Quit Smoking Perspectives – “The System” Analogy

I discovered how to quit smoking three years ago and when I did quit it was as easy as falling off a log. One of the things that struck me so much when I did discover the secret, was the importance of your perspective on smoking. The importance of your relationship with smoking.

I am not going to be able to tell you how to quit smoking in this article – I haven’t enough time to so what I want to do is give you an analogy to explain how your perspective is so important on how you can deal with smoking. This is a cornerstone of cognitive behavioural therapy (CBT) and it works differently to other quit smoking methods because it relies so much on getting your view of the world fixed.

To explain the importance of perspective, I want to tell you about a program I watched on TV a few months ago. Its topic was intriguing and what the program promised to deliver was incredible. The program was called “Derren Brown: The System” and it was advertised explaining “Derren has a system for winning at the horses and in this one-off special he tells a single mum from London which horses are going to win, again and again!”

“The System” started with her receiving an email telling her to look out for another email in which an anonymous tipster would tell her which horse would win a particular horse race. It stated that she should not bet on the tipped horse but just watch for the result. Sure enough, a few hours before the race in question, she received an email and it stated which race and which horse and sure enough, the horse won. Impressive!

A few days later she received another email saying she would be given another tip but again, that she should not bet on it. Sure enough, a few hours before the race, she received her email and sure enough the horse won! Great.

The process continued and she was told to bet $10 on the third tip, rather than not betting at all. She won about $50 back.

The next race she was told to bet $50 and sure enough, she won again. This poor, hard working, devoted single mum on a seriously limited income was getting a break. As a viewer, you couldn’t help but think this couldn’t happen to a nicer or more deserving person. I was genuinely impressed and happy for her as no doubt were many other viewers.

For the fifth race, she was again contacted by email and told to bet the winnings from he previous race on the next race. She did. She won. Brilliant!

Then for the sixth race she was told to go to a specific racecourse and that she would meet the anonymous person who had been providing the tips. She was also told to gather as much money as she could and bring it with her because once she had met the tipster, he would make this his last ever tip. He would explain how he had developed The System and that she could then go on and use The System as much as she wanted.

Sure enough, having seen 5 consecutive winning tips, our single mum borrowed money from her dad and from friends and emptied her account and raised all the cash she could. In total she had about $8,000 to bring and place on this final bet. It was her entire worth in life and it was all about to be laid down on this last final bet approved by the anonymous tipster.

On arrival at the racecourse, she met the tipster – Derren Brown, a TV illusionist who is well known in the UK for his ability to achieve the seemingly impossible. Upon realizing her tipster was Derren Brown, our single mum exclaimed how she wished she had sold her house and all her possessions and gone to a loan shark to get even more money, so certain was she that The System was failsafe.

Not only was her expectation heightened by the previous 5 flawless tips, upon realizing it was Derren Brown providing the tips, any underlying doubts she had were wiped out as she thought she had a rock solid, 100% guaranteed foundation for winning.

She handed over her life’s worth and Derren went off and placed a bet on Horse “X”. To add to the excitement, the program then showed the expressions on our single mum’s face as she watched Horse “X” come in last. The look of utter despair made for great TV.

Luckily, Derren hadn’t bet on Horse “X”, he bet on the winning horse instead! Our single Mum had just won several thousand dollars. This was great TV! The System worked! Or did it?

On the face of it, Derren had given her 6 consecutive winners in 6 consecutive races but that is only because of the way that we watched the program. Our single mum was actually one of 6 guests at the racecourse that day. The other 5 lost (and were given their money back).

On the fifth race, there had been 36 people involved in the filming and all but 6 of them won. The other 30 went home losers.

On the fourth race, there had been 216 people involved in the program, 180 of them lost that race and were no longer part of the program. There had been 1296 people at the third race but 5/6ths dropped out as losers afterwards. In the second and first races, there had been a total of 7776 and 46656 involved in the experiment. Every time, 5/6ths of the experiment didn’t win their race because of the way that The System worked.

Each race had only 6 horses in it and from the initial 46,656 people, they were divided into 6 groups of 7,776 and told to look out for horse 1 or horse 2 or horse 3 etc. Those that lost were dropped from The System and the remainder were then divided up into six groups and told to look out for horse 1 or horse 2 or horse 3 etc. in the next race and so on.

All this good TV was the result of perspective. Your perspective or my perspective as a viewer to be precise. Because we followed our single mum, we saw The System the way she saw The System; as a successful betting plan. In reality, she was the inevitable result of a carefully executed scheme.

Our single mum was the inevitable result of this experiment. She happened to be the lucky person who happened to be assigned each and every winning horse in each and every race. From her perspective and our perspective; Derren had an infallible system.

But what has this got to do with how to quit smoking? Well, everything when it comes to cognitive behavioural therapy (CBT) because CBT turns your view of smoking on its head.

Just because you hold a specific point of view or because you see life through a particular perspective, it doesn’t mean it is the truth. It is just your version of the truth and it is often completely wrong!

You have a perspective about smoking which includes your ideas about why you do it, how much you enjoy it and how difficult it can be to quit. The way you feel about these things is all a product of your perspective. It is your version of the truth.

CBT reviews and analyses all your perspectives about smoking. The big reveal at the end of the program which destroyed our perspecive of The System is what CBT does to your views about smoking.

The Great American Smokeout

The third Thursday of November is coming and so here comes the Great American Smokeout, sponsored by the American Cancer Society.

Smoking is the leading cause of lung cancer and a huge contributor toward overall cancer rates in America and Europe so it is noble that the American Cancer Society run this event to help people get off the smokes. However, there is a side point about being a smoker and being told a specific day is the day when you should try to quit.

In the UK, there is the national no smoking day and do you know what? It makes not the slightest difference to most smokers because smokers do not try to quit smoking ‘en masse’ because anti-smoking organisations want them to. Smokers quit (successfully) when they are good and ready and prepared.

On national no smoking day in the UK, the office blocks still have the smoking hoards outside them, shivering in the cold. Being told ‘today is the day’ isn’t going to wash it, particularly on any old day in November when there isn’t a reason to quit. What’s more, smokers smoke because they are addicted to nicotine and going a whole day without it is a tedious and irritable experience for most smokers. Quitting smoking for one day is a bit like getting a hangover. It is uncomfortable, unnecessary but at least the next day you feel normal again!

Your best bet are to attempt a quit on a day when there is a significant reason for you to quit such as your birthday, new year, your wedding anniversary or your child’s birthday or Armistice Day or the 4th of July or Thanksgiving. Quitting on a random day in November is not a poingnant enough reason to stop.

What’s more, trying to quit without having learned how to quit is quite a futile process and leads to 95% of quitters failing which erodes confidence and hope. My advice is to quit when you are good and ready and have mustered up the reasoning and determination to quit. Also, make sure you have planned how to go about it, or learned from a process such as the EasyQuit System how to make quitting easy and painless.

If you are going without a smoke on the smokeout, good luck and if you are going to try and quit, even more luck to you! Never stop trying to quit.

Chantix – an 8 in 10 failure rate or worse?

by John R. Polito

Saturday, December 16, 2006

Ten links at Pfizer’s “My Time to Quit” website (www.mytimetoquit.com) transport visitors to
its Chantix website. If it truly is time for them to quit, it’s unlikely that Chantix is the answer.

Pfizer markets varenicline as Chantix in the U.S. and Champix in Europe. On September 29, 2006 its press release boasted that “after one year, approximately one-in-five patients who received the 12-week course of varenicline remained smoke-free.”

What we do not know is whether Chantix’s modest 1 in 5 success rate is attributable to the effects of Chantix, to the 16 clinical counseling sessions participants received, to the use of nicotine replacement therapy (NRT) following 12 weeks of Chantix use, or to the fact that more than 1,000 hard to treat smokers who would likely have generated substantially higher failure rates were denied participation. What we do know is that Pfizer’s clinical Chantix studies were not blind as claimed.

Understandably, Pfizer wants to assign full credit for the results from its five varenicline studies to Chantix. Understandably, it wants smokers to believe that, as in its clinical studies, 1 in 5 who purchase Chantix will succeed. But if cessation pharmacology study history teaches any lesson it is that clinical studies are engineered for victory. Unless real-world users can find a way to duplicate study engineering they should expect to experience dramatically lower success rates.

Pfizer’s five clinical trials of varenicline were published in July and August 2006. Three are comparable in that they involved a 12-week treatment period using 1mg of varenicline twice daily. The study headed by Gonzales produced a 21.9% one year Chantix quit smoking rate, in Oncken the rate was 22.4% and in Jorenby 23% – an average of 22%.

But these rates were achieved under highly artificial clinic study conditions. Pfizer spared no expense in creating one of the most intense clinic quitting experiences in any smoking cessation study ever. Real-world quitters, alone with their Chantix pills, or even participating in Pfizer’s GetQuit support plan, will be fighting under entirely different battlefield conditions.

Varenicline study participants received a free 12-week supply of Chantix, were reimbursed travel expenses associated with visiting their health provider to obtain it, attended 16 clinic visits involving one-on-one sessions lasting up to 10 minutes, with counselors trained in motivation and coping skills development, and received 8 follow-up telephone support calls from their provider.

The Impact of Motivation, Counseling and Support

How much of Chantix’s 22% one-year quitting rate is due to Chantix and how much attributable to the 26 times in the Jorenby study that participants spent quality one-on-one time with their Chantix provider, either in person or over the telephone?

Evidence tables in the June 2000 U.S. Tobacco Cessation Guideline combine and average similar smoking cessation studies and provide estimated six-month abstinence rates for a host of quitting methods and conditions. For purposes of comparison, varenicline’s six-month rates were an identical 29.7% in both the Gonzales and Jorenby studies and involved up to 160 minutes of counseling time (10 minutes x 16 sessions) plus an additional 8 telephone calls of unknown duration.

Table 13 of the U.S. Guideline examines the impact of program contact time on cessation rates. It combines 16 different study arms and concludes that programs involving 91 to 300 minutes of total contact time should be expected to generate an average six-month quit smoking rate of 28.4%.

The only way smokers will ever know how much of varenicline’s 29.7% six-month rate should actually be credited to Chantix is for Pfizer to design and conduct studies which make varenicline stand on its own, without substantial contacts, counseling or ongoing support. Such studies were conducted when the nicotine patch and gum went from being prescription quitting aids to over-the-counter products.

A 2002 study by NRT pharmaceutical industry consultants combined and averaged the seven over-the-counter nicotine patch and gum studies and found that just 7% were still not smoking at six-months – a 93% six-month relapse rate. Although a well-kept industry secret, the one-year OTC NRT rate is likely a bit less than 5%. Yes, a 95% failure rate and near 100% failure for second time users.

Contrasting Early NRT Studies

Compare the over-the-counter patch and gum’s approximately 5% one-year rate with rates generated in early nicotine gum studies which, like Pfizer’s Chantix studies, were often loaded with education, counseling and support elements.

Varenicline’s 22% one-year rate is actually lower than the 1976 nicotine gum study headed by Russell in which 23% were still not smoking at one year. It also fails to measure up to the 1980 Raw study which produced a whopping 38% one-year rate, to the 1982 Jarvis study’s 31%, the 1983 Schneider study with 30%, the 1984 Hialmarson study at 29%, the 1986 Daughton study at 31%, the 1987 Kornitzer study at 32%, or the 1989 Tonnesen study which boasted a 44% one-year quit smoking rate.

Diverse Study Site Evidence

Online FDA varenicline documents raise serious concerns that factors other than Chantix or Chantix impacted performance. The Medical Review shows striking contrasts at a number of study sites in four week continuous quitting rates (CQR) during the final weeks of varenicline treatment, weeks 9 to 12.

At the University of Massachusetts Medical School, 46% of the 22 member placebo group were still not smoking at 12 weeks compared to 50% for the 22 member varenicline group. Hardly an impressive victory. New York’s Medical and Behavioral Health Research witnessed 35% of the 17 member placebo group still smoke-free at 12 weeks compared to only 6% of the 16 member varenicline group.

Did counseling sessions at these study sites place greater emphasis on front-end quitting tips such as the importance of stabilizing blood sugar, overcoming time distortion, handling alcohol, understanding elevated blood serum caffeine levels, and recognizing emotional loss? Would doing so have allowed a far greater percentage of placebo group members to successfully navigate the up to three days needed to rid their body of all nicotine and endure the worst of withdrawal?

Did sites generating dismal placebo group rates fail to counsel participants on the fact the reason they could skip meals while still smoking and not experience wild blood sugar swings is because nicotine was their spoon, with each puff pumping stored fats and sugars into their bloodstream?

Were placebo group counseling concerns totally ignored at Tulane University where 0% of 8 placebo group members were still not smoking at 12 weeks, in San Francisco where 0% of 10 survived, in central Kentucky with 0% of 12, and at the University of Mississippi with 0% of 9? What possible explanation is there for the tremendous diversity in 12-week quitting rates among Chantix users? In Brooklyn only 18% of 12 varenicline users were still smoke-free at 12 weeks, at New York’s Central Park just 6% of 16 remained quit, and in Jackson, Mississippi only 14% of 15 were still healing.

On the flip side, Chantix users did amazingly well at the University of Nebraska where 67% of 18 users were still free at 12 weeks, at Newport Beach, California where 64% of 28 remained quit, at Palo Alto with 69% of 13, and the Mayo Clinic with an amazing 81% of 21 users were still standing.

Did counselors at some sites strongly encourage Chantix users to endure and persevere through medication side effects while counselors at other sites were not as persistent? Adverse events among the 692 varenicline users in the two identical studies (Jorenby and Gonzales) included 199 participants reporting nausea, 51 reporting flatulence, 50 with constipation, 81 reporting abnormal dreams, and 36 reporting sleep disorders. Did symptoms contribute to researcher awareness of participant group assignment and failure of the study’s blind?

Were counselors at some clinical sites – such as the Mayo Clinic – better trained than others? Were their backgrounds primarily in pharmacology cessation counseling or in behavioral cessation counseling? How will Pfizer’s boast of a 1 in 5 Chantix one-year success rate be affected by the fact that almost all real-world quitters will use it without the benefit of sixteen one-on-one counseling sessions?

Nicotine Replacement Therapy Use During Chantix Studies

The brain’s dopamine pathways not only produce a neurochemical “aaahhh” reward sensation surrounding species survival events such as eating, drinking, reproduction and accomplishment but also generate powerful and salient reinforcing memories that ensure we return for more.

But by happenstance the nicotine molecule fits the brain’s nicotinic type acetylcholine receptors responsible for generating dopamine. Chronic nicotine use causes the brain to fight back and attempt to diminish nicotine’s impact by growing or activating millions of extra acetylcholine receptors in at least eleven different brain regions – a process known as up-regulation.

The larger receptor playing field creates a tolerance cycle of escalation in which the smoker often must gradually use more nicotine in order to overcome additional brain up-regulation and de-sensitization. Any attempt to quit using nicotine will briefly leave the dependent user de-sensitized during the brief period of time needed for the brain to down-regulate and restore natural receptor counts.

The theory behind NRT was that it allowed dopamine flow to continue while buying the smoker time to extinguish psychological nicotine feeding cues and conditioning. Its downfall has been that, outside of extremely supportive clinical studies, few quitters have the self-discipline and motivational stamina needed to engage in a lengthy period of gradual stepped-down withdrawal on their own.

Dismal real-world NRT success rates have resulted in the industry actually blaming quitters for not using it properly. But proper use often results in the quitter getting hooked on the cure. In 2004 GlaxoSmithKline consultants noted that nearly 40% of nicotine gum users are dependent upon it, or, as the consultants like to put it, they’ve become “persistent users.”

A May 2005 study found that varenicline causes alpha4 beta2 type acetylcholine receptors to produce 30 – 60% of the dopamine flow that nicotine would produce if sitting on the same receptor site. Not only does this raise ongoing nicotine-type dependency concerns, which Pfizer asserts only impact about 3% of users, but concerns over permitting NRT use during varenicline studies once the 12-week treatment period was complete.

Although Pfizer’s studies acknowledge keeping records of nicotine use during the 40-week post-treatment monitoring period, that data has not yet been made part of the public record at the FDA. As stated in the Oncken study, “During the follow-up period, use of nicotine replacement therapy did not disqualify subjects from being considered abstinent.”

The obvious question becomes, what percentage of the 1 in 5 of Chantix users reported as have successfully quit for one year were still chemically dependent upon nicotine? In that almost all varenicline users will purchase Chantix with the goal and dream of breaking nicotine’s grip upon their mind and life, do they have a right to know the actual percentage that Pfizer counted as success stories, who were in reality still solidly hooked?

Excluded Smokers

Chantix’s real-world performance rates are likely to be further eroded by the fact that a substantial percentage of difficult to treat smokers applied to participate in each study but were denied. In Gonzales 1,843 smokers were screened and 458 were excluded (25%), in Oncken 980 were screened and 333 excluded (34%), and in Jorenby 1,413 were screened and 386 excluded (27%).

Excluded from participation were those suffering from cardiovascular disease, alcohol abuse, major depression, panic disorder, systolic blood pressure greater than 150 or diastolic pressure greater than 95, a history of cancer, a body mass index (calculated as weight in kilograms divided by height in meters squared) of less than 15 or higher than 38; weight less than 45kg, those with a “clinically significant medical disease,” those over age 75 or younger than age 18, those smoking fewer than 10 cigarettes per day, and those known to have recently relapsed during NRT or Zyban/Wellbutrin quitting attempts.

Most within these groups reflect populations that have historically been extremely challenging to assist in quitting, including youth who often smoke fewer than ten per day. Real-world conditions will not bar them from using varenicline.

Their use of Chantix has not yet been studied and we have no idea how their status and conditions will impact outcome. What we do know is that their exclusion from Pfizer’s studies has likely resulted in a significant overstatement of varenicline’s true one-year effectiveness.

FDA Must Demand Solid Science

Will the U.S. Food and Drug Administration (FDA) continue to allow pharmaceutical companies to design and conduct chemical studies guaranteed to produce clinical efficacy but which result in approval of products that in real-world use perform no better than quitting without them?

The FDA knew or should have known that both NRT and varenicline studies were not blind as claimed, and that resulting odds ratio victories have little or no foundation in science. Instead of exposing known blinding failures they remain quiet and allow horribly flawed science to be used to exploit the dreams of smokers dying to break free.

Nicotine is a psychoactive chemical producing a powerful dopamine/adrenaline high. Those addicted to it are dependent upon prolonged dopamine aaahhh” reward sensations accompanied by central nervous system stimulation. It gets the heart pounding faster, their senses perked, their fingers and toes growing cold, and energizes the addict as nicotine causes the release of stored fats and sugars into the bloodstream.

Smokers who have attempted quitting know what their withdrawal syndrome feels like – a rising tide of anxiety which breeds irritability, impatience, anger and depression. They joined NRT and varenicline clinical studies after being promised the “chance” of receiving free medicine, which they hoped would diminish their withdrawal syndrome.

Pfizer’s studies indicate that eighty to ninety percent of varenicline study participants had attempted quitting at least once previously and failed. In both NRT and varenicline studies, the expectations of withdrawal syndrome reduction were frustrated by assignment to the placebo group, or fulfilled by assignment to the active group, with the arrival of nicotine or varenicline in the brain.

A June 2004 study by Mooney reviewed 73 allegedly double-blind NRT studies and declared that the limited number of studies assessing blindness were not generally blind as claimed in that “subjects accurately judged treatment assignment at a rate significantly above chance.”

Mooney warned researchers that, “to determine the prevalence of failure, clinical trials of NRT should uniformly test the integrity of study blinds. Moreover, if blindness failure is observed, subsequent efforts should be made to determine if blindness failure is related to study outcome and, if so, to provide an estimate of treatment outcome adjusted for blindness bias. Without these methods and analyses, the validity of NRT clinical trial results could be questioned.”

Were blinding studies conducted in association with any of Pfizer’s five varenicline studies? If so, the results have not yet been made public. Using Mooney’s warning, smokers have legitimate reason to question the core validity and integrity of Pfizer’s five studies.

The blinding analysis in a 2005 study by Dar found that 3.3 times as many placebo group members correctly guessed that they had received placebo (54.5%) as guess nicotine (16.4%). Although the Dar study focused on smoking reduction, Tonnesen’s 1993 nicotine inhaler quitting study produced strikingly similar placebo group findings with 3.8 times as many in the placebo group correctly guessed placebo (58%) as guessed nicotine (15%). Among inhaler users, Tonnesen found that 3.5 times as many correctly guessed inhaler (46%) as guessed placebo (13%), while 42% on active and 27% on placebo did not know which treatment they had received.

The FDA knew that placebo group expectations and frustrations in NRT studies are identical to those experienced in varenicline studies. They sought some degree of reduction in their withdrawal syndrome and none occurred. It was no secret to Pfizer that roughly 80% of the placebo group would relapse within two weeks, handing the active group victory by default.

Smokers join clinical studies in hopes of receiving promised medications that result in withdrawal symptom reduction. Their expectations differ from the 80 to 90% of annual quitters who attempt quitting cold turkey, who fully expect to sense and navigate withdrawal.

It is an important distinction because government authorities continue to turn their heads while Pfizer proclaims to smokers that its nicotine replacement products competed against and defeated cold turkey quitters. Those wanting to quit cold turkey were never invited to clinical NRT studies. The representation is false and extremely deceptive.

Although it may be impossible to randomize alternative expectations of fully enduring or dramatically diminishing physical nicotine withdrawal, the pharmaceutical industry can and should recruit and fully serve both expectations from the same general population when conducting clinical studies. Subgroups with similar traits could then be compared and odds-ratio victories would at last have some validity. If education or counseling is to be included we must accept the variance that its intensity, duration, focus and content should be tailored to each group’s differing cessation needs.

But pharmaceutical industry financed studies will likely never pit “real” cold turkey quitters against those wanting to sense a diminished withdawal syndrome as the expected results would likely destroy more than one golden goose.

WhyQuit looks forward to the day when it can at last report that a new quitting product truly is effective in real-world use. On that day we will become the product’s most vocal advocate. All preliminary evidence to date suggests that Chantix isn’t it.


No Copyright – This Article is Public Domain

John R. Polito is solely responsible for the content of this article.
Any factual error will be immediately corrected upon receipt of credible authority

Quit smoking cold turkey success rates

I have been thinking about why people think that quitting smoking cold turkey has such a low success rate. I think I have come up with an answer too. To understand what I mean it is important to understand what I mean by quit smoking cold turkey.

To quit smoking cold turkey merely means that you should not be using any intervention other than verbal or written word. You should not be on varenicline, (chantix and champix), zyban (wellbutrin and bupropion), nicotine patches, gum, lozenges, tabs, nasal sprays or inhalers. You should not be using acupuncture, laser therapy, silver acetate sprays, aversion therapies, chain smoking, hypnosis, clonidine, opoid antagonists, anxiolytics, anti-depressants, nicocure, nicobrevin, lobeline or mecamylamine – to mention a ‘phew’ of the options!

To quit smoking cold turkey, all you should be using is education and knowledge and that is the key.

Most people think to quit smoking cold turkey as just stopping smoking one day, without any help, support or education. But it shouldn’t be like that. It should involve education and support.

I promise you that every time I tried to just quit smoking, out of the blue, I would fail miserably. Even when I read all the pamphlets and advice from my doctor and the stuff in the nicotine patch packet, it didn’t help one bit.

Telling me why I should stop smoking is different from telling me how I should stop smoking!

I needed to know how and when I did, it was a cinch!

The reason why people think that quitting smoking cold turkey has such a low success rate is because it has never been studied properly. It is assumed that quitting smoking cold turkey just means trying to stop smoking using willpower alone. When you know how to quit smoking, you don’t need any willpower anyway, you just need to want to quit smoking.

In most studies, the ‘control group’ (the cold turkey group) are just told to quit smoking. They may be given some sugar pills or some sticky patches (without nicotine) but they are normally just left to their own devices. No surprise then that they all fail miserably with only about 5% successfully quitting.

There is a difference between just trying to abandon smoking and learning how to quit smoking. One you have learned how to quit smoking, your potential success rate rises to 100%. Let me use an analogy to explain.

Imagine sitting in front of an internet-enabled computer for the first time and being told you have 1 week to build a database of all the employees of a company with all the relevant details of pay and personal circumstances. Do you think you might need help?
Well, 5% of the population might just figure it out all by themselves but at least 95% wouldn’t and that is what quitting smoking is like. You are either lucky/smart/clever enough to figure out for yourself how to do it or you are like the rest of us who need to be pointed in the right direction.

It is important to realise why you should quit smoking. There are more medical reasons to quit smoking then for any other ailment. Smoking poisons your whole body, not just you lungs – virtually every aspect of your body and metabolism is affected by tobacco smoke. Knowing this gives you the motive to quit smoking. Understanding how to quit smoking cold turkey will give you the means to quit smoking and finally, you will need the opportunity. What most people don’t realise is that today is as good an opportunity as you will ever be presented with.

Never stop trying to quit.

How addicted are you?

A “yes” answer to any question indicates some degree of impairment; the more “yes” answers, the more serious the problem. Here are the questions:

1. Have you ever tried to quit, but couldn’t?

2. Do you smoke now because it is really hard to quit?

3. Have you ever felt like you were addicted to tobacco?

4. Do you ever have strong cravings to smoke?

5. Have you ever felt like you really needed a cigarette?

6. Is it hard to keep from smoking in places where you’re not supposed to?

When you haven’t used tobacco for awhile, or when you tried to stop smoking . . .

7. Did you find it hard to concentrate because you couldn’t smoke?

8. Did you feel more irritable because you couldn’t smoke?

9. Did you feel a strong need or urge to smoke?

10. Did you feel nervous, restless or anxious because you couldn’t smoke?

Courtesty of J.R. DiFranza, J.A. Savageau, K. Fletcher, J.K. Ockene, N.A. Rigotti, A.D. McNeill, M. Coleman, C. Wood, “Measuring the loss of autonomy over nicotine use in adolescents: The Development and Assessment of Nicotine Dependence in Youths Study.” Archives of Pediatric Adolescent Medicine. 2002;156:397-403.

John Cleese on the meaning of life (after cigarettes!)

John Cleese

I can’t remember my first ever cigarette, but I know I had a rather odd attitude to smoking when I was at school in the late 50’s. Some of my friends smoked surreptitiously. They used to go to the cinema in the afternoon in Bristol, primarily to smoke cigarettes and I remember thinking, ‘That’s really pathetic!’

I was a bit of a late-starter when it came to smoking because of my attitude towards my school-friends. I didn’t start until I was 25 and rehearsing a show in New York at the end of 1964. We were working in a theatre club and there was a big cigarette machine there. I started off smoking menthols, then after a bit I moved onto Larks and Parliaments. Most of the time that I was doing Monty Python (and certainly Fawlty Towers) I was smoking quite a lot and I got into a cycle, as many writers do, of making myself a cup of coffee, then having a cigarette with it.

I knew that smoking didn’t make me feel too good, but I never thought of myself as a very heavy smoker. I was vaguely thinking about giving up and then, when I was talking to my dear friend, Robin Skinner, he said something that made a big impression on me. He had been a heavy smoker, but had given up some time before. I think we were talking about smoking and I said that I thought smoking cigarettes relaxed me. He suggested that the next time I had a cigarette, I check my pulse, before and after. I tried it and the moment I realised that having a cigarette put my pulse rate up, I stopped believing that it was relaxing!

Later on I went to see a nututrionist. The nutritionist tried to persuade me to cut out both coffee and cigarettes because he said they were both poison. I hate to say it, but I found it relatively easy to give up, which I think had something to do with the fact that I gave up coffee at the same time. It was a pretty wholesale lifestyle change for me. I went back to coffee eventually but I don’t think that I could have given up smoking if I hadn’t given up coffee as well. It also helped that I’d cut right down some time before I quit smoking completely. That might not work for everybody, but I think it helped me. I was lucky in that I didn’t suffer very severe withdrawal symptoms, I just began to feel a little bit better. I’d always had a bit of a wheezy smoker’s cough and I soon noticed that it had started to clear up. My sense of taste improved quite quickly and there’s no question that your lungs get better when you quit smoking.

I’d given up for some time when I was approached to do some anti-smoking ads by the Health Education Authority. I’d worked with them before and I trusted them to do a good job. They had some very, very good scripts for those ads and that persuaded me to get involved. The best single joke in the campaign was that wonderful one where I’m sitting there with a full ashtray, talking about how much ash the average 40-a-day man creates. “But then of course,” I add, “ they’re not all cremated!” There was another ad in which I coughed non-stop for ages, and one in which I shot a packet of cigarettes with a revolver.

Over the years I’ve spent quite a lot of time in the US, and I never cease to be amazed by the fact that although fewer and fewer older people smoke in America, there still seem to be loads of young people taking it up. The tobacco industry’s marketing obviously works very well as they are addicting new smokers all the time. I think it’s one of the most cynical commercial operations that I’ve ever witnessed. A long time ago, way back, in the early ‘80s, I was approached by a tobacco firm, who asked me to do some cigarette advertisements in Australia. That was when I was smoking 20 a day, and I’m ashamed to say that I agreed to do it. You’ve got to remember though, that the research gradually strengthens the case against tobacco in your mind, and at that time, even though I knew it wasn’t the healthiest habit in the world, I didn’t realise just how bad it was. I remember doing a couple of ads for them, which were shown only in Australia, but I would never agree to do such a thing now.

It is a source of concern to me that my two younger children still smoke, but my approach to trying to modify anyone’s behaviour is not to be dictatorial, as that has exactly the wrong effect. I do say things like, “Check your heart-rate, because then you’ll realise that it’s not relaxing you,” but I would never try and lay down the law.

John’s Top Three Tips:

If you still think that smoking is relaxing then try the ‘Pulse Rate Test’ like I did. Check your pulse before, and after having a cigarette, and you’ll see that smoking really makes your heart race.

Tapering off the number of cigarettes I smoked helped me to quit, but I wasn’t a very heavy smoker, so others might need to stop more abruptly.

Make it a major lifestyle change and consider giving up (or reducing) the amount of tea and coffee you drink. A bigger change can feel like more of a fresh start, and coffee or tea are closely associated with cigarettes for a great many smokers.

Christy Turlington’s quit smoking story

Christy Turlington

Another interview with celebrity ex-smokers. This interview is with supermodel Christy Turlington who has graced countless magazine covers during her successful modelling career. After losing her father to a smoking related disease, she finally managed to beat her own addiction to tobacco and went on to lend her support to the US tobacco control movement.

I was 13 when I first started. I was never directly pressured to smoke by my friends, but by surrounding myself with others who were also experimenting with cigarettes, I felt more socially ‘comfortable’. After about three years of smoking and thinking I wasn’t addicted, I discovered that I was, after all. Young people are most prone to addiction between ages 13-19, so I was right on target! My career contributed to my addiction in that it just wasn’t an issue for people in the modelling business. No one was concerned about my smoking. As a result, I was completely accepted as an adult and a confirmed smoker at a premature age.

I used to smoke at least a pack a day. I would get up and out of the house to wherever I was going, and light up as I got to my destination. It became a familiar part of my work routine. Throughout hair and makeup sessions, breaks would be taken to smoke, as well as between shots. Once back at home at the end of the day, I’d carry on smoking while watching TV.

After a while I was finding myself far too short of breath for my years. My skin had a sallow complexion, and dullness. My hair and skin smelled all the time and my teeth needed to be cleaned more frequently than usual. My immune system was quite broken down as well. I didn’t have much resistance to infection and would frequently go down with colds, strep throat and bronchitis. I hated being addicted to anything, especially cigarettes and I attempted quitting many times. I was ashamed for having let myself (and others) down repeatedly. I was tired of being out of control. I was also motivated to quit by losing my own father to a smoking-related disease.

By the time I finally quit five years ago, the decision came naturally, and I had the strength to do it. I now have no desire to return to smoking. In fact, I’ve experienced many physical benefits since stopping. I feel much more clear-headed, there isn’t any ‘fogginess’ in my head when I wake up in the morning either. I resumed a strict exercise regime, where I increased cardiovascular training as a means to clean out my lungs and blood, while trying to also maintain weight control. I also gave up drinking alcoholic and caffeinated beverages temporarily, to assist my effort.

It’s now five years since I quit smoking and it’s proved to be a major turning point in my life. I knew when I quit that I could do anything I set my mind to. I’m dedicated to discouraging young people from smoking by sharing my story and speaking to teenagers about the manipulative nature of advertising which sometimes uses glamorous imagery to market products that are both harmful and addictive.

Christy’s top three tips for successful quitting:

Make a firm commitment to yourself.

Set a quit date, and don’t stray from it.

Think about all of your loved ones, especially children if you have them, and know that they depend on you. You owe it to them to stick around for as long as possible.

Larry Hagman’s quit smoking story.

Larry Hagman

This article was originally published in Stop! Magazine and it provides an interesting insight into the changes in attitudes around smoking.

TV star, Larry Hagman became a national favourite when he played ruthless Texas oilman, J.R. Ewing in the hit series, Dallas. But success led to excess for Larry, whose smoking and drinking nearly killed him.

My father smoked and so did my step-mother and my step-father. It was accepted completely back then. For my 16th birthday, my mother gave me a carton of cigarettes and a cigarette case! I guess she thought if I was going to do it anyhow, she’d help me get started! I was 14 when I had my first smoke, and I was going out with a 16 year old girl. I really wanted to come across as a man not a boy. She said, “I’ll tell you what, if you take a drag of my cigarette I’ll let you put your hand on my breast!” That was it. I took that first drag, got my reward and then went on to smoke for the next 20 years!’

I was 30 and was making films, when I got the lead role in ‘I Dream of Jeannie’ with Barbara Eden. The show was a big hit and established me as a TV star. It was then that I read about the Surgeon General’s new report on Smoking and Health; it was big news. I read about it in Time magazine and thought, “Gee that sounds just like me, I must be addicted to cigarettes.” I tried to stop straightaway but soon discovered that it was very difficult.

I was doing a film in Italy, when I first started to worry about what smoking might be doing to my health. I had a really terrible cough, so I went to a local doctor for a check up. I couldn’t speak any Italian and the doctor couldn’t speak any English. When he showed me my X-rays, they had scary looking arrows drawn all over them. Struggling to find the right words, he said, “Morte, Morte!” I thought he was telling me that I was about to die, but looking back, I think he was really saying that I had to quit smoking soon. It really got to me.

I made a number of attempts to quit or control my smoking, none of which were very successful. Usually I’d manage to last for a day or two but then I’d be right back where I started. I tried switching to pipes, cigars and chewing tobacco; I tried all kinds of stuff but none of it worked. At most I could go for maybe two weeks without smoking and then … oh God was I miserable to be around! In the end I stopped cold turkey. I threw all my cigarettes away and hung on in there until the cravings went away. There were no treatments around to help you quit back then so I didn’t have much choice really.

Larry’s top three tips:

I’d recommend keeping a diary of when you smoke, so you can analyse your smoking habits and prepare to quit. Just the physical thing of writing it down will remind you of what you’re doing.

You have to stop using all forms of tobacco. Don’t make the mistake of thinking that light cigarettes or pipes or cigars will be any less harmful. Tobacco’s tobacco and it’ll kill you.

Don’t worry, be happy and feel good. As an ex-smoker and an ex-drinker I have more chance of feeling good for longer. As a matter of fact, I feel like I can walk on water!

Emphysema – you do not want this!

Sorry I didn’t get to post yesterday… busy, busy, busy!

I want to talk about some of the illnesses associated with smoking to provide some motivation for you to go on and learn how to quit smoking. If you have read many of my other posts you will know that I refer to learning how to quit smoking quite frequently. The gist is that you need to learn how to do things before you can do them successfully. The simplest example is changing a car tyre. It might seem obvious to you how to do it but you have to undo the nuts before yojack the car!

Anyway, I digress.

Emphysema is the disease I want to talk about today and it is a horrible disease so this is worth learning about!

When you smoke, the particles in the tobacco smoke are inhaled into your lungs where they stick to the membranes throughout your lungs. The particles cause the lungs to be irritated and as a result, you body tries to expel them, using cillia. The cillia though, become overwhelmed by another reaction to the cigarette smoke and that is the overactivity of the mucus glands within your lungs.

With mucus all over the cillia, they lose their ability to function and as a result, the particles (toxins) in the cigarette smoke remain in the lungs. This is why cigarette smokers have black lungs as opposed to nice pink ones found in non-smokers.

Having been overwhelmed, the lung’s next response is to swell up. The inflammation is a natural response to the continued irritation. (Think what happens when you get an insect bite.) When your lungs are inflamed, they release a mixture of enzymes and other metabolic chemicals into the surrounding tissue, but most notably the enzyme elastase is released in large quantities. Elastase breaks down the elastic proteins in the lung tissue. This reduces the lung elasticity which in turn makes the lungs less ‘rubbery’ and less effective for inhaling and exhaling air.

The lung structure breaks down and the vast numbers of highly flexible alvioli (air sacks) are replaced with a holed tissue that is inflexible and useless for absorbing oxygen into the blood. Furthermore, the lack of elasticity within the lungs prevents the sufferer from being able to exhale the air in these holes. The result is stale air that remains in the lungs doing absolutley nothing for the sufferer.

Emphysema is diagnosed using spirometry, checking lung volume and exhaling capacity/speed. Sufferers in early stages will find themselves becoming breathless very easily and often hyperventilate. Hyperventilation over-oxygenates the blood and results in a reddening effect of the skin. Early emphysema sufferers are often referred to as ‘pink puffers’ reddened palour. This is in direct opposition to bronchitis sufferers who become blue from lack of oxygen in the blood (known as cyanosis from the Greek word ‘cyan’ to describe their colour).

Emphysema leaves it sufferers struggling for breath and they often have to purse their lips to improve the effectiveness of their breathing. It is totally incurable and can only be managed with the use of bronchodilators, steroid medications and oxygen. Sufferers are largly incapacitated not only because they become so breathless, but also because treatment with oxygen means carting a 20kg bottle of oxygen everywhere with them.

The single most important contributing factor in emphysema cases is smoking and emphysema effects about 1 in 20 smokers in later life. If you die from it, you suffocate to death over a period of years with no quality of life whatsoever.

I hope that helps motivate you to quit smoking.