“I haven’t had a cigarette in 15 years,” says Dr. David Hazelip. Prior to 1990, Hazelip was smoking an average of one pack a day. Now, as a smoking cessation consultant in Charlottesville, he uses his personal story of triumph over nicotine to help other aspiring nonsmokers. Hazelip says the clean slate of a new year inspires many to try quitting. “Almost every year I’ve had full houses for my seminars in January,” he says.
An estimated 46 million Americans smoke, according to the American Cancer Society, and more than half of them would like to quit. But giving up nicotine may be the hardest thing they’ll ever do. Just ask Mary Stuart (not her real name), who quit smoking in January 2002. Stuart was a smoker for more than 40 years and had tried quitting more than a dozen times. According to the National Institutes on Drug Abuse, almost 35 million smokers make a serious attempt to quit each year. For Stuart, who is now 64, it was the experience of becoming a grandmother that finally motivated her to putt down the butts.
Stuart took Hazelip’s smoking cessation course first in 1998, and again after relapsing in 2002. “At the end of the course, I selected a quitting date. I decided to just quit, cold turkey,” says Stuart. “You really, really have to want to quit. There’s no magic anywhere, you just have to work for it.”
By “work” Stuart means getting past the most difficult withdrawal symptoms of a nicotine addiction. The struggle to overcome the nicotine—a chemical that naturally occurs in tobacco—has prompted some experts to compare it to crack cocaine and heroin. With each puff of a cigarette, nicotine goes straight to the brain and affects the smoker’s central nervous system. If you’re smoking a pack of cigarettes a day, your brain is getting hundreds of small nicotine doses with each inhalation, amounting to thousands of “hits” a day. The frequency of the doses and the direct route of nicotine to the brain easily leads to addiction.
While trying to break nicotine’s powerful grip on their bodies, most serious smokers experience withdrawal symptoms as mild as irritability and as serious as insomnia. To help get them through that difficult period, many would-be nonsmokers turn to nicotine replacement products like chewing gum or skin patches, while others take antidepressants, use acupuncture, or try herbal remedies to help curb nicotine cravings.
According to Hazelip, chewing nicotine gum “can help take the edge off during withdrawal,” but he cautions against using the products for longer than absolutely necessary.
The danger with nicotine replacement products is that they can prolong a nicotine addiction. For instance, it’s not uncommon for smokers who struggle with quitting to find they have replaced their cigarettes with a new habit—chewing nicotine gum. And nicotine gum and patches, while useful in the interim, are costly. Even though several states have increased the taxes on cigarettes, the average national cost for a pack of cigarettes in 2003 was only $2.92 according to the Prevention Dividend Project. By comparison, nicotine gum can cost as much as $60 for 108 pieces of gum.
In recent years, hundreds of different companies have sprung up offering cheaper alternatives to nicotine replacement therapy. Products range from herbal “Smoke Away” pills to extra filters and sealant-like gels placed on the end of a cigarette to reduce the intake of nicotine. One promising, well-researched option is a non-nicotine pill called “Dimmer Switch,” which is in the final stages of approval by the U.S. Food and Drug Administration. It targets the same brain receptors that nicotine affects, “dimming” them to the chemical’s effects, and diminishing a smoker’s enjoyment of cigarettes.
The truth is, the promises offered to help smokers quit are countless. But despite all the how-to books, pills, magazines and nicotine-replacement products, at the end of the day, quitting involves a lot of willpower and very few shortcuts. To be a nonsmoker, experts agree that the decision to quit must be backed up by behavioral changes.
For instance, if you have a cigarette every morning on your drive to work, take a crunchy snack like a sliced apple or chewy breakfast bar to occupy your mouth and mind. Have a cigarette on your coffee break? Try switching to tea, or bring a book or magazine to flip through to occupy your hands. Small changes can create a new daily routine, one that doesn’t involve lighting up.
If you don’t? Well, according to the National Institutes of Health, the majority of smokers who attempt to quit without making a behavioral change relapse within a few days and many don’t make it past a year.
“Behavioral changes are primary,” says Hazelip, who is a certified drug counselor and has helped more than 200 people quit smoking over the past six years. “The idea is to give people skills to deal with craving and the triggers and cues that come along with daily living.” Triggers, Hazelip explains, are normal occurrences that make a craving particularly irrepressible, “like being around other smokers, or in areas where there are other smokers, or just getting up in the morning, when craving is the strongest.”
For Mary Stuart, her behavioral changes went beyond her daily routine. “I decided that I would substitute some kind of physical activity [for smoking]. I joined a gym and I go there three times a week,” she says. “Physical activity takes your mind off yourself and, for me, it reinforced the benefits of not smoking.”
“It’s never too late to quit,” says Hazelip who frequently sees “new mothers who stop smoking during their pregnancy, middle-aged smokers who are slowing down and want to stop smoking, or older folks who smoked for a long time and tried to quit and they just would really like to quit.”
For smokers who have tried all else and failed, hypnosis may be a winning option. Andrew Leon, a certified hypnotherapist in Charlottesville, has been helping people quit smoking with hypnotherapy for four years. “We put the person in a trance and ask them to take us back to the first time they smoked a cigarette,” Leon says. By helping a smoker revisit that first puff in the junior high bathroom, Leon says he can often reveal the patient’s impetus for grabbing a cigarette in the first place. Once that original reason is revealed, smokers can confront their addiction with a new perspective.
“In hypnosis, we work with the subconscious mind,” Leon says. “When you’re in a trance, you’re aware of everything that’s going on. It’s like driving down a road you’re very familiar with.”
But the hypnotic approach isn’t for everyone. “The person must want to quit for themselves,” says Leon. “It cannot be done without that commitment.” Becoming an ex-smoker is a powerful decision, and if a person is unwilling to participate in the process fully, hypnotherapy, Leon says, will be ineffective.
For those who are serious about quitting, hypnosis offers a proven avenue to explore. “You came into the world as a nonsmoker and we bring them back to this phase,” says Leon, who sees each client for an average of four to six 60-minute sessions.
Hazelip offers a more traditional approach, and has designed an intensive five-session small group smoking cessation workshop in Charlottesville, and also offers individual consulting through his private practice, Smoking Cessation Consulting. Quitting with others has proven more successful than quitting alone, and for this reason, Hazelip says working with groups is his “first love” as a counselor. In fact, smoking cessation organizations, like the American Legacy Foundation, have found new and innovative ways to bring people together to quit smoking.
In Washington, D.C., the American Legacy Foundation has developed aglitzy reality TV-inspired website called Maryquits.com that features three weeks of video clips of “Mary,” a young African-American woman who struggles to quit smoking. In addition to providing a glimpse at the hard reality of nicotine withdrawal, “Mary” writes daily weblog diary entries about each day’s challenges. The website creates a community by offering quitters a chance to talk on the website’s discussion board and by posting their own stories of success and failure.
Although research shows that the success rate is only about 15 percent to 20 percent for first-time quitters, Stuart remains resolute and optimistic with her advice. “If at first you don’t succeed, try and try it again,” she says.
Quitters 101
UVA helps Wahoos put down the packs
Anyone who’s been in a college bar knows that lighting up is practically as prevalent as flipped-up collars on the Corner. For local students who want to quit smoking, the UVA Student Health Center offers free “quit kits” and smoking cessation resources. Alison Beaver, Interim Director of Health Promotion for the Student Health Center, sees a handful of students each month who want to reduce the amount of cigarettes they’re smoking or quit altogether.
“For students, their problem is that they smoke when they drink or socialize,” Beaver says. But for a generation that grew up watching Big Tobacco lawsuits and aggressive anti-smoking advertisements, the dangers of smoking are well understood. “I think most students know about the long-term health effects of smoking, but I don’t think they know that every time they take a puff of a cigarette they are changing their brain chemistry,” she says.
Nevertheless, the number of adolescents reporting cigarette use has risen in recent years, and college students are a growing segment of adult smokers. Additionally, the anti-smoking public relations campaigns of recent years have also helped fuel a backlash from young smokers who feel their right to smoke is being threatened by laws prohibiting smoking in bars and restaurants. New York City, Boston and San Francisco are among cities that have discouraged bar and restaurant patrons from lighting up with stringent anti-smoking laws. (While Charlottesville has yet to follow suit, other college towns like Madison, Wisconsin, and Burlington, Vermont, have moved to ban smoking in restaurants and bars.)
To help UVA students give up cigarettes, Beaver helps them devise a plan that is suitable to their lifestyle, and encourages students to pick a time to quit that isn’t around exam time or stressful family holidays. For instance, Beaver suggests that students start by creating a “smoke-free zone,” like the bedroom, where they can be sure not to smell smoke or be tempted by smoking friends.—K.W.
