December 31 will mark the 20th anniversary of my last cigarette. In the years since, I have developed a strong dislike for the smell of burning tobacco, which can throw me into paroxysms of writing angry columns. Research and anecdote tell me that I am not alone. Few people react as strongly to cigarette smoke as ex-smokers. It may be physiological. It may be psychological. It may stem from the old adage that none is more passionate in a cause than a newly-won convert.
I became a convert when I quit cold turkey, without fanfare or announcement. One day I was a gregarious guy with a cigarette in one hand and a beer in the other; the next, I was a bear that nobody wanted to be around. It took me about two weeks to work through the withdrawal and cravings, but I have never regretted it. After a while, my friends came back around, my life got back on track, and I joined a gym and started working out seriously for the first time in years.
Now I learn that my cold-turkey heroics were not so smart after all. Dr. Matt Carpenter, of MUSC's Institute of Psychiatry and Clinical Neuroscience, tells me that there is help for anyone thinking of going smoke-free in 2006.
"Don't do it alone," Carpenter said. "Get help from others. Cold turkey is the most commonly tried way to stop smoking and it is the least effective."
To stop smoking and make it stick usually requires mental and physical preparation, Carpenter said. After all, nicotine is one of the most powerfully addictive substances known to science, and cigarettes are everywhere in our culture.
The first step is to get a plan and the folks at MUSC Health Connections can help you do that. So put down that butt and dial 792-1414. It may be the smartest thing you do in 2005.
Among the options available through Health Connections to anyone wanting to stop smoking are group counseling, cessation classes, and medication.
Nicotine replacement therapy has been around for years and is still controversial in some quarters, Carpenter said. NRT uses small amounts of nicotine delivered through patches and other devices to wean smokers off cigarettes.
"Some people are dismissive of nicotine replacement therapy," Carpenter said. "They think it doesn't make sense to give nicotine to somebody who is trying to quit nicotine. But nicotine itself has very little harmful effect." There are about 40 other substances in cigarettes that are toxic and that a smoker inhales trying to get his nicotine fix.
"If we can get a person off cigarettes and on to the patch to get his nicotine, then that's a good start," Carpenter said.
Along with the patch, gum and lozenges are also available over the counter. An inhaler and nasal spray are available by prescription. There is also the non-nicotine drug butropion, which is available by prescription under the names Zyban and Wellbutrin.
Group therapy is also available at MUSC, Carpenter said. "In group therapy everyone supports everyone else and everyone learns from each other."
Medication and group therapy can be reinforced by controlling environment and behavior. But such controls require planning. "The first thing you might do is remove all cigarettes and ashtrays from your home," Carpenter said. "Then have some kind of substitute behavior ready, such as hard candy or bottled water, when you start getting the cravings."
Another behavior modification is to gradually decrease the number of cigarettes you smoke. If you are smoking 20 cigarettes a day, cut back to 18, then 16, Carpenter said. "It's a lot better to take small steps and succeed than large steps and fail."
The important thing to remember, he said, is that nobody stops smoking in a single day, not even when they stop cold turkey. To do it right requires planning ahead, and then days of growling and fidgeting, as the last of the nicotine works its way out of the system.
"Many will relapse," Carpenter said. "Only about five percent of those who try to quit on their own succeed. About 30 percent of those who get help will still be smoke-free after six months."
"Many will have to try several times before they succeed," Carpenter said. "Sometimes it takes six or seven attempts. But it's important not to use past failure as evidence of future failure." Past failures should be a learning experience.
Carpenter also admonished me to lower my rhetoric against smokers. In the past, I have referred to them as nicotine addicts and worse. The doctor says this is polarizing language at a time when we need cool tempers and straight thinking to set a responsible public smoking policy in Charleston. So this is my resolution for 2006: I will cool the anti-smoking rhetoric — and I will redouble my efforts to create a smoke-free town.