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On November 15, 2000, visitors to www.Turnto10.com chatted online with William Shadel, PhD, a psychologist at the Center for Behavioral and Preventive Medicine at The Miriam Hospital. Following are excerpts from the chat. Moderator: Welcome to our Lifespan Doc Chat with Dr. William Shadel. Rhonda: I'm a 44 yr. old, long time smoker. I quit cold turkey for 3 months 7 years ago, when I heard my father-in-law learned he was dying of lung cancer. How do you feel about Zyban, as I had samples a couple of years ago. Dr. Shadel: Have you tried Zyban or any other medications to help you quit smoking? Rhonda: My doctor won't prescribe it because he feels it is all psychological, which I agree. Zyban allowed me to keep my mind free. I tied a sample. It helped. I quit for 3 days after taking 1 pill a day for 3 days. Dr. Shadel: Zyban is considered a first-line treatment to help smokers ease withdrawal that they might have after quitting smoking. It is safe and has been proven to be effective. Rhonda: Unfortunately I went right back to smoking. Can you suggest a doctor in South County who will prescribe for me? I need to stop!!! Dr. Shadel: Smoking is both psychological and physical. Most smokers need help with both components of the addiction. I can't recommend a specific doctor. Sorry. Rhonda: My Mom has emphysema. I asked my doctor for Zyban when I cracked a rib last year. I just had a great physical. I will ask my doctor again. I think Zyban is my answer though. Dr. Shadel: I would also emphasize that you need help with the physical component to your addiction and that Zyban would help. Mercedes: Every time I try to quit, I gain weight. Any suggestions? Rhonda: Lose weight before you quit—and TIC TACS!! Dr. Shadel: Women tend to be more concerned about weight gain than men, but the reality is that you only gain about 5-7 pounds. Mercedes, are your eating patterns different when you quit? Rhonda: Good luck all! Mercedes: Yes, I find myself nervous, and to calm myself...I EAT! Kenning: I don't understand much about the addiction. How can I be supportive of my partner when he repeatedly tries to quit and succeeds for only a few weeks? Dr. Shadel: If your eating patterns are different, like eating more, I would recommend using low calorie substitutes for smoking. If you are eating because you're nervous, try some slow, deep breathing to help you relax. Kenning, ask your partner what he needs from you in order to be successful. Try not to nag. Mercedes: Thank you Dr. Shadel. I will try. Quitting is very important to me and my family. Earthch1ld: Doctor....I have been trying to quit for about 4 years now and have been down to 4 or 5 cigarettes a day. I can't seem to be able to quit those last few cravings (usually at night) What should I do?? Rhonda: I took walks around my neighborhood to calm down. The fresh air is wonderful therapy. Dr. Shadel: Earth, ask yourself what triggers those last 4 or 5 cigarettes. Earthch1ld: It seems like I can go all day without smoking, but at night I start thinking about it. More mental then physical, although I do get physical cravings at night. Dr. Shadel: It's great that you can go all day without smoking, but what specifically are you thinking about when you think about smoking Earthch1ld: I'm not sure... Dr. Shadel: Sometimes it's helpful to have competing thoughts available to fight thoughts about smoking. For example, think about your reasons for wanting to quit. Diane: I have tried so many times to quit but every time I do, a crisis arises and the first thing I do is light up. Earthch1ld: I hate to smoke, that's the funny thing... Dr. Shadel: Earth, so, tell yourself you hate to smoke when you get a craving. Diane, so, you're saying you smoke to calm down or to cope? Diane: Both I think. It is never a little crisis either. Dr. Shadel: Diane, when a crisis arises, the first thing to do is ask yourself what you want to do: smoke or cope. Diane: I just have no willpower when it happens! I have actually gone for several months without smoking. Dr. Shadel: Diane, it's great that you've gone several months without smoking. That means that you can quit smoking, it's just a question of finding the right combination of factors that's going to help you. Kenning: Sometimes my partner also smokes marijuana--is that more harmful to physical health than cigarettes? Mercedes: I thought that marijuana isn't addictive. Is this true? Dr. Shadel: Let's be clear: both are harmful to your health. Diane: I have considered hypnosis but I am wondering if it works. I don't want to go through the expense if it doesn't work. How well does medication work? Dr. Shadel: Quitting smoking is very difficult. Each person is different and it's a question of finding the right combination of treatments that's going to work for you. There are a lot of treatments available. Diane: How do you go about finding an affordable treatment that will work. Dr. Shadel: Diane, on balance, hypnosis doesn't seem to work. Medications, however, have been shown to be very effective in combination with behavioral counseling. Diane: Any suggestions as to where this could be done reasonably. Dr. Shadel: You could call Lifespan at 401-444-4800 and ask about smoking programs, specifically research programs, which are free. Diane: Thank you! Dr. Shadel: There is also information on research programs online. The key to being successful is being motivated to quit. Once you determine that you're motivated, then ask yourself, what makes this time quitting different from previous attempts? Kenning: Is an addiction to smoking primarily an addiction to nicotine, or is it similar to other excessive behaviors such as overeating? Dr. Shadel: Think about smoking in terms of the smoker's triangle. A physical part, an emotional part and a thinking part. Each one of these is important to address when you're trying to quit. Nicotine is the primary addictive substance in tobacco, but it's not the only part. Because smoking involves the triangle, it's important to keep in mind that no medication is a magic bullet. Kenning: So if one receives, say, medication to help with the physical part and counseling to help with the emotional part, what would help with the intellectual part - something like a conscious changing of routine, things like that? Dr. Shadel: Kenning, good question! Counseling also focuses on the behavioral component. For example, changing your routine, like you mentioned. One key is knowing yourself and knowing your smoking habit. Knowledge is power. Kenning: I've read that restaurants are now debating whether it's valuable to have a smoking and a nonsmoking section. Is there any health value to sitting in a nonsmoking section? Dr. Shadel: Absolutely. Secondhand smoke poses health risks to non-smokers and poses a risk of relapsing for smokers who are trying to quit. Get as far away from the smoking section as you can. Ferdydog: I've been smoking for about 3 years. Is it easier for a smoker to quit if he hasn't been smoking for many years, or does the length of time not really matter? Dr. Shadel: In general, it should be easier to quit if you haven't been smoking as long. However, that doesn't mean it's going to be easy...just easier. Santa: I'm a smoker. I'm trying to quit. I'm afraid that my 13 year old will start smoking if I don't stop soon. How can I let her know that smoking isn't "Cool"? Dr. Shadel: I would make sure that your lines of communication are very open with your daughter. Explain short-term costs versus long-term costs of smoking and about how you wish you never started. Try not to make it something that she will use, as all adolescents do, to rebel against you with. Ferdydog: Is it actually more likely that a child will smoke if the parents smoke? Dr. Shadel: The answer is complicated. In general, yes, but that doesn't mean that all children who have smoking parents will smoke themselves. Kids start smoking for a lot of reasons unrelated to their parents. For example peer groups, friends... Mercedes: Neither one of my parents ever smoked, and I do. And, I'm lucky that my kids don't smoke. Ferdydog: Mightn't it be the case that a kid would be so disgusted by the smell and the messy ashtrays that they'd want nothing to do with cigarettes? Dr. Shadel: Good point, Ferdy. Santa: I hope that is the case with my daughter! Dr. Shadel: So do I, Santa. Ferdydog: Are there any statistics about the success of quitters who seek help versus those who try it on their own? Dr. Shadel: Could you please clarify? Ferdydog: Sorry. Is it your experience that people who are trying to quit and seek professional help are more successful in the long term than those who don't? Dr. Shadel: Ferdy- 5-10% of smokers are able to quit on their own and up to 40% of smokers quit with combined behavioral counseling and medication in a clinical setting. Ferdydog: That's a huge incentive. Thanks. Dr. Shadel: It is an exciting time to be a smoker, because there are so many options available if you want to quit. Ask your doctor about medications that may help you and always scan the newspaper for free research studies about state-of-the-art treatments. Moderator: Thank you for joining us. For more information on smoking cessation studies, call 401-444-4800. Find out more:
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