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Break Free from Tobacco Use

by Maher Karam-Hage, MD, and Paul Cinciripini, PhD

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People recently diagnosed with cancer are trying to adjust to their new reality. They are either working to understand their illness or coping with their treatment and the unwanted side effects of surgery, chemo­therapy, or radiation. Moreover, the daily stressors of life are magnified by loss of income due to inability to work, disruption of family relationships, changes in daily routines, and added strain to ex­isting interpersonal conflicts.

Tobacco use need not be one of these stressors. One of our goals in the tobacco treatment program at MD Anderson Can­cer Center is to help people stop smoking while also learning how to deal with guilt and shame about not being able to quit.

The first question we ask a smoker is, “What are the advantages of smoking?” This question surprises most people be­cause they expect us to barrage them with negative statistics or forcefully try to persuade them to quit. When individu­als answer this question, we hear similar themes in their responses: “Smoking helps me relax when I’m anxious or irritated.” “The cigarette is like my best friend be­cause it’s always there for me.” “It’s a way for me to escape. Whenever I want to get away from people, I can always go outside and smoke.”

Author of Article photo

Dr. Maher Karam-Hage

Tobacco cessation isn’t just about willpower or changing a habit; it’s a biological process driven by the addic­tive nature of nicotine as a powerful drug. Plus, people often learn to asso­ciate smoking with common activities and situations, such as talking on the phone, driving, drinking coffee or al­cohol, and waking. When you have coupled smoking with these activities for years, disassociating the two actions can be extremely difficult.

For instance, some people automati­cally reach for a cigarette at the conclusion of a meal. Smoking and completing a meal become inextricably linked, with one event even triggering the other. By breaking or changing these connections, you can begin to control your smoking behaviors. You may have spent many years learning these associations, and it can take a long time to change. Behav­ioral counseling can assist in changing these patterns.

Author of Article photo

Dr. Paul Cinciripini

While not all smoking triggers can be eliminated, you can employ effective strategies in preparing to quit. In particu­lar, a scheduled reduction technique consists of keeping a record of personal smoking triggers and noting the time of day and the situation when you usually smoke. Once you know your triggers, you will be better prepared to deal with them. Cutting back in a systematic fash­ion helps desensitize you to cigarette triggers and to extinguish your cravings for them.

By making the decision to quit, you must be ready to give up your reasons for smoking and find healthier alterna­tives to achieving the same goals. For example, if smoking serves as a means of relaxation, then you will need to find new ways to relieve stress. One of the easiest relaxation techniques is controlled breathing. By breathing in a slow, con­trolled manner, you can calm your mind and relax your body. Taking a deep breath and holding it for a few seconds before breathing out slowly also has a calming effect. Repeating this process several times helps many smokers reduce tension.

When encouraging people to make the commitment to quit smoking, we often emphasize the importance of rec­ognizing and understanding their reasons for quitting. The health benefits of stop­ping tobacco use are well proven and significant. Quitting smoking translates into better recovery from surgery and better response to radiotherapy and chemotherapy. We often encourage people to write down their reasons for breaking the smoking cycle and to carry these lists around with them as remind­ers. Health, money, and freedom of addiction are some common benefits that people list. In addition to behavioral strategies, a motivational interviewing approach can help those ambivalent about quitting reach the level of com­mitment needed to attempt to quit.

Several medications are also available for tobacco cessation. Those products effectively increase your chance of breaking the dependence on nicotine. Numerous clinical trials have proven that nicotine-replacement medications, such as the patch or gum, and prescrip­tion medicines, including bupropion (Zyban®) and varenicline (Chantix®), are effective tobacco-cessation agents.

The decision and action necessary to stop smoking is not easy, but it is cer­tainly possible. Some people need to try up to ten times to quit, with the average being five or six. Many people, includ­ing those who have smoked for more than 60 years, have successfully stopped smoking. Understanding your motiva­tion for using tobacco is the first step, followed by creating an individualized tobacco-cessation plan. Then pursuing behavioral counseling and starting one or more smoking-cessation medi­cations can dramatically increase your chance of becoming and remaining tobacco free.

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Dr. Maher Karam-Hage is an associate professor in the department of Behavioral Science at The University of Texas MD Anderson Cancer Center in Houston, TX and a Fellow of the American Psychiatric Association. Dr. Paul Cinci­ripini is a professor and deputy chair of the department of Behavioral Science and director of the Tobacco Treatment Program at MD Anderson.

This article was published in Coping® with Cancer magazine, March/April 2012.

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