10 May 2006
	Help for Adult Victims Of Child Abuse. A non-profit making organisation based in the UK dedicated to provide help, support and information to any adult who is suffering from past childhood abuse.

When Survivors Quit Smoking
By Lynne M. Constantine and Suzanne Scott

In the United States, there are approximately 46 million smokers and 44 million former smokers. Although the percentage of the population that smokes has declined steadily during the past 37 years, reaching a new low of 25.5 percent in 1990, Americans still consume as many cigarettes per year (525 billion) as they did in 1963, the year before the Surgeon General's initial report addressing the bad news about smoking.

No specific data exist on survivors of childhood sexual abuse who try to quit smoking. But there are several reasons why addiction to cigarettes might pose special problems for survivors. First of all, nicotine is an unusual drug -- a drug for all moods. One of the most addicting drugs on earth, its primary action is to stimulate the nervous system; in larger doses, however, it acts as a calming agent. For this reason, the survivor might find it the ideal self-medication: a wake-up drug for down moods and a calm-down drug for periods of anxiety.

In addition, survivors who have experienced other addiction problems may be particularly afraid to give up cigarettes for fear that they will move from smoking to "something worse." They may fear that they will not be able to handle the flood of emotions that may come when nicotine is withdrawn unless they have another "crutch."

Most people are unaware of their physical dependence on nicotine until they try to quit. Then they experience the awful symptoms of withdrawal, ranging from irritability, impatience, fatigue, and sleeplessness to headaches, nausea, weakness, inability to concentrate, confusion, or extreme anxiety. These symptoms last anywhere from three days to 3 weeks. Some people who have tried quitting and failed say the withdrawal symptoms are simply too unbearable. Therefore, many stop-smoking programs spend a lot of time on ways to handle withdrawal symptoms with simple behavioral techniques such as sucking on cinnamon sticks or taking slow, deep breaths. Cigarettes are also psychologically addicting. Smoking becomes part of everyday activities such as talking on the phone, driving, or reading the paper. Anxiety-producing activities such as creative work, visiting with family, or meeting new people (or, for survivors, such activities as participating in groups, or asking for help) seem easier to handle with a cigarette in hand. Having "something to do with your hands" and nicotine's potent chemical effects take the edge off uncomfortable situations. For many people, especially women, the greatest barrier to quitting smoking is the fear of weight gain. Smoking speeds up metabolism (smokers bum 100 to 200 extra calories per day), and quitters often substitute sweets or snacks for cigarettes. Many smoker-survivors who have struggled with eating disorders may especially fear the food cravings and possibility of weight gain. The average weight gain after quitting smoking, however, is just between five and six pounds. That gain seems a small price to pay when the health risks of smoking one pack of cigarettes per day equal the health risks of being 100 pounds overweight.

Fear of gaining weight may be one reason that women generally find it more difficult to quit smoking than men do. If current trends in smoking continue, by 1995 the United States will become the first country in the world in which female smokers out-number male smokers. Lung cancer is already the most common cause of cancer deaths among U.S. women, surpassing even breast cancer -- a cancer that women fear far more.

None of these problems is insurmountable, but the key to successfully facing them is planning. For example, survivors should try to schedule their quit dates at times when other stresses will be low. Survivors in therapy may want to schedule their quit dates in conjunction with their therapists.

Survivors who feel the need of support from fellow quitters during the process may want to consider attending a smoking cessation program. A wide variety of these programs is available, from reasonably priced programs offered by nonprofit organizations to more expensive, commercial stop-smoking programs. There is no evidence that the more expensive programs are any more successful than the moderately priced ones.

One type of program that survivors probably should avoid is a program that uses aversion techniques, such as smoking faster or more than normal (which often produces queasiness and other unpleasant feelings). Aversion techniques have not been proven to add to the effectiveness of a stop-smoking program. For survivors in particular, aversion techniques can be counterproductive because they may feel like punishment for smoking.

Survivors who decide to forego a program and quit on their own might consider talking to their primary physicians. Most people who successfully quit on their own (and more than 90 percent of successful quitters do it this way) take advantage of medical advice and encouragement.

In addition, for smokers who have been troubled by nicotine withdrawal symptoms during other attempts to quit, physicians may [help monitor] nicotine gum or nicotine patches as nicotine-replacement therapy during the initial stages of quitting. Nicotine replacement is not a magic bullet. The nicotine patch and nicotine gum are usually ineffective as quitting techniques unless the smoker also participates in a behaviorally based stop-smoking program.

Instead of nicotine replacement, other smokers find alternative health techniques such as acupuncture or hypnosis helpful in stopping the craving for cigarettes. Hypnosis in particular is attractive because it seems so gentle and effortless. In fact, some people quit with very little apparent effort or craving after one or more sessions with a hypnotherapist; others, however, find hypnosis of little help. People who are highly susceptible to suggestion and who are highly motivated to quit are the best candidates for hypnosis.

Whatever method is chosen to stop smoking, the following five pre-quitting steps seem to improve the chances for success:

* Set a quit date. After setting the date, let at least one other person know what the date is.

* Get to know the habit. Many people use a smoking diary to record the time and place of each cigarette smoked and the feelings or activities that precede smoking.

* Find and work with individual motivators. Each person's motivation to quit is different: for one, it may be fear of cancer or other life-threatening illnesses; for another, it may be the desire to protect their family from the effects of passive smoking; still others may simply want nicer smelling clothes and fresher breath.

* Change smoking and behavioral patterns before quitting. Vary your smoking routines. Switch to menthols, for example, or eliminate the least favorite cigarette of the day.

* Make a ritual of quitting, but do not focus on the cigarettes themselves. Making a fuss over crumpling up a pack of smokes may leave the smoker depressed over "losing a friend." Instead, clean out a desk drawer; go out for a festive lunch with friends; or buy something new to signify, "I'm quitting smoking."

For those who are concerned about possible weight gain while quitting, here are a few pointers:

* Do not start a new diet or exercise regimen, especially an aggressive one, while actively preparing to quit. People who quit smoking need all their resources just to deal with the changes brought about by quitting.

* Do not panic over a five- or ten-pound weight gain during your first three months as a non-smoker. Those are the hardest months, when body and psyche are adjusting to life without cigarettes, and it is the period when weight gain is most likely.

* Do try using activity as a behavioral substitute for cigarettes. For example, if a cigarette is traditional after-lunch fare, try getting hooked on an after-lunch walk. Or if a case of nerves calls for a smoke, get a small, soft ball (such as a racquetball) and squeeze and release it a few times until the urge for a cigarette diminishes.

* Do choose low-calorie foods to snack on to keep from smoking. Popcorn is a good choice. Fresh fruits such as strawberries, grapes, and bananas are good substitutes for sweets.

In the quest to kick the nicotine habit, do not give up if the first technique fails. On average, smokers try to quit five times over the course of as many as seven to ten years before they quit completely and for good. The more cigarettes people smoke and the longer they have smoked, the more time and support they may need to experience success. Try everything-and keep trying!

It is also important to avoid the all-or-nothing thinking so common to survivors. Relapse is common with an addiction as powerful as nicotine addiction. Having one cigarette doesn't mean someone has "blown it" and should give up. The goal is to try not to have the next cigarette.

If all else fails, survivors might think especially about the money to be saved by quitting. A person who smokes one pack of cigarettes per day spends more than $500 per year on the habit. That could translate into relaxation tapes or CDs for stress management, several sessions of massage therapy, a workshop in journal-writing, or books to help strengthen your recovery. Or, put the money aside each day, and buy yourself something fabulous at the end of a year!

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