cover next page > title: Keep Quit! : A Motivational Guide to a Life Without Smoking author: Rustin, Terry A. publisher: Hazelden Publishing isbn10 | asin: 1568381042 print isbn13: 9781568381046 ebook isbn13: 9780585317342 language: English subject Tobacco habit--Relapse--Prevention. publication date: 1996 lcc: RC567.R88 1996eb ddc: 613.85 subject: Tobacco habit--Relapse--Prevention. cover next page > < previous page page_iii next page > Page iii Keep Quit! A Motivational Guide to a Life Without Smoking Terry A. Rustin, M.D. < previous page page_iii next page > < previous page page_iv next page > Page iv Hazelden Center City, Minnesota 55012-0176 © 1996 by Terry A. Rustin, M.D. All rights reserved. Published 1996 Printed in the United States of America. No portion of this publication may be reproduced in any manner without the written permission of the publisher 01 00 98765 Library of Congress Cataloging-in-Publication Data Rustin, Terry A. Keep quit: a motivational guide to a life without smoking/ Terry A. Rustin. p. cm. Includes bibliographical references and index. ISBN 1-56838-104-2 1. Tobacco habitRelapsePrevention. I. Title. RC567.R88 1996 613.85dc20 95-52662 CIP < previous page page_iv next page > < previous page page_v next page > Page v Dedicated to the memory of my mother, Jean Moss Rustin, who taught kindness by her example. < previous page page_v next page > < previous page page_vi next page > Page vi HAZELDEN INFORMATION AND EDUCATIONAL SERVICES is a division of the Hazelden Foundation, a not-for-profit organization. Since 1949, Hazelden has been a leader in promoting the dignity and treatment of people afflicted with the disease of chemical dependency. The mission of the foundation is to improve the quality of life for individuals, families, and communities by providing a national continuum of information, education, and recovery services that are widely accessible; to advance the field through research and training; and to improve our quality and effectiveness through continuous improvement and innovation. Stemming from that, the mission of this division is to provide quality information and support to people wherever they may be in their personal journeyfrom education and early intervention, through treatment and recovery, to personal and spiritual growth. Although our treatment programs do not necessarily use everything Hazelden publishes, our bibliotherapeutic materials support our mission and the Twelve Step philosophy upon which it is based. We encourage your comments and feedback. The headquarters of the Hazelden Foundation are in Center City, Minnesota. Additional treatment facilities are located in Chicago, Illinois; New York, New York; Plymouth, Minnesota; St. Paul, Minnesota; and West Palm Beach, Florida. At these sites, we provide a continuum of care for men and women of all ages. Our Plymouth facility is designed specifically for youth and families. For more information on Hazelden, please call 1-800-257-7800. Or you may access our World Wide Web site on the Internet at http://www.hazelden.org. < previous page page_vi next page > < previous page page_vii next page > Page vii Acknowledgments During the twenty-four years I have worked in the addictions field, I have benefited from the knowledge and experience of hundreds of colleagues. Those with a special interest in nicotine and tobacco dependence have been by far the most eager and dedicated of all. For their support over the years, I especially want to thank Richard Hurt, John Slade, Andrea Barthwell, John Hughes, Paul Earley, Abby Hoffman, Jeff Goldsmith, Lucy Barry Robe, Ken Roy, and the staff of the American Society of Addiction Medicine in Washington and New York. The inspiration for my approach to relapse prevention derives in large part from the work of James Prochaska and Carlo DiClemente, who developed the Stages of Change model, and William Miller, who developed the motivational counseling approach to therapy. I am also indebted to the work done on the prevention of relapse in addictions other than nicotine and tobacco by Terence Gorski, Arnold Washton, and many others. Without the support and encouragement of the staff of the Addiction Treatment Unit of the Harris County Psychiatric Center in Houston, Texas, this work would never have been completed. Our unit has pioneered the integration of nicotine and tobacco dependence treatment with the treatment of other addictions, and many of the strategies in this book were developed there. No one gave up, in spite of the difficulties. I am proud of the work of this staff and grateful for their efforts. This book didn't just happen, of course. It arrived after four long, painful, and exhilarating years of growth and maturation, constantly nurtured by my editor, Tim McIndoo. On days when I thought I would never complete it, I lived for Tim's comments in the margins of the early draftsYes, he liked it! Three asterisks < previous page page_vii next page > < previous page page_viii next page > Page viii meant I was really onto something. Every author should have an editor who cares as deeply for the work as does Tim. While I was working on Keep Quit! I know I was often hard to live with (and at most other times, too, to be completely candid). I would often disappear for many hours, losing track of time entirely. I am grateful for my wife, Laura, and my daughter, Rachel, for tolerating my bizarre schedule. Laura, an indexer by profession, agreed to index the text, even though the two of us hardly ever agree about anything. She probably regretted that decision the moment she made it, but she saw the project through. Fortunately for you, she hardly ever took my advice in preparing the index. As you will see, it is clear and precise, and will guide you quickly to the topics you seek. Many thanks, Laura. Finally, I want to acknowledge the contributions made to this book by the many clients and patients I have had the honor to work with over the years. They have taught me what works; my goal has been to put those successful strategies into this book. < previous page page_viii next page > < previous page page_1 next page > Page 1 Introduction The goal of Keep Quit! is to help you stay clean and freeto never smoke a cigarette again. For many years, I have been working on bringing an effective, inexpensive method of recovery from nicotine and tobacco dependence directly to the people who need it; this program is the result. Research has shown that people do better when they move at their own pace, when they set their own goals, and when they take personal responsibility for their recovery. I designed this program with those facts in mind. Most likely, you have tried to quit smoking before; nearly half of all smokers have, and most of them have tried many times. Why do smokers try to quit, but fail? Every smoker knows someone who says, "Sure, I used to smoke. One day, I decided to quit; tossed those coffin nails away and never smoked again. No problem at all." Makes you want to strangle him. (Or herbut more likely him. Women smokers have more difficulty quitting than men smokers do.) Smokers who could quit easily and without help have already done so. There are smokers who can quit by just using the nicotine patch or nicotine gum, or by attending half a dozen classes, or by being hypnotizedbut they have already quit. You are still smoking because your dependence is much stronger. I am using the word "dependence" in the same way we use it when describing an alcoholic as "alcohol dependent" and a cocaine addict as "cocaine dependent." I am a medical doctor, a psychotherapist, and an addictions specialist; I have worked in the addictions treatment field for more than twenty-three years. I discovered long ago that most people who smoke daily meet the criteria for dependence on nicotine (the addicting drug in < previous page page_1 next page > < previous page page_2 next page > Page 2 cigarettes) in the same way that heroin addicts are dependent on heroin and amphetamine addicts are dependent on amphetamines. But there is more: Smokers are dependent on the pleasures of smokingthe fire, the smoke, the inhaling, and the exhaling. Smokers are dependent on the image of being a smoker (created by cigarette advertising). Smokers are dependent on the rituals associated with smoking (the special ways smokers hold, handle, and manipulate their cigarettes). Smokers are dependent on the act of smoking, with its smoke, fire, and oral satisfaction. Smokers are controlled by the many activities they associate with smoking (eating, drinking alcohol, drinking coffee, having sex, driving a car, and talking on the phone, to name just a few). Smokers use nicotine to help them deal with uncomfortable feelings (like anger, embarrassment, fear, depression, loneliness, and boredom, to name a few). When smokers try to quit, they experience significant nicotine withdrawal symptoms (such as anxiety, irritability, difficulty concentrating, trouble sleeping, and intense craving for a cigarette). No wonder it's so hard to quit! Smoking is rewarding, satisfying, and a good deal cheaper than most other addictions. Most of the problems from smoking don't occur until people are past age sixty, and smoking rarely causes any serious social problems. In fact, most smokers find many more reasons to keep smoking than to quit smoking. Over the years, I have tried all sorts of ways to help smokers < previous page page_2 next page > < previous page page_3 next page > Page 3 quit smoking. Most of them didn't work at all. Lectures and advice didn't work; pleading and scolding didn't work; showing pictures of diseased lungs didn't work. So far, I have found only three things that work, each to some degree. They are Having a serious heart attack Wearing the nicotine patch Helping people develop their own plan for quitting smoking The heart attack method works about 30 percent of the time. You would think that any smoker who has had such a serious medical complication from smoking would quit, but most are not able toeven if they really want to. Breaking free of nicotine and tobacco dependence can be extremely difficult. Treatment with the nicotine patch doubles the effectiveness of whatever other measures a person is using. Many smokers hesitate to use the patch because of the costa full course of patch treatment usually costs between $30 and $300. Each patch costs about $3about the same as the average smoker spends on cigarettes each day. If you think the patch could help you, consider the expense as an investment in your future. The very best treatment for dependence on nicotine and tobacco is helping smokers develop their own plan for quitting smoking. You are a unique person; your history, your goals, and your strengths and weaknesses are not the same as any other persons. Personalizing your recovery program will give you the best chance of staying clean and free. Here are some tools you can use: Quit and Stay Quit: If you are just thinking about quitting smoking but have not yet made up your mind, you aren't < previous page page_3 next page >