Running From the Pack : Once a person decides to quit smoking, group programs can offer crucial emotional support.

When Jim Franzen quit smoking in 1993, after 43 years as a smoker, it was his 35th attempt. Like many smokers who want to quit, Franzen, a Ventura resident who works as an artist for Disney Studios, had tried everything--nicotine chewing gum, the nicotine patch, even going it alone “cold turkey.”

“I’m an alcoholic and I had given up alcohol,” Franzen said, “but that was nothing compared to cigarettes. Booze is addictive, but it’s not as portable as cigarettes. And even a drunk doesn’t reinforce the habit as much as a smoker. The pack-a-day smoker gets 400 hits daily; no drug gets reinforced as much as that.”

According to the American Cancer Society, of the 46 million Americans who still smoke--26% of the adult population--80% say they would like to quit. And of the 2.5 million California smokers who attempted to stop in 1993, less than 10% succeeded.

It comes as no surprise to smokers who have tried to quit that the smoking “habit” is widely recognized in medical and scientific literature as full-blown drug addiction. A common scenario of nicotine withdrawal symptoms can include irritability, anxiety, headaches, difficulty concentrating and memory loss, insomnia or an excessive need for sleep, inertia, increased appetite, weight gain, digestive changes, constipation and even depression.

If it sounds like a biblical plague or the tests of Job, it is--ask anyone who has tried. And that’s just the beginning. Once through the initial three to seven days of acute withdrawal, ex-smokers face a lifelong struggle to steer clear of tobacco.

They must contend with a complex mix of habitual behaviors, social rituals, and psychological and emotional dependence--all while resisting the lure of a drug that remains legal, easily available, and, compared to other potent drugs, socially acceptable.

Now for some good news: More than 3 million Americans quit smoking every year, according to the National Cancer Institute. And increasing bans on smoking, combined with a wealth of structured smoking-cessation programs, create a climate in which there has never been a better time to toss the pack.

PICKING A PROGRAM

OK, so the decision has been made. You decide you can no longer ignore the nagging of your family and the unarguable ill effects of smoking on your health (is that me wheezing at the top of the stairs?). Now what? Should you join a program, or go it on your own? What can you expect on the road from “smoking” to “non,” and who has the map?

Franzen says that for him, the biggest boon to finally breaking the habit was the support and inspiration he received from the American Lung Assn.’s Freedom from Smoking program, which he used in conjunction with the nicotine patch.

“When I got cravings during the program and after, I would call my fellow addictees and we’d discuss and compare notes. I needed people I could talk to who were having the same problems, who wouldn’t judge me, and I needed to meet people who have quit, because I figured if they could do it, I could do it. I know it’s not for everyone, but for me it’s a miracle. I feel like I’m really done with cigarettes now.”

For Ventura County residents, the Freedom from Smoking program is one of many options that offer support and teach a variety of coping strategies to help a smoker quit. Most incorporate techniques from behavior modification and cognitive therapies, as well as health education, group counseling and support.

“A large part of breaking the habit is creating new ones,” says Jerry Leavitt, assistant director of the American Lung Assn. and facilitator of the Freedom from Smoking program. “Physically, the nicotine leaves the system in 72 hours, but as hard as that stage is, it’s short-lived. Most people find the on-going psychological addiction much harder to deal with.

“We’re conditioned to want that cigarette at certain times, and it serves a lot of purposes for us: We use it to deal with stress, it’s a break from routine, it’s a social thing, it’s how we cope with loneliness, with boredom, and for some, the cigarette becomes a substitute for friends, and a source of comfort.”

A standard approach is to give the smoker two to four weeks before quitting to observe and record smoking habits, tracking when and why he or she smokes and noting the behaviors and emotions that trigger the desire for a cigarette.

Lynne Rowe, program director for the Smoking Cessation Research Institute in Palo Alto, says that a period of preparation for quitting is essential. “The smoker has all these rituals. You get in the car and you light a cigarette. You finish a meal and you have a cigarette. It’s helpful to give them time before they quit to think about these trigger points, and to create positive replacements.”

Once trigger points are identified, the group and facilitator help the smoker devise coping strategies. Some suggestions: Change your routine; distract yourself by doing a crossword puzzle or taking up needlepoint; avoid places and people that might tempt you to smoke; soak in a hot bath; chew on stick cinnamon, toothpicks, sugarless gum.

According to Rowe, it’s important to think of smoking cessation in positive terms, to replace the pleasure you get from smoking with other pleasurable activities. “You want to take away the feeling of it being a burden,” she says. “If it’s a burden, it’s doomed to fail.”

But habits are more than a collection of behaviors: The rituals around smoking and the effect of nicotine itself, which acts as both stimulant and relaxant, become the smoker’s way of dealing with emotional stress.

“Most people start smoking when they’re young because they think it’s cool,” Leavitt says. “But then it becomes a way of managing stress, and it becomes so ingrained as a way of dealing with emotions that, oddly enough, we use it to cope with pleasurable feelings as well as with negative feelings--like the cigarette after the meal, the cigarette after sex. The earlier you started smoking the less apt you are to have developed alternative coping strategies.”

Of course, Leavitt points out, living a life that is free of stress and emotion is not possible. “But nonsmokers manage, so there are other ways of dealing with it, and the smoker needs to learn them.”

Stress management and relaxation techniques form the backbone of a number of smoking cessation programs. One widely taught method involves learning to breathe.

“It’s essential to breathe deeply to control stress,” says Leavitt. “The smoker typically takes shallow breaths, except when smoking. People who have gone through this program and quit successfully tell me that the single most helpful thing they learned was deep breathing.”

ADDING EXERCISE

Along with stress management, most programs encourage the quitter to begin a physical conditioning program, which helps combat stress and control weight.

“It’s good if you can do something aerobic, but it doesn’t have to be a lot,” says Georgette Davis, facilitator of the American Cancer Society’s Fresh Start program.

“I teach people stretching and relaxation and tell them that if a craving is strong, take a five-minute break and stretch, or get up from the desk and go for a fast walk. The more you exercise the faster you’ll work the nicotine out of your system and feel better. It helps if people see the whole process in a positive way--as part of the creation of a healthy lifestyle.”

As well as helping smokers through the difficult initial period of withdrawal, stress management offers smokers new ways of coping with feelings that cigarettes may have helped them to ignore.

Dr. Nina Schneider, a smoking cessation researcher for the UCLA School of Medicine and the Veterans Administration Hospital in Brentwood, has studied tobacco dependence and run smoking cessation clinics for more than 20 years.

“It’s as if we each carry a tool kit, and we reach in there and pull out a tool for dealing with whatever comes up--a tool for anger, for socializing, for aggression, for being tired,” she says, “But smokers, the first tool they reach for is a cigarette. That’s why it’s important to visualize ahead, to anticipate situations and strategize solutions in advance.

“In clinics I’ll say to people, ‘OK, you don’t smoke. Now here comes something that’s difficult for you to cope with--what will you actually do instead of smoke?’ ”

Davis encourages smokers to learn to deal with emotions directly, and to become more assertive about needs and wants. “Go in your bedroom and beat a pillow and scream, if you have to. Allow yourself to cry. Ask yourself if the situation is one that can be changed by communicating with another person directly, then do that if possible.

“I’ve seen a number of smokers who are leading packed lives--they’re working and then coming home and taking care of the kids, they never have a moment to themselves--and part of the process for them is learning to put themselves first.”

Most programs allow the smoker to use nicotine replacement therapy in addition to the program, and leave this to the discretion of the individual in consultation with a physician. Both the gum and the patch work by delivering a steady dose of nicotine that is gradually decreased over time.

The patch is self-applied once a day, while the gum is self-administered in prescribed doses as needed. Both require a prescription.

While not a magic potion that will automatically turn a smoker into a nonsmoker, nicotine replacement can be a powerful ally. “The patch is not a panacea,” Rowe says. “People think that it will completely take their cravings away. It doesn’t. But it will mitigate them and ease the withdrawal process.”

Rowe recommends that if nicotine replacement is used, it should be combined with a counseling or support program.

“It is essential, while on the patch, to focus on the behavioral and psychological aspects of your smoking--changing your habits, learning to deal with emotions and stress without smoking. Ideally, by the time you come off nicotine altogether, you think of yourself as a nonsmoker.”

KEY TO SUCCESS

According to the National Cancer Institute, nearly half of adults who once smoked have quit; of those, 90% say they did it on their own, without the aid of a formal cessation program.

That doesn’t mean you should discount the help you might receive from a program: like-minded buddies to share ups and downs with, somewhere to vent when times get rough, and a wealth of health information and coping strategies.

But experts agree that whether you choose to participate in a structured program or go it alone, the key to success is the same: The smoker must really want to quit.

“You want to get people when they’re motivated,” Rowe says, “not because their spouse wants them to quit, not because their doctor says they have to, but because they want to. Then you give them a structure to enact that commitment.”

In most programs, the smoker is asked to write a list of reasons for quitting, then to whittle the list down to a primary motivation. When tempted to smoke, smokers are encouraged to repeat their primary motivation to themselves: “I want to live to see my grandchildren grow up,” or “I want to wake up in the morning with clear lungs and be able to breathe freely.” For many smokers, reminding themselves of their goal gives them the impetus to stay away from tobacco.

Strong motivation also creates a willingness in the wanna-be ex-smoker to set priorities and make allowances for the process of withdrawal. In order to stop smoking, for example, you may find it necessary to take time off work to give yourself a block of time that is as stress-free as possible. You may want to tell friends and family that you are giving up smoking and ask their forbearance during your inevitable mood swings.

And you’ll need to forgive yourself for behavior and performance that does not always match the level you have come to expect.

“The problem is we’re all looking for quick fixes, and there are none,” Franzen says. “If you’re going through withdrawal, you will suffer. You will have bouts of anxiety, there’s just no way around it, and it won’t be over until it’s over. Stopping any addictive practice requires being ready and motivated to do whatever it takes.”

Ask those who have successfully quit and they will tell you that leading a smoke-free life is well worth it. Dulanie Ellis-LaBarre, a script supervisor and mother who lives in Ojai, quit smoking three years ago.

“The illusion I lived under as a smoker was that smoking made me more calm, but it turns out to be the opposite,” she says. “I’m much calmer, more patient and tolerant, and my moods are more even now that I’m off the roller-coaster of smoking and craving.

“As hellacious as quitting smoking is--and it is, it’s the worst and nothing else compares--once you get through it, the view from the other side is glorious.”

Getting With the Program

Today is the American Cancer Society’s Great American Smokeout and there has never been a better day to toss the pack. If you are a smoker who is ready to take the plunge, here are some organizations that can help. Call for schedules and more information.

* Freedom from Smoking Clinic (American Lung Assn.), 2575 Wagon Wheel Road, Oxnard, 988-6023. $100.

* Fresh Start (American Cancer Society), St. John’s Hospital, 1600 N. Rose Ave., Oxnard, 656-3437 or 983-8864. $30. Also available from the American Cancer Society: free self-help materials and the videotape “Fresh Start: 21 Days to Stop Smoking.”

* Smoke Stoppers, Community Memorial Hospital, 147 Brent Ave., Ventura, 652-5013. $170; $153 with physician referral; $136 for seniors or for second family member.

* Five-Day Plan to Quit Smoking (Seventh-day Adventist Church), (818) 546-8400. Classes in Camarillo, Thousand Oaks, Simi Valley and Ventura. Donation suggested.

* Smokenders, 800-828-4357. A seven-week home-study program based on the program widely used by corporations to help employees quit. $125.

* Nicotine Anonymous, based on the 12-step program used by Alcoholics Anonymous, provides ongoing group support and encouragement. Ventura, 658-6164; Camarillo, 386-8116; Newbury Park, 499-3470. Free.

* Ventura County Public Health Services, 3210 Foothill Road, Ventura, 652-6503, provides Spanish and English quit-smoking programs for low-income pregnant women. Free.

* El Concilio del Condado de Ventura, 625 N. A St., Oxnard, 983-2336, sponsors training programs for employers on how to help employees quit. Provides bilingual resources and referrals. Free.

* Smoker’s Helpline of California, 1-800-7NO BUTTS; Spanish 1-800-45NO FUME; Asian languages 1-800-400-0866; hearing impaired 1-800-933-4TDD. Telephone counseling for those attempting to quit, thinking of quitting, or needing continued support after completing a cessation program. Free.

* Cyber-Support on the Internet, alt.support.stop-smoking

Diary of an Ex-Smoker

MONDAY

Having decided to quit smoking once and for all, you flush half a pack of cigarettes down the toilet, slap on a nicotine patch and go to the store to buy sunflower seeds, carrots, hard candies, grape juice, sugarless gum and other distractions.

Your first post-smoking task: Begin to work on an article about quit-smoking programs. Unfortunately, you can’t seem to concentrate; images of lighting a cigarette keep flashing through your mind. You try deep breathing, then chew sunflower seeds, carrots, gum. Still desperately craving cigarette.

You give up and go to the gym for a two-hour workout. Immediately after, you feel a great urge to smoke. You stop at a store, buy a half-pound of chocolate-covered almonds, polish them off before getting home.

Later, you attend a reading at Barnes & Noble, throughout which you suck candies like a madman, rummaging in your purse for another as soon as one is finished. You ask lots of questions, loudly, aggressively, interrupting other people who give you dirty looks.

11 p.m. Can’t sleep. Watch David Letterman.

12:30 a.m. Fix a cup of chamomile tea. Take a Benadryl to make you drowsy. Eventually fall asleep.

TUESDAY

You try, again, to work, but it’s hopeless. You’re distracted by cravings. You log onto Internet stop-smoking news group and spend the morning maniacally telling strangers things you’ve never told your husband, your best friend, your therapist.

You find sunflower seeds very satisfying to chew, chomp, pound with teeth, destroy (the little scamps) and tear to shreds. Ha! Take that.

Lunchtime comes very quickly; you’ve moved it up from noon to, oh, let’s see, it must be 11:05 now. Alas, another morning with no work done. You go to the gym and pump the Stairmaster while watching a soap. Cry unabashedly. You ask your husband if he will still love you if you are intense, interrupt all the time, weep uncontrollably and gain 20 pounds. He says he thinks there’s medication you can take, a response that’s less than encouraging.

11:30 p.m. Letterman again. Make a note: Call doctor and ask if she knows of a Benadryl addicts support group.

WEDNESDAY

Dreamed that you had quit smoking and feel happy--then see yourself in a mirror, grotesquely obese. You log onto Internet and post: “If anyone knows of a fat-free sunflower seed, please e-mail me immediately!!!” Make a mental note: Stop using so many exclamations points!!!

You read through notes for the article you need to write, but the words make no sense, and your Internet buddies are getting on your nerves: all that whining, and worse, the cheerleading from the ones who are having an easy time.

5 p.m. Panic. What possessed you to quit when you are facing a deadline? You said you would do anything to become an ex-smoker, but you didn’t expect to give up your livelihood. And what sort of work is available to people with the attention span of an e-mail message?

Images of famous writers sitting at typewriters flash through your head--they’re all holding cigarettes. What made you think you could be a writer, and sane, thin, and a nonsmoker all at once?

Your daughter calls from college, depressed and talks for an hour about her problems (yeah, right, like she thinks she’s got problems). You murmur consoling noises and take deep breaths, while maintaining a silent mantra that goes like this: “I want a cigarette, I want a cigarette, I want a cigarette.”

The husband catches you in the act of eating peanut butter out of a jar and offers a lecture on fat content. You yell at him to get off your back, then have a glass of wine--OK, three glasses of wine. They only make you want to smoke more.

10 p.m. Post frantic note on Internet to ask if anyone has had a craving in the last five straight hours. While posting, devour a package of Oreos. Now you have a headache. Make a note to call doctor: Can you overdose on deep breathing?

THURSDAY

Fall asleep around 1:30 a.m., but the cat wakes you at 4:30 to go out, then at 5:30 to come in. Make a mental note: After breakfast, kill the cat. Annabel in England, who is on her eighth month of not smoking, e-mails you. “Don’t worry,” she says, “you will learn to concentrate, and you can write without smoking.”

You decide she is lying but resolve to stay more relaxed today, focusing on the positives: No more wheezing attacks. Some occasional coughing, but that’s a good sign--the cilia are coming back to life, doing their job. Mouth tastes fresh, skin looks healthier; have more energy. Getting to know Dave Letterman, and he’s actually a warm, nurturing person, very misunderstood.

You decide to try a stick of cinnamon, as recommended. Holding it like a cigarette, you put it to your mouth and take a drag, throwing your head back.

“Don’t I look like Lauren Bacall in ‘Key Largo’? “ you ask your husband.

“Didn’t Bogie die of lung cancer?” he responds.

You “smoke” the cinnamon stick all morning, taking deep breaths, and for a little while--maybe half an hour--you are able to concentrate. In the afternoon you take an hourlong fast walk. You feel great.

Exhausted, you fall asleep at 10:30.

FRIDAY

Dreamed you smoked two cigarettes in a row and enjoyed it. Wake up feeling depressed and hungry. Eat two big bowls of oatmeal. Discover a butt in the jade plant--your old hiding place--and hold it in your hand, imagining how it would feel to smoke it: the instant relief, the calm. Then you smell it and remember the coughing, the wheezing attacks.

It occurs to you that smoking never improved your life in any way--that stress and frustration come and go, whether you smoke or not. You throw the butt in the trash, then log onto the Internet, where you read this message: “I quit smoking one year ago and feel great! How to do it? There are no miracles, no easy answers. At first it’s very hard, but it gets easier every day. Set your mind to other things. Keep busy, drink lots of water, eat good healthy food, and exercise. When tempted to smoke, remember how awful you felt when you smoked, and how much you don’t want to go through quitting again. Look around and let everything you see take much of your attention. Good luck, and peace.”

Outside your office window, a hummingbird buzzes the poinsettia, its iridescent throat flashing bright colors in the sunlight. You take a deep breath and turn to your work, resolved. Next thing you know the morning has passed, and you have the beginning of a first draft.

Rachel Altman is a local freelance writer and still an ex-smoker, as of presstime.