Snuffing cigarettes out for good

Quitting smoking is easy, lots of people say.

It's quitting meals, mornings, coffee, alcohol and sex that's tough.

Nicotine packs a double whammy: It addicts not only physically, but psychologically: Our brains hard-wire a link between the act of lighting up and common everyday activities.

Like a dog who drools at the crinkle of the wrap on his favorite snack, we unconsciously associate the two things: Beer and cigarettes. Coffee and cigarettes. Post-coital glow and cigarettes.

Undoing those associations is one of the toughest things about quitting, says Roger Valdez, manager of the Tobacco Prevention Program for Public Health-Seattle & King County.

But hey, nobody said smokers were wusses! After all, they daily face down cancer, heart disease and social stigma — at least in King County, where 85 percent of residents are nonsmokers.

Thursday, though, smokers will face something more immediately repugnant: Washington weather in December. That is the day a new statewide ban on smoking in public places goes into effect, and health educators are hoping it will nudge smokers in all corners of the state to consider forsaking their habit.

Being forced to smoke outdoors, 25 feet from a workplace, hangout or other public place — even if the smoker loves Washington's seasonal "heavy mist" and soggy breezes — can be powerful motivation to quit.

Elsewhere, public-place smoking bans seem to have pushed people to quit. For example, in New York City, public-health officials say a workplace ban in 2002 played a part in an dramatic decrease in the overall number of smokers. By 2004, the percent of adult city dwellers who reported smoking had dropped from about 21 percent to just over 18 percent.

In Pueblo, Colo., after a 2003 ban on smoking in bars, restaurants and other public places, an 18-month comparison of heart-attack rates in the city found they'd plunged by 27 percent. Meanwhile, in a nearby county, one that had not enacted a ban, the number of heart attacks held steady during the same period, according to research presented at the American Heart Association meeting last month.

Plenty of techniques

So OK, already. You want to quit.

But how?

Patch, pill or gum? Cold turkey?

Tiptoe in, cutting down gradually, or just slam right into it?

Should you enlist friends and family ahead of time? Or should suffer in silence?

One thing's for sure: You don't need to reinvent the wheel.

Others have been there before — many more than once.

As Mark Twain reportedly said: "Giving up smoking is the easiest thing in the world. I know because I've done it thousands of times."

Those who have done it — even those who have done it "thousands of times" — do have some helpful advice to impart, say health experts.

First, know your enemy. Michael Leon-Guerrero, a health educator for Public Health-Seattle & King County, says you must get over the idea that it's about willpower. Or that it's a moral failing, your fault, or any of that stuff.

"It's a physically addictive drug, more difficult to give up than heroin," he says.

Health educators draw a picture, translated roughly thus: In your brain, gazillions of little neural receptors that have grown up on nicotine are waggling impatiently. Stretching their necks upward like baby birds, they squawk and screech until you deliver the goods.

The headache. The depression. The irritability. The fuzz-brain syndrome. The sleepless nights. The sleepy days.

Not surprising that you feel a few withdrawal symptoms.

Valdez points to Public Health's Web site (www.metrokc.gov/health/tobacco/
quitsmoking.htm): "A cigarette is not a product like a Twinkie or cheeseburger. Let us call a cigarette what it really is, a drug-delivery device. Cigarettes are designed and manufactured with a single purpose in mind, to deliver a dose of one of the most addictive and dangerous drugs in the world, nicotine."

To foil tobacco's nefarious hold on your body and psyche is going to take some work.

Know why you're quitting. "It sounds corny, but it helps to do some soul searching," says Paul Zemann, also a health educator with public health. "List four or five reasons you like to smoke, and four or five why you want to quit."

Think about that image thing: Maybe you started smoking because you thought it made you look baaad. Would it help to know that association with "individuality and freedom" was created by the tobacco industry? Surely there's something else you could do to make sure no one will mistake you as a conformist/nebbish.

Think about where and when you smoke. If you know what triggers the urge to smoke, it'll be easier to cope, Leon-Guerrero says.

Breaking the psychological habit, says Valdez, means changing all your associations with tobacco. "Breaking that connection is the first attempt at trying to disrupt the addiction."

If you have your first cigarette after breakfast, he suggests, wait until after lunch. "It's a gradual process of pulling away."

In some cases, the routines are so strong smoking seems part of the activity itself. Zemann is reminded of one young girl who believed the family car wouldn't start unless her mom smoked a cigarette, because mom's routine was unfailing: Put on the seat belt, light up, start the car.

It's also important to recognize you may have a "social addiction" to smoking, one that grips you in circumstances such as bars, lunch breaks or gossiping with friends.

"Social addiction is the hardest one to break," Leon-Guerrero says. "That's why it makes it so difficult for young people to break the smoking habit, because it's almost totally social at first."

In the first two weeks, you'll be most vulnerable. So if your habit is to go to Cowgirls Inc., have a few beers with friends and smoke, you'll have to stop for a few weeks, Zemann says.

The social aspect is another reason why you should tell everyone you're quitting, he says. "Social support is critical."

Be prepared to mourn. You may experience grief at losing your old "friend" tobacco, who's been with you through thick and thin. You laugh, but it's real. Understanding the grief and letting go can help. You might give your tobacco a "proper funeral," suggests the British Columbia Doctors' Stop-Smoking Program.

Plan for physical symptoms. You should expect some withdrawal symptoms — stress, irritability, depression — and make plans to deal with them. Don't be like my Aunt Mildred, a longtime smoker. "Every time I see those anti-smoking ads on TV," she used to say in her wavering voice, "it makes me so nervous I have to go light up a cigarette."

Information on the Web

Public Health-Seattle & King County: www.metrokc.gov/health/tobacco/
quitsmoking.htm.

Washington Tobacco Quitline: www.quitline.com or 877-270-7867; 877-2NoFume (Spanish). Offers free nicotine patches or gum for smokers age 18-29.

Cold turkey quitting support: www.whyquit.com.

American Cancer Society Guide to Quitting Smoking: www.cancer.org/docroot/PED/content/
PED_10_13X_Guide_for_Quitting_Smoking.asp

The Surgeon General's Consumer Guide: "You Can Quit Smoking:" www.surgeongeneral.gov/tobacco/consquits.htm

National Centers for Disease Control and Prevention's "How to Quit:" www.cdc.gov/tobacco/how2quit.htm. CDC's list of scientific articles: www.cdc.gov/tobacco/citation.htm

American Lung Association's Web-based smoking-cessation support: www.lungusa.org/site/
pp.asp?c=dvLUK9O0E&b=22542

QuitNet online support: www.quitnet.com. QuitNet offers a searchable database so smokers can find inspiration from successful quitters located in Washington or other states.

Combo government stop-smoking site: www.smokefree.gov/

B.C. Doctors' Stop-Smoking Program: www.bcdssp.com/quitting_tips.htm

Disgusting downloadable posters: www.ashtraymouth.com/

Some people find it's easier to do one thing at a time. So some cessation counselors push the patch, lozenge or nasal spray, which replace the nicotine so you can concentrate on breaking your psychological and social addiction first.

The prescription drug Zyban (bupropion, also marketed as Wellbutrin), which was originally marketed for depression, also can help, although it's not entirely clear how.

"You get better at it"

In the end, most people quit "cold turkey," Zemann says. By then, many have quit several times.

"Each time you do it, you learn something new," Zemann says. "You get better at it."

Hypnosis, religion, hard candies, exercise, toothpicks, the pill/patch/lozenge, sniffing your post-smoke clothing, watching heart-bypass surgery, hanging out in a funeral parlor — whatever works is what it takes.

There are 50 million people alive in America today who have quit, and the benefits, Zemann says, begin almost instantly. After 20 minutes your blood pressure is down; after eight hours the carbon monoxide in your blood is back to normal, after one year your chance of a heart attack is cut in half.

"Any attempt you make to quit is good," Zemann says. "And the sooner you do it the better."

Carol M. Ostrom: 206-464-2249 or costrom@seattletimes.com