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ADVANCE Perspective: Physical Therapy & Rehab Medicine

Why Is It So Tough to Quit Smoking?

Published April 26, 2011 11:10 AM by Brian Ferrie

By Valerie Newitt, Managing Editor

ADVANCE for Respiratory Care & Sleep Medicine

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."


Interesting post. I live and work in an area of the UK where the primary cause of hospitalization and expense is COPD. There is a strong public health programme to facilitate smoking cessation, yet very few people participate. It never fails to amaze me to work with someone dying of COPD and its complications and then watch their children and loved ones go outside and light up. Even more astounding is watching the health care assistants and nurses go out for a smoke!

Perhaps our focus is off a bit here. Maybe a generation or two are lost forever to smoking. How do we stop the next generation from lighting up? The US has done a great deal to limit marketing to young people. Remember the Joe Camel campaign? There is a reason it disappeared, legislation against marketing aimed at youth. I think here is one area where an ounce of prevention far outweighs a pound of cure. Lets focus on the future generations because I'm willing to bet that the tobacco companies are looking at them already.

Dean Metz April 26, 2011 12:29 PM

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