I want to quit smoking

Published on: 10/12/2014
Tobacco

1. Introduction

We present this handbook, structured in 10 chapters, where inform of effects of smoking as well as of techniques more used to stop to smoke. It requires a time between 30 and 60 minutes for its complete reading.

Quitting smoking cannot be considered just one action at a given point in time. It is a process with different phases:

  • Planning phase: Knowledge and understanding of the extent of the risks associated with continued tobacco use.
  • Mentalising: The person recognises that quiting smoking is always positive. They recognise that it is possible to quit smoking. They mentally prepare to quit smoking.
  • Quit smoking: Never smoke again. Avoid possible relapses.

A lot of smokers do not manage to give up smoking on the first attempt and they often fail once or more, but it is not impossible. When a smoker has tried to quit smoking several times, they need to analyse the previous attempts:

  • How and when was the relapse?
  • Were there withdrawal symptoms?
  • What were the most difficult times and how were they managed?

  • It can be a good moment for one thing a programme of physical activity, in its address or carrying out some mild sport.
  • Another idea is to start up or restart a hobby, social activity or manual work that keeps you busy or helps you to feel better.
  • Make a list with the three or four important reasons for you to quit smoking and always leave it in a visible place.
  • When giving up smoking, it is very important to have a positive attitude that will help you get through the difficult times.
  • Convince yourself that you can do it.
  • It might also be a good idea a few days before quitting smoking to change your brand of cigarettes for one that you don't like so much.
  • Try to smoke 5 or 6 cigarettes less a day.
  • Try to reduce the number of cigarettes that you smoke per day as much as you can a few days before the day that you choose to give up smoking.
  • Try to postpone the first cigarette of the day as much as possible.
  • Set yourself small goals: skip the cigarette after lunch, only smoke one cigarette after dinner until you go to bed…
  • Practise with the urge to smoke. Try to hold out as long as possible before lighting a cigarette.
  • If you have to go out for a couple of hours, leave your cigarettes at home. Learn how to resist.
  • Do not buy boxes of 200 cigarettes. Buy one packet at a time.

Day for quitting smoking

  • It is advisable that on the day that you choose to give up smoking, you should not smoke at all from the moment you wake up. For the first few days, try to avoid the company of other smokers. If this is not possible, stay busy when you are around them.
  • Do not drink too much coffee, coke or other stimulant drinks.
  • Get up from the table as soon as you finish eating.
  • Wash your teeth immediately after meals. The change of taste will give you less of an urge to smoke.
  • For the first few days, do not do any activities that you associate with smoking.

Reflections on the habit of smoking

Take 5 or 10 minutes to think seriously about these questions:

  • Why do I smoke?
  • What does smoking mean for me?
  • Do I want to smoke for the rest of my life?
  • What do I achieve from smoking?

Write a list of the five most important reasons for you to give up smoking:

  1. ___________________________________________________________
  2. ___________________________________________________________
  3. ___________________________________________________________
  4. ___________________________________________________________
  5. ___________________________________________________________

Now write five reasons why you continue smoking:

  1. ___________________________________________________________
  2. ___________________________________________________________
  3. ___________________________________________________________
  4. ___________________________________________________________
  5. ___________________________________________________________

Ask yourself this question:Do I really want to quit smoking?

Effects of smoking on health

The conclusion that various studies have reached when analysing the relationship between tobacco and health is that it is the primary environmental agent that causes human pathology.

Diseases associated with tobacco that have an obvious effect are lung cancer specifically and other types of cancer in general, such as cancer of the pharynx, larynx, urinary bladder, etc., but there are other organic disorders that occur when a person inhales tobacco smoke and it accesses the blood system via the pulmonary alveoli and damages a lot of systems.

Tobacco and cardiovascular diseases

29% of deaths for coronary heart disease are due to cigarette smoking. The mortality rate for heart attacks is a lot higher among smokers than non-smokers.

Tobacco speeds up coronary artery atherosclerosis.

Tobacco and cerebrovascular disease

Several studies have demonstrated that smokers have a 50% higher risk of suffering a cerebral vascular accident (embolism) than non-smokers.

Tobacco and respiratory disease

As the lungs are the organs that receive the toxic substances of tobacco smoke most directly, they are the most affected organs and most damage to the body occurs here.

There is also an increase in bronchial secretions that promote superinfection by a virus or bacteria, as bronchial hypersecretion is a good culture medium for microorganisms.

Smoking has also been associated with snoring and sleep disorders (sleep apnea).

Tobacco and reproduction

Tobacco delays foetal growth and there is a higher incidence of children with low weight, as well of prematurity, miscarriages and childhood diseases.
Recent studies show a connection between infertility in both men and women and smoking.

Female smokers have a premature menopause. Men show sexual dysfunction, impotence and alterations in sperm formation.

Tobacco and skin

Tobacco has also been associated with the acceleration of the skin aging physiological process, resulting in premature facial wrinkles; fine wrinkles appear on the top lip and the outer corners of the eyes (“crow's feet ”), because tobacco smoke alters the elastic fibres in the skin.

Tobacco and oral and gum disease

The most common disorders are:

  • Halitosis (bad breath) and tooth discolouration (yellow teeth)
  • Slight increase in tooth decay
  • Decrease in both taste and smell senses, as the gases and particles present in smoke damage the olfactory receptors and taste buds.

Tobacco and eyesight

The risk of cataracts is increased in smokers and it is linked to the number of cigarettes smoked.

Benefits of quitting smoking

The benefits of quitting smoking are mainly:

  • Five years after giving up smoking, the risk of a stroke decreases to be on a par with that of non-smokers.
  • Breathing improves quickly (walking up stairs, running to catch a bus, etc.)
  • The chance of getting a cough, colds or other infections of the respiratory tract decreases.
  • The skin and face recover from premature aging caused by tobacco smoke.
  • The bad breath of smokers, nicotine-stained teeth and fingers, bad smell of hands and clothes all disappear as soon as you quit smoking.
  • The senses of taste and smell improve.
  • The risk of a gastric/duodenal ulcer is reduced and healing is faster in the event of developing an ulcer.
  • The weight of the foetus ireturns to normal during pregnancy.
  • Children of non-smokers have fewer respiratory problems and it is less likely that they will become smokers.
  • Family and friends can enjoy cleaner air.
  • It improves the quality of life.
  • Economic savings.

Withdrawal syndrome

When an addicted person abstains from smoking or reduces the number of cigarettes that they usually smoke, the levels of nicotine in the blood decrease and this creates the withdrawal syndrome.

This syndrome consists of the symptoms experienced when a person gives up smoking, which is a good thing, because it means that the body is cleaning itself and removing all the harmful chemical substances of the cigarette. These symptoms vary in intensity and duration from one individual to another and they are the main reason that a person relapses and starts smoking again.

The nicotine in tobacco has great powers of addiction, People smoke because it affects their mood due to the sensation of pleasure that it produces and to avoid the unpleasant symptoms that a lack of nicotine in the body causes.

Symptoms start 6-12 hours after giving up smoking and they peak on the second or third day, lasting an average of three or four weeks.

It is necessary to point out that withdrawal syndrome is very frequent, but some smokers do not experience it when trying to quit smoking.

The table below indicates the symptoms of withdrawal syndrome, how long it can last and recommendations to allieviate it:

 

Symptom

Cause

Duration

Relieve it

Irratibility, anger, frustation
The body is requesting nicotine
2-4 weeks
Go out for a walk, a swim, relaxation techniques
Tiredness
Nicotine is a stimulant
2-4 weeks
Have a nap, take it easy
Insomnia
Nicotine affects the function of the brain waves
2-4 weeks
Avoid drinking coffee in the evening, relaxation techniques
Cough, dry throat, runny nose
The body segregates the mucus that obstructs the airways
A few days
Increase the intake of liquids
Dizziness, headache
The body is receiving more oxygen and less carbon monoxide
1 to 2 days until 1 to 2 weeks
Change positions slowly, relaxation techniques
Anxiety, restlessness
Due to lack of nicotine and stress
From days to weeks
Relaxation techniques
Decrease in concentration
The body needs time to adapt to the lack of stimulation from nicotine
A few weeks
Plan the workload, avoid situations of stress
Constipation, gas, stomach pain
Bowel movements decrease for a few days
1-2 weeks
Increase the intake of liquids, a high fibre diet
Increase in appetite for food
You can confuse the desire to smoke with hunger
Several weeks
Drink water or hypocaloric drinks
Intense desire to light a cigar
Due to physical and psychological dependence on the nicotine
Between 2 and 4 days to months, even years
Wait for the desire to pass, it lasts a few minutes, do something distracting, do exercise

How to deal with the withdrawal syndrome?

When you have a strong desire to smoke:

  • Drink a glass of water or fruit juice, chew sugar-free chewing gum, etc.
  • Keep your hands busy with rubber bands, keyring, etc.
  • Strongly reaffirm your decision
  • Breathe in slowly and deeply several times holding the air in your lungs, and breathe out slowly.
  • Change activity, do something that you enjoy (like chatting to a friend, reading, etc. but don't eat).

It is necessary to learn how to obtain satisfaction in other ways that do not involve smoking. This is an important step for becoming a non-smoker.

Recommendations for avoiding relapses

  • Look at non-smokers and compare them with people who have not yet given up smoking.
  • If you in the company of smokers, tell them that you are trying to quit smoking and ask them not to smoke beside you.
  • Throw out all cigarettes, ashtrays and lighters.
  • Do not go to places where you used to buy tobacco
  • Avoid places and situations where you usually smoked
  • Avoid alcoholic drinks, as their consumption reduces self-control
  • Discover other alternatives to tobacco to channel stress
  • Do physical activity.
  • Plan rewards for yourself for keeping off the cigarettes
  • Do not think: “just one cigarette and that's all”

Relaxation technique

To get through the most difficult times when you are trying to quit smoking, relaxation techniques can be of great help, as they help to reduce muscle tension, reduce your heart rate and blood pressure and make you feel more relaxed.

Relaxation techniques are particularly beneficial when they are carried out twice or three times a day.

We have described a very effective technique below:

  • Find a quiet place where nobody will bother or interrupt you for at least 15 minutes and get comfortable.
  • Close your eyes and let your breathing relax, breathe in slowly through your nose and out slowing through your mouth. Repeat a phrase like “I am relaxing” or imagine that you are in a very peaceful place.
  • Place a hand on your stomach and learn how to breathe with your tummy, noticing how it moves. When you breathe in, notice how your stomach pushes out for the lungs to expand. When you exhale the air, press gently on your stomach.
  • After this phase of regular breathing, inhale slowly and deeply and keep the air in your lungs for 3 or 4 seconds, and then release it slowly. Repeat 3 or 4 times. Feel how the tension starts disappearing and how you begin to feel increasingly more relaxed.
  • Change position and gently stretch your arms and legs. Open your eyes.

In emergency situations and/or iwhen you can't stop to do the whole technique the following may be very useful:

  • Breathe in slowly and deeply through the nose.
  • Hold the air in your lungs for 5 to 6 seconds.
  • Exhale slowly through the mouth until you empty your lungs (without forcing).
  • Repeat 5-7 times.

Maintain the weight

Weight gain is one of the biggest causes of relapse according to smokers.

This increase is very variable, but it is usual to gain 3 or 4 kilos.

From a health point of view, the weight gain is a much smaller risk than to continue smoking.

The reasons for putting on weight after quitting smoking are:

  • There is an increase in appetite
  • The metabolism of smokers is accelerated and this normalises when they give up smoking, leading to a small weight gain.
  • The anxiety generated by abstinence is often substituted by an increase in eating.

To avoid or to limit this weight gain, it is recommended to practise a more healthy way of life:

  • Stay active: do a light sport, long walks at least 3 or 4 times a week.
  • Modify your diet: increase your intake of fruit and vegetables, limit fats and alcohol, avoid refined sugars, cakes and pastries.
  • More suitable cooking techniques are using the griddle, baking or boiling.
  • If the anxiety of the first few days makes you want to snack constantly, make sure that you snack on fruit and vegetables.
  • Drink a lot of water to make you feel fuller. During moments of anxiety, drink a big glass of water in 2 or 3 gulps, and the feeling of fullness that it gives you will help you through this moment without ingesting a single calorie.
  • If you are capable of doing something as difficult as giving up smoking, you will definitely find it much easier to lose the few pounds that you might put on in the process.

Quit smoking

Introduction

At the start of the 16th century, after the discovery of the New World, Spain brought the leaves and seeds of a plant to Europe that the conquerors had started to call tobacco. Tobacco was considered to be an effective choice to heal or alleviate illnesses such as deafness, eczema conditions, migraines, toothache, blindness and even to fight coughs and chronic asthma.

After the initial dazzle and euphoria, in the mid-17th century, scientific discredit started to take shape as regards the more noteworthy and hypothetical medicinal virtues of this plant.

During the 17th and 18th centuries, the most popular types of tobacco consumed were cut tobacco, powdered and snuff, which were chewed or inhaled. Smoking tobacco as such did not become popular until the early 19th century. During all this time, the various ways of using tobacco were the social practice of a minority group, generally the elite.

This situation changed drastically at the end of the 19th century due to a series of key modifications in the cultivation, processing and marketing processes of the plant in industrialised nations, which triggered an exponential rise in tobacco consumption during the first half of the 20th century.

The takeoff of this mass use occured in the 1920s in the United States, between the 1930-1940s in Central Europe, and in the 1950s in Spain.

Tobacco constitutes a serious public health problem and it is the most pressing public health problem. Smoking cigarettes is the main cause of avoidable death in our country.

When smoked as a cigarette, in less than 10 seconds, the inhalation of the tobacco smoke has reached the lungs and crossed the blood-brain barrier. That is why it can be so addictive, acts so quickly and is such a powerful booster.

Another significant component of the burning of tobacco is tar. It has a wide variety of components, some of which are carcinogens (eg. benzo(a)pyrene) or co-carcinogens. It is responsible for lung cancer, other cancers and various respiratory diseases. And along with these is the highly toxic carbon monoxide (CO) that plays a significant role in foetal injuries, low birth weight, acute heart attacks, sudden death, arteriosclerosis and chronic respiratory diseases.

Current evidence shows that 50% of people that smoke will die because of tobacco.

Tobacco consumption is the main cause of avoidable disease and mortality in the world. It is responsible for 5 million deaths in the world every year (around 13,500 deaths per day) and if no forceful measures are implemented to counteract this trend, this figure will rise to 10 million in 2020. In Spain, 56,000 people die every year because of tobacco.


Tobacco is addictive. Nicotine is the substance that causes the addiction.

The consolidation of tobacco use is determined by biological, psychological and social factors. The three factors are interlinked, just like with any other drug. The pharmacological-behavioural processes that cause addiction to tobacco are similar to those for other substances.

Substance dependence disorder according to DSM-IV-TR

  • Pattern of repeated self-administration
  • Tolerance
  • Abstinence
  • Compulsive use
  • Irresistible need to use

The psychopharmacological effects of nicotine are due to the boosting power of nicotine through positive reinforcement (satisfaction, pleasure, enjoyment) and negative reinforcement (avoiding the negative effects of abstinence).
The continued consumption of nicotine produces tolerance, dependence and physical and psychological withdrawal symptoms when people quit smoking.

The smoker establishes different associations that are conditioned by the powerful booster that is nicotine, in various psychological and social states. Conditioned associations are gradually established and, in the end, the smoker has to smoke in many different situations and nicotine fulfils a great number of functions as a psychological tool to regulate a bad mood, reduce stress, control weight, etc.

Substance dependence diagnostic criteria according to DSM-IV-TR

Three or more of the following:

  1. Tolerance
  2. Abstinence:
    Withdrawal syndrome.
    Usage to avoid symptoms.
  3. Loss of control.
  4. Unsuccessful desire to quit.
  5. Excessive dedication to the substance.
  6. Limitation of the range of activities.
  7. Continued use despite consequences. 

Nicotine abstinence diagnostic criteria according to DSM-IV-TR

  1. Continued consumption of nicotine.
  2. Suddenly stopping smoking with four or more of the following: The symptoms cause significant discomfort
    1. Insomnia
    2. Depression
    3. Irritability
    4. Anxiety
    5. Difficulty to concentrate.
    6. Restlessness
    7. Decrease in heart rate.
    8. Increased appetite and/or weight.
  3. The symptoms cause significant discomfort.
  4. The symptoms are not made clearer for another physical or mental disorder.

Epidemiology

According to recent data available in Spain, between 35 - 40% of the general population smokes. Of these smokers, 10% are occasional smokers, whereas the rest can be considered dependent.

Tobacco use among men has gone down, but it has increased significantly among women, while the prevalence among young people remains the same.

Estimate of deaths / year related to tobacco use

  • 1990: 3 million deaths / year.
  • 1998: 4 million deaths / year.
  • 2000: 5 million deaths / year.
  • 2020: 8.5 million deaths / year.
  • 2030: 10 million deaths / year.

World Health Organisation (WHO, 2000)

Tobacco and Health

Smoking causes a great number of cancers, especially lung cancer, which is the most common cancer in males and the second most common in females. Other cancers that are clearly related to smoking are those of the oral cavity, oesophagus, larynx, bladder and pancreas. Smoking is the main cause of chronic obstructive pulmonary disease (chronic bronchitis and emphysema). Another set of diseases where tobacco is very much associated are the cardiovascular diseases. We know the consequences of a pregnant woman smoking for the foetus (as a passive smoker), as low birth weight, a higher chance of miscarriage, premature births, perinatal death, complications with the placenta and a higher rate of childhood illnesses. Smoking also contributes to impotency in males, alterations in the formation of sperm and premature skin aging.

In Spain, almost 56,000 people die prematurely from smoking cigarettes. If you want to reduce the risk of developing cancer, the best thing that you can do is to quit smoking.

Mortality attributable to tobacco

  • 85% of deaths due to lung cancer.
  • 80% of deaths due to larynx cancer and oesophagus cancer.
  • 30% of deaths due to cancer of the bladder.
  • 75% of deaths due to COPD.
  • 25% of deaths due to ischemic heart disease.

Passive Smoking

Passive cigarette smoking this is the involuntary exposure of non-smokers to environmental tobacco smoke (ETS). This is a combination of lateral smoke with the exhaled primary smoke that comes from the lit cigarette as a main contributor of ETS and from the smoke exhaled by the smoker.

Environmental tobacco smoke contains more than 4,000 compounds, of which about 50 are carcinogenic, plus others that are irritants, toxic and mutagenic.

Irritants and toxic

  • Ammonia
  • Formaldehyde
  • Carbon monoxide
  • Nicotine
  • Toluene
  • Nitrogen dioxide
  • Hidrogen cyanide
  • Acrolein
  • Acetaldehyde

Carcinogens

  • Benzo[a]pyrene hydrocarbons
  • Tobacco-specific nitrosamines
  • 2-Naphthylamine
  • 4-Aminobiphenyl
  • Benzene
  • Vinyl chloride
  • Arsenic
  • Chromium
  • Polonium-210

 

Passive cigarette smoking occurs in different ways:

Mother's womb, home (smoker parents to non-smoker children or smoker spouses to non-smoker spouses), work environments, public places (offices, bars, restaurants) and in vehicles.

Environmental tobacco smoke is a cause of disease in non-smokers. Studies carried out to date indicate that any level of exposure to ETS involves a health risk (there is no threshold dose). There is a clear dose - response ratio: i.e. the more exposure to ETS, the worse the damage.

Effects of exposure to HTA on health

Established

  • Lung cancer.
  • Respiratory symptoms.
  • Cardiovascular disease.
  • Worsening of asthma.
  • Low birth weight (pregnant woman is exposed).
  • Sudden infant death.
  • Respiratory diseases in children.

Potential

  • Reduction in lung function.
  • Other cancers.

In conclusion, there is unequivocal evidence regarding the damage caused by passive smoking both for adults and for children. It is responsible for one out of every five deaths caused by tobacco and there is no minimum amount of exposure that is safe. The only way to protect non-smokers is to create smoke-free atmospheres.

Beneficios de dejar de fumar

As soon as you quit smoking, your body will start to undergo a series of changes that are beneficial for your health that will be maintained with the time:

After 20 minutes:

  • Your blood pressure decreases.
  • Your heart rate decreases.
  • The body temperature of hands and feet increases.
  • The levels of carbon monoxide in the blood decrease.

After 8 hours:

  • The levels of oxygen in the blood increase.

After 24 hours:

  • The risk of suffering a heart attack decreases.

After 48 hours:

  • Nerve endings begin to regenerate.

  • The senses of taste and smell improve.

Between 2 weeks and 3 months:

  • Your blood circulation improves.
  • Walking starts getting easier.
  • Your lung function increases by up to 30%.

Between 1 and 9 months:

  • There is a decrease in colds, congestion, tiredness and difficulty breathing.
  • The cilia regenerate themselves in the lungs, improving
  • their ability to clean the lungs and to reduce infections.
  • Your energy level increases.

After one year:

  • The risk of coronary disease is half that of a smoker.

After 5 years:

  • The risk of a cerebral infarction is similar to that of a person who has never smoked.
  • The risk of cancer of the mouth, throat and oesophagus is half that of a smoker.

After 10 years:

  • The precancerous cells are replaced.
  • The risk of cancer of the pancreas, kidney, bladder, oesophagus, throat and mouth decreases.

After 15 years:

  • The risk of coronary disease is equal to that of a person that has never smoked.

Other benefits:

  • Your sleep quality improves.
  • The risk of a fire in the home decreases.
  • The effectiveness of medications improves.
  • You will save money.
  • The risk of suffering bronchitis, emphysema and lung cancer decreases considerably.
  • Your memory is better than that of a person who smokes.
  • The risk of osteroporosis and cervical cancer is reduced.
  • It increases your life expectancy as well as your quality of life.

Quit Smoking

There are effective measures for quitting smoking. From self-help procedures to combining pharmacological and psychotherapeutic treatments. We need to learn how to use them and decide which are the most suitable ones for each person.

If you are thinking of giving up smoking, it is important to follow the following steps:

  1. Do not precipitate. It is more than just a decision.
  2. Evaluate your relationship with tobacco carefully (see evaluation section)
    • Determine what the arguments are for continuing to smoke.
    • Determine what the arguments are for giving up smoking.
    • Degree of addiction.
    • Stage of the change of process.
  3. Make a strategy.

Evaluation

The aim is to diagnose the dependence, evaluate the motivation for giving up smoking and to decide what type of strategy to follow to give up smoking.

A. Evaluation of automatic habit.

You have developed an automatic habit of smoking that you need to unlearn. Have patience. Do not expect to eliminate something quickly that is ingrained in the way you go about your life.

Do the following questionnaire and you will find out how many times you have puffed on a cigarette during your whole life. This repeated puffing has created this automatic habit.

Answer the following questions:

How many cigarettes do you smoke a day?___ (a)

How many "puffs" do you take per cigarette? ___ (b)

To find out how many times you puff on a cigarette a day, multiply (a) by (b) and write the result ___ (c)

If you multiply the result by 365, (c) you will find out how many times you puff on a cigarette per year ___ (d)

How many years have you been smoking for? ___ (e)

Now multiply (d) by (e): ___

B. Reasons for smoking.

To learn how to live without tobacco, you need to know what you get out of it. As a result, it is just as important to know why you smoke as to why you want to give up smoking. The following questionnaire will help you to understand why you smoke.

Reasons for smoking   AlwaysFrequently Occasionally  Rarely Never
 I smoke to remain alert  5  4  3  2  1
 Just holding the cigarette is part of the pleasure of smoking  5  4  3  2  1
 I find smoking pleasurable and it relaxes me  5  4  3  2  1
 I light a cigarette when I get annoyed about something  5  4  3  2  1
 When I have no cigarettes left, I get very anxious  5  4  3  2  1
 I light and smoke cigarettes automatically, without even noticing  5  4  3  2  1
 I smoke for stimulation, to maintain high activity levels  5  4  3  2  1
 Part of the pleasure of smoking is in the steps required to light a cigarette   5  4  3  2  1
 Smoking cigarettes gives me pleasure 5 4 3 2 1
 When I am uncomfortable or sad for any reason, I light a cigarette  5  4  3  2  1
 I totally notice when I am not smoking 5 4 3 2 1
 I light a cigarette without even noticing that I haven't finished the previous one 5 4 3 2 1
 I smoke to give myself a break 5 4 3 2 1
 Part of the pleasure of smoking is in the swirls of smoke that I make 5 4 3 2 1
 I crave a cigarette more when I am emotionally comfortable and relaxed 5 4 3 2 1
 When I am low, have problems or am worried about something, I crave a cigarette 5 4 3 2 1
 I feel a great desire to smoke when I have not been able to for a while 5 4 3 2 1
 I notice that I have a cigarette in my mouth and I don't remember lighting it 5 4 3 2 1

 2Questionnaire adapted to the scales created by the National Clearinghouse for Smoking and Health. Center for Disease Control, U.S. Department of Health and Welfare, Atlanta, Georgia.

 
ScoresTotalCategory: reasons for smoking
  A + G + M =     1. Stimulation
  B + H + N =     2. Enhance gestures
  C + I + O =     3. Pleasure-relaxation
  D + J + P =     4. Tension reduction
  E + K + Q =     5. Addiction
  F + L + R =     6. Habit/Automatism


Obtain your scores:

Write down the score given for each situation with a circle in the spaces provided below. For example, if you get 4 for situation A, put a 4 in the space for A, and so on.
Add up the three scores on each line to obtain a total per line. Each total will give you your position for each of the possible reasons that you smoke, for example: whether you smoke for stimulation, for pleasure, etc.

The total scores can go from 3 to 15. Scores of 11 or more indicate that this category describes very significantly why you continue to smoke.


Interpret your scores:

The scores obtained will help you to clarify the reasons, mostly psychological, why you continue smoking. You might get a very high score in several categories. That is very normal. In any case, to clearly identify the main characteristics for your dependence, or some of the powerful reasons why you continue to smoke, which is the same thing, will help you to face the first few days without smoking.

Category 1. As a stimulant:

If you got a high score in this category, you feel that tobacco helps you to clear your head, that it helps you concentrate better, it stimulates you, it gives you more energy and, in general, it helps you to keep going.

Category 2. To enhance our gestures:

Sometimes, having something between our fingers is satisfying. It helps us to endure some situations with greater self-confidence, we feel that it gives us a stronger presence or it is simply enjoyable.

Category 3. For pleasure – relaxation:

It is not always easy to distinguish if we smoke to feel good (category 3), that is, for pleasure, or to avoid feeling bad (category 4). About two thirds of smokers usually get a high score in the pleasure-relaxation category.

Category 4. Reduce tension:

If you got a high score in this category, it is because frequently, you believe that a cigarette helps you to deal with difficult moments, stress, the daily problems.

Category 5. For addiction:

You already know that. You are very addicted to smoking. But what you might not have ever asked yourself is why exactly it is so difficult to do without cigarettes. When you give up, you will realise that you are stronger than tobacco, you will feel very proud of your achievement and you will feel that it is not worth being dependent again.

Category 6. Habit/automatism:

You no longer enjoy the majority of cigarettes that you smoke. Your relationship with tobacco is unconscious, mechanic, automatic. Your main goal now is to break the unconscious associations that you have established between smoking and your everyday habits.

C. Evaluation of nicotine dependence

With a simple scale (Fagerström Test) you can measure your degree of dependency that will help you to determined what type of help you need.

  1. How soon after waking do you smoke your first cigarette?
    • With 5 minutes. . . . . . 3
    • 5 - 30 minutes. . . . . . 2
    • 31 - 60 minutes. . . . . . 1
    • More than 60 minutes. . . . . . 0
  2. Do you find it difficult to refrain from smoking in places where it is forbidden? e.g. church, library, cinemas, etc.?
    • Yes. . . . . . 1
    • No. . . . . . 0
  3. Which cigarettes would you hate to give up most?

    •  The first in the morning. . . . . . 1
    • Any other. . . . . . 0
  4. How many cigarettes a day do you smoke?

    •  10 or less. . . . . . 0
    • 11 - 20. . . . . . 1
    • 21 - 30. . . . . . 2
    • 31 or more. . . . . . 3
  5. Do you smoke more frequently in the morning?

    •  Yes. . . . . . 1
    • No. . . . . . 0
  6. Do you smoke even if you are sick in bed most of the day?

    •  Yes. . . . . . 1
    • No. . . . . . 0

Total score: . . . . . 

Score less than or equal to 4: Low addiction.
Score between 5 and 6: Average addiction.
Score equal to or more than 7: High addiction.

 

D. Evaluation of motivation

One of the best ways that we currently have of knowing the motivation of smokers to quit smoking is to know their scales or change state for the motivation.

The change states are the following:

Precontemplation: those who have no intention of giving up smoking (usually evaluated for the next 6 months).

Contemplation: those who state that they intend to give up smoking in the next 6 months.

Preparation for action: those who state that they intend to give up smoking in the next 30 days and have already made a serious attempt to give up in the past year, having at least one day of abstinence in the previous year.

Action: they have given up smoking for at least 24 hours and less than 6 months.

Maintenance: those who have not smoked for at least 6 months and less than 5 years.

Completion: those who have not smoked for more than 5 years, they do not crave smoking and they have no intention of smoking again. 

The evaluation of the change states can be carried out with a few simple questions. It is a good indicator of the motivation to stop smoking:

  1. During the last year, how many times did you give up smoking for at least 24 hours?
    • No
    • At least once
  2. I currently smoke, but I intend to give up in the next 30 days.
    • Yes
    • No
  3. I currently smoke, but I intend to give up in the next 6 months.

    • Yes
    • No
  4.  I currently smoke, but I do NOT intend to give up in the next 6 months.

    • Yes
    • No
Precontemplation. Answer yes to question 4.
Contemplation. Answer yes to question 3.
Preparation. Answer yes to questions 2 and 1 (at least once).

E. Reasons to quit smoking.

Determine what the arguments are for giving up smoking.

You have to be clear on the benefits for you: improve your health, improve your quality of life, improve your self-esteem, the sensation of self-efficacy and for others, because you will avoid passive smoking for your family and friends and the recognition by them. The financial savings to be made by giving up are notable.

Make a list of pros and cons and go over it often: 

 For smoking  For giving up smoking
____________________  ____________________
____________________ ____________________
____________________ ____________________
____________________ ____________________
____________________ ____________________ 


F. Deterrents or errors.

There are often concerns, prejudices and false beliefs about tobacco and its consumption that act as a deterrent to making the decision to stop smoking or are cause to a sensation of failure:

I do not have any willpower. It is not infrequent that you have tried unsuccessfully to give up smoking or you don't think that you will manage to give up. For sure if you think back over your life, you will find that you have achieved things that are much more complex. You can recover your freedom.

I tried and failed. In the event of previous relapses, you need to analyse what went wrong and find alternatives. Many ex-smokers had to try several times before they managed to give up.

I would like to quit. Postponing the decision while waiting for the perfect time is just an excuse. Face the situation and prepare your strategy.

I will put on weight. Giving up smoking usually causes weight gain because of the increase in anxiety, metabolic changes and recovery of the senses of smell and taste increase your appetite. As a result, it is a good idea to make a plan to avoid a significant weight gain. The weight gain is usually only temporary if you follow some correct food habits.

I will smoke less. Smokers often fantastise about smoking less or changing to a pipe or cigars. Dependence on nicotine causes an irreversible loss of control so we must avoid attempts to control what we smoke as this only results in a feeling of helplessness and failure when we go back smoking as much as before.

If you have a psychiatric disorder, it is advisable to consult with the psychiatrist about your decision to give up smoking before you actually give up. It is likely that you will need supplementary assistance.

At this point, we now know:

- Our level of addiction.

- Why we smoke.

- Why want to stop smoking.

Make your strategy

Giving up smoking is more than just a decision. It requires a plan of action that includes the measures that will make it easier to reach our goal. It is a good idea to make a strategy and we recommend that you take the following points into consideration.

1. Decide on the day that you are going to quit smoking.

I am going to quit smoking on the _____ of _____

What should I do until then?

Do not fret and smoke as much as you want, but…

  • Make a record of your smoking starting two weeks before the day you plan to quit smoking (see record sheet). Fold the sheet so that it fits into your cigarette box and that way you will remember to do it before lighting the cigarette.
  • During these two weeks, you can think about and write down the reasons why you smoke (what you seek from smoking and the benefits/what you get out of it) and in the other column the reasons why you want to give up smoking. But do not fill in the sheet in one go; give it time and do it every day. Leave the sheet somewhere where you will see it frequently (on the bathroom mirror, beside the television) and try to find a new reason every day. Make a small collection of reasons.
  • Make smoking a little more difficult: going without tobacco or promising not to smoke in certain places or during specific hours, changing the brand, delaying each cigarette by a few minutes, etc.
  • Get ready mentally to adopt a positive attitude regarding the decision to quit smoking. You are going to get your freedom back, not lose it.
  • Let your family and friends know about your decision. But, even though you are proud of yourself and you have every reason to be proud, be humble and ask them for help and to understand when you are feeling anxious and maybe even bad-tempered during the first few days. Ask them not to offer you a cigarette and not to give you one if you ask them for one.
  • If you are highly dependent on smoking, consider pharmacological treatment by asking your GP for help. It may be a good financial investment and reduce the withdrawal symptoms that you may have.
  • Prepare alternative activities to the psychological and social situations that you associate with smoking.
  • Change your routine.
  • It might be a good time to start moderate physical exercise if there aren't any contraindications. Don't start with intensive exercise. It should be gradual.

A. Record of cigarettes

Instructions: Fill in the record before lighting the cigarette. Write down the time, describe the situation in one or two words (café, food, drinks, angry, tired, etc.) and the need to smoke according to the following levels: 2 when you feel the same need as the one that is most difficult for you to give up (the first one in the morning, or after a meal); 0 when you have no need (you are offered a cigarette and you smoke it but don't need it); 1 when the need is in-between.

Name: _______________________________________________________ First day: ________

Draw a line for each day

 
 Need  Situation  Time
     
     
     
     
     
     
     
     
     
     
     
     
     

B. On D-Day

When the day arrives that you have picked to give up smoking, focus on these goals for the next 24 hours.

  • Just for today!! Don't think of giving up smoking as a life sentence.
    The goal is to reach the end of the day without smoking.
  • Avoid coffee and alcohol.
  • Drink a lot of liquids.
  • Avoid classical routines associated with smoking
  • Do relaxation exercises.
  • When you are tempted to smoke, remember that it is momentary. You can resist!
  • The withdrawal symptoms will last only a few days. If you have symptoms and they are intense, consider the possibility of nicotine gum.

C. The next few days

Don't let down your guard. The majority of relapses occur during the first few months.

Try to follow these recommendations during those first few days:

a. Food.

  • Have simple meals. Avoid fried food, very seasoned meat or spicy food.
  • Do not drink coffee or alcohol during the first few days.
  • Drink plenty of fruit juice, natural if possible, especially any that are rich in vitamin C (orange, grapefruit, lemon, etc.)
  • Don't forget to also drink at least two glasses of water half an hour before your main meals.
  • Make sure that you eat food that is rich in vitamin B (cereals: wheat germ, brewer's yeast, etc.)
  • If you get up early enough, have a nourishing breakfast that will help to strengthen and calm your nerves.
  • You already know what foods and drinks stimulate your desire to smoke. Avoid them at the start.
  • Also avoid eating too much as a very full stomach will make you sleepy and lower your self-control.

b. Habits.

In the morning:

  • Have a warm shower and end it with cold water.
  • Drink water and fruit juices.
  • Make sure that you have enough time to have breakfast properly.

After meals:

  •  Do not sit down in your favourite armchair.
  •  Brush your teeth immediately.

Break your general routine:

  • Start to use your lungs
  • Do exercise. Take up a new, moderate sport.
  • Walk whenever you can. Go for walks in your local park, walk to work or take public transport, avoid using the lift, etc.
  • Keep your hands occupied during free time. Do those activities that you never had time for before (jigsaws, DIY, play an instrument, new cooking recipes, etc.)
  • Make sure that the activities you do in your free time are refreshing and relaxing.
  • Add spontaneity, novelty and fun to your daily routine.

When you are very anxious:

  • Use nicotine gum
  • Hold objects that are not cigarettes in your hands (pen, ring, bracelet, stress ball, etc.)
  • Breathe deeply and then try to sit down for a few moments in the most comfortable position possible.
  • If possible, have a shower or a bath.
  • Make sure to go to places that are as smokefree as possible.

During the day:

  •  Read and think over your list of reasons for giving up smoking from time to time.

Remember that you are learning a new habit and that, just like learning lots of other things, beginnings are always difficult. Therefore, if at some point your self-control lets you down and drives you to smoke a cigarette, remember that little children fall down plenty of times before learning how to walk. The important thing is to pick yourself up and to try again. Do not forget that to lose a battle does not mean to lose the war. However, to win the war, it is necessary to win battles daily.

c. Complicated situations.

It is important to take into account that certain situations can make you really want to smoke. These are risk situations. Some of them are the same for everyone and others are very personal. Assess them and as far as possible try to avoid them, especially during the first few months and until you feel stronger and more confident.

After meals. Try to avoid them.

Contact with smokers:

It is a good idea as far as possible to avoid contact with smoker or if you know them well, ask them not to smoke in your presence. Try to make it easy.

El alcohol:

Alcohol can reduce your conviction to stay off cigarettes. It is not infrequent to start smoking again on a night out having drunk alcohol.

Mood swings

When people who used to smoke a lot give up smoking, insomia, mood swings and irritability have been noted. These symptoms may be related to the withdrawal syndrome for nicotine and they will disappear in approximately three weeks. Failing that, if these symptoms last or are very intense, you should consult your doctor.

Weight gain:

As we have already mentioned, you can gain weight when you give up smoking. The weight gain is faster in the first few weeks and then it stabilises. It is necessary to remember that smokers weigh less than non-smokers and when they give up smoking, they can put on some weight. The vast majority of smokers will weigh the same when they give up smoking. However, we must remember that the benefits of giving of smoking are far superior to the physical, psychological and image consequences from weight gain.

Desire to smoke:

This is one of the most complicated situations when giving up smoking. The desire is most intense during the first few weeks and then the frequency and intensity decrease progressively. You must try to identify what situations make you want to smoke and be able to deal with them.
When the desire is very strong, count 5 minutes on your watch and at the same time:

  • Distract yourself. Keep your hands occupied. Do things that are incompatible with smoking.
  • Change your situation.
  • Revise the circumstances and causes.
  • Remember the reasons for dependence.
  • Remember the reasons why you want to give up smoking (pros and cons).
  • Carry out relaxation techniques:
    1. Sit down comfortably and make sure that your back is straight and relaxed.
    2. Breathe in normally.
    3. Hold the air in till the count of 10, without having breathed in deeply beforehand.
    4. Exhale slowly.
    5. Breath in deeply and slowly.
    6. Hold the air in till the count of 10.
    7. Exhale slowly.
    8. Relax the muscles in your neck.
    9. Relax your shoulders.
    10. Repeat steps 5 to 7 five times.

Concerns

During the process of quitting smoking, ideas often come up that make it more difficult to stay off the cigarettes.

Sensation of lack of progress. "I still have the desire to smoke". We have already said that this is one of the biggest workhorses of the decision to give up smoking. Give it time. It will gradually go away. Remember that you are not going to get rid of a long-term habit in just a few weeks.

Sensation of lack of improvement. "I feel worse". It is not unusual that during the first few weeks, we can have some respiratory-type discomfort and the feeling that we are worse physically. This is the process of the body reconditioning itself and it will disappear after a few weeks.

Fantasies of being in control. "Sure just one is fine". Don't be deceived! That phrase is the expression of psychological dependence. Remember that you are addicted to tobacco and therefore cannot control it. The loss of control is irreversible. This fantasy of being in control that appears months or years after giving up smoking can be the trigger of a relapse. Be aware that if you want to recover your freedom from tobacco, you need to realise that the condition of addict is permanent and that you can only neutralise your dependence on tobacco if you stay off it completely.

Relapse: If you have managed to stay off cigarettes for a few days, then you can do it for the rest of your life. Keep trying.

D. Risk situations.

Record them and think of alternatives.

 Risk situations  Alternatives that I will have planned
 At home: _________________________
_________________________ _________________________
_________________________ _________________________
_________________________ _________________________
_________________________ _________________________
_________________________ _________________________
_________________________ _________________________
_________________________ _________________________
_________________________ _________________________
At work: _________________________
_________________________ _________________________
_________________________ _________________________
_________________________ _________________________
_________________________ _________________________
_________________________ _________________________
_________________________ _________________________
_________________________ _________________________
_________________________ _________________________
_________________________ _________________________
During your free time: _________________________
_________________________ _________________________
_________________________ _________________________
_________________________ _________________________
_________________________ _________________________
_________________________ _________________________
_________________________ _________________________
_________________________ _________________________
_________________________ _________________________

 R. Success

When you quit smoking, you may feel a certain sense of loss as you are giving up something that you have been doing for a long time, but remember that you have made a decision that is going to bring you great benefits. You must remember that:

  • You are recovering your health.
  • You are recovering your freedom.
  • You are saving money.
  • It is better for the health of those around you.

After a while, you will feel that giving up smoking was one of the most important decisions in your life.

Bibliography

Abrahams DB et al. The tobacco dependence treatment handbook. New York. Guildford Press. 2003.

Becoña E., Guía Clínica para ayudar a los fumadores a dejar de fumar. Socidrogalcohol. University of Compostela. 2004.

Sánchez Agudo L; Tobacco Control Resource Centre. Madrid. 2005.

It is possible to quit smoking. National Committee for Tobacco Prevention (CNPT). 2005. Ministry of Health and Consumer Affairs.

Resources on the Internet

World Health Organization (WHO): www.who.org

Ministry of Health Care and Consummers' Affairs: www.msc.es

www.Treattobacco.net

Authors

Eugeni Bruguera i Cortada. Medical Psychiatrist. Expert in Addictive Behaviours.

Josep Lluís Matalí Costa. Clinical Psychologist.