Any smoking cessation program I offer, whether it's for a group in a classroom or one-on-one always starts off with a lecture. This chapter is the first part of the lecture: The Three Secrets of the Successful Ex-Smoker. You can of course quit smoking without having these secrets, but I believe they help lay the foundation for the successful use of hypnotherapy to make quitting smoking much easier. Many people tell me that hearing these secrets was far more fascinating for them than the actual hypnosis, which they say is actually quite anti-climatic! So on to the first secret:
Secret #1: The Smoking Addiction is About 95% Psychological
I know this is a hard sell but let me make the case. I often hear the statement: "quitting smoking is harder than quitting heroin." Is this statement true or false? The answer is: it depends on your perspective. From the medical perspective, the case could be made that, indeed, curbing nicotine addiction is harder than heroin addiction. After all, when a patient comes in with a heroin addition, a doctor can prescribe methadone, which is essentially a substitute for heroin without the sudden intense rush and thus, less after-effects. A person can take methadone after being addicted to heroin and have pretty much a fairly functional life. The success rates with methadone replacement are good: about 80 percent.
Is quitting heroin more difficult that quitting smoking? The answer is it depends.
When we look at nicotine replacement therapy, the figures aren't so good. Success rates of nicotine replacement therapy (NRT) alone are actually quite dismal: just about 15 percent, which is just slightly above the placebo level. Keep in mind I don't in any way discourage NRT; I discuss the role NRT can have in the smoking cessation process in a later chapter. As such, you could make the case it's easier to get over heroin than nicotine. Looks kind of depressing, right?
I would argue, however, that it's not that nicotine is more addictive but rather, a different type of addiction. Imagine a person (or yourself) going through nicotine withdrawal. You've just gone cold turkey and now it's been a few days (or perhaps, hours) since your last cigarette. What would you feel? Irritable? Agitated? Anxious? Now, think about a person going through withdrawal from either heroin, or cocaine, or an alcoholic who abruptly quit drinking. What are their symptoms? Well, typically, nausea, sweating, seizures, hallucinations, and intense vomiting. Often, he or she will have to be hospitalized. An alcoholic who suddenly quits will sometimes die from alcohol withdrawal. Looking back on smoking withdrawal, it's certainly unpleasant but have you ever heard of a person who quit smoking who then experienced nausea? Or seizures? Or even sweating? Have you ever heard in your life a person who quit smoking who then had to be hospitalized?
Notice how the withdrawal symptoms of cocaine, heroin, and alcohol are mostly physical and the withdrawal symptoms of nicotine are mostly psychological. In fact, the few arguably physical attributes of nicotine withdrawal often vanish 2-3 days after the last cigarette. Research has shown that nicotine is often completely flushed out of the body within this time frame. Drug replacement strategies, which often work wonders for the so-called "hard drugs" doesn't work very well for smokers. This all points to a crucial psychological component of nicotine addiction. Therefore, to quit smoking, a psychological approach is critical as a main component with drug replacement as a helpful supplement. The bad news is that without a psychological approach, a nicotine habit would be harder to break than a heroin habit. But with a psychological approach, quitting nicotine can be a somewhat easy process, far easier than quitting heroin.
Nicotine is mostly a psychological addiction. Therefore, a psychological approach is needed.
When we consider the dearth of physical symptoms for ex-smokers and the importance of behavioral modification for quitting smoking (i.e. hypnotherapy) that's found in medical/psychological journals, it's quite reasonable to assert that smoking is indeed a psychological issue requiring a psychological approach.
Secret #2: What's Psychologically Addictive isn't just the Nicotine
So we see that smoking is mostly a psychological addiction. But what makes it such a strong psychological addiction in the first place? I would argue that what's actually so psychologically addictive about smoking is not the nicotine or the habit but something else. Let's first rule out the first two before figuring out what this third "something else" really is.
Scientists classify drugs into three groups: stimulants, depressants, and hallucinogen. Cocaine is a major stimulant. Alcohol is a well known depressant. Need it be said that marijuana is a hallucinogen? So in which of these categories do we find nicotine? Stop reading, think about what your answer would be -- if you already know the answer, imagine you didn't and you had to guess.
The answer... is a stimulant. But if you're like many people and most smokers unfamiliar with the pharmacological effects of nicotine, you'd probably guess it's a depressant. Why? Well, most people who do smoke generally smoke to relax. When you reflect upon your own experience with smoking, you might consider that you first realized you were addicted when you felt anxious and needed something to calm down . In fact, what often kills any attempts to quit smoking is when the shit hits the fan, all hell breaks lose, and a person needs to relax. The he or she thinks that the only way to relax is with a cigarette. That's when the addiction hits home.
But this doesn't make any sense. Why are people taking a stimulant to calm down? Would a person take cocaine or caffeine to relax after a long day at work? Not likely. There is something relaxing about smoking, but it's not the nicotine part.
The key to quitting smoking is to know what's relaxing about smoking, and it's not the nicotine!
Often I'll hear, "it's the habit" or something about an oral fixation. Yet virtually every, a person who carries around a cigarette and goes through the motions of smoking without actually lighting up still desires that lit up cigarette. You can try it for yourself: carry around a cigarette without lighting it up and go through the motions -- you'll find it's not any more relaxing. Something is missing.
So we have this paradox: people smoke to relax, while the active ingredient of cigarettes, nicotine, is a stimulant. Following the habit of smoking is a wash: it's neither a stimulant nor a relaxant. What's so relaxing about smoking?
Think of the one body function you do while you relax. When you look at a person, how do you know that he or she is relaxing? When you hold a child in your arms, what's the tall-tale signal that that kid is starting to relax? Need another hint? It's one of only two body functions that can be controlled either by the conscious or the sub-conscious (the other is blinking). Give up?
Breathing. Consider that every time you take a puff from a cigarette, you're taking a nice deep breath. Let's say every cigarette you smoke you take 15 puffs or drags. Well, that's 15 nice, deep breaths in about five minutes. Pretty relaxing! In fact it's that instant stimulus from the nicotine followed by the relaxation from the breathing that offers that addictive kick. To further clarify this point let's do some quick math followed by an imagination exercise and then my personal favorite, psychological behavioral pattern analysis! It's graduate school all over again! But it'll be well worth it to illustrate the point.
Let's say your typical smoker smokes a pack a day. That's 20 cigarettes. Let's say this smoker takes about 15 drags from each cigarette. That's 15*20 = 300 drags a day. And these drags aren't little sips of air but actually large gulps of air as the smoker sucks in all that cigarette smoke. Next time you see a smoker, observe how much he or she actually breathes in. It's actually quite impressive. The air flows in, is kept in the lungs, and is slowly exhaled. This process can take anywhere from 8 to 13 seconds. Now imagine taking three hundred of those deep breaths in one sitting. If it takes 10 seconds and we multiply that by 300 before dividing by 60 to get minutes, we find that from one pack of cigarettes we get 50 minutes worth of deep breathing. That's one hell of a relaxation session!
Each smoker is used to an hour long deep breathing relaxation session spread out at exactly the most stressful times of the day!
Through my hypnosis training, my graduate school training, and the pre-doc/post-docs, I've learned about quite a few different types of therapies. Arguably, one of the more effective types of therapy is to simply have the patient come in, sit in a comfortable chair, breathe deeply, and talk (complain) about life and its dramas. The therapist need only say "uh-huh" and "remember to breath deeply." After only a few minutes the patient feels better and after 30 minutes to an hour, like a huge weight has been lifted.
Next, let's imagine two smokers at work; we'll name them Erica and Charley. Today, Erica takes her smoking break after a particularly bad phone call from an irate customer. She goes outside where she'll typically sit and smoke with her friends and trade horror stories of angry customers and generally discuss the drama of their lives. As she complains, she takes a drag -- a deep breath. As her friend and co-worker tells her to not worry too much, Erica will take another deep drag.
Charley works at home. Since we're in L.A., Charley reads scripts and determines which ones are good and which ones aren't. After he reads one script that could go either way, he smokes out on the patio to make up his mind. He goes into his metaphoric cave where it's just him. And he breathes deeply while he contemplates not just the script but what he did this morning and what he has to do this afternoon.
Personality psychologists might label Erica an extravert and Charley an introvert. Both smokers have different rituals to relax but they both involve that process of deep breathing and deep dissociation. "Dissociation" in this context is separating oneself from the problem in order to gain perspective and decide the next step. The only real difference is this process is that Erica recharges by being with friends and Charley, by being by himself.
Of course, you don't need to smoke to complete these rituals. For example, I'm more like Charley. After an important meeting or right before a series of patients, I'll go into my little cave and plan out my next step. If you spied on me, you'd see that I'd be naturally breathing deeply, deeper than usual, though I wouldn't notice. But if you look at smokers and compare them to non-smokers, you'll notice that when smokers smoke, they are much more likely to breathe deeply. When they don't smoke, they are much less likely to breath deeply, compared to non-smokers. (side note: I was actually going to study this formally for my doctoral thesis, but the methodological qualms were simply too great. I'd have to attach an O2 reader to a participants finger for a few days and instruct him or her to just "breathe normally.") Next time you see a smoker grab a pack of cigarettes, you'll notice the smoker start to breathe deeply before the pack is even opened.
So we see here the importance of breathing and environment on the relaxation process. It's actually so great that even though nicotine is a stimulant, the end result is deep relaxation.
Breathing and "getting away from it all" ultimately create that relaxation that people seem to attribute completely to nicotine.
To understand how this relates to smoking or, rather, quitting smoking, let's go back to Erica and Charley. Let's say they both quit cold turkey on Monday. Things seem to go smoothly until their first lousy day at work, the very next day on Tuesday. Erica's boss yells at her and Charley just got news of an up-coming writers strike.
Erica's instincts are to start breathing deeply and get away from it all. Retreat! Regroup! Of course, Erica doesn't hear this. All she hears is: "Start Smoking"!
How did this all come about? We can explain this all quite well with something us behaviorists call a behavioral chain. Don't worry-- I'll keep the psychobabble to a bare minimum!
Behavioral psychology started with Pavlov and his dog. Every time Pavlov offered his dog food, he would ring a bell. After a short amount of time, ringing the bell would produce Pavlov, who would salivate in anticipation of the food.
So at first we have the unconditioned stimulus-- the food. And the unconditioned response-- salivating.
The bell is a conditioned stimulus -- "conditioned" meaning it had to be taught. The bell was paired with the unconditioned stimulus (the food) so much that the bell itself started to produce the unconditioned response -- salivating.
It's the same with humans. When we look at Erica, before she started to smoke, she would talk with her friends and naturally breathe deeply. Even if she had a friend who smoked right next to her, she would naturally relax by being with friends and breathing deeply.
Once she started to smoke, she started to pair smoking with breathing and being with friends so much that she started to associate smoking with those forms of relaxation. And now whenever she thinks of needing to relax she thinks of smoking.
Just as Pavlov's dog symbolizes the bell as food, Erica (and Charley) symbolizes smoking as relaxation.
Secret #3: There's no such thing as self-sabotage.
This is a motto I use not just for smoking cessation but for essentially any form of anxiety treatment. Imagine yourself the CEO of a company. The company is your body and mind. Each worker has a special function: digestion of food, dilation of eyes, hearing a sound. You, the CEO, is your conscious. Your workers represent your sub-conscious. Of these workers, you have a whole "security" department whose sole purpose is to keep you stable and out of harms way. If, while hiking, you see a mountain lion, these guys are the ones you make you feel panic. If you haven't eaten for a while, these guys let you know you need to start looking for your next meal.
Just like you need to eat, you also need to relax. So when you start to feel anxiety these guys in the security department look at their notes and see "Smoking = Relaxation." So they produce an urge to smoke.
Your body may end up creating a smoking craving, simply for that chance to breath deeply and escape.
Now, are these guys out to get you? No. Are they there to sabotage your efforts? No. They simply believe that the best way to relax is through smoking. At the end of the day, they don't even care that much about smoking. After all, if you could push a button called "relaxation," such that every time you felt negative or anxious you could push that button and instantly feel fine, would you have any problems quitting smoking?
The good news is that you were certainly able to relax before you started smoking and, really, the nicotine itself is actually a stimulant, so it can be taken right out of the equation. In fact, if you take the time to breathe deeply and give yourself decompression time, you really don't need cigarettes at all to relax. Once your sub-conscious realizes this, the cravings for cigarettes diminish. We can teach your sub-conscious this secret through both hypnosis (see chapter 4) and through behavioral change (see chapter 5). But before we do that, let's explore hypnosis: what it is and what it isn't.