Not a puff

We’re now about a week into the new year. For many people who recently tried to quit, the tricky part will now be staying stopped. In my last post I emphasized the importance of single-mindedness in successfully stopping smoking. Part of that involves clarity of mind that you will not have a single puff of tobacco (or any other) smoke. For many people the thing that trips them up, is the seemingly logical idea that “just one cigarette won’t do much harm”. In one sense that is correct – a single cigarette on its own is unlikely to kill you. But there is plenty of research and plenty of experience from people trying to quit, showing that having a few slips seems to be highly predictive of a full relapse shortly afterwards. It doesn’t have to happen that way. So if you have already had a few slips, don’t feel that you’ve already blown it. Rather it means you have got to be extra focused for the next few weeks to not have another puff. And if you havn’t had a single lapse since your quit day, you are off to a great start and its really important to keep that going. With every additional smoke-free day you achieve, your chances of remaining smoke-free in the long run increase significantly.

So what can you do to make it easier to stay smoke-free? We’ve discussed a lot of the methods on previous blog posts (see one at end of December that lists all of 2007 posts), and I’d be interested to hear directly from readers’ experiences. But in my experience, making sure you have gotten rid of all your tobacco, staying away from places where people are smoking, making use of available social support (whether friends, family or formal treatment services), and taking effective tobacco treatment medicines (e.g. NRT, Chantix or Zyban) are the main factors.

If you are starting to doubt your ability or resolve to stay quit, remember that that’s how the addiction works sometimes. It pops little questioning thoughts into your head (one won’t do any harm, perhaps I can just cut down instead of quitting, maybe this isn’t the best time for me to quit, maybe the stress will be worse for me than smoking, maybe the weight gain will be worse for my health than smoking…etc..etc). Almost always its best to see these for what they are: the addiction trying to get you to smoke again. If you can keep your focus on not putting another cigarette in your mouth, and never inhaling another puff of smoke, you will succeed.

Labels: jonathan foulds, relapse, smoking cessation

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One Cigarette Wouldn’t Do Any Harm – Would It?

Just over half of the “ever-smokers” (those who ever became regular smokers) in the United States are now “ex-smokers”. Of course for all ex-smokers, the possibility of relapse is real, and the shorter the time since your last smoke the greater the risk of going back. As many as 40% of those who go a whole year without a smoke will lapse and have another cigarette or more in the next few years, while for those who havn’t smoked for five years or more the chances of going back to smoking are much lower.

I suspect that most visitors to the Healthline.com website are not current smokers, but that a sizeable proportion will be ex-smokers, many of whom gave up long ago (5 years or more). Most long-term ex-smokers are very happy and relieved to have successfully quit, but many will admit to getting occasional urges to smoke. Being in situations where you previously smoked (e.g. a bar) or doing an activity that was associated with smoking (e.g. walking the dog) or even just being in a certain mood state can trigger thoughts about smoking, even if you hadn’t thought about it at all for weeks or months. On many of these occasions you won’t have any tobacco available and the thought will pass in a matter of a few seconds. But certain things seem to be associated with stronger cravings and relapse risks. Some of these things are very obvious practical factors, such as the availability of cigarettes. Some are factors that serve to lower our inhibitions or lead us to believe that we “deserve” a smoke (e.g. drinking alcohol, being at a celebration or being on vacation). Even though alcohol can trigger cravings directly, sometimes I suspect that consuming alcohol also causes an indirect effect whereby the ex-smoker believes that being intoxicated somehow gives them an acceptable excuse.

One other psychological factor that increases relapse risk is the thought that, “one cigarette won’t do any harm.” This type of thought is very seductive because on the surface it may seem like a very reasonable point. One cigarette on its own is very unlikely to trigger a serious illness. Ex-smokers entertaining this train of thought often find themselves thinking further rationalizing thoughts such as, “and if I hang out in that smoky bar all evening I’ll probably breath in a whole cigarette’s worth of smoke just from other people’s smoke…so whats the difference?”. But the important thing to remember is that the biggest risk from smoking a single cigarette, is that it greatly increases the risks that you will smoke another and then another and so on. We don’t fully understand the mechanism for this type of relapse but some of it likely occurs at a neurobiological level. Even laboratory rats that have learned to press a lever for nicotine may get a sudden reinstatement of bar pressing if they are given a single injection of nicotine. But there is also a cognitive component to it, that is referred to as the “abstinence violation effect”. This is the process whereby an ex- smoker who has a lapse cigarette then finds him/herself thinking, “oh well, I’ve broken my good record now…I may as well finish the pack” (something that the lab. rat probably doesn’t think).

So it is far better to be very clear in your mind that one cigarette could do a great deal of harm, (by prompting a return to pack-a-day smoking) and that “not-a-puff” abstinence is the way to go.

Labels: cigarette, relapse, smoking cessation

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