No Smoking
As the near-total smoking ban in Spain comes into force, the rush is on for smokers to find effective treatments to help them give up their habit. But what are the best ways to quit smoking and how can you work out which method will work for you?
Peter Allegretti has helped hundreds of smokers become non-smokers.
Here, the Barcelona-based clinical therapist guides us through the maze of treatment possibilities.
The smoking ban in Spain is big news. Newspapers and TV news programmes have been filled with reports of medical centres and health care professionals inundated with requests for information about ways to stop smoking. An internet search will guide you to many thousands of pages extolling the virtues of different ways to quit smoking and warning against the ineffectiveness of others. Some methods are researched and tested - others are more esoteric or experimental.
Information overload
Having treated hundreds of smokers in my practice, I am struck by how many methods people have tried. As soon as I think I have heard them all, a patient tells me about a new product. Recently a woman came from Sweden to see me and brought with her an arsenal of gums, sprays and tobacco substitute pouches which all suggested a cure for smoking. Evidently they were of limited effect for her. More and more products are appearing at the chemists and online. There also appears to be increasing confusion about what works and what doesn’t.
To simplify things, we can break down the mainstream treatments into two main categories: Psychological/Behavioural and Chemical/Pharmaceutical.
The facts
Let us first start with the basics. Everyone agrees that smoking lowers your quality of life and can kill. Not a single smoker can say that their health and wellbeing is improved by smoking. That is not to say that some people truly enjoy smoking or that smoking is perceived to be “helpful” in certain situations. The truth is that there is nothing wrong with the “ritual” around smoking – the trouble begins the moment you inhale tobacco smoke, either actively or passively.
Here in Spain, 50,000 people die prematurely every year from smoking and smoking-related illnesses. More than 15 percent of all deaths in this country are smoking related – that’s ten times higher than people who die in road accidents. It is of course by far the biggest cause of lung cancer and bronchial conditions and a heavy contributor to heart disease. The range of knock-on effects is long and ranges from aged skin to reduced sexual ability.
What is actually causing the danger?
The two main problems with cigarettes are nicotine and toxins inside them. Nicotine is a highly addictive drug which can cause dependency very quickly – even after just a few cigarettes. Curiously, it can act as both a stimulant and a depressant. This accounts for why some people smoke to give themselves a boost while others use it to relax. Sometimes the same person can use it for both. It is the nicotine that creates the cravings and which can cause unpleasant withdrawal symptoms when trying to quit.
The more damaging aspect of smoking to your physical health is the range of harmful chemicals you inhale with each puff. The list is long and frightening and includes such toxins as arsenic, formaldehyde, ammonia, acetone, benzene, cadmium, hydrogen cyanide, tar, carbon monoxide, naphthalene, along with hundreds of other chemicals.
But we’ve heard all these things before. So why do people keep smoking?
Largely, it appears to boil down to habit, nicotine, and social acceptability. It is still legal to smoke and in many cases, still acceptable. Nevertheless there is a growing demand for treatment using both researched and unresearched methods to stop smoking which is being accelerated by the smoking ban.
Psychological treatments
Psychological treatments such as clinical hypnotherapy and/or cognitive-behavioural therapy (CBT) are the frontline approaches for breaking the habit and behaviour of smoking. A large part of smoking is simply the repeated action of smoking combined with the habitual association with certain moods or times of day. By understanding more about why you are smoking and working out what you can do instead of smoking to bring you the same benefit, you will have a strong basis for change. A qualified clinical hypnotherapist will work with these behavioural aspects and also include a session of hypnosis which will allow the unconscious mind – the part of the mind in which habits like smoking are stored and maintained – to adopt these new habits on a deeper level.
A therapist with a purely cognitive/behaviourist approach will examine all aspects of your smoking habit and work with you to consciously recognise your thoughts and actions around smoking and what it is doing for you at the moment you light up – and then come up with replacement activities and new thoughts which don’t involve smoking.
There are also many self-help style workbooks which provide templates to help you work out some of this information for yourself.
Nicotine Replacement
But what about the nicotine cravings? Interestingly, the strength of nicotine dependency decreases quickly once you quit the habit. Within 48 hours of stopping smoking, nicotine is eliminated from your body. So it follows that the most testing period of being a non-smoker is the first few days after stopping smoking.
If you choose to go the Chemical/Pharmaceutical route, there is a range of nicotine replacement products which take the form of gums, patches, inhalators, microtablets, lozenges and nasal sprays. These fall under a treatment category called NRT (Nicotine Replacement Therapy). They are usually sold over the counter by a pharmacist who can advise on dosages and costs. They can also be prescribed by a doctor.
Pharmaceutical options
Beyond NRT, there are a couple of drugs on the market which are meant to reduce the severity of nicotine cravings but which themselves are nicotine-free. Their generic names are Bupropion and Varenicline though they are marketed under different names and formats in different countries. These are prescription drugs which require medical visits to assess their suitability for each patient. Some of these you can get at reduced cost under the national health system. Varenicline is a ‘nicotinic receptor partial agonist’ while Bupropion is both an antidepressant and a ‘nicotinic acetylcholine receptor antagonist.’ In essence, they act to reduce the sensation of cravings. Medical doctors may prescribe these to patients wanting to stop smoking. Close medical attention must be paid to the treatment programme and any secondary effects.
So which of these is the most effective?
That is the Million Dollar Question. And the answer is that it is impossible to give a definitive answer. No method is 100-percent. As I have found in the course of my work, each and every smoker comes with a unique combination of circumstances, habits and mindset. This means the ability of the therapist or health professional to diagnose the many aspects of a smoker is a critically important element in selecting an appropriate treatment or combination of treatments. Although a considerable part of my practice is to help people stop smoking with Hypnotherapy and CBT, I reject a number of people who seek me because questioning reveals that this is not the treatment for them. In those cases, I may refer them to medical practitioners. Conversely, pharmacists and doctors refer patients to me who are not having success with pharmaceutical treatment and who they feel will benefit from a psychological-based treatment. Unfortunately, there is no “magic pill” or single method which will make every smoker a non-smoker forever. The overall success rates of each type of approach vary widely depending on how they are measured and how the studies are conducted.
The key to success
The single most important ingredient for successfully stopping smoking is the person’s genuine and whole-hearted desire to be a non-smoker. Even the responsible pharmaceutical companies agree. The “magic pill” is really your true and ongoing desire to be a non-smoker. The different treatment alternatives available to help get you there can all be effective - if they are right for you.
If I really want to stop smoking, what should I do next?
• Read up on the different treatment methods available and then focus on the ones that resonate with you. Listen to your instincts.
• Send away for free information from health authorities and organisations who will give you unbiased advice. (see links at end of this article)
• Talk to friends and people you know about how they quit smoking. You will probably hear a range of stories about what was effective for them. Remember, however, that their experience may not be your experience - everyone is unique.
• Follow up by talking to respected therapists and health practitioners.
• It is a good idea to talk to your doctor about this. He or she can guide you through the various options. Bear in mind, however, that many GPs here are trained to only consider pharmaceutical protocols and may not know about treatments outside of their domain unless they are specialists.
• If you choose a therapist, a good reputation and word-of mouth is paramount. Check to see if they have a website with further information. If they sound interesting, call or email them with a specific enquiry or any general questions you may have. Ask about their methods and success rates.
• When you have firmly decided to become a non-smoker, set about putting together a list of reasons why you want to stop smoking – not just reasons why you think you “should” stop smoking. Add to it every time you think of a new reason.
There are three final points to keep in mind.
The first concerns cost. Each treatment method implies some sort of cost to you, but you need to weigh this against how much you are spending in cigarettes. Work it out by multiplying the cost of a pack of cigarettes by the number of cigarettes you smoke in a month or a year. The number may well surprise you. For example, a pack-a-day smoker paying 4.00 € per pack spends nearly 1,500 € per year in cigarettes. That’s fair a chunk of money. The cost of treatment will therefore pay for itself many times over.
The second concerns willpower. I am often asked if willpower alone can stop someone smoking. The answer is “yes,” it can be done, provided that the person’s willpower is at 100 percent all the time and particularly in “trigger” situations. But if you are a regular smoker, willpower or “cold turkey” is by far the most difficult way to give up smoking.
The final point is about relapse. If you have relapsed you are in a better position to have success in future because you have been a non-smoker for a period of time and have experienced the tremendous benefits of a healthier body and a clearer mind. Details about the moment of relapse will give the therapist or health professional an important piece of information about how to treat you now with a view to becoming and remaining a non-smoker. Rather than view a relapse as a failure, stay confident and know that if you’ve done it before, you can do it again.
http://www.msps.es/ciudadanos/proteccionSalud/tabaco/ayuda.htm (Spanish Health Ministry - A number of publications on how to stop smoking)
http://whqlibdoc.who.int/publications/2010/9789241599511_eng_Chapter8-9.pdf (World Health Organisation report on Smoking)
http://www.cdc.gov/tobacco/ (US Centers for Disease Control - Smoking information)
http://smokefree.nhs.uk/ (UK NHS website with lots of resources and information)
Peter Allegretti is a qualified therapist with clinics in Barcelona and London. He specialises in solution-focussed therapies for effective change using Clinical Hypnotherapy, Cognitive Behavioural Therapy and Neuro-linguistic Programming. He has been based in Barcelona since 2004. You can contact him at peter@allegretti.net