The numbers that were very telling were the percentages that broke down how former smokers had actually quit. Keep in mind this chart is limited, it does not tell us how long they have quit or some other key pieces of information--like did the people who are using quitting aids such as NRT ever actually got off the NRT. But I am not concerned about that at this moment.

So how did former smokers actually quit according to the American Cancer Society report? Those using drug therapies and counseling, 6.8%. Those using other methods, 2.1%. That leaves those who either went cold-turkey or cut down. It seems that the study authors didn't feel a need to separate these two unimportant methods, but since even they generally admit cutting down techniques do not really work, I think we can safely assume that they didn't really have any major impact on the overall number. So basically 91.4% of the people who are successfully classified as former smokers quit cold turkey. On that same page is the following recommendation:

"All patients attempting to quit should be encouraged to use effective pharmacotherapies except in the presence of specific contraindications."

You have to ask yourself how many of the successful ex-smokers in the world today would have actually succeeded if the sought out and listened to professional advice.

So for anyone looking in trying to determine what is the best way to quit, you have a choice. You can go with the experts or you can go with what over 90% of successful quitters have done. If you decide to go with the quitters all you need to do is to never take another puff!

40 Years of Progress?

I am attaching an article below from the January 19, 2004 issue of TIME magazine. It talks about the decline in smoking rates in America since the original release of the U.S. Surgeon General's report in January of 1964. The author was apparently led to believe that a whole lot more quitters would be successful if they would just stop trying to go cold turkey and use the many quitting aids available that can "double a person's chance of success."

One thing I want to comment on is how the article points out that smoking declined from 42% to 23% in the past 40 years, but how the drop-off stalled in 1990. The dates are interesting.

The article is saying is that there are a whole lot more effective ways to quit than by going cold turkey. It is basically talking about NRT products and Zyban. What is interesting is that almost all of these products came into widespread use in the 1990's--the years where the rapid decline in smoking cessation actually stopped.

Nicotine gum was first approved for use in America in 1984, by prescription only. In 1991 and 1992, four patches were approved for prescription use. In 1996 all controls broke loose--the gum and two of the four patches went over the counter and Zyban was just coming into the fray.

So now we have all of these miracle products available, many without prescription. If these products were so good at increasing success, and if they are being used by so many people you would think that smoking rates would be plummeting now when compared to when people just had to rely on their own resolve to quit.

Again, read the following line from the article below:

"The drop-off in smoking stalled in 1990 and has hardly budged since then."

Lets hope not too many miracle products for smoking cessation get introduced in the future as it may result in skyrocketing smoking rates.

The real way to once again increase the long-term success rate of people trying to quit is to help them to understand that they are fighting an addiction to nicotine and that to win that fight and to stay free forever is as simple as making and sticking to a commitment to Never Take Another Puff!

 

Joel

© Joel Spitzer 2004
Page last updated by Joel Spitzer on October 15, 2004

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Y O U R T I M E / H E A L T H
Stub Out That Butt!
But don't try to go it alone. Here are some tricks that make it easier to quit
By CHRISTINE GORMAN

Monday, Jan. 19, 2004

More than 42% of adult Americans smoked when the first Surgeon General's Report on Smoking and Health was published. Today, 40 years later, fewer than 23% do. That's good news, but it could be better; a lot better. The drop-off in smoking stalled in 1990 and has hardly budged since then. Surveys show that 70% of tobacco users want to quit, but kicking the nicotine habit isn't easy.

What a lot of smokers don't realize is that the most popular method of quitting; just stopping, a.k.a. going cold turkey; is the least effective. Studies show that getting intensive short-term counseling, taking drugs like Zyban (an antidepressant) or using one of the many nicotine aids (gum, patch, inhaler, nasal spray, lozenge) all double the chance of success. Preliminary results suggest that combining these methods will increase success rates even more.

The trick is to find out what works best for you. For counseling, you don't have to go into full-fledged psychoanalysis; you can pick up practical strategies from various quit-smoking telephone hotlines (for a list of numbers as well as tips, visit smokefree.gov). As for nicotine products, make sure you're using them the right way. You need to chew the gum slowly, for example, not swallowing the saliva until the nicotine can be absorbed through the cheek, says Dr. Elliot Wineburg, who has used everything from drugs to hypnosis at Mount Sinai Medical Center in New York City to help hard-core smokers quit. Many people try to make do with as little nicotine as possible, which is a mistake. "You don't want the brain to go into withdrawal," Wineburg says.

It's never too late to quit. As the years go by, an ex-smoker's risk of heart disease and stroke diminishes until it's essentially the same as that of a person who has never smoked, says Dr. Corinne Husten of the Centers for Disease Control's Office on Smoking and Health. Alas, the risk of lung cancer never quite gets down to what it would have been without smoking. "Even with cancer, people respond better to chemotherapy if they quit," Husten says. Best of all, of course, would be not to take up the habit in the first place.

I Can't Quit or I Won't Quit

"I don't want to be called on during this clinic. I am quitting smoking, but I don't want to talk about it. Please don't call on me." This request was made by a lady enrolling in one of my clinics over 20 years ago. I said sure. I won't make you talk, but if you feel you would like to interject at anytime, please don't hesitate to. At that she got mad and said, "Maybe I am not making myself clear-I don't want to talk! If you make me talk I will get up and walk out of this room. If you look at me with an inquisitive look on your face, I am leaving! Am I making myself clear?" I was a little shocked by the strength of her statement but I told her I would honor her request. I hoped that during the program she would change her mind and would share her experiences with the group and me but in all honesty, I wasn't counting on it.

There were about 20 other participants in the program. Overall, it was a good group with the exception of two women who sat in back of the room and gabbed constantly. Other participants would turn around and tell the two to be quiet. They would stop talking for a few seconds and then start right up again with just as much enthusiasm as before. Sometimes, when other people were sharing sad, personal experiences, they would be laughing at some humorous story they had shared with each other, totally ignorant of the surrounding happenings.

On the third day of the clinic, a major breakthrough occurred. The two gossips were partying away as usual. There was one young woman, probably early twenties who asked if she could talk first because she had to leave. The two gossips in back still were not listening and kept up with their private conversation. The young woman who had to leave said, "I can't stay, I had a horrible tragedy in my family today, my brother was killed in an accident." Fighting back emotions she continued. "I wasn't even supposed to come tonight, I am supposed to be helping my family making funeral arrangements. But I knew I had to stop by if I was going to continue to not smoke." She had only been off two days now. But not smoking was important to her. The group felt terrible, but were so proud of her, it made what happened in their day seem so trivial. All except the two ladies in the back of the room. They actually heard none of what was happening. When they young woman was telling how close she and her brother were, the two gossips actually broke out laughing. They weren't laughing at the story, they were laughing at something totally different not even aware of what was being discussed in the room. Anyway, the young woman who lost her brother shortly after that excused herself to go back to her family. She said she would keep in touch and thanked the group for all of their support.

A few minutes later I was then relating some story to the group, when all of a sudden the lady who requested anonymity arose and spoke. "Excuse me Joel," she said loudly, interrupting me in the middle of the story. "I wasn't going to say anything this whole program. The first day I told Joel not to call on me. I told him I would walk out if I had to talk. I told him I would leave if he tried to make me talk. I didn't want to burden anyone else with my problems. But today I feel I cannot keep quiet any longer. I must tell my story." The room was quiet.

"I have terminal lung cancer. I am going to die within two months. I am here to quit smoking. I want to make it clear that I am not kidding myself into thinking that if I quit I will save my life. It is too late for me. I am going to die and there is not a damn thing I can do about it. But I am going to quit smoking."

"You may wonder why I am quitting if I am going to die anyway. Well, I have my reasons. When my children were small, they always pestered me about my smoking. I told them over and over to leave me alone, that I wanted to stop but couldn't. I said it so often they stopped begging. But now my children are in their twenties and thirties, and two of them smoke. When I found out about my cancer, I begged them to stop. They replied to me, with pained expressions on their faces, that they want to stop but they can't. I know where they learned that, and I am mad at myself for it. So I am stopping to show them I was wrong. It wasn't that I couldn't stop smoking- it was that I wouldn't! I am off two days now, and I know I will not have another cigarette. I don't know if this will make anybody stop, but I had to prove to my children and to myself that I could quit smoking. And if I could quit, they could quit, anybody could quit."

"I enrolled in the clinic to pick up any tips that would make quitting a little easier and because I was real curious about how people who really were taught the dangers of smoking would react. If I knew then what I know now- well, anyway, I have sat and listened to all of you closely. I feel for each and every one of you and I pray you all make it." Even though I haven't said a word to anyone, I feel close to all of you. Your sharing has helped me. As I said, I wasn't going to talk. But today I have to. Let me tell you why." Then she turned to the two ladies in the back of the room, who actually had stayed quiet during this interlude. Suddenly she flared up, "The only reason I am speaking up now is because you two BITCHES are driving me crazy. You are partying in the back while everyone else is sharing with each other, trying to help save each other's lives. She then related what the young woman had said about her brother's death and how they were laughing at the time, totally unaware of the story. "Will you both do me a favor, just get the hell out of here! Go out and smoke, drop dead for all we care, you are learning and contributing nothing here." They sat there stunned. I had to calm the group down a little, actually quite bit, the atmosphere was quite charged with all that had happened. I kept the two ladies there, and needless to say, that was the last of the gabbing from the back of the room for the entire two-week clinic.

All the people who were there that night were successful at the end of the program. At graduation, the two ladies who had earlier talked only to each other were applauded by all, even the lady with lung cancer. All was forgiven. The girl who lost her brother also came for the graduation, also smoke free and proud. And the lady with lung cancer proudly accepted her diploma and introduced one of her children. He had stopped smoking for over a week at that time. Actually, when the lady with cancer was sharing her story with us, she had not told her family yet that she had even quit smoking. It was a few days later, when she was off a week that she told her son. He, totally amazed said to her that if she could quit smoking, he knew he could and stopped at that moment. She beamed with joy. Six weeks later she succumbed to the cancer. I found out when I called her home just to see how she was doing and got her son on the line. He thanked me for helping her quit at the end. He told me how proud she was that she had quit and how proud he was of her, and how happy she was that he had quit also. He said she never went back to smoking, and I will not either." In the end, they had both given each other a wonderful gift. He was proud her last breath was smoke free- she NEVER TOOK ANOTHER PUFF!

Epilog: I normally say you can't quit for someone else, it has to be for yourself. This incident flies in the face of this comment to some degree. The lady with lung cancer was quitting smoking to save her children from her fate, to some degree undo the lesson that she had taught years earlier. The lesson that she "could not stop." It was that at the time she "would not stop." There is a big difference between these two statements. It holds true for all smokers. The lady in this story proved years later she could quit-too late to save her life, but not to late to save her sons. Next time you hear yourself or someone else say, I cannot stop, understand it is not true. You can quit. Anyone can quit. The trick is not waiting until it is too late.

I really do encourage all people to take this survey, talking to long-term ex-smokers in their real world. People who you knew when they were smokers, who you knew when they were quitting and who you still know as being successful long-term ex-smokers. The more people you talk to the more obvious it will become how people quit smoking and how people stay off of smoking. Again, people quit smoking by simply quitting smoking and people stay off of smoking by simply knowing that to stay smoke free that they must never take another puff!

Again, go talk to as many long-term successful ex-smokers (people off all forms of nicotine for at least a year or longer) in your real world that you can find and find out how they quit. I don't believe that there is a single professional smoking cessation NRT advocate who will suggest to their patients that they take a similar survey. For if they did their credibility would be called into question almost immediately when the patient starting seeing the results of their real life survey. They will end up having to spend quite a bit of time trying to explain away the discrepancy, using excuses like the people who used NRT didn't use it right or didn't use it long enough or were more addicted smokers.

We don't need to spend time trying to explain away the results of the surveys that people will do in there real world settings. All we have to say is the results make it more and more obvious that the way to quit smoking and to stay successfully free is no more complicated than just making and sticking to a personal commitment to never take another puff.

Joel