hi I'm dr. Mike Evans and I think
quitting smoking is a journey for some
that says short journey full of
resilience but I think for most it's a
long journey along a fair if you will of
quitting and relapse a complicated
relationship that can have as much to do
with the person's relationship with
themselves as with the cigarettes what
starts as a pleasant sensation
opportunity rebel or even to belong is
replaced by less pleasure and a feeling
of being trapped a daily or hourly ride
of nicotine withdrawal and then another
cigarette which brings relief most teens
who smoke think they will quit in their
20s and actually don't till their 40s
stopping smoking about making a change
and that is something we're not too good
at what I think can change I think of
two concepts where you all right and the
mechanics of how we change so we should
start where you are at when I started
medical school I thought I could take
somebody who smoked and convert them
into a nonsmoker in one fell swoop now I
see it differently I focus on where the
person is that you may be in what we
call pre contemplation where you're not
really even thinking about change
approximately 75% of smokers want to
quit but 25% are not interested maybe
you're at the contemplation stage
thinking about it but not quite ready to
act
next is preparation this is critical
with smoking especially in the likely
event that you've tried to quit before
what has worked in the past and what
hasn't what caused the relapse maybe
you're at the action stage this is when
you're ready to make your move there's
never a perfect time to quit and at one
point you just have to jump I'll tell my
patients hey it's gonna be a challenge
now I'm just gonna be a challenge of
five years so why not do it now and
finally there's a maintenance stage
where you become a nonsmoker and are
trying to stay that way when we make
change is critical to stop and think how
important this has changed to me and how
confident am I am making this change
what we call yourself efficacy your job
is to be honest my job is to see if I
can move your scores towards 10 the
second concept is about the different
parts of change so there's the what what
are we changing with smoking I suppose
it is straightforward stopping but if
you think about it you might be changing
lots of things I think it is like a
relationship breakup you start by just
keeping things simple and low-risk you
might break up your routine a little bit
avoid certain places
maybe you said juicer every morning to
distract yourself but you will need to
change more than you're smoking to stop
your smoking the next is the why why
change I feel like I could do a 10
minute video just in all the medical
reasons why not to smoke and they are
legion but I'm gonna spare you
partly because you already know partly
cuz you don't need anymore guilt and
partly because in clinic I actually
spend more time asking people what they
like about smoking which sounds funny
but I think we have to recognize their
positives or at least perceived
positives and I think it's important to
reframe these perceptions if we're to
make a change so let's run through a few
of the common ones cigarettes are my
friend they distress me they relax me
hmm I'm not going to deny that you may
feel a sense of relief and satisfaction
when you have a cigarette
but I see it a bit differently you have
a nicotine addiction the nicotine in
tobacco is highly addictive within a few
seconds of inhaling that travels to your
brain causing you to have a temporary
high over time your brain changes
causing you to smoke more to get the
same effect we rate your addiction to
nicotine with a few simple questions do
you smoke more than 15 cigarettes a day
or smoke within 30 minutes of getting up
in the morning do you find it difficult
to go more than four hours without a
smoke the power of nicotine comes from
the repeated small doses you give
yourself when you smoke it may seem
innocent at first but if you take 15 pus
from a cigarette and smoke say 20
cigarettes a day that's 300 drug doses a
day you think smoking relieves your
stress are satisfying but it actually
isn't the cigarette is just making your
nicotine addiction go away smoking
doesn't make your concentration better
it just calms your nicotine receptors
cry for more smoking makes your heart
beat faster increases blood pressure and
breathing these are all symptoms of
stress not stress reduction let me
repeat that the cigarette just reduces
your nicotine stress not your real
stress I've got a lot of trigger times
coffee sex meals certain people break
times
telephone calls the car there are a lot
of triggers you're gonna have to prepare
for you got to change your coffee
routine plan something to do right after
meals throughout your car ashtray I've
no advice that sex but make a plan for
breaks or the telephone with
lots of distractions know that when you
have a hunger or caffeine or other types
of pangs you also have a nicotine pang
it needs to be satisfied you have
associated these but they're actually
separate alcohol and parties double the
risk as you have the Association plus
your imbibing something intends to lower
your resolve I want something in my hand
yes you are making maybe 300 hand
motions a day you may need to replace
this by chewing gum or chewing on a
straw or a cinnamon stick or or playing
on your cell phone to keep your hands
busy to replace this daily habit I will
gain weight yes you might but I think
this is actually more marketing than
reality what I call the Virginia Slims
effect on average people who quit gain
about 2.5 kilograms or 5 pounds so two
thoughts on this firstly if this is a
concern for you you might want to focus
on strategies that affect calories in
and calories out such as your new daily
routines might focus on walking a
special emphasis on being mindful of
emotional eating or that your hand mouth
routine includes carrots or celery
steaks
my second point is about perspective a
possible 5 pounds may be important from
a vanity perspective but from my doctor
perspective the health return is
spectacular ly higher when you stop
smoking
remember we said smoking was a
relationship part of the healing of
stopping a damaging relationship of
starting new healthy relationships so
now is the time to start a deeper
relationship with your bicycle or salads
or walking or gardening and/or your
support of friends next is the how what
do the skills require to change how do I
change with the emphasis on I so what
works well let's start with willpower
it's a strange word on the one hand a
permeates behavior change and all the
interventions we talk about it's also a
word I don't love as people see it as
black and white if a person succeeds
they have willpower and if they fail
they have no willpower the sides of
willpower and smoking gives a mixed
message approximately 5% of smokers who
try to quit cold-turkey achieve
prolonged abstinence for 6 to 12 months
with most relapsing in the first eight
days of attempting to quit on the other
hand most people quit do so unassisted
maybe two-thirds to three-quarters of
people do so by themselves reconciling
these two stats reveal the natural
history of smoking cessation
that quote failures are part of this
process and can be seen as dress
rehearsals for the eventual success
another key pearl here is the data which
tells us that a perception of the
quitting smoking experience is often
much darker than reality in a British
study of people who were surveyed about
their quit experience 53% said that it
was not at all difficult to stop 27%
said it was fairly difficult and the
remainder found it very difficult so to
summarise you can do it by yourself and
it may be less difficult than you think
on the other hand it looks like your
chances are better if you layer on some
other tactics so if you fail try again
and think about adding another strategy
some say there are two types of
cigarettes those that are dealing with
your nicotine addiction and those that
have become part of a routine so let's
see what works for both these types of
cigarettes let's start with treatments
that have not been proven effective and
where you may be wasting your money now
some of my patients have found they
helped and to be honest if they stopped
your smoking I I supposed to don't
really care but under this category I
put laser therapy acupuncture and
hypnosis when we compare these
treatments to a placebo or just compare
them to the quit rates of people on
waiting lists the rates don't appear to
be improved
next is medications to help stop smoking
the data shows that medications
especially when combined with behavioral
support can double your chance of
success many patients are resistant
which I get but I also see an irony in
the fact that people are willing to
inhale chemicals much much worse for
them but they won't take a medication
for a few weeks or months to stop
smoking for the rest of their life if we
use nicotine replacement therapy as
example it allows people to deal with
the addiction of nicotine without having
to inhale the other seven thousand five
hundred and thirty seven chemicals and
cigarettes and that's what I worry about
people die too full 747s of people a
week in Canada from smoking not nicotine
nicotine replacement therapy comes in
multiple forms and there is usually less
nicotine than what you get in a
cigarette you can put on a patch which
is easy and discreet you can chew gum
although in a different way than you
usually chew go you can suck on a
lozenge or you can use an inhaler the
patch gives you a nice baseline nicotine
level to lower your cravings the latter
three offer the advantage of flexible
dosing when you have a nicotine craving
and the familiar routine of opening
packages
putting something in your mouth
important things people need to know
about nicotine replacement therapy are
firstly you can design your own nicotine
program you do not need a prescription
prefer the patch and then the gum or
lozenge your inhaler for breakthrough
cravings great
maybe you smoke under 10 cigarettes a
day and just want to use the gum when
you need it your pharmacist can really
help here people get a bit confused with
the cost and our tea is generally
cheaper than smoking but you might be
buying a month at once money-wise of
course it's a no-brainer a pocke days
maybe $3,600 a year imagine what you
would do with that money imagine what
you would do with ten years of that
savings secondly with nicotine
replacement you can stop cold turkey or
you can wean down your smoking taking
nicotine and smoking together does not
increase your risk of heart attacks
smoking debts you probably started
smoking gradually and I guess the same
can be true of stopping if you feel you
need another month of NRT then that's
fine I'm not going to go into details of
pills for smoking cessation but I will
give you a quick overview of the two
most known ones the first is a banner
bupropion it started just as an
antidepressant then users found their
desire for smoking dropped and they are
able to quit more easily Tampa sort
antics in the u.s. is very night clean
and it is a newer option that may be
even more effective but also has some
side effects that may make it not for
everyone you can discuss these options
with your doctor or other health care
providers the counseling needs to be
individualized the final approach is the
Behavioral Interventions I covered some
of this ground but I don't think people
realize how many fantastic resources are
out there for them governments make a
lot of money from people who smoke and
they fell into superb programs you want
a text message a supportive email you
want expert counseling want to be
connected with other people going
through the same thing or who had just
been there or maybe you just want to
talk to someone
go online call the helpline buy the book
get the message in the first month fall
in quitting I want you to prepare for
the roadblocks of risk and stress so
avoid high-risk situations you know what
they are you might want to tell the
people involved in advance and I want
you to focus on stress reduction
stressful things are going to happen to
you but you create the stress tell
people hey I'm quitting smoking this
plan so what's the least stressful
strategy that works I also get people to
think about the
three A's avoid situations you know are
stressful for you alter expectations so
when you look at your to-do list be
realistic and it's expectations up front
before it's stressful and the finally is
acceptance if we use driving as example
traffic jams bad drivers and flat tires
happen take a deep breath focus on what
you can control and accept what you can
now let's say you quit smoking that's
excellent
you've broken up so what now well first
of all you're great secondly there's
gonna be some ups and downs more ups
especially after you get through the
first month but some of the things to
expect with nicotine withdrawal or
cravings and these don't follow a
perfect line headaches nervousness
irritability trouble sleeping and you
may want to eat more so have some
healthy foods ready and also people tend
to have more of a cough as their lung
self-clean finally the Japanese have a
proverb that success is falling down
seven times and getting up eight times
if you get derailed don't feel guilty as
I say at the beginning this is a journey
come back and see us this is the best
thing I can do for you don't learn
helplessness learn about yourself and
get ready for the next round thanks for
listening
you