Kicking Habit Isn’t Easy After Decades of Smoking : Tobacco: Hard-core puffers are the people the government hopes to help as it zeroes in on addiction.

The doctor basically put it to Ray Dahlin this way: Do you want to live or do you want to smoke?

The choice is that stark for the 58-year-old Fountain Valley resident, who has emphysema, diabetes, high blood pressure and a history of six heart attacks since the early 1980s.

“I’m starting all over from scratch again,” said Dahlin, speaking after the first session of a smoking cessation class, two hours after finishing what he has dubbed his last cigarette. He hopes this Kaiser Permanente class in Anaheim will work better than the aversion therapy, hypnosis, nicotine patch, scare tactics and cessation classes he has tried before.

“It has to work,” he vows, as much to himself as anyone else in the room. “It will.”

Dahlin and his classmates don’t show much interest in an federal Food and Drug Administration panel’s pronouncement last week that nicotine in cigarettes can be addictive. They don’t tend to use the “A-word,” and the news didn’t give them much more incentive to quit than they already have. But they represent the kind of tough cases that government hopes to help as it zeroes in on the addictive nature of tobacco.

FDA or no FDA, they have a habit--this thing that used to be all right with almost everybody and went well with dinner, drinks and just about everything else--and now it’s abundantly clear must be stopped.

But quitting, as they know from painful experience, is hell.

These are hard-core puffers, many of whom learned to light up before they learned to drive. They have been nagged by relatives, prodded by co-workers, preached at by doctors, zapped by electrodes--and now warned by a federal panel. Still, there is something about the pleasurable memories smoking evokes, how it breaks up a stressful day or tops off a good wine, that keeps them reaching for that pack and matches.

And there’s something about the anxiety, grouchiness, insomnia, inability to concentrate and the I-don’t-know-what-the-heck-to-do-with-my-hands feeling, for example, that keeps them from following through with those heartfelt pledges to go clean.

Do they really want to quit?

“That’s a hell of a loaded question,” said Dahlin, who started stealing his father’s cigarettes at the age of 8, a half-century ago.

He wants to live to see next year, he said. He needs to quit. But he keeps getting waylaid by little things, like the time he quit for three weeks, then went out for drinks with the guys.

“Between the vodka and the sevens, the cigarettes popped up, and away I went,” he said.

Some pull out Freudian concepts to characterize their internal struggle.

“Rational thinking says I want to quit,” said Hermann Haselbeck, 69, of Rancho Santa Margarita, whose habit is 49 years old. “But you don’t get away with just rational thinking. There’s such a thing as the subconscious mind.”

Haselbeck, who is not in the Kaiser class, half-jokingly attributes his habit to early trauma.

“My mother took the pacifier away from me too soon,” he said, adding: “She must have had a hell of a time getting me to give it up.”

In fact, doctors say addiction to cigarettes has powerful psychological components, as well as physical ones.

“The problem from a psychological standpoint is cigarettes seem to go with everything,” said Dr. Richard Helfant, a UCI cardiologist who has written a book on heart disease in women, which addresses the problem of quitting smoking. “For a lot of people psychologically, it’s not just a diversion but a way of relating to life. . . . There is a real reflex to reach for a cigarette when under stress.”

Smokers are “unwilling to step out of their comfort zone,” said Kaiser Health educator Carolyn Russell, who has taught smoking cessation classes for 14 years. “It’s, ‘What am I going to do when I’m sitting in traffic, after my meal, with my coffee. How am I going to handle stress?’ Those are the things that prevent them” from quitting, she said.

Some smokers liken the comfort a cigarette provides to that of a comrade.

“It’s a friend, it’s my friend, “ said Garden Grove resident Carol Cobleigh, 51, a two-pack-a-day smoker who has been at it since she was 14. “No matter what kind of a bad day I’m having I can just go sit down and have a cigarette and it always makes me feel better for a few minutes.”

Cobleigh readily admits that she is addicted to cigarettes, but many smokers avoid that term.

“They don’t want to admit they are addicted to a really little stick. . . . They just don’t want to be labeled a drug addict,” Russell said.

The smoking industry, too, prefers the term “habit,” likening the effects to those of substances like caffeine.

But doctors say the physical addiction to nicotine can be powerful, and the effects of withdrawal on the body can be fierce. Some compare the strength of the addiction, but not the symptoms, to that of heroin or cocaine.

Physical symptoms of withdrawal occur because the body gets used to having the chemical enter the system and bind to receptors in the brain, which ultimately cause constriction of peripheral blood vessels, an increased heart rate and a general feeling of alertness.

When the chemical suddenly is no longer there, “the body compensates by becoming more anxious,” said Dr. Rimal Bera, director of clinical inpatient services at the UCI neuropsychiatric hospital.

“Initially, I think (the withdrawal’s) more physical,” Bera said. “It can last several weeks to months.” Later, a craving can linger that he said may be more psychological.

Bera said the memory of smoking, the lingering impression of those physical sensations, can keep that craving alive for as long as a few decades.

Craving, in fact, was the reason most often cited for relapse in a 1993 study of 132 smokers by Copenhagen researchers.

Many successful quitters “sense this urge, but as time goes on they learn to keep this urge under control,” Bera said.

That’s not much comfort to Garden Grove resident Cobleigh.

“When I hear people say ‘I quit 28 years ago and I still want a cigarette,’ that drives me crazy,” she said.

She doesn’t much look forward to the short-term effects of kicking the habit either. Even when she had a nicotine skin patch, which is intended to wean smokers gradually from the drug, she was overcome by stress.

One day at the insurance office where she worked, a week after she stopped smoking, “everything was bugging me. . . . I started talking real loud about something somebody did that shouldn’t have happened. I way overreacted and ended up in tears.”

To calm down, she took a walk and lit a cigarette.

“The thing was, I wasn’t doing the things physically that I was used to doing. I kind of like would look forward to that one cigarette all day long. For me, not to smoke, it’s like giving up a part of myself.”

Other smokers say that the skin patch seems to help with the physical symptoms of withdrawal, but it’s no cure for that nagging craving. Laboratory testing of the patch before it was introduced showed that about 20% of people remained smoke-free after one year’s use, but the actual success rate is thought to be much lower, with estimates ranging down to 9%.

Bera said it would be possible for some physical withdrawal symptoms to persist even with the patch, since the nicotine is seeping slowly through the skin, not being inhaled into the lungs where it quickly passes into the bloodstream.

Doctors, educators and smokers seem to agree that some combination of the patch with other supports, especially encouragement from family members and a class or support group, is most effective.

George Wilkinson, 44, who watched his father die of emphysema and wants to avoid the same fate, sure hopes so.

“I tried to quit two times,” the Yorba Linda resident said. “Quit number one, I was trying to use tapes and a class. For four days, I religiously put my heart into it. Something was missing there.

“The second time, I did the patch without the class. That didn’t work either because I found out I could use the patch and smoke. . . . This time, I’m going to try class and the patch.”

The good news for the persistent bunch who repeatedly have tried and failed to quit is that research shows they are more likely than first-timers to succeed.

“The more you’ve tried, the better your chances,” Helfant said.

Also, he said, it’s almost never too late to quit; the risk of smoking-related disease drops substantially after a year of abstinence.

Experts stressed that hurling scary information at smokers and trying to browbeat them into quitting is not productive.

“It isn’t that these people don’t know the dangers or that they don’t want to quit,” Helfant said. “Many of them do want to quit, but they feel that the habit, for all of these reasons, is too strong for them.”