor is when watching a person smoke, the natural tendency is for the ex-smoker to start to fantasize about how good a cigarette will be at that given moment. A more productive way to handle the situation though is to really watch the person smoke one, and then wait a few minutes as they light another and then another. Soon you will see that they are smoking in a way that you don’t want to and probably in a way that they don’t want to either. But they have no choice. You do. I am attaching a letter here that addresses this issue. It is a little harder to describe because it is based on a demonstration I do at live seminars. One demonstration I do at all my live seminars is a little smoking contraption made out of a plastic Palmolive bottle with a mouth piece inserted to hold a cigarette. The simulation shows how much smoke comes in when a person inhales, and how much comes out when they exhale. Smokers often feel they take in smoke and then blow most of it out, when in actuality, a very small percent actually comes out (about 10%). I always use cigarettes given to me by people in the audience, if I used one I brought people would think I was using a loaded cigarette. Anyway, below is a letter I wrote for clinic graduates who have seen this demonstration but the concepts apply to those who haven’t also. Viewing smoking as it really looks will minimize the temptation for even a puff.

The letter is as follows ...

Whenever you watch a person smoking, think of the Palmolive bottle demonstration you saw the first day of the Stop Smoking Clinic. Visualize all of the smoke that goes into the bottle that doesn’t come out. Also, remember that the smoker is not only going to smoke that one cigarette. He will probably smoke another within a half-hour. Then another after that. In fact, he will probably smoke 20, 40, 60 or even more cigarettes by the end of the day. And tomorrow will be the same. After looking at cigarettes like this, you don’t want to smoke a cigarette, do you? I always suggest that clinic participants follow this simple visualization exercise to help them overcome the urge for a cigarette. When I suggested it to one participant who was off for three days she replied, “I see, you want me to brainwash myself so that I don’t want a cigarette.” Somehow I don’t consider this technique of visualizing smoking brainwashing. It is not like the ex-smoker is being asked to view smoking in an artificially horrible, nightmarish manner. To thecontrary, I am only asking the ex-smoker to view cigarette smoking in its true light. The Palmolive bottle demonstration accurately portrays the actual amount of smoke that goes in as compared to the small amount that you see the smoker blow out. Most smokers believe they exhale the majority of smoke they inhale into their lungs. But, as you saw by the demonstrations, most of the smoke remains in the lungs. When you visualize all the smoke that remains, it does not paint a pretty picture of what is happening in the smoker. Maybe not a pretty picture, but an accurate one. When an ex-smoker watches a person smoke a cigarette, he often fantasizes about how much the smoker is enjoying it-how good it must taste and make him feel. It is true he may be enjoying that particular cigarette, but the odds are he is not. Most smokers enjoy a very small percentage of the cigarettes they smoke. In fact, they are really unaware of most of the cigarettes they smoke. Some are smoked out of simple habit, but most are smoked in order to alleviate withdrawal symptoms experienced by all smokers whose nicotine levels have fallen below minimal requirements. The cigarette may taste horrible, but the smoker has to smoke it. And because the majority of smokers are such addicts, they must smoke many such cigarettes every single day in order to maintain a constant blood nicotine level. Don’t fantasize about cigarettes. Always keep a clear, objective perspective of what it would once again be like to be an addicted smoker. There is no doubt at all that if you relapse to smoking you will be under the control of a very powerful addiction. You will be spending hundreds of dollars a year for thousands of cigarettes. You will smell like cigarettes and be viewed as socially unacceptable in many circles. You will be inhaling thousands of poisons with every puff. These poisons will rob you of your endurance and your health. One day they may eventually rob you of your life. Consider all these consequences of smoking. Then, when you watch a smoker you will feel pity for them, not envy. Consider the life he or she is living compared to the simpler, happier, and healthier life you have had since you broke free from your addiction. Consider all this and you will - NEVER TAKE ANOTHER PUFF!

A picture of the Palmolive Bottle Demonstration This looks like it was an exhalation after about 10 previous exhalations, not that much is seen in this particular photo. I normally get a tremendous amount of smoke out of the bottle with every drag, normally we can smoke up a room with one cigarette. If you look at the mouthpiece of the bottle, it is almost solid brown with tar. It used to be clear. I have used this bottle with somewhere between 300 and 400 cigarettes. While that may sound like a lot, most people smoke more than that in any given month. Even the bottle is pretty yellow and I blow out almost all of the smoke used when it inhales. The bottle is dry allowing me to do this, your lungs are moist trapping most of the tars when inhaled. Literally over 90% of the tar that is inhaled stays in the lung, when you see a person exhale they are literally blowing out about 10% of the smoke. You can see how the smoke had darkened the bottle after about a few hundred cigarettes. You can start to see how the smoker’s lungs below became so discoloured. Smokers don’t just put a total of a few hundred cigarettes in their system; they literally deliver hundreds of thousands of cigarettes over their shortened lifetime. This discoloration effect is more than just aesthetically unpleasant-it is in fact deadly.

Many chemicals currently banned for human consumption were removed from usage if they even caused 5% or less cases of cancer in similar experiments. Cigarette tars contain some of the most carcinogenic chemicals known to man. Consider this when watching people smoking and exhaling only 10% of the tars they actually take in. Not only are these chemicals being painted into the lung, but smoker are also constantly painting them up on their lips, tongue, larynx, swallowing some and thus painting it in the esophagus and throughout the digestive tract. Smokers have increased incidents of cancer in all of these exposed sites. Now that you know what it looks like on a large scale and feels like, lets take a look at the microscopic level of things that happen in the lung from smoking. The following series of slides illustrate microscopic changes that happen when a person smokes. The first slide is showing an illustrated blow-up of the normal lining of the bronchus.

On the top we see the cilia, labelled (H). They are attached to columnar cells, labelled (I). The cilia sweep the mucous produced in the goblet cells, labelled (J) as well as mucous coming from deeper glands within the lungs and the particulate matter trapped in the mucous. The bottom layer of cells, labelled (L) are the basal cells. Below we start to see the changes that occur as people begin to smoke. You will see that the columnar cells are starting to be crowded out and displaced by additional layers of basal cells. Not only are fewer cilia present but the ones that are still functioning are doing so at a much lower level of efficiency. Many chemicals in tobacco smoke are toxic to cilia, first slowing them down, soon paralyzing them all together and then destroying them. As you see with the cilia actions being diminished, mucous starts to build up in the small airways making it harder for the smoker to breathe and causing the characteristic smokers cough in order to clear out the airways. Eventually though, the ciliated columnar cells are totally displaced. As can be seen below ominous changes have taken place. Not only is the smoker more prone to infection from the loss of the cleansing mechanism of the cilia, but these abnormal cells (O) are cancerous squamous cells. These cells will eventually break through the basement membrane wall and invade into underlying lung tissue and often spread throughout the body long before the person even knows they have the disease. If a smoker quits before cancer actually starts, even if the cells are in a precancerous state, the process is highly reversible. Cilia regeneration starts in about 3 days once smoking stops. Even if cilia has been destroyed and not present for years, the lining tissue of the windpipe will start to repair. Even the precancerous cells will be sloughed off over time, reversing the cellular process to the point where the lining tissue goes back to normal. But if a smoker waits too long and cancer starts, it may be too late to save his or her life.

Then it is only a matter of time before it leaves the lung and spreads throughout the body. If the smoker quits smoking before this last cellular change occurs, before a cell turns malignant, the process seen in this last slide can be avoided. In fact much of the damage seen in the second picture here is highly reversible. In three days cilia start to regenerate and usually within 6 months the normal cilia function is returned. Also over time, the extra layers of cells will be sloughed off and the lining tissue of the bronchus will return to normal. Unfortunately, if a smoker waits until a malignancy has started, the outlook is grim. The overall 5 year survival rate for lung cancer is only 14%. Lung cancer, is a disease that while once uncommon, is now the leading cancer killer in both sexes. Cancer is actually many different diseases with many different causes. If we look at cancer trends over the last century we see some amazing changes. While cancer was always around, it was different sites that were primary problems. Lung cancer, at the turn of the century was almost unheard of. If a doctor saw a case he would have easily gotten it printed up in a medical journal. Now, it is the major cause of cancer death in our society, killing more men and women than any other site. The primary difference between now and then is smoking. Before the turn of the century smoking was a limited practice. A very small percentage of people smoked and even the ones who did smoked many fewer cigarettes. Cigarettes were not even mass produced till the very end of the 1900’s. We always hear of a cancer epidemic, how more and more people die of cancer every year. Actually, if you pull the smoking related sites out of the equation, cancer deaths have been on a decline. Some sites, like stomach the incidence dropped dramatically, not fully understood as to why. Other sites, like breast, even though the morbidity rate (number of cases) didn’t drop, because we now have better treatments and earlier detection, the mortality (death) rate has dropped. But the smoking cancers; lung, mouth, lip, tongue, throat, larynx, pancreas, esophagus, pharynx, urinary bladder have all seen marked increases over the 20th century. These cancers have gone from obscurity to some of the major causes of death in our country. Actually, for the first time in a hundred years we are starting to see an early decline of morbidity and mortality because we are seeing fewer smokers now with the drop in the percentages of adult smokers.

You see a dramatic difference in men and women, especially in lung cancer rates. The reason is women started smoking much later than men, about a 30 year time delay before it became socially acceptable for women to smoke. Male smoking rate jumped dramatically between World War I and another big boost during World War II. Free distribution of cigarettes to soldiers was a big factor. Women smoking rates happened much later and the time delay is reflected in the time delay in cancer and other diseases going up too. The above pictures were primarily about how smoking causes cancer of the lung and other sites. But the assault on the lungs from the tars in tobacco are not just limited to causing cancer. Other lung diseases are directly caused by smoking, the most well known are the chronic obstructive lung diseases. The most well known smoking induced COPD is emphysema. This is another one of those diseases that primarily happen to smokers. Over 90% of the cases are smoking induced. There are cases in some families where there does seem to be a genetic predisposition, where non-smokers get it too. This is from a rare condition, a lack of a blood enzyme called alpha1antitrypsin. This again is rare, but if you do have family members who never smoked a day in their life get emphysema there may be a genetic tendency. But again, over 90% of emphysema cases are simply caused by smoking. Eradicate smoking and you eradicate the risk of the disease.

To get a sense of what it feels like to breathe with emphysema take a deep breath and hold it. Without letting out any air, take another deep breath. Hold that one too. One more time, take one more breath. Okay let it all out. That second or third breath is what it feels like to breathe when you have advanced emphysema. Emphysema is a disease where you cannot exhale air. Everyone thinks that it is a disease where you cannot inhale but in fact it is the opposite. When you smoke you destroy the lungs elasticity by destroying the tissue that pulls your lung back together after using muscles that allow us to inhale air. So when it comes time to take your next breath it is that much more difficult, for your lungs could not get back to their original shape. Imagine going through life having to struggle to breathe like those last two breaths I had you take. unfortunately, millions of people don’t have to imagine it, they live it daily. It is a miserable way to live and a slow painful way to die. Hopefully when you breathe normally today you are not in pain and you are not on oxygen. If you don’t smoke you will continue to give yourself the ability to breathe longer and feel better. Never lose sight of this fact. To keep your ability to breathe better for the rest of your life always remember to - NEVER TAKE ANOTHER PUFF!

The Isolation of a Widowed Smoker

Life had become a boring routine. She had just been going through the motions of maintaining a normal semblance of existence. Waking up, having a cigarette. Washing up and brushing her teeth, having a cigarette. Eating breakfast, having a cigarette. Doing some light cleaning, vacuuming, dusting, and having a cigarette. Watching a little television while having a cigarette. Preparing a sandwich for lunch, having a cigarette. Taking a short nap, waking up for a cigarette. Reading the newspaper, having a cigarette. Making a list of needed groceries, having a cigarette. Getting ready to do some light shopping, having a cigarette. Driving to the local market, having a cigarette. About to enter the store, but stopping to have a cigarette. Checking out at the cash register, leaving the store and having a cigarette. Going home and starting to prepare dinner, having a cigarette. Eating dinner, having a cigarette. Clearing the table and washing the dishes, having a cigarette. Watching a little television, having a couple of cigarettes. Washing up, brushing her teeth and getting dressed for bed, having a cigarette. Getting into bed, having a cigarette. Going to sleep. Ever since the loss of her husband many years ago, nothing in her normal daily existence seemed to give her life any meaning or any real happiness. Weeks would go by with her barely cracking a smile. Almost nothing seemed to bring her joy anymore. But this day was starting differently. After breakfast her phone rang. She ran for a cigarette. On the fourth ring she made it to the phone and picked up the receiver. It was her daughter. She lived only an hour away, but because of her career, her husband’s schedule and the kid’s school, soccer, piano, ballet lessons, etc., they only were able to visit occasionally. Well, to her pleasant surprise, she found out that they were coming on Saturday to spend the day. For the first time in weeks she seemed truly happy. As soon as she hung up the phone she grabbed for a cigarette. She had to start planning and preparing to see the kids. She called her beauty shop to make an afternoon appointment. When she hung up the phone she took a cigarette. She got dressed and ready to go shopping, and right before leaving, she took a cigarette. In the car driving to the store she hurriedly smoked two cigarettes for she knew she could not smoke while in the store. She hurriedly went up and down the aisles, with a certain bounce in her step for she was still so excited about the visit. When she left the store she hurried to her car and lit a cigarette. She went home, put away the groceries, prepared and ate a quick bite, smoked a cigarette and hurriedly left the house to be on time for her beauty shop appointment. While she was there she smoked and conversed with the other patrons, glowing as she told of her exciting weekend news. When she got home, she smoked a cigarette, and starting preparing a turkey for the big Saturday night meal. She smoked and ate, smoked and cooked and smoked and prepared for bed. One last cigarette and she slowly dozed off, happy and excited about the joy of the upcoming day.

When she woke up she excitedly grabbed for her first cigarette. She got up and cleaned and brushed her teeth, and took another cigarette. She ate breakfast and smoked again. She started preparing her feast and smoked numerous cigarettes. Even though she was not conscious of the fact, she was smoking more than normal. Through years of conditioning she had learned that since she couldn’t smoke when around the grandchildren she had better have plenty of nicotine in her system by the time they arrived. A little last minute cleaning, and cooking and smoking. She was ready. The door bell rings. She hurries to the door and opens it up. There is her family. Everyone is excited. She goes to kiss the youngest, who says “Oh grandma, you smell like an ashtray!” She was used to these comments, she loved him anyway. After 15 minutes of talking with all the kids and her daughter and son-in-law, she and her daughter go to the kitchen to work on the dinner. After a couple of hours she starts to feel the twinge for a cigarette. But she knows she can’t smoke. The kids are running through the house vigorously. As the hours pass, her patience becomes strained. Too much noise she thinks to herself, boy, does she wish she could smoke a cigarette. She starts to complain of a minor headache. They decide they better eat early, grandma is seeming a little tired and a little hassled. They sit down to eat. The food is good and everyone is enjoying. But grandma seems to be feeling worse and worse. Four hours have passed and still no cigarette. After dinner they all decide grandma needs some rest and mutually everyone agrees they will leave early. She kisses them all good-bye and rushes them out. As the door closes she hurries to her pack and smokes three cigarettes in a row. She finally starts to feel better. She now sits down in a quiet empty room thinking how lonely she feels and how sad that they had to leave so soon. But at least she has her cigarettes. But it had been a long day. She washes up, brushes her teeth, gets dressed for bed, and has one last cigarette. Tomorrow would be another routine day.

Medical Implications of Smoking

Some people who enrol in our program are not quite convinced that they really want to quit smoking. Others claim that they cannot even think of good reasons to quit. In fact, there are many good reasons. The most important one is to avoid the dangerous health effects of cigarette smoking. Worldwide, over four million will die this year from cigarette smoking, while here in the U.S. smoking will claim over 440,000. That is more Americans than die from all accidents, infectious diseases, murders, suicides, diabetes, and cirrhosis combined. In fact, this is more than all of the Americans killed in World War II. The disease most often associated with cigarette smoking is lung cancer. One hundred years ago, lung cancer was so uncommon that if a doctor ever saw a case of it he would have written it up in a medical journal. Even as recently as 1930 most doctors never came across a case of primary lung cancer. This disease, which 50 years ago was almost unheard of, is now the leading cause of cancer deaths in men and women. Lung cancer accounts for one third of all cancer deaths of men. Lung cancer was once believed to be predominantly a disease of males. By the mid 1980’s, lung cancer overtook breast cancer to become the number one cause of cancer deaths in women. Over 85% of the people who die of lung cancer could avoid the disease completely if they just didn’t smoke. Besides the lungs, other sites where cigarettes exert a carcinogenic effect include: mouth, lip, tongue, larynx, pharynx, and esophagus. In addition, cigarettes contribute to cancers of the kidney, bladder, pancreas and stomach. While most people associate smoking with cancer, even more people die from circulatory problems caused by cigarette smoking than from cancers caused from cigarettes. The effects on the circulatory system are both immediate and dangerous. Nicotine is a stimulant which raises the heart rate and blood pressure, constricts the arteries, and, in conjunction with carbon monoxide, causes atherosclerotic conditions within the artery walls. This clogging process affects the heart as well as other sites of the body such as the brain or peripheral circulation in the extremities, sometimes resulting in gangrene and amputations.

Over 200,000 of smoking related deaths are attributed to the combined effect of nicotine and carbon monoxide on the circulatory system. Chronic obstructive pulmonary diseases, such as emphysema and chronic bronchitis, are major cripplers caused by cigarette smoking. While emphysema is not as deadly as lung cancer, patients with it often envy patients with cancer. People with lung cancer will usually die within six months of diagnosis. Patients with advanced stages of emphysema are permanently crippled, but it may take years for them to die from it. In its later stages, emphysema is a living hell. As one of our popular panellists proclaims, “When I die, I’m going to die healthy!” Some smokers come into our clinics wondering if they need to quit smoking. They claim to feel fine. No symptoms of any diseases are yet obvious. Even their doctors say they appear normal. Unfortunately, the first sign of some of the smoking related illnesses is sudden death. This is not a preferable time to consider smoking cessation. The best time to quit to maintain the optimal benefits from not smoking is when you are alive and relatively healthy. If you are off cigarettes now, stay off. Your risk of all of the smoking related illnesses will eventually drop down to that of a non-smoker. They can still happen, but it is much less likely. If you currently smoke you will destroy more tissue and cause more damage and irritation every day you smoke. We only have one body and one life. Some people feel they should have a choice to do the most with the time they have, so they should eat, drink, smoke and be merry. These people are partially correct.

We should have the choice of what we can do to obtain the most fun and fulfilling life. But going through a long crippling period, followed by a long lingering death is not the best utilization of time. It is not fun. Consider all of the risks in comparison to the momentary pleasures that some of your cigarettes may have brought you. Give yourself a chance for a long, productive and happy life. When things get rough and you feel like you want a cigarette, just take it one day at a time. You can always go out and buy cigarettes tomorrow. You cannot go out and buy health. I guess that is why it is said that “ The best things in life are free.” In order to stay free - NEVER TAKE ANOTHER PUFF!

Reasons People Want to Quit Smoking

During my almost 30 years of being involved with smoking cessation education, smokers have given a multitude of reasons for wanting to stop smoking. Many needed to stop for medical purposes. This isn’t surprising considering that over 400,000 Americans die every year from diseases caused by cigarettes. Among the more common ailments directly caused by smoking are: heart disease, cancers, strokes, peripheral vascular diseases, emphysema, bronchitis, ulcers and others. In addition, treatment of pre-existing conditions can be complicated by smoking. Risk of anaesthesia and post-operative complications are increased by use of cigarettes. Social pressure is another major reason for quitting. Smoking is now viewed as smelly, offensive and disgusting by non-smokers as well as by many of the over 50 million ex-smokers in our country. While smoking was once thought to be sophisticated, people who smoke today are scorned by many of their peers. Some smokers now feel that they appear lacking in self control and looked down upon for not having the intelligence to quit. Some wish to quit smoking to set a positive example for their children. The expense of smoking is another major reason. Many remember saying, “If cigarettes ever reach $1.00 a pack, I will quit!” Now cigarettes are approaching triple that amount and these same people have continued to smoke. A smoking couple can be motivated to quit when realizing they are spending in excess of $3,000 a year to maintain their addiction. Besides, smokers burn holes in their clothes, car, furniture and carpeting. One past clinic participant even burned a hole in a bride’s wedding gown. Not only can costly burns result, but accidental fires can be started. In fact, over half of the fire deaths in our country are caused by cigarette smoking. Many of my clinic participants have quit smoking previously for a substantial period of time and returned to smoking. When they were free from cigarettes they felt healthier, calmer, and happier. But lack of understanding allowed them to tempt a puff. This resulted in reinforcement of their full fledged addiction. They come to the clinic ready to re-establish their lifestyle as an ex-smoker. While people come to us for a variety of reasons, most have one basic motivation in common. They need help to quit smoking. They know the dangers, hassles, and expense but still cannot stop. Cigarette smoking is an addiction. It is imperative to remember that once you are an addict, you are always an addict. Once you are off smoking for a short period of time, staying off is relatively easy. You will have occasional thoughts for a cigarette, but they are nothing compared to the urges encountered from withdrawal during the early quitting process. But you must always keep in mind that one puff will put you back to a state of full fledged dependency. Then you will either have to go back to smoking or once again go through quitting. Those are both lousy options. Think of both of them whenever you consider taking a puff. Stick with the winners and - NEVER TAKE ANOTHER PUFF!

Individual Approaches Used to Motivate Smokers to Quit

Every now and then, someone informs me of an original technique they devised or heard of to help motivate family and friends to quit smoking or to at least consider getting outside assistance to break free from this deadly addiction. I feel that since the majority of people who have given up smoking have done so on their own without any professional intervention, these approaches are often viable alternatives for smokers who wish to quit or for you as ex-smokers to use to help significant others stop smoking. Most recently, a clinic participant told us of a friend who wanted to convince her husband to give up smoking. She considered his chemical dependency not only to be deadly but also wasteful and expensive. To illustrate her point to the husband, every time he purchased a new carton of cigarettes she promptly went to the nearest sewer and deposited an equivalent amount of money. This was making the poor husband sick. He usually retorted, “Why don’t you at least donate it to a worthy cause?” She would reply, “At least my way of wasting money isn’t hurting anyone.” This activity went on for a little over a month, at which time the husband, realizing the real waste of his addiction to nicotine, decided it was time to stop. He made it. Not only was he saving money, but, more important, he was saving his life. I give the wife a lot of credit for having the guts and perseverance to continue this unconventional practice to motivate her husband to help himself. At all my clinics, I always tell the story of the lady who eight years ago had a circulatory condition, Buerger’s disease, and had to have her right leg amputated. As you may recall, she quit smoking and had no further circulatory complications for three years. Then one night at a party, a friend offered her a cigarette. She figured that since she had been off cigarettes for so long, she now had control over her addiction. If she liked the cigarette, she would smoke one or two a day. If she didn’t like the cigarette, she just wouldn’t smoke anymore. Well, she took the cigarette. She didn’t particularly like the cigarette, but the next day she was up to her old level of consumption. Four days later she lost circulation in her other leg. She knew the reason. After three years with no problem and only four days after going back to smoking her circulation was affected. Her doctor told her that if she did not quit immediately, she would probably lose her other leg. She enrolled in a smoking clinic that week and quit smoking. Almost immediately her circulation improved. The doctor took her off anti-coagulant drugs. She no longer needed them. Soon, things were back to normal. Nine months later, I called to ask her to serve on a panel. At that time, she replied, “I can’t come. I have been in the hospital the last two months.” When I asked what had happened, she replied, “I had my toes amputated.” She had gone back to smoking. She tried one because she just couldn’t believe she would get hooked again. She was wrong. She lost circulation, had her toes removed and eventually had her leg amputated. I have had other clinic participants with similar experiences. The reason I talk about this story is I again ran into her about 3 years ago, at which time she told me she had finally quit smoking. I told her I was surprised, I thought she had permanently lost control. After all, she had her leg removed, the toes from her other foot, and eventually her second leg. When I confronted her with that information she replied, “The doctor finally convinced me. He said, ‘You might as well keep on smoking, I’ll just take your arms off next.” That scared her into quitting smoking. Her next comment to me was unbelievable. She looked me straight in the face, dead seriously, and said “I didn’t need a house to fall on me to tell me to quit smoking!” I still have periodic contact with her, and whenever I bring up that conversation, we both find ourselves amazed that she could ever have made such an irrational statement. She happens to be a very rational, bright and inspirational individual. She gets around on wooden legs, socializes, and even occasionally sings and dances on stage. Once she had broken free of the drug’s effects and the smoker’s psyche, she knew she could do anything. Frequently, I encounter people who quit smoking on their own. When I ask how they did it, they tell me of this marvellous lady they met who told of how she used to be hooked on smoking. Hooked so bad, in fact, that she had her legs amputated from a smoking related illness. It usually turns out to be the same person. By spreading her story, she offers inspiration and hope to countless smokers to break the addiction before the addiction breaks them. You, too, probably have stories you can share with your smoking friends of your past experiences smoking, or of people you met in your clinic. Maybe you know of ways to help motivate family and friends to quit. Try to help those people most important to you. If they try to stop but can’t on their own, remember, we are always out here to help them. You can really make a difference in their lives. Share your knowledge. For friends who have already quit, as well as for yourself, don’t forget to reinforce the one principle - NEVER TAKE ANOTHER PUFF!

“If Cigarettes Were as Deadly as You Claim They Are, The Government Would Not Sell Them!”

Whenever I do my first day slide presentation, members of the audience often openly express this sentiment. We explain how smoking causes heart disease, cancers, circulatory conditions, emphysema and many other deleterious conditions. We go on further to claim that cigarette smoking is the number one most preventable cause of death in the United States, causing an excess of 434,000 premature deaths yearly. This is more deaths than those caused by all accidents, infectious diseases including AIDS, murders, suicides, diabetes, atherosclerosis, kidney disease and liver disease combined. More Americans will die this year from cigarette smoking than all the Americans killed in 24 years of battle deaths from World War I, World War II, the Korean War and the Viet Nam War, combined! These statistics are staggering. Many smokers assume that if cigarettes were this dangerous they would not be allowed legally on the market. Chemicals like cyclamates, red dyes and other carcinogens are pulled off the shelf. Cigarettes are sold, so they must be safer. People thus suspect that my figures must be greatly exaggerated. In response to this scepticism, let me explain that these figures originate with the United States Surgeon General’s Reports. Since 1964, these reports have been produced annually by the government’s office of Health and Human Services. The reports review all studies and available information, not only from America but from all over the world. The general consensus for over 20 years of accumulated data is that cigarettes are killers. Some people assume that the government is exaggerating how deadly cigarettes are. This is not very likely. If the government was going to mislead the public on the dangers of smoking, it would be denying the dangers, not exaggerating them. The United States Government has had a strong vested interest in tobacco production and dissemination. In 1984 tax revenues generated from tobacco products exceeded 6 billion dollars annually. The government owned close to one billion dollars of surplus tobacco. Even with this strong vested interest, the report that year claimed that over 300,000 Americans died prematurely from cigarette smoking that previous year. Before 1964, the U.S. Government did not issue much information about the dangers of smoking. Other developed countries without vested interests were warning their citizens of the inherent dangers of cigarettes. Today, the evidence is so conclusive that the government recognizes its obligation to report the facts. The United States government, medical associations, and the general world-wide medical community all agree that cigarettes are lethal. Consider this information when confronted with what some ads call the smoking controversy. The only controversy is with the tobacco industries. They claim their product is harmless and offers great advantages to their customers who smoke it. This “harmless” product is everything but harmless. It is addictive. It is expensive. It is deadly. Consider all this and remember- NEVER TAKE ANOTHER PUFF!

So I Can’t Run Marathons

“So I can’t run marathons - big deal, I never wanted to anyway.” Many times I encounter a smoker who claims that his smoking isn’t a real problem in his life. Sure, he can’t do vigorous activities, but generally he is able to meet life’s essential demands. Unfortunately, many fail to consider that giving up strenuous activities today means possibly giving up essential capabilities in the future. Today, jogging may not be possible, but tomorrow, getting up stairs, walking, and eventually getting out of bed may be more than the smoker can handle. Hundreds of thousands of smokers become permanently crippled every year by diseases like emphysema. Typically, the smoker was warned by his physician to quit smoking before the disease caused minor impairments. But even when this threat became a reality, the smoker failed to quit. However, once a breathing impairment becomes evident, every day of smoking makes it progressively worse. It will get to the point where normal breathing becomes painful, then impossible. Day by day he must give up yet another essential activity. Soon he becomes totally dependent on his family to carry on his responsibilities. Not only can’t he shovel snow, he can’t leave the house if the temperature drops below freezing. He can’t help prepare dinner, he hardly has the strength to chew it. And then one day breathing becomes impossible. His entire world becomes oxygen tent, and death becomes his only way out. At this point, death is not an unwelcome alternative. The dying patient may think back to when he made the comment “So I can’t jog. Big deal.” If he only knew then what he knows now, he would not have treated the subject so lightly. Unfortunately for him, it is too late to repair the damage. You may feel that you have smoked so long that it is too late to quit now. But the odds are, you are not at this tragic point yet. If you quit, your odds of ever becoming this impaired are dramatically reduced. If you continue to smoke, well then every day this nightmarish existence becomes a closer possibility. Consider what activities you can do now. They may seem insignificant or unimportant. But what will life really be like when you can no longer do them. If this type of life, or more accurately, slow death does not appeal to you, then - NEVER TAKE ANOTHER PUFF!

He Will Quit When He “Bottoms Out!”

It used to be believed that when dealing with drug addictions, such as alcoholism or illegal drug abuse, the addict had to “bottom out” before realizing the need for help. Bottoming out meant life became so complicated and unmanageable that the abuser would finally see that there was no other alternative except to quit drugs or lose everything and everyone close to him. What types of situations would precipitate an addict to come to such a realization? Things so severe as losing a family, career, health, or maybe even ending up homeless or in jail. All these occurrences are traumatic and should be considered life shattering experiences. However given a lot of time, support and professional assistance, the addict can often regain some semblance of a normal lifestyle. Many even feel that living through such an experience gives them a real love of life and sobriety that they could never have fully appreciated without having survived such devastating experiences. As long as bottoming out doesn’t entail loss of life, there is always some hope for rectifying the problems the drugs brought on and maybe coming out stronger than they were before drugs became a part of their lives. Smokers, too, are drug addicts. Unfortunately, some smokers are content with the idea of waiting to bottom out before making a drastic move like quitting smoking. Until then they feel that their lives are quite manageable. When things get bad enough they believe they will quit with relative ease. While this sort of logic has been known to work with other drug dependencies, there is a major flaw in approaching smoking in this manner. Bottoming out experiences for smokers are not normally correctable by time. Smokers generally won’t lose their families from smoking. They probably won’t lose their job, and they probably won’t end up homeless and penniless trying to support their addiction. They won’t end up in jail for smoking, and they will never be committed to treatment without their own consent. So what kind of incident is likely to be considered bottoming out for the smoker? Diagnosis is the most common way smokers bottom out-diagnosis of a disease like cancer, heart disease or emphysema. While quitting upon diagnosis may improve chances of survival, a lot of irreparable damage is already done. With emphysema, the patient’s breathing will be impaired for the rest of his or her life. Stopping smoking will significantly slow up or stop further deterioration, but normal breathing will never again be possible. Waiting for a diagnosis of cancer or circulatory disease as the bottoming out experience may cost the smoker his or her life. In fact, some smokers never have the opportunity to bottom out. The first discernible symptom for these smokers is sudden death which is not the bottoming out experience the smoker was likely counting on. Many who quit before bottoming out recognize that they feel physically and emotionally better than they have in years and truly do appreciate the health and self esteem improvements. Those who quit should be proud of their accomplishment. They quit before they had to, and they will derive the greatest benefits for having taken that action. For those who are waiting for that magic moment when they know it is time, be forewarned. You may not have the strength to quit at that time; you may not get the desire to quit in time; and, most importantly, you may not have the opportunity to quit in time. Last year, 390,000 Americans died prematurely waiting for the right time. They never found it. Don’t feel the need to wait for some unforeseen inspiration. Quit now before you have to. Quit now and – NEVER TAKE ANOTHER PUFF!

“It’s only cigarette smoking - it’s not like a crime punishable by death”

“So I failed in quitting smoking, big deal. I’m not going to feel guilty or be hard on myself. I mean, it is only cigarette smoking-it is not like a crime punishable by death.” I had to refrain from laughing at this statement. It was seriously quoted to me by a clinic participant who failed to abstain from smoking for even two days. She had the same old excuses of new job, family pressures, too many other changes going on. But to say that cigarette smoking isn’t a crime punishable by death-that was news to me. According to the United Nations, tobacco kills 4.9 million users per year. While we know that these people were killed by tobacco, it is hard to classify these deaths. Were they murders, suicides or accidents? When examining the influence of the tobacco industry, one is tempted to call all tobacco related deaths murder. The tobacco industry uses manipulative advertising trying to make smoking appear harmless, sexy, sophisticated, and adult. These tactics help manipulate adults and kids into experimenting with this highly addictive substance. The tobacco industry knows that if they can just get people started, they can hook them on cigarettes and milk them for thousands of dollars over the smokers’ lifetimes. The tobacco industry always contradicts the research of all credible medical institutions that have unanimously stated that cigarettes are lethal. The tobacco institute tries to make people believe that all these attacks on cigarettes are lies. If the medical profession was going to mislead the public about cigarettes, it would be by minimizing the dangers, not exaggerating them. The medical profession has a vested interest in people continuing to smoke. After all, the more people smoke, the more work there is in treating serious and deadly diseases. But the medical profession recognizes its professional and moral obligation to help people be healthier. On the other hand, the tobacco industry’s only goal is to get people to smoke, no matter what the cost. It could be argued that a smoking death is suicide. While the tobacco industry may dismiss the dangers, any smoker with even average intelligence knows that cigarettes are bad for health but continues to smoke anyway. But I do not believe in classifying most of the smoking deaths as suicidal. Although a smoker knows the risk and still doesn’t stop, it is not that he is trying to kill himself. He smokes because he doesn’t know how to stop. A smoking related death is more accidental than suicidal. For while the smoker may die today, his death was in great part due to his first puffs twenty or more years ago. When he started smoking the dangers were unknown. Society made smoking acceptable, if not mandatory in certain groups. Not only did he not know the danger, but also he was unaware of the addictive nature of nicotine. So by the time the dangers were known, he was hooked into what he believed was a permanent way of life. Any smoker can quit, but unfortunately many don’t know how. Whatever the classification-murder, suicide or accident-the end result is the same. You still have a chance, you are alive, and you know how to quit. Take advantage of this knowledge. Don’t become a smoking statistic - NEVER TAKE ANOTHER PUFF!

Smokers Need Not Apply!

In recent years this message has begun to appear at the end of job descriptions in many different fields. Except for the closing clause, some of these positions seemed perfect for a current smoker. The smoker may feel such hiring practices are discriminatory and feel great resentment toward the prospective employer. In fact, some companies are now implementing no smoking rules for current employees. Where once the smoker was able to smoke at his or her desk without a hassle, now they must go to designated areas. And in some cases, they may not be able to smoke at all for eight hours a day due to total bans on smoking. Even though an employer may face animosity from such an anti-smoking policy from existing employees, prospective applicants, and even some clients, the practice is gaining popularity in the business community. Why would management be in favour of such restrictions on smokers? Because a smoking employee is a financial liability. Estimates of the additional costs of an average smoking employee range from several hundred to several thousands of dollars per year. Multiplied by several employees, smoking may end up costing an employer tens or even hundreds of thousands of dollars annually. Smokers cost more due to increased medical costs, higher insurance premiums, decreased productivity, more illnesses, and more accidents. Besides this, employee morale becomes affected when the second hand smoke issue surfaces. All in all, the economical and logistical burden placed on an employer due to employee smoking is substantial. It used to be that all a smoker had to worry about were the crippling and deadly effects of smoking. Then the social stigma became a major concern. But now he must also consider the professional ramifications of smoking. After all, if he can’t find work, it will become increasingly difficult to afford a several hundred dollar a year addiction to cigarettes. Being a smoker can limit your potential for physical, mental, social, professional and economic growth. Today, being personally and professionally successful is a difficult venture. All smoking will do is further complicate an already overly complicated situation. Besides this, the physical assault of smoking will affect your health and may eventually cost you your life. Is smoking worth all these risks? If you don’t think so then - NEVER TAKE ANOTHER PUFF!

Every Quit is Different

Every quit is different. Not only that, but when a person quits multiple times, each one of those quits is different also. Some people quit and have a terrible time, relapse down the road and are terrified to quit again because they “know” what will happen the next time. Well, actually they don’t know. The next time may be a breeze in comparison. On the alternate side, some people have an easy quit, go back with the attitude, “Oh well, if I have to, I’ll just quit again.” They may find the next quit horrendous, and possibly not be able to pull it off. The reason I mention this is it is possible that you won’t have any major symptoms this time. I have had a lot of four pack a day smokers who smoked 40 plus years who toss them with minimal withdrawal or discomfort. The reason they never tried to quit before is that they witnessed people who smoked one fourth of what they did go thorough terrible side effects and figured, “If it did that to them, it will kill me.” But when the time came, their quit was easy in comparison. You may find that this quit will be relatively easy. Stranger things have happened. But if it does, don’t think that this doesn’t mean that you were not addicted. The factor that really shows the addiction is not how hard or how easy it is to quit. What really shows the addiction is how universally easy it is to go back. One puff and the quit can go out the window. Summing up, the first few days may be relatively easy, or for some, it may be very difficult. Who knows? The only thing we know is that once you get past the third day nicotine free, it will ease up physically. Psychological triggers will still exist but more controllable measures can be taken with them, basically keeping your ammunition up for why you don’t want to be a smoker. Easy or hard, quitting is worth it. Once you have quit for even a few hours, you have invested some effort, time, and maybe even a little pain. Make this effort count for something. As long as you hang in there now, all of this will have accomplished a goal. It got you off of cigarettes. After that, to stay off, the make or break point simply translates to knowing to NEVER TAKE ANOTHER PUFF!

I’m Not Going to Smoke Today!

During the quitting process, you most likely woke up thinking of this concept, either with great determination or incredible trepidation. Either way, it was imperative that you aimed a high degree of focus at this lofty goal. The incredible cravings elicited by the addiction required that you had all the motivation and ammunition to squelch the seemingly irresistible need to take a cigarette. Whether or not you understood it, immediately reaffirming your goal not to smoke upon waking was crucial during your initial quitting phase. The fact is, restating the simple concept of “not smoking today” is not only important when you first quit. You should restate this upon waking for the rest of your life. Each day you should start with “I’m not going to smoke today.” Equally important, each day you should end congratulating yourself and feeling a sense of pride and accomplishment for achieving your worthwhile goal. For even years and decades after successful cessation, every day you continue to breathe and think a relapse to smoking is an inherent risk. The addiction to nicotine is as powerful as the addiction to alcohol or any illicit drug. The habituation of smoking nicotine permeated almost every area of your day-to-day existence. You may allow complacency to fill the void left by your old addiction and habits by disregarding the monumental effort and achievement which accompanied overcoming them. Complacency causes your guard to drop and you may begin to forget the reasons you wanted to quit. You will no longer recognize the many vast improvements in the quality of your physical, social and economic well being which accompanied smoking cessation. Then, one day when smoking seemed to be a part of an obscure past which had no real relevance to your current status, a thought for a cigarette is accompanied by an opportunity to “innocently” reach for one. Maybe it is under an insignificant social circumstance, or maybe a major life crisis. Either way, all the elements seem to be in place. Motive, cause and opportunity are present, reasoning and knowledge of addiction are conspicuously absent. A puff is taken. New rules are now in place. Your body demands nicotine. A preordained process is now set in motion, and, even if you don’t realize what has happened, a drug relapse has occurred. The wants and desire to take back the action are overpowered by the body’s demand for nicotine. You will have no control of the physiological process set in action. Soon your mind bows to your body’s dictates. You will very likely feel great regret and remorse. An overriding feeling of failure and guilt will haunt you. You will soon find yourself longing for the days when you had hardly thought of cigarettes at all. But those days will slowly become a fading past image. Weeks, months or even decades may pass before you once again muster the resolve to attempt a serious quitting process. Sadly, you may never again have the appropriate strength, initial motivation, or, tragically, the opportunity to quit again. A terminal diagnosis or sudden death may preclude the well-intentioned future attempt that may never have a chance to be realized. Don’t take the chance of becoming entrapped in this kind of tragic and dismal scenario. Actively strive to successfully remain smoke free and maintain all the associated perks - the physical, emotional, economic, professional and social benefits of not being an active smoker. Always start your day off with the statement “I won’t smoke today.” Always end your day with a self-affirmation and sense of pride and accomplishment for once again winning your daily battle over your addiction. And always remember between your waking up and the ending of your day to - NEVER TAKE ANOTHER PUFF!

“Minimizing the Most Common Side Effects to Quitting Smoking”

Blood sugar plummets in many people when first quitting. The most common side effects felt during the first three days can often be traced back to blood sugar issues. Symptoms such as headache, inability to concentrate, dizziness, time perception distortions, and the ubiquitous sweet tooth encountered by many, are often associated with this blood sugar drop. The symptoms of low blood sugar are basically the same symptoms as not having enough oxygen, similar to reactions experienced at high altitudes. The reason being the inadequate supply of sugar and/or oxygen means the brain is getting an incomplete fuel. If you have plenty of one and not enough of the other, your brain cannot function at any form of optimal level. When you quit smoking, oxygen levels are often better than they have been in years, but with a limited supply of sugar it can’t properly fuel your brain. It is not that cigarettes put sugar into your blood stream; it is more of a drug interaction of the stimulant effect of nicotine that affects the blood sugar levels. Cigarettes cause the body to release its own stores of sugar and fat by a drug type of interaction. That is how it basically operated as an appetite suppressant, affecting the satiety centers of your hypothalamus. As far as for the sugar levels, nicotine in fact works much more efficiently than food. If you use food to elevate blood sugar levels, it literally takes up to 20 minutes from the time you chew and swallow the food before it is released to the blood, and thus the brain, for its desired effect of fuelling your brain. Cigarettes, by working through a drug interaction cause the body to release its own stores of sugar, but not in 20 minutes but usually in a matter of seconds. In a sense, your body has not had to release sugar on its own in years, you have done it by using nicotine’s drug effect! This is why many people really gorge themselves on food upon cessation. They start to experience a drop in blood sugar and instinctively reach for something sweet. Upon finishing the food, they still feel symptomatic. Of course they do, it takes them a minute or two to eat, but the blood sugar isn’t boosted for another 18 minutes. Since they are not feeling immediately better, they eat a little more. They continue to consume more and more food, minute after minute until they finally they start to feel better. Again if they are waiting for the blood sugar to go up we are talking about 20 minutes after the first swallow. People can eat a lot of food in 20 minutes. But they begin to believe that this was the amount needed before feeling better. This can be repeated numerous times throughout the day thus causing a lot of calories being consumed and causing weight gain to become a real risk. When you abruptly quit smoking, the body is in kind of a state of loss, not knowing how to work normally since it has not worked normally in such a long time. Usually by the third day, though, your body will readjust and release sugar as it is needed. Without eating any more your body will just figure out how to regulate blood sugar more efficiently. You may find though that you do have to change dietary patterns to one that is more normal for you. Normal is not what it was as a smoker, but more what it was before you took up smoking with aging thrown in. Some people go until evening without eating while they are smokers. If they try the same routine as ex-smokers they will suffer side effects of low blood sugar. It is not that there is something wrong with them now, they were abnormal before for all practical purposes. This doesn’t mean they should eat more food, but it may mean they need to redistribute the food eaten to a more spread out pattern so they are getting blood sugar doses throughout the day as nature really had always intended. To minimize some of the real low blood sugar effects of the first few days it really can help to keep drinking juice throughout the day. After the fourth day though, this should no longer be necessary as your body should be able to release sugar stores if your diet is normalized. If you are having problems that are indicative of blood sugar issues beyond day three, it wouldn’t hurt talking to your doctor and maybe getting some nutritional counselling. In order to allow your body to maintain permanent control over the amount of glucose (sugar) in your brain ... NEVER TAKE ANOTHER PUFF!

How Can I Get My Family and Friends to Quit Smoking?

That is the question that I’m often asked by successful clinic graduates wishing to help those closest to them achieve freedom from their deadly addiction to cigarettes. Unfortunately, there is no simple solution. Smokers are going to smoke until they are ready to quit. Pestering, threatening, insulting, destroying or hiding cigarettes all cause the smoker to feel resentful and usually result in higher consumption of cigarettes for spite. These are not the methods of choice. One method which I do suggest is understanding. Smokers do not smoke because they are stupid. They don’t smoke because they are mean or obnoxious and wish to hurt their families and friends. They smoke because they are human, and as humans they make mistakes. One that all smokers are guilty of is experimentation with a highly addictive and dangerous drug - nicotine. Many of them took up smoking long before any dangers were known. When they realized the dangers, they may have attempted to quit, but for some it is not easy. They are hooked on a drug, and it will take strong resolve and a support system to overcome the initial difficulties encountered during the quitting process. The best support which can be provided by significant others is to offer love, patience and understanding, and to try to make the smoker’s life as easy as possible over the first few days. The smoker giving up cigarettes may have severe emotional outbursts and be irritable, depressed, and even irrational. These are all the effects of nicotine withdrawal. Many family members and friends will encourage them to smoke rather than act like that. If they were recovering alcoholics, they would not be offered drinks by these people. If they were reacting to chemotherapy they would not be begged to give it up and sacrifice their lives for the family’s momentary comfort. Unfortunately, many friends and family members often do not take smoking cessation seriously enough. We are not talking about giving up a simple little annoyance such as biting of nails. We are talking about a powerful and deadly addiction. They are dealing with a real physiological need as well as a strongly ingrained psychological dependence. Offer the most encouragement you can. Be tolerant of their temporary emotional outbursts. They will soon return to normal, and you will have the personal satisfaction of knowing you helped them over one of the greatest challenges of their lives - giving up cigarettes. While non-smokers may offer their love, patience and understanding, you, as an ex-smoker, have the unique ability to be a highly supportive and credible source to the individual attempting to quit smoking. You know what it was like to smoke. You know how much nicer it is to go through life as an ex-smoker. Share this knowledge. Be honest – if you still have “thoughts” for a cigarette, tell them. But clarify what the thoughts are like. If you are a typical ex-smoker, the thoughts occur quite infrequently, and even when they do occur they last only seconds and are just a passing desire rather than a real painful episode such as those encountered during initial cessation.

People giving up cigarettes need to know this natural evolutionary process of smoker to ex-smoker. When they encounter urges after the first two weeks, they are no longer experiencing physical withdrawal, rather they are responding to a psychological trigger. They are experiencing a new situation for the first time without a cigarette. The urge will pass and they will have learned how to face all future similar experiences as an ex-smoker, with no discomfort. Share with them the information we shared with you. Give them the same support that the others ex-smokers gave to you. Most important, once smokers give up their cigarettes, offer periodic support to them letting them know you care about them, and always reinforce one concept to guarantee success in their continued non-smoking status - NEVER TAKE ANOTHER PUFF!

Can people quit smoking and still drink alcohol?

There are different groups of people that must be taken into consideration when addressing alcohol and quitting: people who have never taken a drink in their lives; people who are truly social drinkers; drinkers who consider themselves to be social drinkers but who may in fact have a drinking problem; people who know that they are alcoholics and who have quit drinking; and people who are actively drinking alcoholics. There are different considerations involving quitting for each of these groups.

Never Drinkers

The easiest group of course is people who have never been drinkers and don’t plan on ever drinking. There is nothing they need to worry about regarding alcohol consumption when quitting smoking.

Social Drinkers

Truly social drinkers can still drink alcohol without risk of smoking relapse, but being mentally prepared can be crucially important for them. They must go into ALL drinking situations reminding themselves that they are recovering nicotine addicts and that they are going to be recovering nicotine addicts for the rest of their lives. While that may not sound great in concept, being a recovering nicotine addict, it sure beats being an actively using nicotine addict, hands down. For over time, being a recovering nicotine addict has no real signs or symptoms and no real adverse health or even social effects associated with it. Being an active user would actively be destroying tissue with every puff, depositing cancer-producing chemicals with every puff, assaulting your heart and circulatory system with every puff, costing you money with every puff, and making you reek with every puff. It is important for these people to know that everything that they could do as smokers, they can also do as ex-smokers. They just have to teach themselves how. There are some things that new quitters are forced to learn early on like how to eat, sleep, use the washroom, breathe, etc. These are things that are required from day one for survival. So even though they may resist doing one of them, they can’t resist for long and will thereby be forced to start to break the association to smoking early on. Other things are sometimes put off and seen as unimportant to face early on. Tasks like doing housework, laundry, cleaning, brushing teeth, combing hair, or maybe even going to work and doing their jobs. While it is true that people won’t die if they stop doing one or more of these activities for a day or two, putting off doing them too long will create a set of problems that can be quite annoying to those around them. Besides threatening their livelihood and making them look like slobs in general, if carried on too long, it can really start to make them feel intimidated that they may never again be able to do these activities. Again, it must be repeated, everything a person did as a smoker they can also do as an ex-smoker, but they have to teach themselves how. Now when it comes to areas of less importance like watching television, sports, playing cards, being a couch potato, and yes, even drinking with friends, things that are not necessary for survival and in fact, things that may not even be good for a person, well, the truth is people can do these things too as ex-smokers. The same process is necessary though. They have to teach themselves how. Holding off too long can create a sense of intimidation, the feeling that they can never do the specific activity again. This simply is not the case. They will be able to get themselves back to their prequitting existence if they choose to. Drinking is a special case because the association is so strong and by its very nature lowers their inhibitions. It can cause people to do some very irrational behaviours. Smoking can be one of them. Because of the drug’s influence, it is best that people take it on gradually, in the beginning in a safe environment. These people should probably limit themselves to one drink the first time out just to show themselves that they can have a drink without smoking. Also, they should do it with people who are non-smokers and who really are supportive of their quitting. This is a much safer situation in the beginning than going out with drinking buddies who smoke cigarettes and who may be a tad envious of their quitting, and who, while drinking themselves also have their inhibitions lowered. It may manifest in behaviours of encouragement of smoking at a time when the person is more vulnerable. Soon ex-smokers will be able to face these environments too. Again it is best that they do it gradually, breaking some of the association and intimidation factors in the safer controlled environments. The fact is, though, for the rest of their lives they will need to keep their guard up, in a sense reminding themselves of their reasons for having quit and the importance to stay off smoking, every time before they go drinking. It prepares them to face the situation in a much safer state of readiness. These people need to use timetables that they are comfortable with, but the sooner they take on activities like drinking the sooner that they will prove to themselves that life goes on without smoking.

Problem Drinkers

The next group is people who define themselves as social drinkers but who do in fact have a drinking problem. These are people who cannot drink in a controlled manner, or people whose drinking at one time has adversely affected their health or caused them any economic, professional, legal, or personal problems. These people need to think long and hard about whether they are in fact problem drinkers or possibly dealing with alcoholism issues. If a person says that they know that their drinking will cause them to take a cigarette and relapse back to smoking, and then they take a drink and relapse, they are in effect problem drinkers for they have now put their health on the line in order to drink.

Recovering Alcoholics

A person who has acknowledged that he or she is an alcoholic and has successfully quit drinking probably has a rather thorough understanding of addiction. If he or she didn’t, he or she would not be successfully off drinking but more likely rather still is an active drinker. People who are successfully recovering from alcoholism probably understand the relapse implications of just one drink, or just one sip. All a person who has quit drinking needs to do to quit smoking is to just transfer his or her experience and knowledge with alcohol, while aiming it straight at nicotine. The same problem -- drug addiction. The same solution -- stop delivering nicotine into his or her system. The recovering alcoholic will probably be scared about quitting, feeling that life will never be the same without smoking. ” The odds are pretty good that he or she probably had those exact same fears when quitting drinking. The recovering alcoholic was right when he or she thought his or her life would be different. It in all likelihood became immeasurably better. The same will hold true with quitting smoking. I always state it this way. Treat an addiction as an addiction and a person will learn to control it. Treat an addiction like a bad habit and the person won’t have a prayer. Nicotine use is an addiction. If a recovering alcoholic takes his or her understanding of addiction and aims it at nicotine he or she will do fine. I should point out that whenever I have a person who quits smoking after quitting another substance, he or she often has a harder time quitting than the average smoker. Smoking may have been a crutch used to help them get off of the other substance. Now, when quitting cigarettes, not only is the person trying to break free from a primary addiction, but he or she is also trying to remove the crutch that he or she feels supported recovery from the other addiction. While it may be harder up front, people recovering from alcoholism or any other addiction can be more prepped for success than the average quitter, for once again, they understand addiction. If the quitter aims their alcohol recovery program at treating this addiction, they will do fine with nicotine dependency recovery, too.

Drinking Alcoholics

The last group is people who are actively drinking alcoholics who want to quit smoking. When it comes to nicotine addiction, the only thing these people need to do to successfully quit smoking is to stop delivering nicotine. Are there other things that some people may also have to get rid of after they quit smoking? Sure there are. If a person were a diabetic while smoking and not watching his or her diet, he or she would likely have to get his or her sugar intake under control when quitting smoking. The fact is, though, he or she probably needed to get his or her sugar under control when he or she was still smoking. Quitting didn’t change that variable. Alcohol is no different. If a person has a drinking problem before quitting, he or she will still have a drinking problem after quitting. Still, all the problem drinker needs to do to get off nicotine is just to get off nicotine. The drinking problem still exists and still needs to be dealt with. A person first realizing he or she has an alcoholism problem and who also wants to quit smoking either has to quit both substances at the same time or get drinking under control first. The only reason I say that some people probably need to quit drinking first is because of the limitation of how the person’s alcohol treatment program will advise him or her when they find out that he or she is a recent quitter of cigarettes. Many if not most alcohol recovery programs will inadvertently or very purposely push a new ex-smoker entering the program to smoke. Over the years I have in fact had actively drinking alcoholics in smoking clinics, people who made it abundantly clear that they knew they had drinking problems and smoking problems but wanted to treat the smoking first. I really do try to get them into alcohol treatment concurrently but cannot force them to do it. On more than one occasion I have seen the person successfully quit smoking, stay off for months and sometimes longer, and finally get into AA, only to be assigned a smoking sponsor who tells the person that he or she can’t “get off smoking and drinking at once,” and who actually encourages the person to smoke again. Note the sequence here, the ex-smoker has been off of nicotine for an extended time period but the smoking sponsor says that the person can’t quit both at once. It is unfortunate that most alcohol and drug treatment programs just don’t recognize smoking as another drug addiction. You will not often see an AA sponsor say that you can’t give up drinking and heroin at once, so if you have been off heroin for six months and now want to quit drinking, you should probably take heroin for a while until you get alcohol out of your system. The bottom line is that there are other things that ex-smokers may need to address but not in order to sustain their quits, but to sustain their health or control other problems. To successfully overcome smoking and arrest a dependency upon nicotine requires only that a smoker make and stick to a personal commitment to - NEVER TAKE ANOTHER PUFF!

Replacing Crutches

“Boy did I ever drink my brains out, today,” a clinic participant enthusiastically proclaimed, “But I did not smoke!” She was so proud of her accomplishment. Two whole days without smoking a single cigarette. To her, being bombed out of her mind was a safe alternative to the deadly effects of cigarettes. Just 24 hours earlier I had made a special point of mentioning the dangers of replacing one addiction with another. In quitting smoking one should not start using any other crutches which might be dangerous or addictive. But this was not of concern to her. She said, “I already have a drinking problem, so what more could go wrong with getting drunk to quit smoking.” Twenty minutes into the program, she stood up, passed out and had to be carried out. Quitting by crutch replacement carries varying degrees of risks. Turning to any other addictive substance, even legal or prescribed drugs, carries the risk of a new addiction. In many of these cases the end result will be a more significant problem than just the original smoking. The new addiction can cause the person’s life to end in shambles, and when it comes time to deal with the new dependence he or she will often relapse to cigarettes. Turning to food, especially high calorie sweet foods, will usually result in a psychological need with a subsequent weight gain. The risk of weight gain is insignificant in comparison to the dangers associated with cigarettes. The ex-smoker would have to gain over 75 pounds to create the equivalent health hazard of cigarette smoking. But weight gain often results in a state of panic and frustration which can lead the ex-smoker to conclude that he or she would rather be a skinny smoker than an obese ex-smoker. The fallacy which causes the ex-smoker to reach this conclusion is that only two options exist for him or her - smoke or eat more. In fact, other choices exist. One is not smoking and eating in a manner similar to when he or she was a smoker. Another is increasing activity levels to compensate for the added caloric intake when eating extra amounts. Some people turn to a healthy alternative as a crutch, like jogging or swimming. These activities carry low risk and, in fact, often result in physical benefits. But if they are being done as a direct crutch in maintaining abstinence, they pose one major threat. As with drugs, alcohol, or food, when the day comes that one must stop the activity, the seemingly successful ex-smoker will often relapse. Sometimes a minor ankle sprain will temporarily end a jogger’s running, or an ear infection will interfere with swimming. What should be a temporary minor inconvenience ends in a tragic result - relapse to cigarettes. Again, the ex-smoker believes that only one of two states exist for him or her - either smoking or mandatory exercise. But, in actuality, a third choice exists, not smoking and doing nothing. This is not to say an ex-smoker should not take up physical activities after quitting. But exercise should be done for the enjoyment and for the true benefits derived from it. The ex-smoker should do it because he or she wants to, not because he or she has to. If you are going to develop a crutch, make sure it is one which you can maintain for the rest of your life without any interruption. One that carries no risks and can be done anywhere, anytime. About the only crutch which comes close to meeting these criteria is breathing. The day you have to stop breathing, smoking will be of little concern. But until that day, to stay free from cigarettes all you need to do is - NEVER TAKE ANOTHER PUFF!

Pharmacological Crutches

Due to the recent release of Nicorette ® , a chewing gum containing nicotine, I feel it is necessary to issue a special warning to all clinic participants who may be considering experimenting with this product. The gum is intended to be used by smokers to ease the severity of symptoms encountered during initial smoking cessation. But the ex-smoker occasionally desires a cigarette months and even years after quitting. He may feel that the urge is due to a physiological residual effect of withdrawal. This thought may lead to the idea that trying the gum may help get rid of the desire. But, the actual cause of the thought for a cigarette is due to a psychologically triggered response. Some situation, person or event is causing the thought for a cigarette. While these occasional triggers may be annoying, they pass in seconds and may not occur again for hours, days or even weeks. If the ex-smoker tries the gum, the end result will be tragic. For once he takes the first piece, his addiction to nicotine will be re-established. Once again he will be in nicotine withdrawal. Then he will have to make a choice-either relapsing into full fledged smoking or once again encountering the two week nicotine withdrawal. All this because he anted to ease a thought for a cigarette which would have only lasted seconds. Even the intended use of nicotine gum presents certain problems. Many hope the gum will be a panacea for the truly addicted smoker. But caution must be given to the indiscriminate use by any smoker who feels that this new aid will help him break free from cigarettes. For while the gum may reduce the severity of initial withdrawal, it does so at a cost. Normally, when a smoker quits, physical discomfort will peak within 72 hours and totally subside within two weeks. While the first three days may be traumatic, with proper support any smoker can successfully get through this period. Use of the gum may reduce the initial severity of withdrawal when quitting. The ex-smoker may continue chewing the gum for months, never reaching peak withdrawal. But because blood nicotine never reaches the levels maintained by cigarettes, nor totally leaves the body, he feels minor withdrawal symptoms on a chronic basis. When he finally quits using the gum, he will probably experience the same withdrawal he would have originally encountered when quitting cigarettes. The gum may help an addicted smoker break some of the psychological dependence and conditioned responses before experiencing potential difficult withdrawal. But the cost for this easing of initial symptoms is a prolonged chronic withdrawal followed by peak symptoms when giving up the gum. This is a lot of long term discomfort which could be avoided by simply ridding the body of all nicotine by quitting cold turkey. When you quit smoking, you broke free from the addiction to nicotine. As long as you keep all nicotine out of your body you will never again have to worry about the health consequences of smoking or deal with the withdrawal of quitting. If you wish to stay free, don’t try the gum, and as for cigarettes, cigars or pipes - NEVER TAKE ANOTHER PUFF!

NOTE: This was originally published in 1984. Since then, a number or similar products, (e.g., patches, gums, other devices are currently under development), have been introduced as over the counter cessation aids. The same principal applies to them all -they are transferring the delivery system of the drug nicotine. If the smoker simply stops, withdrawal will peak and start to subside within 72 hours. Use of the agents will unnecessarily prolong the cessation process as well as add to the expense.

Pharmacological Aids: Prolonging Withdrawal Syndromes

“I could wring your neck! What is this 72 hour garbage you are preaching about. It is not getting any better! You lied to me from day one!” This warm greeting was thrust upon me on a Sunday night by an irate clinic participant. Sure, she had reason to be mad. After all, being in constant withdrawal for five days is enough to make any person lose her composure. While she had every right to be angry, it was aimed at the wrong person. She had only herself to blame for this prolonged agony. For unlike the majority of people in her group, she did not throw out her cigarettes during the clinic session Tuesday night. Instead, she had a couple of cigarettes that evening. Then on Wednesday she took a couple of sticks of Nicorette chewing gum. I then told her that due to the administration of nicotine from the cigarettes and then the gum, she was back at square one. She was angry at me then, too. She wanted to know what right I had to tell her she was failing. But she said she would throw out the cigarettes and get rid of the gum. Unfortunately for her, she did not dispose of the gum and continued to chew a couple of sticks a day. The next three days were horrendous. Every night she came back to the meeting and complained bitterly. But this is nothing out of the ordinary, many people are suffering in the initial three days. On Saturday, she still complained of bitter symptoms. But she knew that she quit a day late, so this too could have been expected. But by Sunday, it should have been getting better. It was not though, and she was fuming. I told her the gum was prolonging the withdrawal process. “But it’s only a couple of sticks, and it’s not like I am smoking.” It was her failure to recognize this point that was causing all of her problems. Chewing the gum was exactly like taking a couple of puffs. She was administering a small amount of nicotine - not enough to reach the peak nicotine level she desired, but just enough to reinforce her addiction and cause chronic withdrawal symptoms. After the explanation she was still defiant. She would not accept that the nicotine gum was causing her problem. The next day, though, she came back to the clinic. All of the other participants had successfully overcome the first weekend. They all talked about how they still occasionally desired a cigarette but no longer were suffering the powerful cravings they had encountered the first few days. As usual, they were visibly calmer and enthusiastic about the progress they had made. Almost everyone in the group expressed similar sentiment. Everyone except our friend with the gum, who still complained bitterly. And she still insisted she needed a cigarette or the gum to make quitting possible and bearable. In the beginning of the meeting she tried to monopolize the discussion. But soon she realized the group had no desire to sit and listen to her complain of the horrors of quitting. It was history to them, and they had more pertinent issues to address. Finally, after sitting and listening to all the positive feeling expressed by her other classmates, she started to realize that she was the only one suffering. Our predictions of easing of withdrawal after 72 hours were true. And the only difference between her and the other group members was her first few cigarettes and her subsequent nicotine gum use. Quitting smoking should be done in a manner which is as easy and effective as possible. Cease all administration of nicotine in any form. In a few days withdrawal symptoms will ease up, and in two weeks will stop all together. Then, to avoid ever having to quit again - NEVER TAKE ANOTHER PUFF!

NOTE: This was originally published in 1986. Since then, a number of similar products, (e.g., patches, gums, nasal sprays, and inhalers currently under development), have been or are soon to be introduced as over the counter cessation aids. The same principal applies to them all - they are transferring the delivery system of the drug nicotine. If the smoker simply stops, withdrawal will peak and start to subside within 72 hours. Use of these agents will unnecessarily prolong the cessation process as well as add to the expense.

The Easy Way Out!

Did you hear about the lady who went on two diets simultaneously to lose weight? Doing both at once she ate enough food to satisfy her appetite and figured she would lose weight twice as fast. This humorous story illustrates a very serious point. Human nature dictates that we look for the easiest and least painful route to make necessary changes. Unfortunately, what often appears to be the easiest technique may not always be the best. If this lady really relied on this twisted logic, she would not only fail in losing weight, but would probably end up weighing more than before she started her diets. And while this story may seem farfetched, many people who try to follow medically unproven and controversial weight control programs often end up with this very dilemma. But weight control is not the only situation where people rely on unsuccessful techniques. Cigarette smoking is another problem for which people try to find different solutions. People are always looking for new and easy ways to quit smoking. Many behavioural scientists believed that smoking is only a learned pattern. If this were so, there would be many different approaches available to quit. Behaviour modification techniques such as reducing the amount of or exposure to a substance or situation, aversion therapy, hypnosis, acupuncture, record keeping, desensitization and countless other approaches have been used for years to help people unlearn unwanted behaviour patterns. But cigarette smoking is not simply a learned behaviour or bad habit. It is more complex, more powerful, and worst of all more deadly than most bad habits. Cigarette smoking is an addiction. This fact becomes quite evident the first day of every smoking clinic. Just about every person in the group can relate some story which demonstrates that to some degree he or she is controlled by cigarettes. Some have gone so far as to rummage garbage cans in the middle of the night in search of cigarettes. Others take butts out of dirty ashtrays. Still others sneak cigarettes while hospitalized from smoking-related illnesses even though smoking is expressly forbidden by their physician. After hearing of these dramatic experiences, few people argue the point that the addiction to cigarettes exerts tremendous control over the smoker. Addiction does not respond to cut-down approaches. Addiction does not lend itself to controlled use of the substance. If people try to treat an addiction as a bad habit, they will lose to the addiction. If, on the other hand, they treat an addiction as an addiction, they stand a good chance of beating it. Once a person is addicted to a substance, he must totally avoid any use of that substance or else relapse into a full- fledged drug dependency. This holds true for alcohol, heroin, nicotine, and a host of other drugs. As far as nicotine is concerned, if the smoker quits cold he will overcome the strongest stages of withdrawal within 72 hours. After two weeks, physical withdrawal ceases. Then, once it is understood that any amount of nicotine administered in any manner will reinforce his dependence, he has all the ammunition he needs to overcome the occasional desire. He must always base the decision of whether or not he should smoke a cigarette on his true options. He has the choice of smoking none or smoking everything. There is no in between. Based on that, his choice is clear - NEVER TAKE ANOTHER PUFF!

I Will Quit When...

“I will quit when my doctor tells me I have to.” “I can’t quit now it’s tax season.” “Maybe I will quit on vacation.” “School is starting and I’m too nervous to quit.” “I will quit in the summer when I can exercise more.” “When conditions improve at work, I will stop.” “Quit now, during midterm, you must be nuts!” “Maybe after my daughter’s wedding.” “My father is in the ospital. I can’t quit now.” “If I quit now, it will spoil the whole trip.” “The doctor says I need surgery. I’m too nervous to try now.” “When I lose 15 pounds, I will stop.” “I am making too many other changes to stop now.” “I have smoked for years and feel fine, why should I stop smoking now?” “I’m in the process of moving, and it’s a real headache. I can’t stop now.” “It is too soon after my new promotion, when things settle down I will stop.” “When we have a verifiable bilateral disarmament agreement, I will consider quitting.” “It is too late. I’m as good as dead now.” Amazing, isn’t it, how so many people can come up with so many excuses not to stop smoking? If any of these were valid reasons why now is not a good time to quit, when did 33,000,000 ex-smokers in our country stop? They must have been experiencing at least one of these situations during the initial quitting process. The only difference between successful ex-smokers and the smokers making these statements is that the ex-smokers were bright enough to recognize that smoking was not really necessary to deal with any of these situations. The best time to quit is NOW. No matter when now is. In fact, many of the times specifically stated as bad times to quit may be the best. I actually prefer that people quit when experiencing some degree of emotional stress. In most cases, the more stress the better. This may sound harsh, but in the long run it will vastly improve the chances of long term success in abstaining from cigarettes. When people quit at an easy time in their lives, they begin to feel comfortable as ex-smokers as long as no problems surface. But there is always the fear that when things get difficult they will not be able to cope without cigarettes. Many, when facing their first real catastrophe, return to smoking because they were not equipped to deal with real stress as ex-smokers. If, on the other hand, they had quit during a difficult time, they would have realized that even under severe emotional stress life goes on without smoking. They will be secure in the knowledge that they can deal with crisis, any crisis, as non-smokers. Once they overcame the initial quitting process they found they were able to deal with stress better. They were able to meet the physical and emotional demands in their lives more efficiently than when they were smokers. They were truly better equipped for survival in our complicated world without the “help” of cigarettes. So, no matter what is going on in your life, quit smoking. When things get tough - show yourself how tough you are. And once off smoking, deal with all future problems in as constructive a manner as you possibly can, always keeping one essential stress management technique foremost in your mind - NEVER TAKE ANOTHER PUFF!

Understanding the Emotional Loss Experienced When Quitting Smoking

In her 1969 book, On Death and Dying, Elizabeth Kubler-Ross identified five distinct phases which a dying person encounters. These stages are “denial,” “anger,” “bargaining,” “depression,” and finally, “acceptance.” These are the exact same stages that are felt by those mourning the loss of a loved one as well. Denial can be recognized as the state of disbelief: “This isn’t really happening to me,” or “The doctor doesn’t know what he is talking about.” The same feelings are often expressed by family members and friends. Once denial ceases and the realization of impending death is acknowledged anger develops. “Why me?” or “Why them?” in the case of the significant others. Anger may be felt toward the doctors, toward God, toward family and friends. Anger, though, doesn’t change the person’s fate. They are still in the process of dying. So next comes bargaining. In bargaining, the person may become religious, trying to repent for all the sins that may be bringing about their early demise. “If you let me live, I will be a better person, I will help mankind. Please let me live, and I will make it worth your while.” This stage, too, will come to an end. Now the patient, becoming aware he is helpless to prevent his impending fate, enters depression. The patient begins to isolate himself from his surroundings. He relinquishes his responsibilities and begins a period of self mourning. He becomes preoccupied with the fact that his life is coming to an end. Symptoms of depression are obvious to anyone having contact with the patient in this stage. When the patient finally overcomes this depression he will enter the last stage, acceptance. The patient now reaches what can be seen as an emotionally neutral stage. He almost seems devoid of feelings. Instead of death being viewed as a terrifying or horrible experience, he now peacefully accepts his fate. As stated above, these stages are not only seen in the dying person but likewise in the family members mourning the loss of a loved one. However, on careful observation we can see these same stages in people who lose anything. It doesn’t have to be the loss of a loved one. It could be the loss of a pet, the loss of a job, and even the loss of an inanimate object. Yes, even when a person loses her keys, she may go through the five stages of dying. First, she denies the loss of the keys. “Oh, I know they are around here somewhere.” She patiently looks in her pockets and through her dressers knowing any minute she will find the keys. But soon, she begins to realize she has searched out all of the logical locations. Now you begin to see anger. Slamming the drawers, throwing the pillow of the couch, swearing at those darned keys for disappearing. Then comes bargaining: “If I ever find those keys I will never misplace them again. I will put them in a nice safe place.” It is almost like she is asking the keys to come out and assuring them she will never abuse them again. Soon, she realizes the keys are gone. She is depressed. How will she ever again survive in this world without her keys? Then, she finally accepts the fact the keys are gone. She goes out and has a new set made. Life goes on. A week later the lost keys are forgotten. What does all this have to do with why people don’t quit smoking? People who attempt to give up smoking go through these five stages. They must successfully overcome each specific phase to deal with the next. Some people have particular difficulty conquering a specific phase, causing them to relapse back to smoking. Let’s analyze these specific phases as encountered by the abstaining smoker. The first question asked of the group during the smoking clinic was, “How many of you feel that you will never smoke again?” Do you remember the underwhelming response to that question? It is remarkable for even one or two people to raise their hands. For the most part the entire group is in a state of denial - they will not quit smoking. Other prevalent manifestations of denial are: “I don’t want to quit smoking,” or “I am perfectly healthy while smoking, so why should I stop,” or “I am different, I can control my smoking at one or two a day.” These people, through their denial, set up obstacles to even attempt quitting and hence have very little chance of success. Those who successfully overcome denial progress to anger. We hear so many stories of how difficult it is to live with a recovering smoker. Your friends avoid you, your employer sends you home, sometimes permanently, and you are generally no fun to be with. Most smokers do successfully beat this stage. Bargaining is probably the most dangerous stage in the effort to stop smoking. “Oh boy, I could sneak this one and nobody will ever know it.” “Things are really tough today, I will just have one to help me over this problem, no more after that.” “Maybe I’ll just smoke today, and quit again tomorrow.” It may be months before these people even attempt to quit again. Depression usually follows once you successfully overcome bargaining without taking that first drag. For the first time you start to believe you may actually quit smoking. But instead of being overjoyed, you start to feel like you are giving up your best friend. You remember the good times with cigarettes and disregard the detrimental effects of this dangerous and dirty addiction. At this point more than ever “one day at a time” becomes a life saver. Because tomorrow may bring acceptance. Once you reach the stage of acceptance, you get a true perspective of what smoking was doing to you and what not smoking can do for you. Within two weeks the addiction is broken and, hopefully, the stages are successfully overcome and, finally, life goes on. Life becomes much simpler, happier and more manageable as an ex-smoker. Your self esteem is greatly boosted. Your physical state is much better than it would ever have been if you continued to smoke. It is a marvellous state of freedom. Anyone can break the addiction and beat the stages. Then all you must do to maintain this freedom is simply remember - NEVER TAKE ANOTHER PUFF!

Can we motivate a smoker to quit if he thinks he

doesn’t want to quit?

Over the years I have seen numerous smokers thrust into my program, totally against their will, who still manage to succeed in quitting smoking. I sometimes get young people who are being forced by their parents to attend. Sometimes it is adults who are forced in by doctors, while other times it is adults who have been tricked into coming to my seminars by family and friends who literally bring them to the program under some form of false pretence, such as they are just going out to dinner. While I won’t say this tactic works in the majority of cases, it works far more often than most people would think. To say that these people had no prior motivation or desire to quit smoking would probably not be true. I suspect most smokers have some level of motivation to quit, but motivation without an understanding of nicotine addiction and its treatment isn’t enough to succeed. That is what I try to do in the first session of a clinic or in the single session seminars. I try to cram in four areas of information, all of which I think are crucial for the smoker to understand if he is going to have a reasonable shot at success. The areas I try to cover are why people smoke, why they should stop, how to quit, and how to stay free. All four of these areas are crucial points of understanding for a person contemplating quitting. Without a firm grasp of each component, the smoker will be handicapped in his or her effort to quit. Understanding why he or she smokes helps the smoker see that all the magical qualities associated with smoking were based upon false beliefs and feelings. While most smokers think they smoke because they want to, the real reason they smoke is because they have to. They are addicted to nicotine and their bodies are demanding that they smoke. They are drug addicts, plain and simple, and understanding this premise is the crucial first step. As with any other addiction or 12-step program, the premise of being powerless over the drug is the first step in recovery. I try to help them to see that while they thought smoking was keeping them calm, it was actually increasing their stress levels, or more accurately, their reactions to stress. While they thought smoking made them energetic, in fact, it was robbing them of endurance and energy. While smokers often felt that smoking allowed them to have fun and lead more socially active lifestyles, it was actually impairing and limiting their ability to engage in many activities and to develop new relationships. As opposed to enhancing their ability to be vibrant and active members of society, it was in fact causing them to resort to many antisocial behaviours. It led them to smoke in lieu of human contact, often leaving gatherings or refusing to attend functions where smoking was no longer permitted. Why a person should quit smoking is probably the least surprising type of information, as most smokers already know that smoking is bad for them. The problem is that most people don’t recognize how bad it is. Many attending are overwhelmed when they fully realize the true magnitude of the dangers from smoking. While I don’t spend a great quantity of time on the issue, maybe only an hour and a half out of ten hours of presentation time, it is still one of the areas that many people refer back to years later as a major motivating factor in staying off nicotine. The recognition that quitting smoking is in fact a fight for survival is often of paramount importance in long-term success. This information is often critical for dealing with the occasional thoughts that are still triggered by circumstances and situations faced throughout the ex-smoker’s life. How to quit - now this is a shock to most attending the session, especially if they did any research and reading prior to coming to the program. If they are medical professionals who have been bombarded with state-of-the-art smoking cessation techniques, what I am proposing is so radical that it takes them a few minutes to overcome the idea that I must be totally out of my mind. After being presented with study after study and expert after expert saying to use nicotine replacement or other pharmaceutical aids, to come out and accept that the easiest and best way to quit smoking is simply to “quit smoking” seems totally simplistic and ludicrous. It is only when I have them think really hard of all the long-term (one year plus) ex-smokers they know, and how these people initially quit, that they start to realize that the vast majority of these people – and in many cases all of them - quit cold turkey. It is often like a light bulb goes off in their head as for the first time they see the obvious, even though it flies in the face of what they have been taught was conventional wisdom. Finally, how to stay off, here is another remarkable revelation. Almost every piece of professional literature on smoking cessation produced over the last 30 years has buried within it, or sometimes printed very prominently, one line of text that will undercut the most truly motivated and educated smoker. The line is “don’t let a slip put you back to smoking.” That makes as much sense as saying to a recovering alcoholic “don’t let a drink put you back to drinking,” or a heroin addict being given the message “don’t let a little injection put you back to using.” The message needs to be stronger than that. Not, “do not let a slip put you back to using,” the message had better be - DON’T SLIP!

There is no such thing as a slip, or an accident, or a mistake, or a puff, or just one - they are all terms that are actually defining a RELAPSE! This point, more than any other is what is going to make a quit last. Forgetting this concept, or worse, never knowing it all but assures failure. I have seen the power of education work thousands of times in helping properly prepare smokers to quit. Again, that problem is more than just teaching the physical dangers of smoking. It entails the smoker developing a full appreciation of the physical, mental, social, economic, and aesthetic implications of smoking. I have also witnessed personal understanding evolve into a powerful tool utilized by thousands of ex-smokers in maintaining their resolve to stay quit too. They will continue to maintain their resolve so long as they continue to appreciate why they quit in the first place, and keep those reasons in the forefront of their consciousness. Can we motivate a smoker to want to quit? I think most smokers who have smoked cigarettes for any appreciable period of time are already motivated. While maybe not all smokers in general, it is likely that any smoker who shows up at a quit smoking clinic on his or her own accord, or who has typed the word “smoking” into an internet search engine, has some initial interest and wants more information on how to quit. So basically, the answer to whether or not a person can be motivated to want to quit is “yes.” In fact most smokers already have some motivation in place. The emphasis must be on helping to teach the smoker how to quit and then how to stay off. It’s really an easy lesson to teach. It’s a matter of helping the cigarette smoker understand that to quit smoking and stay quit is simply a matter of knowing to NEVER TAKE ANOTHER PUFF!

“You know smoking two or three cigarettes is better than having smoked two or three packs!”

This statement was angrily snapped at me by an irate clinic participant on her third successive day of cheating during her stop smoking clinic. She was mad because I kept telling her that she was blowing her chance at quitting smoking. I told her that as long as she smoked three or two cigarettes or even a single puff, she should just smoke the other two packs she would normally consume in a typical 24 hour period. She was suffering horribly and was convinced that all this misery had to serve a useful purpose. I was belittling her valiant attempt, and she was mad as hell at my arrogance. She had been in other professional programs before. The other programs considered an 80% reduction in smoking a great accomplishment. Sure, they thought 100% would be better, but not all people could do 100%. Her physician would probably agree as well, that, if she couldn’t quit, at least she drastically reduced her smoking. Her family and friends were most likely equally impressed by her major victory. Then she would come in to our meeting and I would say she was back to square one and should either smoke everything or stop all together. What made her so mad was her conviction that I really thought she was doing a great job but wouldn’t admit it to her. Contrary to her beliefs, I did not consider her attempt at reducing smoking a praiseworthy effort. Cigarette smoking is an addiction. Because of this, smoking is an all or nothing proposition. While her other programs, family, friends and other professionals may have viewed her drastic reduction as impressive, they all failed to understand that reduction was a temporary state. Reducing smoking by 50, 80, 90, or even 99.99% is worthless. It will result in a complete failure in the attempt. This failure will most often result in an eventual return to the old level of consumption and may even lead to a substantial increase over the level smoked prior to the attempt at quitting. It does not pay to cut down for a day or week or even a month just to become a heavier smoker for years afterward because of it. The end result of such a pattern is often the loss of one’s health and eventually one’s life. No one has ever lost his or her life from following our clinic’s cold turkey and total abstinence approach, but many have already died and many more will die from disregarding it. Eventual loss of health and life is not the only problem with cutting down in our program. There is the more immediate problem of intensified withdrawal lasting over a longer duration of time. It’s not that the quitter is treating herself to one or two a day. In fact, she is prolonging the period during which she feels that she is depriving herself of 30 or 40 per day. This period will last until she either totally quits and survives through the initial quitting phase or until she reaches her old level. Unfortunately, the latter is the outcome in the vast majority of similar situations. For a person truly dependent on nicotine, cutting down on tobacco consumption is guaranteed suffering and failure. It doesn’t pay to suffer just for the sake of suffering. Quitting cold may cause some discomfort, but it is short term, and the end result can be freedom from cigarettes. Sure, quitting cold turkey can be difficult. But for an addict, quitting by any other means is virtually impossible. Given the choice between difficult and impossible, go for the difficult. At least there is a chance of success. With that success comes improved health, self-esteem, societal acceptance, more money and an overall improvement in the quality of life. Once quitting is accomplished, all that needs to be done to maintain a life free from nicotine addiction is to - NEVER TAKE ANOTHER PUFF!

“You said it would get better. It’s just as bad as the day I quit smoking!”

Recently I was met with this warm greeting from a clinic participant on his eighth day without smoking. As you may recall, we explain during the clinic that if a smoker can get through the first three days without smoking, the physiological withdrawal will start to diminish, and within two weeks all physiological withdrawal will stop. While we can accurately predict the physiological withdrawal, psychological withdrawals can occur at anytime. It is possible that the urge this man was having was just as painful as the ones he had a week earlier. While the urge may have been as strong, it was different. When he had an urge before, there was really nothing he could do to get over it. If he just held out a few minutes, the urge would pass. But psychological urges are more under the exsmoker’s conscious control. A good analogy demonstrating the difference between physiological and psychological pain can be seen by analyzing a common toothache. A rotting tooth can cause a lot of pain. If your dentist explains to you why the tooth hurts it really doesn’t resolve the situation. You know why it hurts, but it still hurts. Simply understanding physical pain does not make the pain go away. To illustrate another point, say you go to the dentist and find out that you have a cavity. He has to drill the tooth and put in a filling. The drilling can be a very rough experience. After it is all over the pain will stop, but whenever you hear the sound of a dentist’s drill, even if it’s years later, you cringe at the thought of the pain. Once you realize that you are simply reacting to the sound, you know that you are not really in danger and the reaction will end. Understanding the root of the fear alleviates the anxiety and the associated pain. Any urges for cigarettes that occur today are reactions to conditioned triggers. You are doing or experiencing something for the first time without smoking. It may be going to a bar, a wedding or going on a plane. It may be seeing a person or being in a place where you always had a cigarette in the past. It may be something you hear or even an old familiar aroma. The sense of smell is a powerful mechanism for triggering old emotional feelings. So today, if you find yourself desiring a cigarette, look around you and see why at this particular time and place a cigarette is on your mind. Once you understand that the desire is being triggered by some reaction to an insignificant event, you can just say “no” to the cigarette without further problem. All you need to do is understand what triggered the thought. The urge will pass. The next time you encounter a similar situation you will not even think of a cigarette. You will have learned how to face another experience as an exsmoker. Quitting smoking is a learning experience. Every time you overcome an urge you will have overcome another obstacle that threatened your status as an ex-smoker. As time goes by, you will run out of obstacles and you can comfortably go through life a happier and healthier person. All you need to remember and practice to stay an ex-smoker is - NEVER TAKE ANOTHER PUFF.

“I have smoked for so long and so much, what is the use in quitting now?”

On the third day of a recent clinic, a woman participant in her late fifties who had been off smoking for just over 48 hours asked one of those questions that I have heard hundreds of times in past programs. “I have smoked so long and so heavily, what good will quitting smoking do for me now?” A few minutes of explaining the bargaining phase people go through when they are initially quitting smoking seemed to clarify why she was having such thoughts rationalizing why she didn’t really need to quit. A few minutes later, she told me a story about her personal family history, one that quite simply gave a better answer to her original query than I could ever have come up with. “My father was a chain smoker,” she said. “He quit when he was 60 because he had a heart attack. Never smoked one after that. Even though he was a heart attack victim, after he quit smoking he felt better than he had felt in years. Much more endurance, greater vitality. He lived to the age of 95, bright and alert to the end.” On the sixth night I called her to see if she had made it through the weekend all right. “I feel so bad,” she replied. “I had a terrible evening last night and I had a major problem dealing with a client at work this morning. I was just so upset from lack of sleep and frustration, I finally broke down and took a cigarette. I’ve been beating myself up for it ever since. I am more depressed now than I was before. Why am I beating myself up so, and what should I do now?” I said she had two options, quit right then and face a potential full three day withdrawal or go back to full fledged smoking all over again. If she didn’t make a decision, her body would automatically make the decision for her. Again she expressed the sentiment that she was beating herself up so badly and wanted me to explain why she was so upset with herself. She just couldn’t believe that one cigarette could be so important to be making such a big issue. A few minutes later, she told me the story of how her husband had once been off for three years. One day while they were in the car together, for one reason or another he bummed a cigarette from her. She raised the issue with him of what good would a cigarette be after all that time, but he convinced her it was no big deal. What right did she have to protest anyway, she thought, she was a chain smoker herself. He finally got his way. He never stopped smoking after that day. Four years later she got a call at work that her husband had collapsed at her mother-in-law’s home. By the time they got to him it was too late. He had died of a sudden and totally unexpected heart attack. She has little doubt that his last four years of smoking was a major contributing factor to his sudden and premature death. So why was she now making such a big deal out of a cigarette? Once again, her own personal history was giving her a more powerful answer than I could ever have expressed. One cigarette, in a car a number of years earlier helped to end her husband’s life. If he had known the implication that one cigarette would have had, he would never have considered the thought for more than a second. In retrospect, she had the opportunity to look back to that day and realize how a fleeting urge followed by poor judgment helped to end or shorten her husband’s life. With the kind of personal experiences she had witnessed associated with smoking, it is quite easy to see how she could be so hard on herself for what occurred earlier that day. She witnessed how smoking diminished the quality of her father’s life and almost brought on a premature death. Equally important, she saw how quitting smoking vastly improved his health and general feeling of well being. She also witnessed how her husband’s momentary lapse of judgment resulted in her suffering such a grave loss just a few years earlier. If he had the opportunity, he would surely have cursed the day he lit just one. She had the benefit of hindsight, which now was haunting her because she had made the same mistake that day he had made just a few years earlier. He never got the chance to quit again. She still has time to make a decision—and she was asking me what she should do now. Again, I feel her own personal experience and the immediate emotional reactions she was now experiencing were giving a more powerful answer to her question than I could. If she listened to her heart, I am sure it was telling her to - NEVER TAKE ANOTHER PUFF!

“I’m just too weak to quit smoking!”

“I can’t believe it, I’m just too weak to quit smoking.” This statement came to me on the fourth day of a clinic by a participant who could not stop smoking for even one day. When I asked him where he kept getting the cigarettes from, he replied, “They are mine, I never threw them out.” When I asked him why he never got rid of them he said that it was because he knew the only way for him to handle not smoking would be by keeping cigarettes around in case he needed one. This man was not capable of succeeding in his attempt to quit smoking. Not because the addiction to nicotine was too powerful. It was his fear of throwing out his cigarettes which rendered his attempt a failure. He figured if he needed them, he would have them. Sure enough, every day he needed one. So he would smoke one. Then another and still another. Five or six a day, never reaching his optimal level and never breaking the withdrawal cycle. He was discouraged, depressed, embarrassed, mad, and, worst of all, smoking. Quitting smoking needs to be done in steps. First, the smoker should strengthen his resolve as to why he wishes to quit. He should consider the health consequences, the social implications, the fact that he is totally controlled by his cigarettes, the expense and any other personal problems cigarettes have caused him. It is helpful to write down all of these negative aspects of smoking. In the future when he does get the thought for a cigarette, his own reasons for quitting become powerful ammunition for not returning to smoking. When the decision is made to quit, the smoker should implement a program that has the greatest potential of success. The first and most important step is to quit cold turkey. To accomplish this goal he should dispose of all smoking material. Cigarettes, cigars, pipes, butts, ashtrays, lighters-anything that was considered smoking paraphernalia. If cigarettes are not there, they cannot be smoked. Then the person only needs to live through the first few days, one day at a time. Physical withdrawal may be rough or very mild. The symptoms will be overcome by making it through the first few days without taking a puff. Within three days the physical withdrawal will peak and by two weeks will cease altogether. But the real obstacle is the psychological dependence to cigarettes. Most smokers are convinced smoking is essential in performing many normal daily activities. Dealing with stress, working, driving, eating, sleeping, waking up, relaxing - just about everything requires smoking. The only way to overcome this perceived dependence is by proving to oneself that all activities done with cigarettes can be done equally well without cigarettes. Just living through the first few days and functioning in normal required roles will prove that the smoker can survive without cigarettes. It may be difficult, but it is possible. Once the initial quitting process is overcome, the rest is simple. Sure there will still be times when the ex-smoker wants a cigarette. But the ex-smoker must realize that he does not have the option of only one. Because he is a nicotine addict, smoking is now, and always has been an all or nothing proposition. The thought of relapsing back to his old level of smoking with all the associated consequences is all the ammunition needed to - NEVER TAKE ANOTHER PUFF!

We Understand Why You Relapsed

There are times when a member of a support group relapses and another well-meaning member jump in saying that he or she “understands” the causes of the relapse. The well-meaning member feels that the person who has relapsed needs to be consoled and nurtured for the bad choice that he or she had made. I have even seen times when the forum’s managers or seasoned group members have been criticized for not offering unconditional love and support to the relapsed person, as if these people don’t understand or fully sympathize with his or her plight. Well, the fact is, in our case our management and our longer-term successful members all understand how the person relapsed, all too well in fact. The person violated the law of addiction, took a puff of nicotine, and is paying the mandatory penalty - relapse. We also know that any excuse that the person is attempting to give for having once again started up an active chemical dependency in his or her body is total nonsense. There is no justification for relapse. Today, there are support forums on the internet where, almost daily, you can watch relapsing members return and go unopposed as they attempt to convince the entire group that their justifications for relapse were legitimate. Should the people who just relapsed feel better after explaining and having everyone understand why they relapsed? That depends I guess. If the person has joined the group in order to feel better about smoking then, sure, he or she should be quite relieved. But if the person is participating because he or she trying to save his or her life, then I don’t think he or she should take much comfort in all the hugs and well wishes he or she receives. I guess it is like someone standing on a ledge of a building. Do you want the people standing on the ground giving the person on the ledge reasons not to jump, or after listening to all the woes in the individual’s life saying, “Gosh, I understand what you are saying.” “I feel that way too.” “I guess if I were in your shoes I would jump too.” “Don’t feel guilty, though, we understand.” I don’t want this statement to be read like a mockery of those attempting to offer help. I am trying to illustrate an important point. Obviously, if the person on the ledge jumps he or she will die. But understand, that if a person relapses and doesn’t quit, he or she is likely to face the same fate, just time delayed. Yes, if you saw a person on a ledge you would try to use empathy to coax him or her back. But, empathy would be in the form of explaining that you understand his or her plight but you totally disapprove of his or her current tactic for dealing with it. There are better ways to resolve these problems than committing suicide. The same concepts hold true for taking a puff of nicotine. You may understand the feelings the person had. You may have even felt them at some point yourself. But you don’t give into the feeling because the implication is relapse to smoking, and that can lead to death. I sometimes read posts indicating that there are other quit smoking message boards that are far more accepting of relapse, in fact they see it as a normal and acceptable process. It’s a very accurate observation. I think that any member of an education and support forum who feels that the group’s relapse policy is too “tough” should look for another site. The majority of members who join no nonsense education oriented support programs do so because they offer the type of understanding and support that the person couldn’t locate elsewhere. If you are dead serious about quitting smoking and involved in a program committed to the belief that there is “no acceptable excuse for relapse” then you are probably in the right place to be. But if you find a given group’s relapse philosophy too restricting don’t try to change it. Trying to alter the group policy is as unfair as members from the serious forum going into an unstructured site and trying to change their tolerance towards excuses being made for relapse. Groups should be tolerant of the other sites and fully appreciate that some people will be happier elsewhere. But each member needs to do an assessment of what type of group enhances his or her personal chances of success. A group that makes you just feel better may not be the group that is actually enhancing your chances of successfully quitting. Hopefully, whatever group you end up participating in will help you remained focused on making it through today. Whether this is your first day or thousandth day not smoking, it will be a much better day if you walk away with the understanding that no matter what happens in your life, either issues of great happiness or sadness, importance or mediocrity, exhilaration of sheer dullness, no matter what the circumstances, the only way to sustain your quit is to NEVER TAKE ANOTHER PUFF!

My Support Group is Responsible!

Case 1: Case 2:

“How do you expect me to quit smoking? All of my family, friends, and work associates smoke. Whenever I try to quit they all try to sabotage my efforts. With support like that, I can’t quit smoking!” “I know I will quit. Nobody wants me to smoke. My kids beg me to stop, my husband hates it when I smoke, and we’re not allowed to smoke at work. I feel like a social outcast wherever I go. With all those people on my back, I know I won’t fail in quitting!”

In both of the above cases, the smoker is wrong in their assessment of whether or not they can actually quit smoking. Success in quitting smoking is not primarily determined by significant others. It is based on the strength of the smoker’s own desire to quit. In case one, the smoker is blaming his failure on lack of support and actual sabotage attempts by others. But not one of these people physically forced a lit cigarette into his mouth and made him inhale. Considering that the only way he could reinforce his nicotine addiction is by inhaling a cigarette, none of his smoking associates had the final say on his success or failure. Case two, on the other hand, was working under the false assumption that quitting smoking would be a breeze since everybody would support her because they hated her smoking. Not once, though, did she say that she actually wanted to stop for herself. She was stopping because everyone else wanted her to. In essence, she was depriving herself of her cigarettes to make everybody else happy. While she may not have lit up when surrounded by others, sooner or later she would be alone. With no one around, what personal reason does she have to strengthen her resolve not to take a cigarette? When you joined our clinic, you may have initially blamed others for your failure or erroneously credited the clinic and others with your success. No one failed or succeeded for you. You did it. While significant others can influence how easy or difficult quitting will be, your own personal resolve is the major determinant of success or failure. If you failed when you tried in the past, stop blaming others. Realize that your personal desire to stop was not strong enough to overcome the powerful grip cigarettes exerted on you. Rather than making one half-hearted attempt after another, make a personal assessment of why you smoke and why you wish to stop. If your personal reasons are good enough, then try to stop. As long as your ammunition is strong, no one will be able to make you smoke. On the other hand, if you succeed, don’t feel that the clinic or anyone else made you do it. You broke free from a powerful addiction. You did it by making up your own mind, throwing out your cigarettes, and refusing to take another one no matter how much temptation you faced. For this you should be proud. And to maintain that pride for the rest of your life - NEVER TAKE ANOTHER PUFF!

“I Liked My Other Smoking Clinic More!”

Almost 20 years ago when I was conducting one of my first Stop Smoking Clinics, one of the successful participants, a lady named Barbara, told me that she had once attended another clinic and liked it more than ours. I asked her how long she had quit for in that program and she said, “Oh, I didn’t quit at all.” I then asked her how many of the other people quit. She replied, “I don’t know if anybody quit.” I then asked, if nobody quit, why did she like the program more? She answered, “When I completed the program, I didn’t feel bad about smoking!” The task of any smoking clinic should be to help the participant break free from the powerful grip of the nicotine addiction. To do this, each participant needs to have a thorough understanding of both why he or she smokes and the consequences associated with maintaining use of cigarettes. Cigarettes are addictive, expensive, socially unacceptable, and deadly. How in the world can any individual or clinic realize these effects and minimize the significance to the point where a smoker doesn’t feel bad smoking? The natural impulse of most smokers is to deny the health and social implications of smoking. When he picks up a newspaper and sees a headline with “Surgeon General”, he will read no further. When he hears a broadcast on radio or television about the dangers, he either totally disregards the message or maintains the false belief that the problem doesn’t apply to him. But eventually, even his own body complains. He may experience physical symptoms such as coughing, wheezing, pains in chest, numbness in extremities, headaches, stomach aches, hoarseness, and a variety of other complaints. He will generally pass the blame to the weather, his diet, to his stress, to a cold or flu, to allergies or any other excuse he can muster up to protect his cigarettes. Our clinic was designed to permanently destroy all rationalizations of smoking by the smoker. He may make up lots of excuses for smoking, but he knows that they all are lies. Our clinic will accomplish one of two goals. Either the smoker will quit smoking, or the clinic will screw up his smoking for the rest of his life. No longer will he be able to sit back at the end of a day and think to himself in ignorant bliss how much he enjoyed his cigarettes. To the contrary, if any thought of smoking is allowed to creep into consciousness, it will be over how stupid it was to inhale 20, 40, 60 or even more cigarettes that day, and how sad it is that he is probably going to do the same again tomorrow. Why do we want to make the smoker miserable about smoking? Because maybe if he gets mad enough about smoking he will stop it. Sooner or later logic may motivate him to stop. Maybe he will do it on his own, or maybe he will come back to us for help. How he does it is not important; what is important is that he does quit. For, while the concepts we instill in him may make him miserable, not understanding them can cause more significant long-term suffering. If our clinic did what Barbara’s first clinic accomplished – alleviating negative feelings toward smoking - it could result in the ammunition necessary to maintain smoking. Since cigarettes are responsible for over 300,000 premature deaths per year and the crippling of literally millions of others, alleviating the anxiety of smoking is not in the best interest of the smoker. Consider the physical, psychological, social, economic and any other personal consequences of smoking. Consider them all and - NEVER TAKE ANOTHER PUFF!

How Does Your Program Compare To...

“How does your program compare to hypnosis or acupuncture?” “Do you know anything about the single session treatment program advertised on the radio?” “I hear they have an inpatient treatment program at another hospital, what do you think of that for quitting smoking?” “My doctor said I should try nicotine gum, do you agree?” “I hear there are programs which promise no withdrawal or weight gain.” “How about the shock treatments with money-back guarantees?” “Why should I choose you over the free program offered at...?” Almost daily we will receive calls asking at least one of these questions. It seems everyone wants us to compare what we do with that of other “treatment” strategies. While the specific questions vary, my advice is inevitably the same. If you are considering us or another program, go to them first. People seem to be surprised at this advice. I think some wonder whether or not I am receiving a kickback from the other organization. But money is not the factor influencing the advice to seek help elsewhere before attempting us. Or maybe they think I can’t defend our program over the other “proven” method. This assumption is also incorrect. Why then, am I willingly turning away potential customers to the local competition? Anyone who has gone through our clinic will attest that participation in our program requires a 100% effort and commitment to attempt quitting. That is not to say that every participant must know beforehand that he is going to stop. The person must be resolved to the fact that he will try as hard as he can to stop for just two weeks, a day at a time. Then, once past the initial withdrawal syndrome, he can decide whether or not he truly wishes to smoke. We want him to reach the point where he has a free choice. But he must base his decision on his true options, smoke nothing or everything, there is no in-between. Anyone coming into our program with a backup method in mind, is not normally willing to give the 100% necessary to break the initial grip. When things start getting tough, which they almost inevitable do, the person just throws in the towel and takes a puff with the idea that it is no big loss, he will just try the other program next time. But his assessment is grossly mistaken - taking that first puff may very well be the biggest mistakes he ever made in his life - one that may in fact cost him his life. He may never again have the desire, strength, or opportunity to quit again. What of his hypothesis that the other program will probably work better for him? Well, let it suffice to say, that when I suggest that a smoker goes to another program to quit before coming to ours, I am not really worried about losing potential income. I am just postponing when I may actually meet and work with the individual. In fact, the odds are, our price will increase significantly by that time and they are usually willing to pay. In the interim, they spent hundreds to thousands of dollars trying all these magical programs or feeding their addiction. But money is not the major factor which needs to be considered. Smoking an extra five years, 10 months, or even a few weeks carries a potential risk. You just don’t know which cigarette may be the one to initiate an irreversible process, such as cancer or a fatal heart attack or stroke. Every day you puff these risks remain high. But the day you stop, you begin to reduce your risks, and eventually, they can drop to that of a person who never smoked a day in his life. Then, to keep your risk as low as possible and to never again have to go through the quitting process, simply - NEVER TAKE ANOTHER PUFF!

“What should I call myself?”

An online forum member recently posted a message asking whether or not she should call herself a non-smoker since she had in fact quit smoking. Basically the answer is yes, although for some people it can create a state of confusion. These are people who look at the term from a historical perspective before the term smoker and non-smoker had any real negative or positive connotations. Early on the term was often used to refer to a person who never smoked a day in his or her life. I guess the more accurate term for usage today for a person who never smoked should be a “never-smoker.” But it is hard to undo commonly accepted terminology. Sometimes on official documentation, such as insurance forms, there may be a legal distinction between the terms smoker, ex-smoker and never smoker. But for personal and general purposes, the term non-smoker is fine as long as you understand that there is a difference between a non-smoker and a never-smoker. Other terms that can apply to a person who used to smoke but no longer do are ex-smoker, reformed smoker, recovering smoker, or arrested smoker. Although, I think they should all be preceded by “very happy” as in “very happy ex-smoker” so the term is not interpreted with a tone of sadness or deprivation to the person who it is being said to. It is crucial that each and every person who used to smoke but no longer does understands that there is a big difference between a never smoker and an ex-smoker. Even though physically and mentally the never-smoker and ex-smoker may feel the same, even to the extent of having the exact same attitudes or outlook, there is one important physiological difference. The ex-smoker still has an addiction. It may now be asymptomatic but it exists nonetheless. This difference may only be apparent in one situation. A never-smoker could, if they really wanted to (which, for no logical reason should ever happen) take a nice deep drag on a cigarette and in all likelihood, they would cough, gag, and possibly even throw-up from such a stupid and impulsive act. They might feel crummy for a while and hopefully would never consider doing it again. An ex-smoker could do the same irrational act, taking a drag, coughing, gag, and maybe even throwing-up. He or she could feel absolutely horrible, physiologically, maybe even worse than the never-smoker who did the exact same thing. He or she is likely to end up hating the experience and be very angry at himself or herself for having done so, but within minutes, or hours or maybe days, he or she will likely have an uncontrollable urge and smoke another. The second time he or she may get the same reactions, feel absolutely horrible and sick. Soon the person will find himself or herself smoking more nicotine and will either quickly or gradually return to his or her prior levels of daily nicotine intake or maybe even higher than before. The difference lies in the fact that the first drag - even though unpleasant - creates additional uncontrollable urges in the ex-smoker as compared to likely fostering repulsion in the never-smoker. One drag of nicotine means relapse to an ex-smoker. The addiction that was lying dormant is now brought back to full force. You are an ex-smoker now, or whatever term you are comfortable with. But at every level of your consciousness, always remember you are still and always will be a recovering nicotine addict. It is not necessarily a pleasant way to think of oneself, but if your recovery is to endure, it is important to retain a basic awareness that because of your underlying arrested dependency, you must always remain on guard. For as negative as it may feel and sound in having to identify yourself an ex-smoker, it is far superior to having to again say, “I am a smoker.” A smoker is a person who is currently under control of a drug that compels them to constantly administer dose after dose, puff after puff after puff, dozens or possibly even hundreds of times a day. And with that active drug - nicotine - he or she is also receiving over 40 carcinogens (cancer producing chemicals) and more than four thousand other chemicals, hundreds of them poisonous (arsenic, hydrogen cyanide, carbon monoxide, and formaldehyde, to name a few). The smoker is increasing his or her risks of some of the most debilitating and fatal diseases known to man. He or she smells perpetually bad and he or she is a social outcast while actively using his or her drug delivery system. Yes, ex-smoker may not sound perfect, but active smoker is a much more horrible thing to have to admit to and experience. To keep your current status using whatever name you’ve chosen, and to never return to the deadly way of life of a smoker, just remember to NEVER TAKE ANOTHER PUFF!

“I’m going to have to carry cigarettes with me at all times for me to quit smoking.”

I hear this comment almost every time I start a new clinic. The smoker truly believes that if he does not have cigarettes with him, he will not succeed in quitting. His reasoning for carrying cigarettes is that he has to show himself that he is stronger than the cigarettes, or that if he is faced with some traumatic stress he will need a cigarette to survive through the situation. Both of these beliefs carry serious implications, which almost guarantee failure at permanent cessation from cigarettes. The first hypothesis—that the smoker must show he is stronger than the cigarette—assumes that the smoker believes he is stronger than his cigarettes. This is the gravest mistake the smoker can make. He is not stronger than his addiction. The day he admits this fact will be the day he has a fighting chance at quitting, the day he forgets it will be the day he again is caught in the grip of addiction. If he were stronger, he would have been smoking one or two cigarettes a day whenever he wanted. But by the time he enrolled in our clinic he was probably smoking twenty to thirty times that amount. If he were stronger than cigarettes, he would never have showed his face in a smoking clinic. He would have just stopped. But at the time he joined, he recognized he was not in control. He was probably out of control for many years. And as with any other addictive drug, he would never be in control again. Once he forgets that cigarettes controlled him, he will probably smoke his first cigarette. That will be a tragic day when he relapses into his past addiction and he may never be able to muster the strength necessary to break free from cigarettes again. The second idea - that cigarettes are essential to overcome life’s traumas - will almost certainly result in smoking within days of trying to stop. No matter how thorough the smoker is at planning a tranquil period when stress is at a minimum, stress will occur. With cigarettes present, one is sure to be taken. Even if he overcomes that one situation, the idea that cigarettes are capable of making life bearable is a false and dangerous belief. The smoker feels he needs cigarettes to function properly in our world. Then he takes it one step further, he begins to believe that he will not only be less effective at functioning, he will be totally incapable of surviving. He is giving up the substance that makes life possible. With this belief present, he has about as good a chance of giving up smoking as he has of giving up breathing or eating. If cigarettes are essential to maintain life, quitting is a futile effort. But this is just not true. Everything a smoker can do with cigarettes he can do without them, but he will not learn this or believe it until he successfully quits and starts dealing with life without smoking. Don’t ever forget how cigarettes once controlled your behaviours and beliefs. When you quit smoking you admitted cigarettes controlled you. You were literally afraid that one puff could put you back. That was not an irrational fear. One puff today will lead to the same tragic results as it would have the day you quit. Cigarettes were stronger than you before, and, if given the chance, will be stronger than you again. If you want to show you are now in control, do it by admitting you can function without having cigarettes as a worthless and dangerous crutch. To permanently stay free from cigarettes, all that needs to be done is to NEVER TAKE ANOTHER PUFF!

Sleep Adjustments

Sleep can get pretty disruptive the first few days. Some people will get very little sleep, waking up every hour or not sleeping at all yet not feel tired. Others can sleep 20 hours a day and be exhausted during their waking hours. Whichever way it goes, sleep will adjust itself when you quit and eventually go back to normal. But there is a catch. You don’t know what normal is. Normal is what it was prior to being a smoker with aging thrown in. Some people have not been normal for decades. Nicotine is a stimulant drug that once it wore off threw the smoker into a physiologically depressed state. To overcome this depressant effect the smoker would smoke again to stimulate him or herself. Soon it would wear off and the endless cycle would be repeated over and over. Blood sugar and hormone levels would skyrocket, only to come crashing down later. By the end of the day the smoker could be physically exhausted from this chronic stimulant/depressant roller coaster. They had to adjust their sleep around these effects. Without this chronic abuse, these ex-smokers may find that they can get by on less sleep after they quit smoking, sometimes knocking out hours of what they thought was needed sleep time. Others only minimize sleep by a short time period but it is very obvious when the alarm goes off they can jump out of bed full of energy and ready to go, or sometimes even wake up before the alarm with newfound energy. When they were smokers they were often exhausted upon waking, hating the alarm and needing cigarettes to pick them up and get them going. There are a smaller number of people who need more sleep when they are ex-smokers. These are people who often smoked heavily at the tail end of their days. Their bodies were crying for sleep but they kept pumping nicotine into their system to override the body’s need. Without nicotine as a constant stimulant they now have to listen to their bodies and go to bed when tired. They could take speed and get the same effects but normally realize that they wouldn’t resort to a drug for this effect, yet they can rationalize that smoking was suitable for the exact same purpose. Well it wasn’t. The schedule they were maintaining had a price attached and the long range cost for this “benefit” could be death. Anyway, don’t panic by the amount of sleep you get for the first few days. It is not your normal amount of sleep as an ex-smoker, it is your normal amount of sleep while in drug withdrawal. These are not “normal” times, nor will they last long. Anyone experiencing such problems the first week or two after quitting probably is likely just having adjustment issues. But, a health care professional should evaluate disruptions lasting longer, especially beyond a month. Many other causes can be responsible for such disruptions including physical, psychological, medication reactions, etc. Blaming such symptoms of sleep disruption on quitting smoking for a few days in most cases is probably justified, but at longer periods the ex-smoker needs to be more objective and getting a professional medical evaluation is then warranted. Sleep will eventually settle in to a normal pattern for you as an ex-smoker. Then aging will exert its normal adjustments. Whether it turns out to be more sleep or less, you should at least sleep sounder knowing you are no longer under the control of nicotine and no longer posing such deadly risks to yourself by still smoking. To sleep happier because you know you are staying healthier and likely to live longer, always remember all the times you are awake to NEVER TAKE ANOTHER PUFF!

The Smoking Dream

The smoking dreams are common if not universal among exsmoker’s. It is especially common when a person is off a short time period, and if it occurs within days or weeks of a quit, it is likely to be extremely disturbing and very realistic. Realistic enough in fact that the ex-smoker will wake up smelling and tasting a cigarette, convinced that he or she has actually smoked. I have had numerous clients search the house for the butt, it was that realistic of a sensation. Let me explain first why the physical sensation is so pronounced. When first quitting, one of the early physical repairs that start up is cilia production. Cilia are tiny hair-like projections that line your trachea and bronchus, constantly sweeping particulate matter out of your lungs. When you smoked, you first slowed down, then paralyzed and would eventually destroy cilia. This is why smokers often have more colds and flues, they wipe out the first line of defence against the incoming microbes causing these illnesses. When a person stops smoking, usually within 72 hours or so, cilia starts to regenerate. The ex-smoker may start cleaning out the lung in a matter of days. One of the early symptoms first encountered is coughing and spitting out, this is mucous and trapped matter that was never being cleaned out efficiently while smoking but now has an escape route and mechanism to start sweeping it. Ugly but good, you are starting to clean out a lot of garbage in your lung. Much of the garbage is tobacco tar, tobacco tars that have a very distinct taste and smell. Let’s say you are dreaming now, maybe a totally innocuous dream having nothing to do with smoking. While sleeping, cilia are sweeping, tobacco tars get brought up, reach sensory nerves for taste and smell and low and behold, you create a dream sequence involving a cigarette. But not only are you now dreaming, physical sensations of taste and smell persist upon awakening. This then becomes a real smoking sensation. This gives a plausible explanation of why the dream occurred and why it was so vivid. But that is not the end of the significance of the dream. The dream can be interpreted in one of two ways upon awakening, and quite often, the ex-smoker takes it as a sign that they actually want to smoke. After all, they had been off smoking and just dreamt about it, that means they want to smoke, right? I used to get calls in the middle of the night for clinic participants panicked by the dream. They would start off saying, “They can’t believe it, off all this time and they still want to smoke.” They knew they wanted to smoke because they dreamt about it. I would then ask them to describe the dream. They would tell about the vividness and realism, and they would almost always say it started to take on a nightmarish proportion. They would wake up in a sweat, often crying, thinking that they just smoked and blew the whole thing, that they were now back to square one. That all that time off smoking was wasted. As soon as they would finish describing their feelings, I pointed out one very obvious fact. They just dreamt they smoked and assumed that meant that they wanted to smoke. They woke up and upon further clarification, they describe the dream was a nightmare. This is not the dream of someone who wants to smoke; it is the dream of someone

who is afraid of smoking. This is a legitimate fear considering the ex-smoker is fighting a powerful and deadly addiction. Hence, it is a legitimate dream too. It kinds of gives you a sense of how bad you would feel if you actually do go back to smoking. Not physically speaking but psychologically. If the dream is a nightmare it makes you realize how bad this feeling is without having to actually have smoked and fallen into the grasp of nicotine addiction again. It can give you some perspective about how important not smoking is to your mental health. The dangerous dream is when you smoke a whole pack in it, hack and cough, get socially ostracized, develop some horrible illness, end up on your death bed about to let out your final live breath—and all of a sudden wake up with a smile on your face and say, “that was great, wish I could do that when I am awake.” As long as that is not the dream you were having, I wouldn’t let myself get to discouraged by it. If that is the dream, then we may need to talk more. In regards to smoking, no matter what you do in your dreams, you will be OK as long as you remember in your waking state to –NEVER TAKE ANOTHER PUFF!