Preparation to Quit Smoking
Quitting smoking is a process
Most smokers ( 80% ) attempt to quit smoking one or more times during the course
of their smoking habit
95% of successful quitters have a history of AT LEAST 3 or 4
temporarily successful attempts prior to experiencing a sustained
peroiod of abstinence from smoking.
The likelihood of successfully quitting increases if the smoker has tried
and failed quitting in the past
If this is the first time you are attempting to quit there is a chance you
will never smoke another cigarette in your life.
Smokers with one or more prior attempts to quit who try to quit again have learned from those prior
attempts and a larger pourcentage of these will succeed in never smoking again.
If you have quit in the past for a period of up to a year or more the chances of successfully
quitting forever are very good.
The Smoker's dilemma
It is common and normal for the smoker to have both a desire to quit and a desire not to quit at the same time.
The Smoker's Dilemma is one of indulgence vs restraint, i.e. wanting to indulge oneself with the
pleasure and stress reduction rewards of smoking yet living in fear of
adverse health and social consequences of smoking....the are fears of dealing with the discomfort of
withdrawal, the stress, the weight gain etc but also the silent shaming of self as a nicotine addict if one
were to fail to quit successfully. In many ways giving up smoking is like renouncing a long term friendship,
a companion ever present and appreciated and always there in those times when
one most needs a friend...
Would be helpers and spouses of smokers need to fully understand this dilemma, and need to
understand the loss the smoker experiences, the trials and tribulations a smoker must face to quit,
in order to place themselves in a supportive encouraging role.
Nagging and shaming the smoker are not helpful and by increasing the stress probably are
counter-productive also.
Readiness to change concept
Making a decision to change is a dynamic process in which a person
gradually moves through stages of varying readiness to change. It is
important to recognize and respect where a person is at along this continuum
and aid the person in moving from one stage to the next...
X--------------------x----------------x-----------------x
Not ready.........ambivalent.....decision making.....changing
to change
Advice giving, confrontation and nagging may be counter productive in
that it
tends to activate resistance and power struggles by threatening personal
autonomy and freedom and can
lead to see-saw dialogues and debates of the type where person A says: "why don't you do or try X, Y or Z . . .
and person B rebutts with: "Yes. . .BUT. . . "
More helpful are comments of support and understanding and acceptance with active listening in which
the smoker comes up with ideas and solutions on his or her own....
4 stages in the
process of
change as described by Prochaska and Diclemente
Precontemplation stage
...not ready to consider changing...
Contemplation stage
...willing to consider change sometime in the
future
Action stage
...ready to work on changing now!!
Maintenance stage
...desire to work on making the change a permanent
one...
The concept of motivational interviewing states that one should deliver a
message adapted to a person's readiness to change stage and is that is designed to help the
person move from one stage toward the next, leaving the person totally in
control of their life decisions...
If one gives advice or information that is not adapted to the person's readiness to
change stage the person will tune out the message and possibly dig their heels in all the more,
feeling misunderstood and lectured to....
Take a questionnaire about what stage you are in!
Approach to smoking cessation for would be helpers: the 5 A's
This section is primarily directed toward MD's, family and spouses of smokers and all others
who want to be helpful to a smoker thinking about quitting....
Address the agenda
Openly discuss the issues and the desire to help if there is interest to
quit smoking...
"I see you are a smoker and you should quit someday. If you are interested
in quitting sometime I would be happy to help you."
Assess the individual situation...
- assess the readiness to change stage: what stage is this smoker at using this model?
- assess the smoking history : what age did the person start, how much does he or she smoke on the average...
- assess any smoking related symptoms and problems: cough,shortness of breath, heart problems,
vascular disease, etc
- assess all prior attempts to quit, what methods to quit were used and what type of withdrawal symptoms occured
- assess the smoker's knowledge, beliefs, barriers, questions about quitting
- assess the personal pros and cons of wanting to quit and wanting to continue smoking
- assess the person's major fears and concerns about quitting
Advise
- teach the smoker about the process of quitting, the benefits of abstinence, the type of
withdrawal symptoms to expect, and describe the various methods of quitting
- provide counter arguments to beliefs and barriers
- send a clear "you MUST quit" message to all smokers, and if
the person is ready to change make an attempt to get a contract or promise to
quit AND set a precise quit date...which increases the chance of success
fourfold
- personalize the message linking any tobacco induced physical/emotional
symptoms in the person to the person's smoking, and correlate smoking related health risks to the
smoker's family history of cancer, stroke, heart disease, lung disease. Also
explore any other personal risk factors that could make a smoking
related health hazard more likely.
Assist
- give support, willingness to help, in a context of empathy and
respect
- express optimism and a positive attitude
- identify and break down barriers, help solve problems
- identify and enlist supports, resources
- assist in selecting a method for quitting and in setting a precise quit
date
Arrange follow-up
- schedule visits and phone contacts
- measure progress with a diary or tracking sheet and give support
- help deal with relapses, slips...
- join in the celebration of success!!!
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last modified April 18, 2006
please send comments to Robert Shubinski MD