Stopping Smoking is its Own Reward Nicotine Monkey

In my research on smoking I recently came across a book and a website with the following titles: ‘Smoke-free in 30 days’ and ‘STOP SMOKING! in 28 days’, respectively.

Here’s a quote from the latter: ‘Getting hooked doesn’t happen overnight and getting unhooked is best done in the same way: over a period of several days.’

This is wrong on both counts. Smokers start with one puff on their first cigarette and then they carry on smoking – because they’re already hooked. And on what basis does the writer claim getting unhooked is best done over several days? Unless you stop smoking completely you’re still smoking! And the website goes on (and on) with encouraging statements such as, ‘Quitting can be a long and hard process.’

The book, likewise, in the very title sets you up for a hard time: it’s going to take 30 days to become smoke-free. A skim-through shows the method is based on nicotine products and it mentions the typical list of unpleasant withdrawal effects: depression, stomach upsets, insomnia, cravings, etc.

These sorts of books or websites are usually based on one person’s experience of struggling to stop smoking. They eventually succeed and then set out to cure the world of smoking by relating the difficulties they’ve had and assuming that other smokers will be in a similar position.

It’s a pity smokers are expected to have to struggle like this. A description of two people’s experiences is very different from my experience as a doctor who’s successfully treated hundreds of smokers in face-to-face sessions. I should add that most of what I know about smoking I’ve learnt from my patients.

The first thing I learnt is that stopping smoking needn’t be difficult at all; it can be surprisingly easy and even enjoyable. Second, the best way to stop is – just stop! It’s unfortunate that this is often referred to as cold turkey, implying you’ll go through a tough time after quitting abruptly.

What I’ve found is that smokers can indeed stop abruptly and experience very little trouble. It all depends on one’s attitude. If you expect to go through hell, that’s probably what you’ll feel. On the other hand, with the right information and support, quitting without a struggle is within any smoker’s grasp.

The problem is that nearly everyone, especially doctors, will tell you it’s going to be tough, and then they rub it in by mentioning a long list of unpleasant withdrawal symptoms as in the example above. (Try Googling nicotine withdrawal symptoms.) And it will take a long time: 28 or 30 days or even longer. There will inevitably be emphasis on nicotine treatment to help you get off your addiction to the nicotine in cigarettes. And if that doesn’t work, try a prescription drug for twelve weeks. You’re almost defeated before you start.

The good news, however, is that all this is nonsense. In my experience the reality is as follows:

Quitting smoking is easy
One session of ninety minutes to two hours is usually sufficient
The typical long lists of withdrawal symptoms are greatly exaggerated or untrue
The best time to quit is right now
Setting a ‘quit date’ is a bad idea
Nicotine products and prescription drugs make it harder to stop and should not be used

Furthermore, many smokers suffer from an additional major handicap: they don’t really want to quit.

This is illustrated by the following incident which occurred when I recently stayed at a friend’s house in London. Emerging one sunny morning I (GS) met a Polish labourer (PL) taking a break from his work nearby. He was smoking a cigarette. We exchanged greetings and a light-hearted conversation ensued:

GS: Good morning! By the way (pointing at cigarette) that’s bad for you!
PL: Everyone says that.
GS: Aren’t you worried about your health?
PL: You’ve got to die of something.

Now let’s suppose I’d approached this gentleman differently.

GS: Good morning! I see you’re smoking a cigarette. How refreshing! That must make you feel really good!
PL: Yes, I feel great after a cigarette.
GS: Does that mean then, that before you smoked it, you weren’t feeling good?
PL: Well, yes, I suppose you’re right.
GS: But why weren’t you feeling good before you smoked it?
Etc.

We can look at this situation from another perspective by considering the re-emergence, as October was again approaching, of an email I received from the Stoptober smoking cessation scheme run by Public Health England.

There was an invitation to ‘Watch Stuart’s story’. Stuart started smoking aged 13 or 14 and continued for 30 years, with one or two breaks. Eventually, his daughter persuaded him he ought to stop, and after a struggle, he did. There he is with a self-congratulatory smile on his face telling us all about it.

Now just a minute. Why are smokers who have managed to quit presented as if they’re such heroes? What have they achieved? They have finally stopped poisoning themselves with tobacco fumes. That’s all. Of course, in a sense that’s something deserving of commendation, but suppose they had been heroin addicts who had managed to quit before it killed them – what would we think about that?

Watch Kevin’s story: he used to shoot up five times a day in the last ten years, and now with the help of Stopvember he’s clean again. See, the needle marks are fading! How much healthier his veins are! Think of the money he’s saved!

Our fictional Kevin would probably hang his head in shame at the memory of having been a heroin addict. But there’s an important difference between Stuart’s and Kevin’s situations: nicotine use is legal whereas heroin is illegal.

I think the time has come to stop regarding ex-smokers as heroes. Although they will undoubtedly feel better from quitting, the damage to the DNA of the cells in their lungs and other organs leading to later cancer may be irreversible.

This is not to say that smokers are to blame. But governments, for knowingly since the early 1960s allowing the largely unrestricted sale of cancer-causing cigarettes, have a lot to answer for. Something as dangerous as tobacco should long ago have been banned. And it’s still not banned.

It also reflects the ambivalent and confused attitude of society to smoking: it can’t be as bad as they say – after all, if it were, it wouldn’t be allowed, would it? Give up smoking, however, and many congratulations! In contrast, how do we treat the addict shooting up in a public lavatory who by some miracle ceases to do it and leads a normal productive life again?

It all side-steps the reality of smoking as legalised drug addiction. It’s OK to smoke. Well, not really, but you may do it walking along the street and all that will happen, if anything, is that people nearby will hold their noses.

‘Everyone says that. You’ve got to die of something!’

The picture is an engraving, ‘Tobacco Smoking’, by Johan van Beverwijck (1594–1647). Credit: Wikimedia Commons.