Quitting Smoking - The Challenges and Rewards

In this part of the world, it is common knowledge that smoking cigarettes is detrimental to health and that the effects of second-hand smoke are just as dangerous to family and friends. Government legislation has forced many people to quit smoking by making it more challenging to continue the addiction, enforcing a 20-feet (6 m) or 30 feet (9 m) boundary around most public buildings, and making it illegal to smoke within any public building. And while smoking rates in men have declined from 61% in 1961 to 20% today, some 4.2 million Canadians continue the habit and continue affecting their health.^[1]

Now, we must give credit to the large population of people who have tried or are currently trying to quit smoking. Breaking any habit is not easy, and especially when the physiological body response is strong, creating change can result in some very real withdrawal. According to the US Centers for Disease Control and Prevention, it takes 8 to 11 attempts to quit smoking.^[2] An individual who has attempted multiple times may theoretically be more committed, but may also have some serious obstacles to overcome or tried methods that were not the best option for their lifestyle. In the last few years, the Ontario government has advertised smoking-cessation support groups, created a smoker’s helpline, and encouraged funding to extended health-care plans for smoking-cessation programs.

Certain methods include the nicotine patch, chewing nicotine gum, counselling, and cold turkey. But the goal is the same, and at the end of the day if we can lower the cravings, reduce the nicotine response, and normalize the body systems, one should not need a cigarette.

Let’s talk about this physiological response to smoking for a second. Did you know that in the first 20 minutes after putting down a cigarette, the body already starts to respond and repair itself? Heart rate and blood pressure are the first things to drop back down to normal. Now, an elevated blood pressure and stress response may very well be the reason why someone picked up the cigarette in the first place, but we will discuss that when we get to reasons why people smoke. Within 24 hours of no smoking, the risk of coronary artery disease and heart attacks begins to drop, and by 48 hours the nerve endings of the tongue and nose restore taste and smell. At this point, the most common symptoms of cravings start to kick in. This can include anything like anxiety, appetite, frustration, poor focus, dizziness, or constipation. One month later, lung tissue begins to regenerate, respiratory symptoms subside, and exercise tolerance increases.^[3] Based on this timeline, I think it’s safe to say just how amazing it is that the body can heal and recover so quickly. It is important to share this timeline with highly motivated clients, because it helps them understand how even the smallest change during the early struggle can already reap rewards in terms of health.

As naturopathic practitioners, we believe in individualized health-care, which means helping a patient find the best program for their needs as well as the right diet and nutritional support to help with withdrawal symptoms. The first place to start is to assess the current smoking level. “Heaviness” of smoking can be influenced by the number of years they’ve been smoking, number of cigarettes per day, type of cigarette, and time since the last cigarette. Chances are, someone coming to a smoking-cessation program has just entered the building after smoking a cigarette as their final hurrah! Have they tried quitting before? If so, get an idea what methods they have used and which ones they liked or didn’t like, as well as how long they went cigarette-free before taking up the habit again.

It is also very important to gauge the patient’s level of motivation. Of course, practitioners are only coaches and at the end of the day, the patient is the one doing the hard work and running the race. This can be determined by asking the number of smoking attempts in the past, having them rate motivation on a scale of 1–10, or discussing their reason for quitting in the first place. Our thoughts drive our feelings and behaviours, so in order to change a behaviour, we must first identify the thought and feeling behind it. This means that working with smoking cessation must have a counselling component and must give the patient the opportunity to open up about their triggers and stresses. The most common reasons why people begin smoking and want to quit are listed below:

For most people, smoking is a very social event and can bring people together at work, at home, or elsewhere. Identifying who else smokes around this patient is important in determining level of motivation and ultimately potential for success. A patient who smokes alone at home but has many work friends who smoke together on breaks, is unlikely to see significant progress unless he/she decides to leave the friend group or convince everyone to quit smoking together. Many patients in this situation have chosen to exercise through lunch breaks, continue working, or eat at their desk in order to avoid these social groups and associated pressures. If there are other smokers at home, the most successful route is having everyone support each other in quitting. Once all these questions have been answered, additional tools for encouraging the cessation process include:

Acupuncture Protocols: Acupuncture can help calm the mind, reduce the stress response, and decrease endorphins responsible for cravings. It can open the lungs, reduce wheezing, clear the airways, and support detoxification. The most common acupuncture protocol is the NADA protocol, designed to stimulate different parts of the ear and normalize the body’s response to nicotine.^[4] It has been a highly successful approach along with counselling and nutritional support.

Dietary Counselling: The act of smoking and the effects of nicotine are known to deplete certain nutrients in the body. Because things centred around the mouth are often nurturing, a common response to withdrawal is an increased appetite for snacking or chewing on something. Have these individuals carry celery or carrot sticks, small portions of dry cereal, or healthy snack foods as short-term substitutes to stabilize appetite. Vitamin and micromineral support may be necessary at the start to help improve energy levels and the adrenal response.

Guided Meditations: As discussed, many people smoke because of high stress and anxiety. It is no surprise that deep breathing is a successful tool for smoking cessation, because after all, when smoking a cigarette, you must take deep breaths in and out. Perhaps if one were to feel an intense craving and focus on breathing instead, they may be able to decrease the urge for a cigarette and lower his/her stress at the same time. Several cessation programs include hypnosis; the success rate with this approach has yet to be determined. However, the fundamentals are related to lowering the stress response and having the body reach a state of peace and tranquility.

Counselling: No matter what the triggers, counselling is an essential component to any cessation plan. Have the patient outline all the reasons he/she wants to quit and carry it around in their wallet. Create a regular exercise routine if he/she is worried about weight gain, and enlist the support of family and friends to help hold him/her accountable. Make him/her aware that many routine or social situations will trigger the urge for a cigarette, and encourage him/her to set new routines and habits that no longer include smoking or people who smoke. Help him/her establish new coping techniques to use if he/she encounters a stressful situation such as a family emergency or illness, and reward every week that goes by smoke-free. Negative thought patterns linked to smoking are helpful to reverse the pleasurable sensations normally associated with the habit, but this will take time to develop. In the meantime, point him/her in the direction of resources and groups in the neighbourhood to encourage a supportive environment. Finally, make sure he/she is aware that punishments for unsuccessful behaviour are not productive and should he/she not be successful once, he/she can always try again!