President Obama continues to struggle to quit for good

The White house released the results of President Obama's first physical which noted that occasional use of nicotine replacement therapy (NRT). Obama admitted to smoking an occasional cigarette but what does that mean -what is "an occasional" cigarette. Regardless of his apparent health--no one who smokes is healthy. One cigarette increases the heart rate, blood pressure, releases carbon monoxide into the blood system and damages the blood vessels. But the bigger threat of having "just one" is that many former smokers relapse by thinking they can have "just one" every now and then. The addictive nature of nicotine is vastly underestimated when it comes to relapse prevention. Smokers have an abundunce of nicotinic acetylcholine receptors in their brain. Nicotine fits into those receptors and the brain lights up and craves another cigarette. I've treated smokers that had quit for over 20 years and relapsed back to full time smoking very quickly after having "just one".

But to quit for good, President Obama should track when he has those occasional cigarettes--when is it, what is going on--there is probably a pattern that will show up. Often men relapse in positive social situations whereas women often relapse due to stress and negative emotions. It is assumed that because he has a stressful job that he is smoking out of stress but that may not be the case. An occasional cigarette is not due to the physical craving but it is a behavioral challenge and we don't know what his triggers are. Instead of stress, it could be that it's when he's out on the golf course, socializing with his buddies , we just don't know. Everyone is connected to their cigarettes in a unique way--there is NO one size fits all, or even one size fits most when it comes to quitting--it must be a personalized plan that fits the individual, not what worked for someone else. By tracking when he has those occasional cig's, his pattern will emerge and then he can formulate a plan to deal with his individual triggers.
My hope is that because the President understands the difficulty in quitting that he will pave the way to increase treatment options and coverage for other smokers struggling to quit.  Smoking is NOT just a bad habit or a lack of willpower but a physical addiction. Right now, it's not popular to pay for treatment. Non-smokers don't understand why the smoker just doesn't put them down and walk away, former smokers state that if they can quit anybody can quit and current smokers scream that it is their right to smoke. Yet I work everyday with those who struggle, who think that something is wrong with them  because they just can't put them down and walk away. Former Surgeon General Koop called nicotine more addictive than heroin or cocaine--yet if someone was a heroin addict, 30 days of in-patient treatment is paid for and then 90 meetings in 90 days is suggested--4 months of treatment, yet for a substance (nicotine) that is more addictive, we blame the smoker for lacking willpower, and for many years we promoted the product (both in our military and overseas) and we protected the pusher (the tobacco companies).

Smoking is a Class Issue

A woman called me about signing up for my smoking cessation class which is $100. For those that this would be a financial burden, I let them make payments. As this woman was sucking on her cigarette, she said, "You don't understand, I can't afford to buy milk for my children!" I thought at the time that if she hadn't bought that pack of cigarettes, she could have paid for a carton of milk.
Someone told me that with these hard economic times that smokers would quit to save money. It is the opposite, in times of stress, smokers will smoke more to relieve their stress. In one study sponsored by a tobacco company, it showed that when a smoker had to choose between cigarettes and food, they would choose the cigarettes. that certainly was true for the woman that called me.

There is an interesting commentary from England about smoking being a class issue. That when smoking was first popular that it was the rich that embraced it. As the health issues arose, the rich stopped smoking and the poor continued. There is a lot of truth to this. In the United States, most smokers are from a lower socio-economic status and 50% of current smokers in California are either a substance/alcohol abuser or have a mental illness. There is a popular myth that women find it harder to quit than men but when the research is controlled for all factors, what was discovered is that women are more likely to live at or below poverty level than men and it was these women who were more likely to smoke. So it appears that smoking is a class issue not only in the United Kingdom but in the United States as well. Unfortunately, it is the poor that also lack access to the help they desperately need to quit.

There was a Master Tobacco Settlement that was supposed to penalized the tobacco companies for lying all these years about the effects of tobacco. Each state receives money from the Master Settlement yet there are no restrictions on how this money is to be spent, often it goes into the general budget. Doesn't it make sense that at least some of this money is spent to help smokers kick nicotine out of their lives for good?

http://www.guardian.co.uk/commentisfree/2008/jul/01/civilliberties.smoking

Dealing with Emotions when Quitting Smoking

Smokers reach for a cigarette for many different reasons--habit, physical craving, boredom, and strong emotions. When angry, lonely, sad, happy, afraid, a cigarette seems to help the situation. but in reality it is just blocking the emotional need. When angry, a person needs to vent in a healthy way instead of reaching for the cigarette. When celebrating a special event, often the smoker will feel deprived and feel they can't have as good a time with out their cigarettes. To be a long term success at quitting, a quitter needs strategies to deal with strong emotions when they come up--a plan of action. For anger, maybe a brisk walk to release some of that pent up anger. When lonely-reaching out to a friend for support. When we are afraid, we need to feel safe. There are gender differences as well. Women will often reach for a cigarette to deal with negative emotions and men in positive, social situations. Learning to deal with our emotional needs is a big component of living a smoke free life.