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ADVANCE Perspective: Nurses

Why Is It So Tough to Quit Smoking?

Published April 25, 2011 3:08 PM by Valerie Newitt

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 brain 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," said Leone. "Realize 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."

2 comments

Hi these are just tips, but they're useful:1-Count the ctgeraties you smoke every day,  -1 each day/week,slowly!2-If you're into coffe-cigarette thing, stop drinking coffee!3-If you can't help smoking one, smoke it with the hand you usually don't use, don't sit, stay in a place you don't like. Uncomfortable feelings related to smoking do help!4-don't buy ctgeraties!At least you can ask someone for one.But if you haven't got the packet, it's more difficult to smoke!5-No lighters in your house, no ashtrails.No one is allowed to smoke in your house, not even YOU.6-Tell everyone you quitted smoking, so if they see you smoking they're going to have fun on you or think you're weak-willed.7-Is there a taste in your mouth that doesn't make you smoke at all (for me, strawberry candies) use it!8-Are you into alcohol/beer-cigarette thing?Avoid it!9-I think it's better to quit smoking slowly instead of quickly, but if you want to try then choose an important date (your birthday party, the arrival of a thing you're waiting, your new car's first day, first day of holidays, stuff like that) and from there, you cannot smoke!10-You smoke because you're stressed, or need a moment of rest in the day?Buy a fake cigarette. Smoking, apart from nicotine, is a substitute for meditation!Think about it. When you smoke, you slowly inhale, wait, then exhale your breath, slowly, feeling the air coming inside you and going to the lungs and then going out through the mouth/nose IT IS meditation!Try doing the same process with a fake cigarette, a pencil or whatever.Breathing deeply helps I hope you'll succeed. Good luck!Cheers

Veronica Veronica, BLjKGLQjrPmoRmJoj - SZaHCOPrFqhXBdkC, NfNOkXeZVZxRIQ April 12, 2013 6:56 PM
VHxdpgLejwYHDHbG NE

Husband has been trying to quit for a month. He spent 2 weeks with Chantix, to no avail -- it only made him tired, cranky and very anxious AND he was still smoking. Now he's off the Chantix and thinking about trying the patch again. He's been smoking for 45 years and desperately wants to quit. Maybe it will help him to know that cutting down is actually a form of success.

Candy Goulette April 25, 2011 10:52 PM
Lincoln CA

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