don's report archive

by Donald B. Ardell, Ph. D.

Wellness in the Headlines
(Don's Report to the World)

I suspect that very few visitors to this website are smokers, but many non-smokers who come here know someone who smokes. Most smokers, it turns out, would like to quit. Therefore, you may find these stop smoking considerations of interest, even if you don't need them personally. All facts alleged in this essay are from government sources, such as the most recent guidelines put out by the Department of Health and Human Services (DHHH) entitled, "Treating Tobacco Use and Dependence." However, that document is very dull, whereas my interpretations of the facts and my guideline tips are gussied up and hugely interesting!

The Federal guideline writers hold that "tobacco stands out as the agent most responsible for avoidable illness and death. Millions of Americans consume this toxin on a daily basis. Its use brings premature death to almost half a million Americans each year, and it contributes to profound disability and pain in many others. Approximately one-third of all tobacco users in this country will die prematurely because of their dependence on tobacco. Unlike so many epidemics in the past, there is a clear, contemporaneous understanding of the cause of this premature death and disability -- the use of tobacco."

Well, no punches pulled there! It gets better when the authors of the government report state, in no uncertain or wishy-washy terms, that it is "a testament to the power of tobacco addiction that millions of tobacco users have been unable to overcome their dependence and save themselves from its consequences: perpetual worry, unceasing expense and compromised health. Indeed, it is difficult to identify any other condition that presents such a mix of lethality, prevalence and neglect, despite effective and readily available interventions." Given all that, the challenge remains: How to quit and/or help others do so?

After an exhaustive review of 6000 plus studies by dozens of agencies and expert scientists, the DHHS report concluded:

• Tobacco dependence is a chronic condition that requires repeated intervention.
• Some treatments can produce long-term abstinence for some people.
• Doctors must be encouraged in every way to do more to promote smoking cessation.
• The best results seem to be obtained from practical counseling (problem solving/skills training), providing social support as part of treatment and offering help securing social support outside of treatment.

The report authors also concluded that over-the-counter nicotine patches are more effective than a placebo, and their use should be encouraged. They also suggest that all insurance plans should provide reimbursement or payment for counseling and certain pharmacotherapeutic treatments. Despite such lofty Federal guidelines, change is slow in this area. In the Federal report, this statistic seemed striking: "Only 15 percent of smokers who saw a physician in the past year were offered assistance with quitting, and only 3 percent were given a follow up appointment to address this topic."

So, how to quit or give good advice to smokers who want to quit? Here are some basic suggestions. Different folks need different approaches. The simplest is a form of "just say no," now, on your own, but only a few can handle that. Ever heard of "tapering?" In this case it means cutting back your dependence on nicotine. Smoke fewer and fewer cigarettes each day, until you can stop completely. This is the approach advised in concert with the use of patches and gums. Either way, the important thing is to focus on one step at a time -- not the end-state (which is being comfortable as a non-smoker.) The desired end-state will take a while. Whatever method you use, keep these facts in mind:

• An addiction to smoking is both chemical and habitual. You have to overcome both physical and psychological patterns or set ways of dealing with stress, anxiety and all manner of tense situations.
• Redesign of the environment is crucial. You must think like a non-smoker. Lose not only the cigarettes -- get rid of ashtrays, lighters, smoke-saturated clothes and friends who smoke!
• Identify in advance the kind of smoking triggers that might set you off -- and take advance precautions. Coffee drinking, doodling (in other words, wasting time) and, if you've watched too many old movies, after sex is when smokers tend to go for their fix. Decide before the situations come up that you are not going to do the ritual smoking anymore.
• Build a support system. Ask friends, family and co-workers to perform constructive roles. Keep the interested ones up to date on your progress. However, don't get carried away and become a pain in the butt -- or lots of other butts. Excuse the pun.
• Don't give up if you screw up! Some say that those who succeed in turning away from cigarettes for life did so only after failing to stay quit about 15 times. Thus, the "failures" really were not failures, just necessary learning stages along the way to nicotine freedom.

There is one other piece of advice that should trump all the rest, though it goes hand in hand with the others -- make vigorous, daily exercise a part of your freedom from addiction plan. Exercise daily -- twice daily, if you can. Long walks are great, but so are all other forms of aerobic conditioning.

Well, lots of luck, whether you are seeking to be a winner at quitting, or helping others achieve freedom from the deadly addiction of smoking. It's a wonderful thing to help yourself or others overcome "perpetual worry, unceasing expense and compromised health" and the otherwise deadly "mix of lethality, prevalence and neglect" that smoking represents.

Be well, and always look on the bright side of life.

(Note: This essay will be filed in the archives in the PHYSICAL DOMAIN under the skill area of lifestyle habits. Additional articles related to this theme may be found there.)

(Ed. Note: Views expressed in this and other columns are those of the author and not necessarily those of the SeekWellness Editorial Board.)

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