Okay, so the nicotine patches and gum didn't work. Somebody suggests hypnosis, but having someone experiment with your brain doesn't sound appealing right now. Maybe it's time to try a little group support.
That's what Susan Gosden, did. Desperate to stop smoking, she found inspiration -- and release -- in a smoking cessation group held by Kaiser Permanente. Nine months after attending the 10-week support group, the 45-year-old administrative assistant from Los Angeles is still smoke-free. It was her fourth try in 25 years -- and with luck, it will be her last.
Power in groups
"I think there's a power in the group," says Gosden, who was heartened by other members' stories of relapse and recovery.
Sit in on any one of hundreds of smoking cessation groups around the country and you will get a sense of the grueling battle people are waging. According to the U.S. Department of Health and Human Services, smoking will kill about half the members of any given group if they don't quit. And yet tobacco is so powerfully addicting that, some health experts say, it's harder to kick than heroin.
Smoking cessation clinics are considered one of the best ways to stop for good, with some programs boasting success rates as high as 65 percent. That means that one year later, nearly two-thirds of graduates say they've refrained from lighting up. But the true success of groups is difficult to measure. Some medical studies say that three out of four smokers who use group therapy to give up tobacco will relapse in the year following their quit date.
You're more than twice as likely to quit smoking if you use nicotine gum, patches, inhalers, medications, or group therapy than if you do nothing at all, according to John R. Hughes, MD, a University of Vermont psychiatry professor who has studied smoking cessation programs. But smokers who have used the group approach say it has the advantage of reducing the psychological pain and stress, particularly if it's supplemented with other stop-smoking treatments.
What happens in a group
Therapist Linda Barrad, who runs the Kaiser Permanente group in Los Angeles, keeps a relaxed atmosphere in her group. Those who celebrate tobacco-free anniversaries, like Gosden, get a round of applause, and those who are still struggling get lots of sympathy and support.
Stop punishing yourself, she tells the participants. You had a relapse? "Relapsing is part of it," she tells them. "Just keep coming to the meetings." (In fact, most smokers take between five and seven attempts before they stop.) "You've been smoking for a lot of years," Barrad adds. "If it takes a while, don't be hard on yourself."
Domingo has been off tobacco for four weeks. "My body doesn't want it, but my mind comes and goes," he says. One incentive he's using is to put all the money he would have spent on cigarettes in a shoebox. "I put away $260 so far," he says.
In Barrad's group, smokers get an extra benefit: Their health plans pick up the cost of nicotine patches and, in some cases, medication such as Zyban, which are often prescribed as a stop-smoking aid. (When prescribed for depression, the drug is known as Wellbutrin, but the antidepressant is only prescribed as an antismoking aid in the form known as Zyban.)
SmokEnders, probably the oldest of the group therapy programs, claims an abstinence rate of 65 percent after one year for those who complete its six-week course. The program, which began with open seminars in New York, is now available primarily in corporate settings, but it also offers a Learn to Quit Kit online at http://smokenders.com. SmokEnders is a for-profit program originated in 1968 by 44-year-old housewife Jacquelyn Rogers and her dentist husband Jon. The Rogers were motivated mostly by Jacquelyn's deep but frustrated desire to stop smoking.
Jacquelyn Rogers had a feeling that her addiction to tobacco was going to end badly, she says in her book You Can Stop Smoking. Yet nothing could induce her to give up her two-pack-a-day habit. "I tried all the books and gimmicks and free clinics and psychotherapy and cessation programs and hypnosis and even nicotine lozenges called, of all things, Life Savers," she says.
So the couple began to try to deconstruct the smoking addiction in all of its aspects, with an eye toward finding a cure.
The Rogers began using techniques that are now standard in smoking cessation sessions. First, rather than imposing a quick no-smoking edict on group members, the plan require them to keep smoking for the first four weeks of the six-week course to prepare for quitting. Each week, they get small assignments and tasks to raise their awareness of their habit. You can spot a SmokEnders client by the little piece of graph paper stuck into his or her cigarette pack. Each time they light up, they record the event on the paper.
They can smoke as much as they want, but each week they must switch to a brand with a lower nicotine level. Then certain situations become off limits, such as smoking when drinking alcohol or in the morning with a cup of coffee.
Alternatives to lighting up
To reduce the strains of those first weeks, SmokEnders has a variety of suggestions -- from exercise for the moments of anger or anxiety to frequent tooth brushing for oral satisfaction to just pampering yourself as a reward for giving up smoking. The American Lung Association, in its book 7 Steps to a Smoke-Free Life, also suggests stretching, doodling, or taking a shower to distract yourself.
When your quit date finally rolls around, your nicotine intake has been reduced, the pattern of your habit has been disrupted, and, theoretically, you're ready to give up smoking.
Unfortunately, there aren't enough smoking cessation clinics to go around, and private programs, sometimes costing several hundred dollars, may be too expensive for the average smoker. In addition, most of the group programs are concentrated in metropolitan areas, leaving many rural areas without the service.
"The problem is that they're not available at the time a smoker is ready to quit," says Ron Todd, the American Cancer Society's director of tobacco control. "People decide they want to quit, and they need help right away. They don't want to wait a month or a year for a new group to start up."
Gosden, the smoker who tried three times before she found the answer in a group, says she's a believer now. Her group experience worked -- and not a moment too soon. "I didn't have another quit in me," she says.
American Cancer Society. www.cancer.org/docroot/PED/PED_10_3x_Find_Support.asp?. Type in your zip code on the site to be connected to a list of places that sponsor smoking cessation groups.
American Lung Association. www.lungusa.org. Type in your zip code on the site to find out about programs in your area.
Treating Tobacco Use and Dependence: Clinical Practice Guideline, published by the U.S. Public Health Service in June 2000.
H.A. Lando et al. Comparative evaluation of American Cancer Society and American Lung Association smoking cessation clinics. American Journal of Public Health, Vol. 80, Issue 5.
Interviews with Ron Todd, director of tobacco control for the American Cancer Society, and John R. Hughes, University of Vermont professor of psychiatry.
Edwin B. Fisher Jr., PhD. American Lung Association's 7 Steps to a Smoke-Free Life. John Wiley and Sons Inc..
Jacquelyn Rogers. You Can Stop Smoking. Pocket Books.
Jacquelyn Rogers. Burning issues waft over smoking and the workplace. Employee Benefit News.
John R. Hughes, MD. New Treatments for Smoking Cessation. Ca: A Cancer Journal for Clinicians.