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Staying ‘Quit’

“I am an expert on how to quit smoking—because I have quit at least 20 times.”

Quitting tobacco is hard, but for some, staying “quit” is just as hard—maybe even harder.

Tobacco addiction is a chronic life-long condition that is characterized by relapse. Simply stated, tobacco cessation is not a one-time treatment like taking an antibiotic for an infection. Rather, it is a long-term process that involves both biological and psychosocial interventions and life-long maintenance.

The process of changing

Changing stubborn behaviors and addictions, such as smoking or chewing tobacco, have been described in scientific literature as a process that occurs in five sequential stages. They are:

Precontemplation — having no intention or desire to change
Contemplation — knowing one needs to change but not taking any steps toward change
Preparation — taking the initial steps to change, such as learning more, seeking advice or just committing to change
Action — engaging in a change behavior
Maintenance — incorporating change into one’s daily life, while preventing relapse

Strategies for maintaining change

Successfully overcoming the withdrawal and distress associated with quitting tobacco is reason for celebration but also for caution. Like a hungry lion, relapse is always waiting for an opportunity to pounce. Relapse never occurs in a vacuum—there is always a triggering event or circumstance that creates craving, poor judgment and, ultimately, tobacco use. For this reason, maintaining abstinence from tobacco requires an aggressive and proactive approach. Here are some helpful strategies for maintaining change:

Regularly review your reasons for quitting and think of all the benefits to your health, your finances and your family.
Remind yourself that there is no such thing as just one cigarette—or even one puff.
When cravings occur, be tough and ride them out because they don’t last long. But do not fool yourself into thinking you can have just one.
Review your strengths and weaknesses. Be honest with yourself about your progress and setbacks.
Review your goals, accomplishments and any setbacks each week.
Keep a private journal of your thoughts and feelings as you live tobacco-free.
Look for ways to improve your plan—ask others for help and suggestions.
Stay in regular touch with those who support you.
Periodically assess the level of support and accountability you need to remain tobacco-free and adjust accordingly.
Write down and discuss any new relapse triggers or risky situations you encounter.
Ask for specific feedback from your friends and/or loved ones regarding your progress (or lack of) and your attitude.
Learn more about tobacco cessation and your health. Consider attending a workshop or conference or getting involved with local or national organizations such as the American Heart Association or the American Lung Association.

Preventing relapse

“You cannot help it if a bird lands on your head. But you can keep the bird from building a nest in your hair.” —Chinese proverb

Relapse is always associated with thoughts and feelings that, if indulged, inevitably lead to tobacco use. Here are some common relapse triggers for tobacco users:

being around tobacco users
drinking alcohol
feeling hurried or overwhelmed, stressed
being overconfident
being isolated from supportive friends and loved ones
having feelings of anger, self-pity or entitlement
not complying with treatment recommendations
feeling tired and poor sleep quality
overworking
not taking time for self
having a negative, pessimistic attitude

Surrender

Accepting that you are addicted to tobacco and need help to maintain abstinence is a major breakthrough. Those who continue to fight this fact are much more likely to relapse. Surrender is hard to define. It is having peace about and accepting the fact that tobacco harmed your health and well-being, while believing that that you will live healthier without it.

Sources: Gold, M.S., Edwards, D.W. (2000). Treating cigarette smokers in 2000. Your Patient & Fitness, 14(4) 6-11; Changing for Good by J.O. Prochaska, J.C. Norcross and C.C. DiClemente, William Morrow, 1994; “The Health Benefits of Smoking Cessation: A Report of the Surgeon General,” 1990.