No Ifs, Ands or Butts to Quitting : Facts on Breaking the Habit on Great American Smokeout Day
Some call them devil weed. Cancer sticks. Or coffin nails.
But others, curiously enough, think of cigarettes as friends.
Cigarettes are always there to help smokers cope “in any emotional situation,” explained Debbie Mahood, director of smoking education for the American Lung Assn. of Orange County. “When they quit, there’s something missing in their lives, and they can only describe it as a friend.”
“The hardest patients I ever worked with were people who smoked a long time and lived alone,” added Nina Schneider, a research psychologist at UCLA who has studied smokers for 14 years. “They had no one when they let go of their cigarettes.”
Nonsmokers urging their smoking friends to quit on the Great American Smokeout Day today might find this hard to understand in light of what appears to be an airtight case against cigarettes. According to the surgeon general, smoking kills an estimated 350,000 people a year through lung and other cancers, heart disease, emphysema, bronchitis and allied conditions. When pregnant women smoke, their babies may be harmed, born prematurely or have a low birth weight.
Nevertheless, smoking researchers say grief over losing one’s “best friend” is one of the intense withdrawal symptoms of the mind and body that keep a quarter of all Californians and one-third of all Americans hooked--even though surveys show the vast majority want to quit.
More than a behavior, many researchers now consider smoking to be a dependency as strong as addictions to heroin or alcohol. Only 30% of all those who try to control their alcohol, heroin or tobacco consumption will succeed, according to Dr. Joseph Herskovic, a psychologist and nicotine researcher at the VA Medical Center and UCLA School of Medicine.
In fact, diagnostic manuals of the American Psychiatric Assn. and the World Health Assn. have recently added the term “tobacco dependence disorder” as an official syndrome that can be listed as cause of death on a death certificate.
What is it about cigarettes that make people continue to smoke them when they don’t want to? What could possibly make people confuse burning sticks of flaked tobacco with friends?
Smoking researchers believe that it is nicotine, the natural psychoactive alkaloid found in the tobacco plant. A poison that is harmful in much larger doses, nicotine increases the heart rate and blood pressure, raises skin temperature and causes changes in the peripheral nervous system, researchers say. And those changes foster such pleasant mental states that if it weren’t for its side effects, nicotine would be an “excellent psychological tool,” Herskovic said.
A ‘Phenomenal Illusion’
Propelled by smoke, nicotine hits the brain within a short and gratifying seven seconds of each puff. Smokers are either instantly stimulated or sedated, depending on how they smoke, he said. With short puffs, smokers can raise their spirits; with deep puffs, they can tranquilize themselves.
Nicotine, one researcher said, provides a “phenomenal illusion” of emotional control.
Cigarettes tend to calm introverts and stimulate extroverts; they also help increase concentration and improve work performance, Herskovic said.
He said he tries to persuade smokers who regard cigarettes as friends that while cigarettes may appear friendly, they are really “back-stabbing enemies.” While scientific studies are as yet inconclusive, nicotine is highly suspect as the addicting agent in cigarettes, he said.
And regardless of whether nicotine itself is harmful, it is apparently dependence on nicotine that causes smokers to continue to expose themselves to the carcinogens produced in the combustion process, researchers say.
Suits Against Tobacco Firms
“Nicotine addiction” is a controversial term, Herskovic said, due to lawsuits against tobacco companies. The suits basically claim that people who have died as a result of smoking were unable to control their smoking and were improperly warned of potential dependency. The first case went to trial this month in Santa Barbara.
Historically, officials have been warning the public against tobacco since 1604, about 100 years after Christopher Columbus introduced tobacco from American Indians to Europe. That year, King James I of England issued “A Counterblaste to Tobacco.”
But no one is known to have abstained until April 5, 1679, when the Sheriff of Turku, Finland, Johan Kastu, wrote in his diary: “I quit smoking tobacco,” according to the Guinness Book of World Records. It is unknown what method he used or whether he succeeded, because he died one month later.
“Substance abuse” in cigarette smoking usually starts with experimentation leading to regular use, which then progresses to increasing dependence and escalation in the number of cigarettes smoked daily, wrote William Pollin, the former director of the National Institute on Drug Abuse, in an editorial in the Journal of the American Medical Assn. last year. For most dependent smokers, at least 10 cigarettes a day are required to keep them satisfied, he said.
Withdrawal Symptoms
Because nicotine is more of a stimulant, withdrawal symptoms are less predictable than those involved with depressants such as alcohol, said Ellen R. Gritz, associate director for research of the Division of Cancer Control at UCLA’s Jonsson Comprehensive Cancer Center.
Individuals report varied withdrawal symptoms. “Physical symptoms go away the first week or so and decrease in time,” Gritz said. In that period, those trying to quit may be irritable, moody and hostile, she said. They lack energy and can’t concentrate. Sometimes they can’t sleep. Some experience constipation or diarrhea. They all crave cigarettes and some start craving sweets. Women smokers in particular tend to gain weight.
“It is tough,” said Robert Comstock, 42, a shop foreman from Anaheim. Comstock started smoking at age 13 and worked up to a three-pack-a-day habit. He said he tried to quit several times on his own by using nicotine chewing gum. But the withdrawal symptoms always drove him back to cigarettes.
‘My Nerves Were Gone’
“I would start sweating, my stomach would cramp, my temper was short. My nerves were gone. I just couldn’t see myself existing without a cigarette. The longest time I went was for two days.”
He said his wife and others would ask him: “Why don’t you just walk away?”
“They don’t realize how addicting it is. Like a disease, like alcoholism,” Comstock said. He said he had no problem giving up alcohol on his own four years ago, but added: “I could not give up a cigarette on my own. . . . I thought I’d actually go to my grave with a cigarette in my hand.”
Even though he woke up every morning with chest pains, Comstock said he could not sleep knowing that he didn’t have a cigarette to wake up to. He had to make sure he had enough cigarettes to last him driving from one destination to another.
Comstock said he has been so desperate he unrolled cigarette butts too short to smoke and put the tobacco into rolled up paper bags to smoke. He has gone out to his car at 3 a.m. to look in the ashtray for butts long enough to smoke, he said. “That’s how addicting it is.”
Enrolled in Program
Finally, he said that when his wife pointed out to him that cigarettes were dominating his life, he decided to enroll in a $285 program through a Huntington Beach clinic. Now, three months and two weeks (he has now stopped counting the days) after he began the program, he believes that he is cured him and that he has “no desire” for cigarettes.
There are no good statistics on relapses, Schneider said. One problem, she said, is that a quarter of those surveyed were found to have lied when asked whether they had quit smoking after one year. Now studies include breath tests for carbon monoxide, she said.
She also said there is no accepted time frame after which a quitter can be said to be “cured.” Herskovic said he knows of a case in which a smoker reported urges to smoke 30 years after quitting.
Any drug that causes a “state change” also produces a memory--like a conditioned response--that appears under stress or environmental situations that one has associated with smoking, researchers say. (Unfortunately, Schneider said, the annual Smokeout Day is held just before the holidays, when parties and socializing promote strong smoking stimuli and make it more difficult for smokers to succeed at quitting.)
Recalling Negative Side
The neurons that remember nicotine do not seem to recall the negative side of smoking, such as bad breath, finger stains, coughing, lack of wind, burn holes in clothing or smells in the hair, Gritz said.
Instead, they remember only an unrealistic, idealized picture of the old personal companion and the positive feelings of emotional control, Schneider said.
An interesting characteristic of relapsers, Schneider noted, is what she called “the promise.”
“No matter how well they’re doing (at not smoking), they made themselves a little promise that if things got bad enough, they could smoke. It almost inevitably led to failure. There’s no way their lives would be stressless forever.
“The people who make the promise are never safe. All they have to do is have the slightest thing go wrong in their lives, and they set up for relapsing again.
“Then there’s the ‘just one’ syndrome,” she said. That is when smokers succeed in quitting for several months or years and think that they can handle smoking one cigarette, and then become dependent again.
Commit to Letting Go
The sooner quitters commit to letting go of cigarettes forever, the sooner they will lose their cravings, she said.
Learning alternate ways to cope is the key to successful quitting, according to Gritz. For example, a woman may be uncomfortable with showing anger or strong emotion and has used cigarettes to snuff out her anger. When she quits, “she has to learn to be assertive or show feelings without blowing up,” Gritz said.
Likewise, people with chronic eating problems who use cigarettes to suppress their appetite need to learn alternate distractions or other ways of curbing their use of food, she said.
Because of the constant exposure to smoking stimuli, in some cases, tobacco smokers have a more difficult time giving up their cigarettes than heroin addicts, Pollin said. However, he noted that 30 million smokers in the United States have been able to stop altogether in the last two decades.
85% Quit on Their Own
One recent study from the Institute for Preventive Medicine at the Methodist Hospital in Houston has determined that stop-smoking programs offered at workplaces are more successful than programs offered through outside clinics.
However, Gritz said, 85% of people who have quit smoking have quit on their own without formal help. Less than half, however, made it on their first try, she said.
“Smokers have to get smoking out of their repertoire of responses,” Schneider said. “They have to clearly recommit themselves throughout the period of cessation that they will never smoke again. And no matter what happens to them, smoking is no longer one of their options. By their own choice.”
