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Perspectives on Smoking Cessation
Before working with smokers in their quest to become smoke-free, I'm frequently asked how I envision the smoking cessation process. Assuming that you are curious as well, I've spelled out some of my thoughts on the nature of the process in two position papers. The first, The Challenge of Becoming Smoke-Free, can be read directly on this page. The second paper, Psychological Perspectives on the Etiology and Treatment of Addictions, can be read by clicking on the hyperlink near the bottom of this page. Your comments and/or questions about either or both of these position papers would be most welcome.
The Challenge of Becoming Smoke-FreeBecoming smoke-free can frequently be a challenging process. "Just stop!" some well-meaning friends will say. "Don't you know what you're doing to yourself?!", they continue. Well, sure you know what you’re doing to yourself. In the 20 years that I have been helping smokers become smoke-free, I have yet to come across a single individual who has truly been ignorant of the role smoking plays in aggravating his or her cardiac, pulmonary and circulatory problems – including both those associated with and not associated with diabetes. What these well-meaning people don’t realize is that becoming smoke-free is actually a complex process. With that in mind, let’s take a look both at what makes it as complex as it is and what, given that complexity, it takes to become smoke free. To begin with, these folks are revealing both their lack of information about the addictiveness of the nicotine that is found in each and every cigarette you smoke and the discomfort that you and your fellow smokers may experience when withdrawing from it. They don't appreciate how really uncomfortable it is to be nervous/irritable for an extended period of time as well as to have difficulty sleeping and/or walking around with a dry mouth. And let's not forget the frequent urge to let up - and to "just have one". Fortunately for you, there are a number of medications available that, when used as part of a comprehensive smoking treatment program, have been found helpful in reducing the discomfort often associated with this aspect of becoming smoke-free. Aside from being naive about the addictiveness of nicotine, these same folks don’t appreciate what a strong habit smoking has become in your life. Smoking is, in part, an habitual response – one that you’ve likely become accustomed to making, seemingly automatically, over a period of years when around certain people, in the midst of certain events or when at certain places. Recognizing this, it’s important that your own smoking cessation efforts address this aspect of your smoking experience as well. For some smokers, obtaining professional assistance, both in terms of identifying such habitual patterns, breaking them up and establishing healthier ones is sufficient to become smoke-free. Unfortunately, for many smokers, such efforts are often not sufficient. What is typically missing in such efforts, particularly group cessation efforts, is recognition of what I consider the most significant obstacle to becoming smoke-free. Current experiences with and/or memories of certain people, places and events have a way of unconsciously triggering strong uncomfortable psychological reactions, such as nervousness, anger or depression in each of us. When you have such reactions, it is likely that you have, over period of many years, turned to cigarettes to, in some way, help you to "feel better", i.e. to reduce the felt intensity of your reaction How is it that cigarettes are experienced as doing so? Well, that’s a psychological process that varies from individual to individual. There could be many possible explanations. For example, you, perhaps, have unconsciously come to regard holding a cigarette at a particularly trying time as symbolically holding the hand of a comforting loved one. On the hand, instead of getting directly angry at someone, you may, again unconsciously, find it more comfortable to light up and let your cigarette "fume" for you. Or perhaps focusing on the continuous lighting - puffing - shaking-off-of-the-ashes process helps distract you more generally from other upsetting thoughts and/or feelings that you have been harboring within you. In such situations, what is called for are discussions with a psychological professional trained in dealing with unconscious processes, that will lead to an understanding of what cigarettes and smoking have unconsciously come to me to you. Often, it is only through such discussions that hard-core smokers such as yourself can truly and permanently become smoke-free.
Psychological Perspectives on the Etiology and Treatment of Addictions
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