SMOKING CESSATION: PART II
Dr. Henry Owens
VIRTUALLY EVERY medical treatment (such as Nicotine Replacement Therapy) has been proven to be much more effective when combined with psychological or behavioral smoking cessation methods.
First I will present an overview of the procedures and how well they work. Next I will describe what I learned from my personal journey in becoming a nonsmoker and what I do in my clinical practice to help others to successfully quit. Before describing the methods, keep in mind that you do not have to choose between a medical vs. a psychological treatment.
Besides medical treatments, what options are available to help you quit, and how well do they work?
- Self-help: Some people are “do-it-yourselfers” and prefer to quit on their own. There is a wide variety of informational material and resources, including self-help books and pamphlets, audio tapes and web sites. In general, self-help methods are less likely to work than those that involve at least some contact with a counselor or health care professional. Self-help programs are best suited for people with low levels of nicotine dependence, those with good social support, and those without problematic psychological or addiction issues.
- Individual Counseling and Group programs: Group smoking cessation programs are usually led by a specially trained facilitator/counselor. Research shows that, in general, group programs are among the most successful types of services to help people quit smoking. However, not all people feel comfortable in group situations. Some individuals, with deeper psychological or addiction problems may do better with an individual therapist who specializes in addiction and smoking cessation treatment.
SUPER MODEL Christy Turlington, an ex-smoker whose father died of lung cancer, is also an anti-smoking activist as well as being a sufferer of emphysema. In the United States, cigarette smoking is responsible for about one in five deaths annually, or about 438,000 deaths per year.
Hypnosis: In general, research studies have not supported hypnosis alone as effective in smoking cessation. Part of the problem with the research is that hypnosis methods and practitioners vary a great deal. However, there are ways of using hypnosis effectively in combination with other psychological and medical approaches. I will discuss how I use hypnosis in my practice later in this article.
- Acupuncture: While some individuals report that acupuncture decreased their desire to smoke, there is no solid evidence that it is effective as a smoking cessation tool.
- Mechanical Devices: Filters that reduce tar and nicotine in cigarettes are generally not effective since studies show that smokers who use filters actually tend to smoke more.
- Smoking Deterrents, Herbs and Supplements: Other methods have been used to help stop smoking, such as over-the-counter products that change the taste of tobacco, stop-smoking diets that curb nicotine cravings, and combinations of vitamins, herbal supplements and homeopathic aids. However, there is little scientific evidence to support that these products work.
- Biofeedback: Biofeedback uses technology to measure and display an individual’s physiological response (such as stress level) for the purpose of helping them develop better control of their physiological and psychological reactions. Although there has been no research on use of biofeedback alone in smoking cessation, there is ample evidence that biofeedback helps individuals develop relaxation and stress management skills. Because individuals typically experience considerable stress (from psychological and physical withdrawal) when they attempt to stop smoking, biofeedback can be very helpful in both reducing the stress inherent in the smoking cessation process as well as in learning to relax and reduce stress without smoking.
What to Look for in a Stop Smoking Program
Stop smoking programs are designed to help smokers recognize and cope with problems that come up during quitting and to provide support and encouragement in staying quit. In deciding on the type of program that is best for you, consider the following:
- Studies have shown that the best programs include either one-on-one or group counseling. There is a strong link between the intensity of counseling and the success rate. In general, the more intense the program, the greater the chance of success.
- How much do you smoke? Heavier smokers tend to benefit more from quit smoking medications, group programs, and more intensive counseling. Light smokers tend to do relatively well with self-help programs or brief counseling.
- Look for programs designed or implemented by qualified professionals.
Research shows that the most successful psychological treatments (at least one-year abstinence corroborated biochemically) include the following components:
- Setting a quit date with scheduled reduced smoking
- Education regarding relapse prevention (e.g., role-playing coping responses when the urge to smoke occurs)
- Handling weight gain problems
- Learning stress management skills
What I Learned From Personal Experience
Let me share a crucial truth that I discovered in my personal experience in finally giving up my 20-year, two-and-a half-pack-a-day nicotine habit. I had an uncle that I saw every year or so at a family gathering.
Each time he saw me, he first looked around furtively to make sure his wife was not looking, and then asked me in hushed and conspiratorial tone for a cigarette. Here he was at age 77, still sneaking cigarettes — not really smoking, according to him, since one cigarette every once in a while wouldn’t hurt him. Maybe for health concerns, one or two cigarettes a year, or even a month is not a major health risk. But here’s the point: Each and every cigarette he sneaks, or just puffs on, keeps his appetite and urges for cigarettes alive.
He’s torturing himself by not letting the desire extinguish. In fact, taking a hit of nicotine after a period of abstinence gives the nervous system more of a blast and is more reinforcing than nicotine delivered regularly.
With nicotine cravings, the more you feed the desire, the stronger it will get and the longer it will stay to bother you. For those who took behavioral psychology, it is the principle of partial or intermittent reinforcement: a learned behavior that is reinforced once in a while will take longer to extinguish (disappear) than a behavior that was learned through continuous reward.
In my case, maybe I was fortunate to find that quitting was difficult enough for me to resolve that I never wanted to go through it again. Once I quit, I never had so much as even a puff. Gradually, I lost all desire for nicotine. I can guarantee that if I smoke even a few cigarettes, or even take a few puffs, I would re-awaken the desire and subsequently re-addict myself. The key is to refrain completely, and the desire will go away.
More On Hypnosis
In my practice, I use a three or four-session individualized program that combines motivational enhancement, biofeedback and relaxation training, and hypnosis, along with physician consultation for adjunct medication treatment if indicated. Let me explain how I use hypnosis.
IN THE U.S., among adult smokers, 70 percent report that they want to quit completely, and more than 40 percent try to quit each year. Nearly 21 percent of U.S. adults (45.3 million people) are current cigarette smokers.
Hypnosis is defined as a relaxed and absorbed state of focused attention, guided by suggestion. Many have an image of hypnosis that comes from movies and TV shows, which often show a hypnotist snapping his fingers or commanding an individual to “sleep.” The individual then closes his eyes, his head falls to the side, and “goes under” a deep trance, from which he recalls a repressed memory, relives an event, regresses to a younger age, or in the case of stage hypnosis, comically acts like a duck.
Unfortunately, this portrayal of hypnosis is neither accurate nor helpful. While it’s beyond the scope of this article to go into more detail, suffice it to say that clinical hypnosis, which is the use of hypnosis for a therapeutic or positive outcome is a cooperative process between hypnotherapist and client. Find the program that best suits your level of addiction and “Just do it!” Good luck.
Henry Owens, Ph.D. is a licensed psychologist and director of the Owens Center for Biofeedback & Psychological Services. He received his doctorate in Psychology from St. John’s University in New York. Treatments include psychological counseling and testing, biofeedback, sex therapy, EMDR, hypnosis, and parent training, stop-smoking. Specialties include ADHD, anxiety and mood disorders, child behavior and learning disorders, alcohol and substance use. His proudest accomplishments include quitting an over-two-pack-a-day smoking habit and being the proud father of two daughters. He can be reached at 321-757-6321 or www.OwensCenter.com.
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