Tuesday 18 December 2018

How to quit smoking - for good: Psychologist David Coleman on his own nicotine addiction

You've tried to kick the habit before. But that just means you're in a stronger position to try again, says psychologist David Coleman, who charts his own battle with nicotine addiction

Clinical psychologist David Coleman
Clinical psychologist David Coleman
Tobacco kills about seven million people worldwide every year, according to the World Health Organisation
David Coleman

David Coleman

Nobody wakes up one morning and, out of nowhere, stops smoking. Successfully giving up smoking takes a lot of thought, planning, effort and commitment.

There is a lot of psychological research about change, about how we come to change, what motivates us to change, what makes us welcome or resist change and how we can reach the desired goal of change most effectively.

Some of that research has helped us to develop models, or ways of conceptualising how change occurs.

The model of change that I like most is one proposed by two researchers, James Prochaska and Carlo DiClemente, back in the 1980s. They put forward a six-stage model that most people will predictably follow when they are engaged in changing any behaviour or habit.

This Wednesday is National No Smoking Day
This Wednesday is National No Smoking Day

You can see a graphic of the model they proposed (below).

As you can see, they suggest that we begin any change process in a stage of pre-contemplation, then we start contemplating, or thinking about maybe changing. After that we make a decision to, or determination to, change. The next step is taking concrete actions in order to change. Then the challenge is to maintain the change, because, for many people relapse occurs and we slip back into our old ways of behaving.

I think this is a very useful way to consider the process of quitting smoking. Many people fall into a habit of smoking. Whether the habit develops behaviourally, or because of a chemical dependence on nicotine, we do typically start off in a blissful world where smoking may not feel like a bad thing.

Indeed, when you are in the early stages of a smoking habit, you might really enjoy it. I know I did back when I used to smoke. One of the strongest behavioural triggers for me was that I always associated smoking with taking a break, and having some "me time".

Clinical psychologist David Coleman
Clinical psychologist David Coleman

So, if I felt a break was needed, then a smoke was my first choice. There was certainly a time when I refused to consider any of the health warnings about smoking. Those were for other, older, people. I had the invincibility that comes with youth.

A lot of my friends smoked. I could smoke almost anywhere I wanted. My girlfriend at the time, now my wife, tolerated my smoking. I had no reason to quit and so I never even thought about it. I was happily in that opening stage of pre-contemplation.

As time passed though, some of the health promotion literature started to broach my consciousness.

I saw the ads about the dangers of smoking. I could even feel that my own breathing was affected. I still didn't think about quitting. I just allowed the possibility that smoking might not be good for me to penetrate my thoughts.

Usually we need quite a lot of information about the dangers, or the drawbacks of any behaviour before we begin to contemplate or consider changing. A lot of evidence might need to stack up, to persuade us that we need to change. Without it, the positive benefits that we associate with our habit remain too strong.

Somewhere in this process then, the balance of the benefits and potential costs, associated with the behaviour, start to shift and weigh heavier in terms of the costs, leading us to consider the possibility of change.

I can recall that my smoking had a serious financial cost, even back then, as I was a student. I never liked the smell of stale smoke either.

One of my biggest eye openers, though, happened when I was living in a student-rented house and took a picture down off the wall. Behind the picture the wall was coloured off-white, while the rest of the wall was a darker, almost yellow colour. The rest of the wall was smoke stained. I thought, "if it can do that to paint, what is it doing to my lungs?"

I got married fairly soon after that and my wife then got pregnant. That was the first moment that I seriously considered quitting. I didn't want to be smoking around my pregnant wife (I had never really considered her health before that). I also didn't want my new child to grow up in a smoking environment. I didn't want to be role-modelling what I now firmly knew to be dangerous behaviour.

So, in terms of the change process, I had moved from thinking about change to making a decision and having the definite intent to change. This is probably a part of the process, when giving up smoking, that can be tricky to navigate.

What is the best way to quit? Should you read Alan Carr's book, or buy nicotine patches. What about a HSE smoking cessation course, maybe take up vaping, or perhaps do all of these things?

I know I decided to just go cold turkey, as I didn't want to spend money on "replacements" for smoking and I also felt that my baby-to-be, my expanded family, deserved to have a non-smoking dad. That was actually, for me, incredibly powerful motivation.

Whatever actions you take, to support your decision to quit, are what will bring about the actual change, where you move from being a smoker, to being a non-smoker. It'd be lovely if this was the end of the process, but in many ways it is just the start of the hard bit! Maintaining the change, keeping ourselves in the new way of behaving is often the most challenging thing.

There are many triggers, or associations, that we make with smoking. To this day, I find it hard to avoid smoking when I am in the company of certain people, who continue to smoke, and with whom I have shared cigarettes, stories, laughter and tears. I still feel the pull to smoke with them, because it was such an intrinsic part of our friendship. You'll have your own triggers, particular times of the day, places you go, people you are with, stresses that you feel.

In truth, those triggers to slip back into smoking can be very powerful, and even overwhelming. When that happens, it is considered to be relapse. Falling back into old ways of behaving.

For most of us, this is a common experience on the cycle of change. In fact, the researchers Prochaska and DiClemente found that, on average, people will go through the cycle of change seven times before successfully maintaining the new behaviours and avoiding relapse.

So, some smokers will successfully quit at their first attempt. Others will make many more than even seven attempts. But, even when our efforts to quit smoking aren't successful, we will have learned something that we can use to our advantage the next time we try to stop.

We may realise that we need more support, or some kind of nicotine replacement, or even just a more compelling reason to stop. We can even identify what bit of the change process was hardest, for some it will be the attitude change that leads them to decide to change, for others it will be the behaviour change that comes when we start taking action to change.

But what I like about this way of thinking about change is that it backs up the old saying, "if at first you don't succeed, try, try again". It is our willingness to give quitting another go that will eventually allow us to quit for good.

* This Wednesday is National No Smoking Day. If you need help giving up cigarettes for good, go to quit.ie

Cigarettes and you: The facts

ih smoking5.jpg
Tobacco kills about seven million people worldwide every year, according to the World Health Organisation
 

* How many of us are still smoking? 

According to the 2017 Annual Report of Tobacco-Free Ireland Action Plan, about one in five people smoke tobacco every day. The report records 23pc of Irish people as current smokers, while 4pc of Irish people admit to smoking occasionally. 28.5pc of the tobacco market is now made up of smokers who roll their own cigarettes. The Health in Ireland Key Trends 2016 report shows that cigarette consumption has declined over the past decade. Smoking prevalence was 18.7pc, down from 28.3pc in 2003.

Health authorities, both at home and abroad, are likely to focus on preventative measures, and with good reason: Almost 69pc of those who tried smoking went on to smoke daily, according to a new analysis of global survey data. The findings from the UK, US, Australia and New Zealand found 60.3pc of people had tried smoking and an estimated 68.9pc of those progressed to a daily habit.

* Who's most likely to smoke?

One in four of those aged 25-34 still smoke. The second highest prevalence is among those aged 18-24 years at 24.1pc, however, it has fallen by 3.1pp on the 2015 figure. The smoking prevalence among the youngest age cohort (15-17 years) has increased each year to reach 10.1pc in 2016. According to the report, Those most likely to smoke are 'semi-skilled, unskilled, or unemployed' (DE) as 23.7pc of this group smoke. The second highest proportion of smokers is among those 'skilled manual workers and those manual workers with responsibility for other people' with one-in-five smokers (20.8pc). Professionals and middle management (AB) are least likely to smoke (12.6pc), after 'farmers and farm managers' (F) (10.4 pc).

* Should I try vaping instead?

Vaping may encourage young people to start smoking, but may also help adults quit, according to a US review of scientific research. The report by the US National Academies of Sciences, Engineering, and Medicine is based on more than 800 peer-reviewed scientific studies on the health effects of electronic cigarettes. It was compiled at the US Congress's request, amid a growing international debate over whether e-cigarettes are safe or harmful.

They found that while e-cigarettes contain fewer numbers and lower levels of toxic substances than conventional cigarettes, they are also addictive. The long-term effects of vaping remain unknown as of 2018, yet reviewed evidence suggests that e-cigarettes are likely to be far less harmful than tobacco products.

* I just enjoy the odd one. Do I really need to stop?

According to brand new research carried out at the University of London, amoking just one cigarette a day carries the same risk as smoking 10 when it comes to heart disease and strokes. Researchers found that men who lit up once a day had 46pc of the excess risk of heart disease associated with smoking a full pack a day, much higher than expected. For strokes, the excess risk was 41pc. "If someone smokes one cigarette instead of 20 per day, intuitively we'd think that the risk drops to one in 20, or 5pc," says professor Allan Hackshaw, whose paper analysed 141 previous studies. 'This seems to be the case for lung cancer, but is not true for heart attacks and stroke, where one cigarette per day carries around 50pc of the risk of a pack a day.'

The Health in Ireland Key Trends 2016 report also stated that smoking is directly related to more than 5,600 deaths in Ireland every year. Tobacco kills about seven million people worldwide every year, according to the World Health Organisation. About two million of those deaths are due to cardiovascular disease, mainly coronary heart attacks and stroke. Overall, long-term smoking shortens life expectancy by 12 to 15 years.

Tanya Sweeney

Health & Living

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