stress

I forgot my 7 year quit anniversary, which was back in June. This is the first year I’ve forgotten this, and I suppose I’ve got the perfect excuse but, being a mom, I’ve also got the perfect reason to get on my knees and thank the almighty that I’m no longer pwned by the nicotine demon. So to celebrate, however belatedly, I’m going to share how I did it. Oh and yes, I did it WITHOUT GAINING WEIGHT. In fact, I LOST WEIGHT. (This fact is so monumental, it seriously deserved the cap lock.)

First of all, let me tell you that my smoking habit was intense. I began smoking in 1984, when I was just 15 – a freshman in high school. Sad, I know, but true. I worked my way into a pack a day habit by college, which I pretty much maintained until I quit when I was 33 years old. That’s a lot of cigarettes, a lot of time, and a lot of feeling like shit.

I wanted to quit and managed to quit successfully for two years during that period, from when I was 25 until I was 27. At 27, a serious bout of depression led me back to cigarettes and though the depression got better, the addiction stayed steady for five more years.

During those five years I tried quitting many, many, many times. And I just couldn’t do it. I tried cold turkey and behavior modification approaches, always with the same result – I was a fucking wreck, and I continued to smoke.

Nicotine is, unfortunately, an excellent stress management drug. When I was stressed – and working in psychiatry and juvenile justice, when wasn’t I? – I could have a cigarette and the chemical reaction in my brain was all “Aaaahhhhhh.” Nicotine has the damning effect of being both a decent sedative AND a stimulant, so while helping to ease my frazzled neurons, it was also giving me a much needed lift. In fact, smoking would be perfect, if it wasn’t slowly killing me, and possibly those around me, and maybe even you.

I didn’t really want to die or get sick from smoking, so I had to do something. Maybe you’re in that place now and you have to do something too. If so, I offer the steps below and a whole lot of hope that you can get this done.

If I could do it, I’m telling you now, you can.

And I have to say this. I am NOT a doctor or a medical professional. I am a licensed clinical social worker, which qualifies me to do psychotherapy. This is not psychotherapy. Hell, it’s not even advice. My advice? QUIT SMOKING.  What follows here is simply the story of how I quit, and why I believe it worked so well. If you want to try this, you will need the blessing and assistance of your own physician, which you should be able to easily obtain.

That said, I offer the following steps to get you off your butts.

1. Find your motivation.

Nothing, nothing happens in this world without us being motivated to make it happen. Some of us are motivated by fear, some by rewards. On this occasion, I was motivated by a combination of fear and guilt. I had promised my husband I would quit smoking before our wedding, which was about 4 months away at the time. I love my husband, but my love for him and my own desire to quit really were not enough to get me through the agony of nicotine withdrawal. I needed something drastic to shake me loose, and as life would have it, something drastic did happen.  My brother got very, very sick.

My brother was extremely disabled from the time he was 6 months old, and at this point he was in his mid thirties. He had a bout of pneumonia, something that happened to him all to often as he got into his adult years. But this episode had him in intensive care, on a respirator.

I recall going into the hospital to visit him. He wasn’t aware of my presence at all, and I’m glad because I was hysterical at the sight of him.  I can still see that alarming image of him, unconscious, on that respirator. I thought myself some special kind of asshole to treat my body the way I did, especially my lungs, when there he was, trapped in a very disabled body, now fighting for his life, having his breath drawn for him by some cold medical appliance.

It was my moment of clarity.

Now, I pray that you don’t have this kind of experience. But I do hope that you have something in your life that gives you that perfect view of reality and gets you motivated to change. Maybe it’s wanting to be around for your kids. Maybe it’s a person you love or simply know who is now fighting cancer. Maybe that will be enough for you to think, hey, I’m really an asshole** for smoking and I’m going to do something about it. For real.

**Calling myself an asshole over and over again helped ratchet up my guilt, which helped me quit. This may not work for you, I realize. No, I don’t think you are an asshole for smoking. I think you are addicted to cigarettes, like I was. Thinking it was my fault, however, helped me realize I could actually do something about it.

2. Recognize the truth

Nicotine is a drug, that’s all. When you smoke, you are administering a drug whose only purpose is to get you to keep using it. This realization pissed me off, which was a big help. When I would smoke, leading up to my quit date, I would think “I’m taking a drug that’s going to eventually kill me.” It was the truth, and it helped me de-symbolize what smoking had become to me.  It was no longer a comfort, an old friend, a peaceful moment. Smoking was me slowly killing myself. Once I saw it that way, I had to decide that I wanted to live.

Go ahead and get dramatic with yourself in this situation, because you know what? It is a life or death situation. It’s just usually a long-term threat to your life, not an immediate one, which is what makes it such an evil thing. When you want to smoke, you want to smoke NOW and shit. When you get lung cancer or a stroke, you probably get it years from NOW and shit.

If the effects of smoking were immediate, like say, a bullet to the head from a loaded gun, you probably would never smoke.

Aren’t cigarettes a bitch?

3. Don’t fight alone

It’s human nature that we are more likely to succeed at something when we make a commitment to someone else. It’s all about ego, which I have plenty of, and the need to save face. You can totally use this to your advantage.

That promise I made to my husband really helped me in this regard. I also told everybody – I mean EVERYBODY – that I was quitting smoking. I told all my professional contacts, including my boss, my adolescent clients, parents of my clients, in addition to family, friends, strangers in the grocery store, just to help up the schmuck factor should I try to back out. I also joined NJquitnet.com (terrible name, I know, but a decent online community), so when it was 2am and I was freaking out, there would be a place and people to turn to.

After so many failed attempts at smoking I was desperate, and I understood that my army of supporters and will power alone would be no match for the chemical party smoking threw in my brain and in my body.  I needed something to help me fight the chemical fight, not just the mental fight. So I also turned to my physician for help. She was an excellent ally, and worked with me on a plan and gave me a prescription for Wellbutrin. Which brings me to the next ingredient in my quit smoking pie:

4. Take the right drugs

You might be thinking, Wellbutrin? Isn’t that an anti-depressant? And you’d be right.

Wellbutrin is a trade name for bupropion, which happens to be the same exact medication as Zyban, which is marketed as an anti-smoking medication. It’s the same shit, only my insurance would cover the anti-depressant and not the anti-smoking drug. Stupid ass insurance companies.

Wellbutrin worked very, very well for me because it does something, and I don’t understand what exactly, but something with the part of your brain that deals with compulsive behavior. My smoking was very compulsive – meaning the second I thought of having a cigarette, I had to have one. It would take an enormous amount of will to NOT have a smoke as soon as I thought about it. I couldn’t do that 10-20 times a day succesfully without serious help.

This here is the key: it is/was my compulsive behavior that was the almighty bitch for me – NOT the nicotine. I was addicted to the nicotine, yes, but once I was able to get help with the behavior part, I could simply titrate the nicotine down until I was off of it.

When you quit with bupropion, you simply take it for about a week while you still smoke. After two days on it, you up the dose. The worst part? This increase in the dose may give you anxiety symptoms – bad ones. Heart palpitations, sweating, racing thoughts, feeling scared. They all happened to me, but, since I knew they were side effects of the medication increase, I just dealt with it. The good part is that those side effects typically only last about a day or so. It was very worth it for me, however uncomfortable I was weathering them for the 24-36 hours they endured.

Then after a week on the medication, on a pre-chosen date, I just stopped. That was it. No agony. No crying. No hysteria. Wellbutrin magically made this compulsion problem disappear for me.

It was, no lie, a fucking miracle.

I stayed on Wellbutrin only short-term, like about 8 weeks total. Why? Well, the drug is not without side effects. One of them is complete ditziness, which got sort of pronounced at around the 8 week mark. Also? It lowers the seizure threshold, meaning you are at higher risk for seizures if you take it. This was almost a deal breaker for me with Wellbutrin until my doctor put it in perspective. She said, hey, seizures won’t usually kill you. Cigarettes will. And, the risk of seizure at the dose you take for this is quite low, certainly much lower than your risk for all kinds of terrible health problems with smoking. Anyway, once I was not smoking for seven weeks, I felt like I had patterned my new non-smoking behavior enough, broken the curse, so to speak, that I was safe to come off it. I did, and all was well.

Wellbutrin was not the only drug I used to quit. I also used badass old nicotine itself.

I did not use “the patch,” and I really don’t know why anyone would. I’m not a physician or any kind of quit smoking expert, per se, but anecdotally I can think of 5-10 people I personally know who tried quitting with the patch, but not a single person who actually quit for more than a few weeks.

For me, smoking was not just about getting nicotine – it was also about having something in my mouth (insert crude joke here).  Simple consistent delivery of nicotine through my skin was not going to give me any kind of replacement for smoking behavior, and it wouldn’t come close to mimicing the way I administered nicotine with cigarettes either. With cigarettes you don’t get a steady dose of nicotine for 12 hours, like with the patch. You smoke, you get the hit. The closest thing to this was nicotine gum, which I used with great success, if I do say so myself.

But here’s the catch – I did not use it as directed. I used far less.

When you start to use nicotine gum, they typically tell you to take one every hour, etc. etc. etc. depending on the amount you smoked. My personal opinion is that this system is designed to get you to use too much of it, keeping you on the gum for far too long.

Instead, I waited until I got a nicotine craving. Then I used one piece of gum. My GOD the rush I got was enough to really cement the “nicotine is a drug” concept. One little piece of gum would  keep me craving-free for hours – far longer than a cigarette would have. In the beginning I was chewing maybe 3-4 pieces a day. I gradually spread the time out between gum chewing – much easier to do than with cigarettes. Then I stopped craving the gum. I was off it entirely in about six months. For another six months I kept a few pieces on me – just in case. But I never needed them.

Please keep in mind, you should not try nicotine gum of any sort without first talking to your doctor. There are real side effects and long term risks associated with the gum and you need to be aware of them before you make a decision try it as part of your quit plan.

5. People, places, things

If you have any familiarity with 12 step parlance, you’ll recognize “People, Places, and Things” which really refers to minding the things that trigger your addiction. You can’t avoid all of your triggers, but if you can avoid major ones it can really help.

Back when I was in clubs seeing bands, something I did every weekend for many years back when you could smoke indoors in NYC and NJ, I was constantly smoking. And when I would drink, which wasn’t all that often, I would definitely be smoking. So for about a year I avoided both clubs and alcohol, with the exception of my wedding, wherein I did drink many Cosmopolitans. But, I didn’t smoke. I didn’t miss alcohol, really, and I didn’t miss the clubs much either. In fact, I got the side bonus of my tinnitus getting better. And really, not smoking felt so good after the first weeks I just became more and more committed to it.

6. Get out of the ring

The best piece of advice I ever got about quitting smoking came from someone unspeakably dear to me who has been in recovery from alcoholism/drug addiction for over 25 years. When I asked him how he did it, he had a very simple, elegant explanation.

He said, If I fight against my urge to drink, I’m going to lose. The only way I can win is to not fight. I just have to get out of the ring.

Get out of the ring.

How does one get out of the ring, exactly? Your best bet is distraction.  Think about something else. It needs to be something that can really engage you. For me? I couldn’t really type or play guitar while smoking, so those things helped. I wrote a lot (I had a blog in 1998, and I updated that bitch by hand, yo). There are plenty of activities you can’t very satisfactorily do with one hand. Find something that you really get lost in. Be creative. Or dirty, perhaps. Hey, whatever it takes.

7. Keep going

Who was it, Winston Churchill? He said If you’re going through hell, keep going. Well, same thing here. There will be rough times, and you must keep going. The longer you go, the easier it gets. It’s that simple. Your mind needs a little time to practice the new behavior, to carve new neural paths in your grey matter, for real. Keep practicing and never give up.

To help keep me going, I kept reviewing the benefits of quitting smoking:

When smokers quit — What are the benefits over time? (from the American Cancer Society)

• 20 minutes after quitting: Your heart rate and blood pressure drops. (Effect of Smoking on Arterial Stiffness and Pulse Pressure Amplification, Mahmud, A, Feely, J. 2003. Hypertension:41:183.)

• 12 hours after quitting: The carbon monoxide level in your blood drops to normal. (US Surgeon General’s Report, 1988, p. 202)

• 2 weeks to 3 months after quitting: Your circulation improves and your lung function increases. (US Surgeon General’s Report, 1990, pp.193, 194,196, 285, 323)

• 1 to 9 months after quitting: Coughing and shortness of breath decrease; cilia (tiny hair-like structures that move mucus out of the lungs) regain normal function in the lungs, increasing the ability to handle mucus, clean the lungs, and reduce the risk of infection. (US Surgeon General’s Report, 1990, pp. 285-287, 304)

• 1 year after quitting: The excess risk of coronary heart disease is half that of a smoker’s. (US Surgeon General’s Report, 1990, p. vi)

• 5 years after quitting: Your stroke risk is reduced to that of a non-smoker 5 to 15 years after quitting. (US Surgeon General’s Report, 1990, p. vi)

• 10 years after quitting: The lung cancer death rate is about half that of a continuing smoker’s. The risk of cancer of the mouth, throat, esophagus, bladder, cervix, and pancreas decrease, too. (US Surgeon General’s Report, 1990, pp. vi, 131, 148, 152, 155, 164,166)

• 15 years after quitting: The risk of coronary heart disease is the same as a non-smoker’s. (US Surgeon General’s Report, 1990, p. vi)

That’s a pretty good deal, if you ask me. Nevermind the obvious things like all that damn money you don’t have to spend on cigarettes in the first place. Another good list of benefits is here and there’s a mention of how quitting helps increase your fertility, for those of you struggling to conceive. I won’t even mention smoking and pregnancy, which you already know is bad news. If you’re thinking of quitting when you get pregnant, then consider that quitting might help you get pregnant faster.

It’s good to find ways to reward yourself for quitting. Setting your smokes money aside for awhile and using it on something you enjoy is not a bad technique – I did this back when cigarettes were in the $5-6 a pack range and stuck the money in a jar on top of the refrigerator every day. Seeing all that cash accumulate really did help keep me smoke free.

The Short Version:

Here’s my quit plan, in a nutshell.

1. Find your motivation. Make sure it’s very, very important to you. Figure out whether you’re more motivated by rewards or negatives like guilt or fear. Use whatever works.
2. Don’t bullshit yourself – smoking will kill you, sooner or later.
3. Make a big deal out of quitting with everyone you know, up the schmuck factor if you fail.
4. Talk to your doctor about using a combination bupropion and nicotine gum to curb compulsive behavior and nicotine withdrawal.
5. Eventually get yourself off the nicotine gum – this is really important.
6. Don’t go to places or do things that will drive you nuts if you can’t smoke.
7. Find things to do that you can’t smoke while doing them. Four showers a day? Sure, why not?
8. Keep reviewing all the glorious things that will happen and the perilous pitfalls you will now avoid, thanks to quitting. Oh, and do find ways to pat yourself on the back, like paying yourself not to smoke with your cigarette money.

So, that’s it. That’s how I did it, and I’m certain that you can do it too, if not by following my quit plan, then by devising one that will work even better for you.

When I was in therapy myself during most of my twenties, I often lamented my inability to quit. I felt like a major asshole, a loser, a weak minded git for being unable to stop. I was afraid and I felt out of control. My therapist, who said many helpful things to me over the years said probably the most powerful thing to me of all at this time. He simply said, “When you’re ready, you’ll quit.”

He was right.

So I say that to you now. If you want to quit and have tried and failed, please, please don’t think all is lost. Don’t believe you can’t do it. Just know that you’ll do it when you’re ready.

And, you will know when that is.

PS: HEY WHAT ABOUT WEIGHT LOSS/WEIGHT GAIN?

I know, as a woman who gave birth to twins six months ago and is still hanging onto way too much preggers weight, that’s not a small consideration.

I did lose weight, that is no lie, in the weeks and months after I quit. I lost about ten pounds. The reason is twofold. First and foremost, I worked out. This was something I did for a short time in the months leading up to my wedding because, hey, I was having a wedding and I needed to fit in my wedding dress. Talk about motivation. And there’s no doubt that working out also helped me feel the benefits of quitting much sooner – I was rapidly increasing my physical abilities while also lowering my stress, well, as much as one can lower one’s stress in the months leading up to a wedding. I can just imagine how batshit I would have been if I didn’t have that outlet, given the insanity of quitting smoking in the months before my wedding.

The reason my weight loss was at all possible, I’m certain, is because I did not replace cigarettes with food. And the only reason I didn’t replace cigarettes with food is because I didn’t have that compulsive behavior problem, thanks to the Wellbutrin, and because I used the nicotine gum when I had cravings.

Given the same techniques in your unique context, please be advised your mileage may vary.

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