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."