Self-help Articles

by Marlene M. Maheu, Ph.D.

If you are a smoker or tobacco chewer, you've probably heard it all at one time or another - the desperate pleas and threats from family, the "serious warnings" from doctors, and the snide remarks from people who don't even know you. You probably are smart enough to realize what you need to do. BUT YOU JUST CAN'T.

Well, you are not alone. Most tobacco users are stuck in the same boat with you. They've tried to stop, but have realized they are addicted to nicotine, and just don't know what to do about it. Worse yet, helping professionals often aren't educated about the scientific findings that clearly show how to help you. Usually, one way or another, they end up telling you to "just get some willpower and do it!"

Fortunately, researchers have uncovered the probable causes of your discomfort when you stop using tobacco. Nicotine works on the nervous system in two ways, it is a mild relaxant and a mild stimulant,depending on the situation. Its potency comes not in the level of mood shift, but in the frequency one uses it to shift mood. If you are a bit drowsy and light up to make yourself more alert, you've shifted your mood slightly. If you are irritable or nervous and you light up to "take a break and relax," then you are using nicotine to shift your mood.

To make matters worse, many people tend toward either depression or anxiety with increased age. Using nicotine for decades often hides the body's natural shift toward depression and anxiety. Using nicotine helps older people keep these reactions somewhat under control, or at least more under control than otherwise. When they stop using nicotine, their real state of depression or anxiety surfaces and overwhelms them. Add to these bodily effects the "habit" component - the loss of a 200 - 600 time-per-day, soothing, medicating activity (puffs on a cigarette). Add to that the normal two week withdrawal symptoms,and it often is just too difficult to even try anymore.

You might feel like giving up, but here are some tips for the wise who have the courage to keep at it until they succeed!

• Look back on your family history. Did you have a parent who struggled with anxiety and/or depression? Did they smoke and have trouble quitting? If yes, they might very well have been fighting serious anxiety/depression and "self-medicating" those symptoms with tobacco.

  Many people don't know that nicotine acts like an anti-depressant and anti-anxiety agent (anxiolytic) in the human body. If you think back 20, 30, 40 maybe 50 or 60 years ago, anxiety and depression were not commonly diagnosed. Anti-depressants or anxiolytics were not commonly prescribed. People with these disorders were left to their own devices. When they found something that helped with the sometimes devasting symptoms of these particular disorders, they got "hooked" on that "something" which was tobacco, and they couldnt' stop. Now that we look back at them, we know that their failure to stop smoking or chewing tobacco has to do with the ability of nicotine on that tobacco to calm their nervous systems in a way that nothing else could at that time. When they tried to quit smoking or chewing tobacco, they probably were met with an intensity of feeling that was rarely understood and usually mis-diagnosed by the dotors of that time as well.

  Although these very same people would see their friends quit smoking readily, they knew they just couldn't stop. Without understanding why, they continued to be unuccessful. They just resigned themselves to stop trying and not think about it, not discuss it and make the best of it.

  All this was happenign at a time when big, powerful tobacco companies did their best to make cigarette smoking look not only harmless, but also glamorous, desirable and sophisticated. Who knew that the substance found practically everywhere was so dangerous? Convenience stores, gas stations, grocery stores, billboards, newspapers, magazines, radio, televison - everywhere they turned, this generation was bombarded by tobacco marketing that glorified the smoker and disregarded the lethal effects of smoking or chewing tobacco. Marlboro cigarretes became the number 1 product sold in convenience stores, selling more often than bread or milk.

  Professionals didn't know to intervene because they too, were uneducated about the role of nicotine in depression and anxiety. Even the founders of Alcoholics Anonymous, two of the more courageous and influential figures in the addiction world didn't understand the lethal effects and significant role tobacco played with addicts. Both Dr. Bob and Bill W. died of nicotine addiction as they toured the country to help addicts and alcoholics succeed in their fight against other addictions.

  Professionals of this time didn't understand the role of tobacco and nicotine in the nervous system. As a result, they didn't know how to help. Luckily, must has been revealed in the last 2 decades and you who read this article do not have to suffer the same way. If your parents died or still suffer from anxiety or depression, their fate does not have to be your fate. Much has been learned and you can benefit from it all.

  For now, the first step to recovery is to look at your family history to see if your parents struggled with anxiety or depression and couldn't stop smoking. If yes, and if you have the same struggle with anxiety or depression (or both) when you try to quit, take heart. You might very well have an underlying anxiety or depressive disorder. If that's the case, help is as easy as finding a good physician and/or psychotherapist to help you.

  Get prepared with the right medications, support systems and/or behavioral programs, and you too can be free of cigarettes in about 3 months. Look at your family history, identify the right enemy, then find the success you deserve.

• Find the right help. If you have depression and/or anxiety in your family history, and you realize now that you've been "medicating" your genetic predisposition toward depression or anxiety with nicotine, find a "medication" with fewer negative side effects than nicotine. Anti-depressants are often the best choice because their side effects are not as lethal as nicotine when taken according to directions. (Nicotine is the only substance sold over the counter that, when taken according to directions, will kill you.) Antidepressants can be used to help with anxiety as well as depression. Talk with your physician. If you already are taking antidepressants, do not increase your dose without consulting your physician. You might need another type of antidepressant instead. Also, let your physician know of your plan to stop using tobacco. If you refuse to take medication (as I do), then arm yourself with support, support and more support. Join a hospital program in your community. Find a qualified professional to guide you and meet with you daily at first, then twice a week, then once a week and every other week for at least 3 months. Find an onlien support group and use them every day. When you are on the other side of your quit day, be smart and stay in touch with yoru support system. Cravings can hit at any time, and hit hard. Be on the lookout and be prepared with a written plan that you've practiced for how to deal with sudden and intense urges.
• If you choose to try an antidepressant, start taking it at least 3 weeks before your next attempt to stop using tobacco. It will take at least that long to see if the medication is the right one for you. Make sure you are stabilized on a medication before stopping smoking, chewing, or dipping tobacco. Watch for interactions with other medication you might be taking.
• Talk to your physician about using the nicotine patch or nicotine gum. These products have been shown effective in helping people through the withdrawal symptoms. If you use the patch or gum, start nicotine replacement on the day you give up cigarettes, follow directions and use them for at least 6-8 weeks. If they didn't work the last time you tried, try again. You might need something extra, like coaching or psychotherapy if you are anxious or depressed, rather than eliminating the gum or patch altogether.
• If you've failed repeatedly, hire a coach or psychotherapist with experience in working with nicotine addiction. Increasing numbers of counselors are getting specialized training to be able to help you benefit from scientific research. Such help is available in two formats: group and individual sessions for learning a comprehensive behavioral program. Make the necessary investment of money and time. This is not the time to be cheap. Your life might very well depend on it. Seriously.
• Use psychology to your benefit. Tell yourself that you'll get all the help you can find, and then become "willing to go to any length" to reach your goal. Haven't you gone to extraordinary lengths to use tobacco in your life? Give yourself the benefit of at least that much effort to stop using tobacco. Read more articvles like this one. Learn everything you can about nicotine, your enemy. Make a behavioral plan (actions) for every difficult time of the day, week, month and year.

  After a year of typical holidays, birthdays, anniversaries, seasons and special occasions, you are likely not going to be faced with too many unique challenges. However, if you start noticing that thoughts of nicotine start popping into your head, pay attention and increase the number of contacts with your support system. Quitting smoking is rarely a solo activity.

  Lean on other people as much as needed. Find people to help you, even if they are strangers that you meet at Nicotine Anonymous or online. If you use these support systems, be smart and don't share your address, telephone numbers or details of your private life. Keep it focused on tobacco.

• Keep at it. The average smoker needs four solid attempts to quit smoking before they are successful. That means some people can do it in one attempt, and others might need ten all-out efforts. Do whatver it takes. Millions and millions of others have succeeded, and so can you. Make failure "not an option."
• Success has tremendous advantages in terms of your improved quality of life. Don't do it for "someone you love." Do it for yourself. Quitting smoking is hard for most people. It's just a fact. You know it, so accept it. Given the intensity of the struggle, external motivation rarely works when the going gets rough. Make a list of the reasons YOU want to quit, and stop passing the buck to others. Put yourself in the driver's seat. Once you've taken responsibility, you'll be in a much better position to handle the few tough days that inevitably appear out of nowhere.

About the Author:

Dr. Maheu is an author, speaker, and researcher. She is the lead author of "E-Health, Telehealth & Telemedicine: A Guide to Program Startup and Success" co-written with Pamela Whitten and Ace Allen, published by Jossey-Bass: San Francisco.

She has also been the lead author on these two books: "Infidelity on the Internet" and "The Mental Health Professional and the New Technologies."