How to Stop Smoking (?)

Is this a statement or a question?

In either case it’s a strange idea. Where does the how come into stopping doing something? If people want to stop smoking why don’t they just stop? Why does it seem to be so difficult?

Many methods, ways, techniques, systems, or ‘tools’ for smoking cessation are on offer on the internet and in books. But there is a huge assumption here: why should you need a method, way, technique, etc., to stop smoking?

One method to be found on the internet is called Craving to Quit. The catchy name merely reinforces the idea that ‘craving’ is something a would-be quitter will have to deal with. Craving to Quit uses mindfulness, as it’s known, and involves a twenty-one day course. It was compared in a trial of smoking cessation with a course called Freedom from Smoking run by the American Lung Association—though since this lasts for six weeks it’s not really equivalent. A mere seventeen weeks after starting either method it was found, in the small numbers of participants (84 in total), that most were still smoking: 69% v 94%, respectively. In spite of these methodological flaws it’s claimed by the person who promotes Craving to Quit that it’s been scientifically proven to be effective in smoking cessation.

Smoking is a voluntary activity. Therefore it’s questionable that any method of smoking cessation can be properly assessed in a scientific trial. This is completely different from scientific trials in the treatment of disease. If someone is suffering from, say, a stomach ulcer, it can be objectively diagnosed and treatment A can be compared with treatment B. But a stomach ulcer comes unwanted and unbidden and if the patient is cured he or she would normally do anything to avoid a recurrence. With smoking, on the other hand, if a smoker stops after using method X for one year, and the next day starts smoking again, would this mean method X has failed? No, it would mean the smoker has changed his or her mind about wanting to be a non-smoker.

There are a number of other assumptions in many of the current approaches to quitting: that it’s very difficult to achieve on your own, you will need some method or technique to help you, cravings are involved, you should prepare yourself for the great quit attempt day, and it will take weeks or months to succeed, if it does. These ideas are copied from one internet site or book to another as if they are gospel truths.

It’s sometimes found that when a problem seems insoluble and there are many competing claims for effectiveness, one needs to reconsider the whole foundation on which the current approach is built.

When I first became interested in smoking cessation I started with no preconceptions. But everything I now know about smoking I have learnt from my patients, that is, from the hundreds of smokers I have helped in face-to-face sessions. What has emerged from this is that almost everything most people believe about smoking is wrong.

Stopping smoking is easy, not hard; setting a ‘quit date’ is counter-productive; nicotine patches or drugs hinder quitting and should not be used; gimmicks such as hypnosis, magnets in your ears, laser treatment, twelve-steps, etc., are just that—gimmicks.

For easy quitting, smokers need to be helped to demonstrate to themselves two things: why they really smoke (as opposed to why they think they smoke), and why smoking seems so hard to stop.

But we have a further difficulty: many smokers, in spite of what they may say, don’t really want to quit. This is shown in the following recent situation in which I was involved.

I met an old friend for dinner at a restaurant. I knew he used to smoke but decided it wouldn’t be appropriate to discuss this unless he raised the matter first.

We had an interesting and pleasant chat over good food and wine. Then we walked towards the main road to get a taxi. He was going in the same direction so I thought we could share the ride. But for some reason he didn’t want to go home straight away in spite of the late hour. He wanted to stretch his legs first. All right, let’s take a stroll together and continue our conversation. This wasn’t agreeable to him. Then he confessed: he wanted to smoke. Why? Because it would be so enjoyable after the meal! Was I missing something? I had had a pleasant evening with him and felt quite content—yet my friend wasn’t happy. He needed to top up the nicotine level in his brain to relieve the discomfort he was in, though it was so mild it wasn’t even recognised as such, and then he would feel he’d had a great evening.

The tragedy of smoking is this: even if smokers have it pointed out to them that inhaling burning tobacco fumes into their lungs is not inherently pleasurable—it’s an awful thing to do to oneself—but only relieves the discomfort of the withdrawal symptoms of the nicotine provided by the previous cigarette, they are so stuck in the illusion of pleasure that they can’t face letting it go. However, once the cycle is broken the discomfort goes away and all you are left with is the memory of an illusion. Staying stopped is then simply a matter of not lighting up again. Otherwise they’re in a similar situation to that of a wild bird kept in a cage for a long time: if the cage door is left open the bird doesn’t want fly away but will stay where it is.

What smokers don’t realise is that the only thing they will lose by quitting is the desire to smoke.