TABLE 11. CHRONIC DISEASES ASSOCIATED WITH TOBACCO USE
Lung cancer
Cancer of the mouth
Cancer of the esophagus
Cancer of the larynx
Bladder cancer
Kidney cancer
Cancer of the pancreas
Cancer of the cervix
Peptic ulcer
Coronary heart disease
Stroke
Atherosclerosis of peripheral vessels
Atherosclerotic aortic aneurysm
Emphysema
Chronic bronchitis
Other chronic obstructive pulmonary diseases
Low-birthweight babies
Facial wrinkles
Table 11 lists some of the diseases and disorders caused by tobacco use. Smoking increases your level of risk for most of the major killers of our time. The good news is that, as a former smoker, you will dramatically decrease your level of risk for almost all of the same problems.
Most people cannot name even ten of the above diseases that result directly from smoking. That is because in this country, despite the well-intended but underfunded attempts of public health officials, the majority of “information” available about tobacco comes from advertising. And of course corporate ads feed fantasy rather than reality. In Australia, highway billboards spell out the facts: More people will die from smoking this year than from automobile accidents, homicides, suicides, and AIDS combined. What is true in Australia is true here.
Information about the disease-causing aspects of smoking will make it tougher to minimize the effects of your habit, but if you are like most smokers, you can still rationalize your addiction. You can tell yourself that by the time you develop lung cancer or emphysema, there will undoubtedly be cures for them. The fact is that scientists have already discovered a cure for most lung cancer and emphysema—quitting smoking.
You may say, “We all have to die from something—why not smoking?” Smoking not only causes death, it causes premature death. Tobacco use is presently the single most preventable cause of disease and premature death in the world. Of all the people alive today, five hundred million will die as a result of using tobacco, and half this number will die well before their natural time, losing an average of twenty years of life. If you consider this unequivocal evidence, you must seriously contemplate quitting.
It is important that you allow yourself to become emotional as you progress through the precontemplation stage. The chilling fact that almost one in ten of the world’s citizens will die before his or her time as a result of tobacco addiction should arouse feelings. We should get angry at an industry that glamorizes carcinogens and other disease-causing chemicals, and makes literally billions of dollars doing so. Cigarette manufacturers have been rightly called merchants of death.
After emotion, an inclination to blame yourself may follow. I’ve heard many clients say, “I never should have started in the first place.” Remember, virtually no one who is fully adult chooses to start smoking. You were seduced into the habit as a teenager or as a young adult. You wanted to look older; you wanted to be a sophisticated woman or an attractive, rugged man. You were led to associate cigarettes with socializing, fun, coolness, calmness, and sexual attractiveness. Now, five, ten, twenty or more years later, as a result of smoking, you are likely to look older than average, not sexier. Your risk of all the diseases listed in the chart is greater than if you had never smoked (and greater than it will be a year from now if you stop).
Social liberation can also help you make the commitment to quit. Society is intent on making it much easier for individuals to be free from cigarette smoke—their own and other people’s. The Environmental Protection Agency has ruled that secondary smoke is a Class A carcinogen, and the rights of everyone to be free from this smoke are going to increase as the years go by. Smoking will be banned in more and more work areas and public places, and liability insurance rates will rise for employers and owners who do not cooperate with regulations.
How will this affect you as a smoker? The longer you remain in the precontemplation stage, the more hassles and pressures you will experience. You can fight the forces of social liberation, or you can let them free you from smoking.
Remember to ask who is on your side before you scoff at external pressure; the answers are not so simple. Whose side are medical societies on when they support smoke-free public and workplaces? Whose side are the tobacco companies on when they spend tens of millions of dollars to fight policies designed to free nonsmokers and those who struggle to become former smokers?
If you could help other people not to smoke, would you use that power? If you were fully free of your dependence, would you rather support the American Cancer Society or the American tobacco industry? Would you rather be part of a social movement to prevent unnecessary death and disease, or support tobacco industries that profit at the expense of the world’s health? Use your answers to these questions to help move yourself into the contemplation stage.
Contemplation
Outside influences will not make you quit smoking. But they can help you quit smoking, if you allow them to. If you have begun to drop your defenses and have lowered your resistance, you are beginning to be guided by knowledge, influenced by facts, and moved by emotional and social forces into contemplation.
Next, you must become more aware of the ABC’s—Antecedents, Behaviors, and Consequences—of your habit. What makes you smoke? What does it do for you? What are the results of all the cigarettes you smoke each week?
Typical reasons people give for smoking include:
To cope with stress
To cope with emotions (anger, anxiety, boredom, or depression)
To cope with social situations
To enhance an image
To reduce nicotine craving
To satisfy a long-standing habit
Monitor your smoking for just a couple of days. You will become aware of how often you smoke for each of these reasons. Just monitoring your habit helps to raise your consciousness. It makes you ask yourself, “Why?” each time you light up; it identifies which cigarettes you smoke out of sheer habit, which will be the first you give up once you enter the preparation stage; and it will increase your awareness of the conditions you will need to counter when you take action.
Once the social, emotional, and informational forces are flowing favorably, you will find that you are reevaluating yourself. If you take a look at the real reasons why you smoke, it becomes difficult to view yourself as a rational smoker. You may become upset or even disgusted for continuing to smoke.
Eventually, you will reject the image of the sophisticated smoker, let go of the media-induced image that puts smokers in the social spotlight. You will become aware that smokers are now regarded as not very smart, not socially acceptable, and not glamorous.
As you reevaluate your self-image, you become freer to create a new persona. Imagine how you will feel when you are no longer a smoker, free from the fear you are causing your own death and disease, free from being hooked on a poisonous substance, free from pressures not to smoke in public places, and free from smelly cigarette butts, bad breath, burned clothing, dead taste buds, and stained teeth and fingers. Visualize the tremendous sense of accomplishment you will have in overcoming one of the toughest addictions in the world.
Preparation
In the preparation stage, continue to draw on what you have gained from the two earlier stages. When you are ready to make the commitment to quit, throw your whole self into the process. Rely on your rational side, which is now acutely conscious of the dire consequences of smoking. Allow your emotions to prevail; think perhaps of someone you know who has suffered from emphysema or other disease caused by smoking. At this stage, you can be encouraged by your evaluative skills, which will provide you with a commitment to healthier values for your future life. And you can join with your social self in identifying with those forces that are trying to persuade you to become free of smoking.<
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You also will need to rely on the responsible part of you that makes commitments, for becoming the kind of person you want to be. It’s not necessary to take responsibility for having been a smoker; that decision perhaps was made in adolescence. Now that you are an adult, you must take responsibility for becoming a former smoker.
You don’t have to do it alone; in fact, you shouldn’t. Let your interpersonal self accept the social support that comes from helping relationships. Go public with your commitment to quit and announce to others that you are going to take action and would like their help.
Tell your family, friends, and colleagues that you are planning life-saving psychic surgery and will not be your usual self for a while. Tell them that, like all major surgeries, the process may be painful and distressing, and may not even be successful, but that the chances of success will be greatly increased if they support you. Make sure, too, that they understand that your recovery will be measured in weeks or months rather than in days. As time goes on, you will need their support less frequently, but that support will remain a critical part of your recovery.
If you don’t have helping relationships, join a self-help group. Call your state or local lung association or cancer society to find out about appropriate groups in your area.
Action
As you get ready for action, prepare to counter the conditioning that currently controls your cigarette consumption. Especially in the short run, these conditions include the intense urges you may experience as you withdraw from nicotine. You can counter these urges by chewing sugarless gum, taking deep relaxing breaths, and reminding yourself that urges are like waves in the ocean—they peak quickly and then subside.
If you are highly addicted to cigarettes, and have never been able to quit for more than a few days, a nicotine patch or nicotine gum can satisfy your physical cravings. Just remember that nicotine replacements are not a long-term solution. They are effective with highly addicted smokers only when they are part of a more comprehensive approach to behavior change.
If smoking has helped you cope with stress, you will need to rely heavily on healthy substitute behaviors, especially relaxation and exercise. If you have used cigarettes to cope with distressing feelings, you will have to assert yourself and express your feelings verbally in order to manage your emotions.
In the past you were reinforced countless times for smoking. Now you need to reward yourself frequently for not smoking. Covert or silent praise is often sufficient, although it can be satisfying to receive public acknowledgment of what you have accomplished. Don’t fall into the trap of rewarding yourself with sweets, alcohol, or other unnecessary substances—there’s no reason to substitute a new problem for the old. But do give yourself appropriate rewards. Many people use the money they save by not smoking to buy themselves some long-desired present.
Maintenance
You may slip, take one cigarette or more, and find you are back in situations associated with smoking. If so, you must take action quickly. It is much easier to prevent a single lapse from becoming a relapse than it is to recycle through all the stages of change. You have made it this far: Commit yourself to limiting a lapse to a slip, rather than giving up and allowing it to become a relapse.
Think about your ABC’s, and examine why you are craving a cigarette. Review the long-term benefits of becoming a nonsmoker and the long-term hazards of relapsing. Renew your commitment to throw your whole self into action. If at all possible, get rid of those stimuli that are tempting you to smoke, even if it means avoiding your friends for a while. Rely on the most powerful countering controls you have to get you through this trying time.
Reach out to others you trust. Don’t keep your lapse a secret; share it so that others can give you a helping hand. But be selective about whom you share your lapses with, especially since you will be feeling so vulnerable. Tell friends or relatives who are fully aware of your struggles, who sympathize and are likely to help you back to a positive course.
Remember, as you counter internal and external temptations to smoke, you strengthen your sense of self-efficacy, not only to cope with quitting smoking, but to change yourself into the kind of person you want to be.
ALCOHOL—PRECONTEMPLATIVE HELL
The fact that alcohol is legal makes it no less potent or dangerous than many illicit drugs. Seventeen million Americans either abuse alcohol or are dependent upon it. As many as 50 percent of all emergency room admissions are alcohol-related, as are one hundred thousand deaths each year. Problems caused by alcohol cost this country $136 billion yearly in lost productivity, accidents, health care, and court and criminal justice system expenses. Problems related to alcohol affect one of every four American families.
These figures are staggering. Yet few people admit to having problems with alcohol. You may have heard excuses like these:
I have no such problem. Yes, I drink, but it isn’t a problem for me or my family; my drinking in under control. The way I drink, it could never become a problem, even if I get soused every once in a while. Anyway, most of my friends drink in the same way—we couldn’t all have problems! And talk about problems! My dad had a real problem with alcohol, and I promised myself that I would never become like that.
Such statements are typical of individuals with drinking problems who are in the precontemplation stage of change. And there are a lot of precontemplative drinkers. Although now there is a stigma associated with smoking where one didn’t exist before, moderate drinking remains an integral part of our society. From the wedding toast to the dinner party, liquor consumption is not only accepted but encouraged. This is not a threat to moderate drinkers, but it may be to you. Because national attitudes toward drinking are not clear-cut, few problems are as difficult to own up to as alcohol abuse.
Part of this is due to a lack of education. You have probably heard, or perhaps have made, one or more of the following statements:
I only drink beer; you can’t become an alcoholic by drinking beer.
One sure sign of alcoholism is early-morning drinking, and I never drink before noon.
I only drink with meals; you can’t get intoxicated if you eat while you drink.
I always have a cup of coffee before I drive home from a party so I’m not intoxicated.
Having two or three drinks after work doesn’t pose any problems. The attitude-adjustment hour at the local bar is just what I need to handle the stress of my work.
I only drink at home, so I won’t get into trouble with alcohol.
Some of these statements are completely false; others contain half-truths. All protect the drinking habit, and make it difficult or impossible to recognize the problem. Alcoholism is often called the disease of denial, and indeed denial is a major aspect of the precontemplation stage in which drinkers so often remain.
Precontemplation
There are many reasons to use alcohol. Its sedative effect leads to pleasant physical reactions, reducing arousal and influencing thinking and feeling. For many, the effects are so powerful that they cannot find anything wrong with their drinking: “It can’t be bad for me if it feels so good.”
Alcohol, if ingested frequently enough and in sufficient quantity, creates a physical addiction. Once addicted to alcohol, you suffer harsh withdrawal effects when you stop drinking. The physical addiction is abetted by psychological dependence. People rely on alcohol to cope with anxiety or act as a “social lubricant.” Physical addiction, psychological dependency, and conditioning effects—” Five o’clock, time for a drink”—create a steady, secure habit of alcohol consumption.
When there are such positive reasons to drink, and so many negative aspects to quitting, it is difficult for most people to admit, or even recognize, that they have a problem. The result for them is a lifetime of precontemplation.
There are ways to break through, however. It always helps to ask someone else for feedback. This is not always easy. First of all, the question is a difficult and potentially embarrassing one
. Second, how others evaluate your alcohol consumption depends greatly on their own consumption levels. Heavy drinkers tend to keep company with other heavy drinkers; most teetotalers are uncomfortable with any level of drinking.
What can you do to evaluate accurately whether you have a problem? As with any self-change strategy, it’s best to begin with awareness and consciousness-raising. Start keeping a record of the amount you drink, not just individual drinks, since they can vary in size and in alcohol content. Twelve ounces of beer, four ounces of wine, and an ounce and a half (a shot) of 80-proof spirits all contain the same amount of ethanol; a double therefore counts as two drinks, and a pint of beer as one and a half. Don’t let the numbers or types of alcoholic beverages deceive you. Also, don’t overestimate the buffering effect your body weight has, or how slowly it takes you to down your drinks.
Then take a look at the problems caused by your drinking—for you or others. They are the surest indicators of abuse. To do this effectively, you must be honest and persistent, persistently exploring the possibilities and asking questions. For instance, most drinkers claim not to experience withdrawal symptoms. However, there are many stages of withdrawal that fall short of the DTs (delirium tremens), the worst case. Hangovers, even mild ones, are a form of withdrawal (which is why “the hair of the dog” works so well), as are memory loss and blackouts. Answer these questions:
Do you have frequent morning-after headaches, nausea, and cotton mouth?
Have you experienced blackouts?
Have you forgotten how you got home from a party, dinner, or bar?
Has your drinking caused you any social embarrassment?
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