Why Is It So Tough to Quit Smoking?
Smoking is a lousy, smelly, costly habit. Even worse, cigarette packs come lined with the foil of disease - think emphysema, lung cancer, heart disease, COPD, and more.
We all know smoking is bad for us. So do patients. Education is available and anti-smoking messages are persistent. So ... if a thinking, rational population knows all about the hazards of smoking, how come over 45 million Americans are still lighting up?
Pulmonologist Frank Leone, MD, MS, director of the University of Pennsylvania's Comprehensive Smoking Treatment Program, told a group gathered at The College of Physicians, Philadelphia, earlier today that the reason people don't quit is because they are afraid.
Yup, the fear associated with kicking the habit is greater than the fear of death by cigarette-associated diseases. Say what?
"Nicotine is the most fascinating drug," said Leone. "It literally tickles that place in our brains where the sensation of safety is created. When smokers smoke, they feel safe, happy. The very idea of quitting smoking feels like a threat; it results in anxiety, fear, panic."
Leone suggested that for smokers their honest and existent motivation to stop smoking is trumped by the more primal, instinctual need to feel safe; i.e. the disincentives outweigh the motivation to quit.
"The disincentives do not live in a rational sphere where the [non-smoking] arguments of cost and disease reside," reminded Leone. "They live in a visceral sphere and they function on instincts. And this guides the behavior."
How can clinicians help smokers tame the instinctual panic brought on by the mere suggestion of smoking cessation?
"Recognize patients' non-rational disincentives and validate them. Then find a way to undermine the obstacles," said Leone. "Recognize that smokers are not unmotivated, unknowledgeable, or unskilled. They are all of that and more. But they are simply acting on the instinct of fear. Validate that obstacle and then help to undermine it. Help them to ‘de-catastrophize' fears. You can say, ‘You feel full of panic? So what? It's OK to feel that right now.'"
Leone also reminded that smokers can't simply flip a switch and become non-smokers overnight. In fact, many may never fully become non-smokers. But there is a new way to measure success.
"It's not how many people actually quit," said Leone, "but how many spend more time smoking less. Cumulative reduction in smoking adds up to real health benefits. So getting more people to smoke less is a big, big deal."