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TRANSCRIPT
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Workbook
CIGNA Quit Today®
Tobacco Cessation Program
811834 06/07
1
Introduction
Chapter 1: Understanding Behavior Change: Why Is It So Hard?
Understanding the Process of Change ................................................................................................................ 4
Understanding Relapse ............................................................................................................................................. 5
Chapter 2: Not Quite Ready to Quit
Why Do You Use Tobacco? ........................................................................................................................................ 6
Barriers to Change ....................................................................................................................................................... 6
Defending Your Habit ................................................................................................................................................ 7
The Consequences of Tobacco Use ....................................................................................................................... 8
Possible Health Consequences ...................................................................................................................... 8
Other Consequences ......................................................................................................................................... 8
Cost-Savings Calculator ............................................................................................................................................. 8
Physical Benefi ts of Stopping Tobacco Use ........................................................................................................ 9
Chapter 3: Thinking About Quitting
Special Concerns ........................................................................................................................................................10
Weight Gain ........................................................................................................................................................10
Managing Stress ................................................................................................................................................10
Why Do You Want to Stop Using Tobacco? ......................................................................................................11
Track Your Tobacco Use ...................................................................................................................................11
Chapter 4: Planning to Quit
Your Quit Day Plan ....................................................................................................................................................12
Step 1: Determine How You Will Quit ........................................................................................................12
Step 2: Choose Your Quit Date .....................................................................................................................13
Step 3: Make Plans to Deal With Triggers .................................................................................................15
Step 4: Build Your Support System .............................................................................................................16
Step 5: Begin to Take Steps Toward Quitting ..........................................................................................17
Table of Contents
2
Table of Contents
Chapter 5: Putting Your Quit Plan into Action
The First Days: What You Can Expect ..................................................................................................................18
Strategies for Managing Stress and Your Moods ...........................................................................................19
Becoming Aware of Your Automatic Thoughts ......................................................................................19
Identifying Negative Thoughts and Irrational Beliefs ..........................................................................19
Challenging Your Automatic Thoughts .....................................................................................................20
Reward Yourself…The Healthy Way ...........................................................................................................20
Relaxation Techniques ....................................................................................................................................21
Stop, BREATHE, Refl ect, Choose ...................................................................................................................22
Chapter 6: Living Tobacco-Free
Keep Up Your Eff orts .................................................................................................................................................24
Dealing With Stress ...................................................................................................................................................24
Chapter 7: Preventing/Dealing With Relapse
Preventing Relapse ...................................................................................................................................................26
Common Factors Associated With Relapse .............................................................................................26
If You’ve Had a Relapse ............................................................................................................................................26
How to Prevent Another Relapse ................................................................................................................26
Learning to Forgive ...................................................................................................................................................27
Appendix 1: Real-Life Success Stories .........................................................................................................................................28
Appendix 2: Example: Cost-Savings Calculator .......................................................................................................................30
Appendix 3: Weight Gain .................................................................................................................................................................31
Appendix 4: Self-Care ........................................................................................................................................................................32
Appendix 5: Additional Resources ...............................................................................................................................................33
Appendix 6: References ....................................................................................................................................................................34
My Tobacco Journal .................................................................................................................................................................................35
3
Anyone who has tried to stop using tobacco products knows just how diffi cult it can be. Kicking
your tobacco habit may not be an easy thing to do – but it is possible. By joining this program,
you’ve already taken a major step in starting your journey to a healthier life.
Perhaps you aren’t ready to quit using tobacco. Or...
…you’ve already quit and need some ongoing support to help keep you on track.
…you’ve quit before, but have begun using tobacco products again.
…you’re planning to quit in the near future.
No matter what your situation, the tobacco cessation program can help you to:
■ Gain a better understanding of your tobacco habit.
■ Understand the health consequences of using tobacco.
■ Learn how to resist the urge to use tobacco.
■ Deal with withdrawal symptoms.
■ Learn about the techniques and products available to help you kick your tobacco habit.
■ Prepare to stop using tobacco.
■ Make the choice to live a healthier, tobacco-free life!
Introduction
4
CHAPTER 1
Understanding Behavior Change: Why Is It So Hard?
This program is for you, whether you are just thinking about quitting your tobacco habit or have already made the decision to quit. It will take you step-by-step through the process of giving up tobacco, from making a plan to quit to managing your fi rst few tobacco-free days. Many people who are thinking about quitting have concerns about what will happen to them once they quit. This program will help you learn to understand and deal with any concerns that you might have.
Making the decision to give up tobacco and then following through requires you to make a major lifestyle change. The fi rst step in this process is learning about the process of change, which can help you understand how to set a goal to make this major change in your life.
Precontemplation Stage – You’re currently using tobacco and not considering quitting within the next six months.During the precontemplation stage, people don’t even consider changing and may need more information about making the change. For example, smokers may feel that warnings about the dangers of smoking do not apply to them personally.
Contemplation Stage – You’re currently using tobacco and considering quitting within the next six months.During the contemplation stage, people have mixed feelings about changing. Giving up an enjoyed behavior causes a sense of loss despite the perceived gain. During this stage, people are thinking about the barriers, such as time or fear, as well as the benefi ts of change.
The Stages of Change Model
Action
You can do it!
Preparation
Contemplation
Maintenance
Precontemplation
PROG
RESS RELA
PSE
Preparation Stage – You’re currently using tobacco and intend to quit within the next 30 days.During the preparation stage, people are preparing to make a specifi c change. They may experiment with small adjustments as their motivation to change increases. For example, switching to a diff erent brand of cigarettes or decreasing the number of cigarettes smoked each day signals that the person has decided a change is needed.
Action Stage – You’re not currently using tobacco and have stopped using it within the last six monthsThe action stage is a key stage for a person to reach. Any action that someone takes in this stage is important because it demonstrates the desire for lifestyle change. At this stage, many people need structure, support and new skills to make a change.
Maintenance Stage – You’re not currently using tobacco and haven’t used it for more than six months.Maintenance involves successfully avoiding temptations to return to the unwanted habit. The purpose of the maintenance stage is to maintain your new goal. People in this stage tend to remind themselves of how much progress they’ve made. They constantly change the rules of their lives and acquire new skills to help them avoid relapse. They learn to predict situations that could lead to relapse and prepare a plan of attack in advance.
Understanding the Process of Change
Why is it so diffi cult for people to make changes in their lives – even when they have plenty of “proof” that a change is not only needed, but may also be necessary to maintain their health?
It’s important to remember that behavior change is rarely a single event. During the past 10 years, we’ve come to understand it as a process of stages through which people pass. The Stages of Change model, developed by James Prochaska and his colleagues,8 shows that, for most people, a change in behavior occurs gradually. A person moves from being uninterested, unaware or unwilling to make a change to considering a change, and then to deciding and preparing to make a change. The person is then ready to take real, determined action and, over time, attempt to continue the new behavior. Setbacks almost always happen at some point, but they’re an important part of both the learning process and the achievement of life-long change.
8. See Appendix 6 on page 34.
5
Understanding Relapse
Along the way to stopping or reducing an unwanted habit or making a change, many people experience relapse. In fact, it is much more common to have at least one relapse than not to have any. While disappointment because of a few occasional “slips” may stop the change process and cause the person to give up, most people fi nd themselves “recycling” through the stages of change several times before completely making the change. People often need renewed motivation and support to overcome relapse.
If you experience a relapse, remind yourself that it is normal and okay to have a setback. Instead of getting down on yourself, take the opportunity to learn from your experiences to help yourself achieve future success.
Your Stage of Change
What is your stage of change? Circle the stage that best fi ts where you think you are with your decision to quit using tobacco.
Precontemplation Contemplation Preparation Action Maintenance
How does your current stage fi t in with your long-term goals for becoming tobacco-free?
6
Even if you aren’t ready to quit using tobacco at this time, it’s a good idea to think about your reasons for using tobacco and your feelings about your tobacco use. While tobacco use ultimately becomes a physical addiction, there are many other reasons people continue their habit. Understanding why you use tobacco and your fears about what will happen to you if you stop can help make it easier for you to decide to quit.
Why Do You Use Tobacco?
Once a person begins using tobacco regularly, it’s very diffi cult to quit. That’s because the drug in tobacco, nicotine, is highly addictive. Once you’re addicted to nicotine, what originally began as a want becomes a physical need.
People begin using tobacco for many diff erent reasons. Some like the “buzz” they experience when fi rst
using tobacco. Others use it because it makes them feel more relaxed, or helps them to concentrate. Many people use tobacco without even thinking about it. For example, it may be a habit for you to smoke while you’re driving, or to use chewing tobacco after a meal.
Barriers to ChangeOne of the reasons that change is so diffi cult for many people is that they fear what will happen to them while they’re making the change, or how their lives will be diff erent after they’ve made it. These fears are barriers that can get in the way
when people try to change certain behaviors. Take some time to think about the barriers that may be preventing you from kicking your tobacco habit. Some examples are:
■ Fear of withdrawal symptoms.
■ Fear of failure.
■ Lack of support.
■ Fear of weight gain.
■ Fear of depression.
■ Fear of dealing with emotions.
■ Fear of missing the enjoyment of tobacco.
CHAPTER 2
Not Quite Ready to Quit…
Your Reasons for Using Tobacco
Write down why you like using tobacco. Think about the situations where you usually use it.
What Are Some of Your Barriers?
List the barriers that are preventing you from quitting tobacco.
Did you know…
✔ Smoking causes one out of every fi ve deaths in the United States.1
✔ Participating in a cessation program directly increases your odds of quitting tobacco use.3
1,3. See Appendix 6 on page 34.
7
Defending Your Habit
People who use tobacco despite knowing the consequences often have numerous reasons for continuing their habit. Consider the following examples:
“I have to die of something. Why not die doing something I enjoy?”This statement is an attempt to rationalize behavior. People who say
this aren’t considering the fact that tobacco users typically die much earlier than non-tobacco users.
“I know that smoking can cause cancer. But that won’t happen to me.”This is a statement of denial. People who think this way don’t view the consequences of smoking as applying to them.
“I can’t quit. My boss is so hard on me that I couldn’t deal with him if I didn’t have cigarettes to relax me.”This is a statement of blame. People who feel this way blame another person for their behavior instead of taking responsibility for their actions.
By recognizing your rationalizations for using tobacco, you can learn to overcome them and begin the process of quitting.
Your Rationalizations for Using Tobacco
Write down your rationalizations for using tobacco. Think about situations where you’ve defended your habit to someone else or to yourself.
“Quitting smoking was one of the hardest things I have done, but I did it to save my life!”
– Sue, tobacco-free for 1½ years
8
The Consequences of Tobacco Use
Avoiding tobacco use is one of the most important things you can do to maintain your health. Besides the fi nancial costs, tobacco use has many other consequences. Which of the following health and other consequences concern you the most?
Possible Health Consequences
❏ Increased risk of many types of cancer
❏ More frequent colds
❏ Chronic bronchitis (infection of the tubes that carry oxygen to the lungs)
❏ Emphysema (lung disease that makes it diffi cult and painful to breathe)
❏ High blood pressure
❏ Stroke
❏ Heart disease
❏ Gum disease
❏ Complications with pregnancy – including higher risk of having a miscarriage or a stillborn or low birth-weight baby; increased risk of SIDS (Sudden Infant Death Syndrome); greater likelihood that your baby will have learning and behavioral problems and be sick more often11, 12
❏ Worsening of existing health conditions
❏ Possibility of changing the way your body reacts to certain medications
❏ Delayed healing after illness, surgery or injury
Other Consequences
❏ Bad breath
❏ Discolored teeth and fi ngernails
❏ Decreased sense of taste and smell
❏ Premature wrinkling of the skin
❏ The smell of smoke in your clothes, house, hair, car and everything else around you
❏ Shortness of breath when taking part in daily activities, such as walking up stairs or doing light housework
❏ Financial burden
❏ Exposing those around you to second-hand smoke
❏ Giving children the message that it is okay to use tobacco
❏ Hassle of using tobacco in public
❏ Not always socially accepted
Cost-Savings Calculator
How much does your tobacco habit cost you? It may be more than you think. Use this calculator to see the fi nancial impact that tobacco has on your life. (See Appendix 2 for an example of how to use the Cost-Savings Calculator)
“You have to really want
to do it.”– Susan, tobacco-free
for 10 years
11,12. See Appendix 6 on page 34.
Number of packs/tins used per week Cost per pack/tin_________________ x _________________ = _______________ Cost/week
Enter your cost/week ______________ x 4 = _______________ Cost/month
Enter your cost/month _____________ x 12 = _______________ Cost/year
Enter your cost/year _______________ x 5 = _______________ Cost/5 years
Enter your cost/year _______________ x 15 = _______________ Cost/15 years
Enter your cost/year _______________ x 30 = _______________ Cost/30 years
9
Physical Benefi ts of Stopping Tobacco Use 10
20 minutes
■ Nicotine begins to leave your body.
■ Pulse rate returns to normal.
■ Blood pressure begins to decrease.
■ Oxygen in blood returns to a normal level.
2-3 days
■ Sense of taste and smell improve.
■ Breathing becomes easier.
■ You may begin to cough less often.
■ Your body begins to repair itself as the nicotine leaves your body.
■ Chance of heart attack decreases.
■ Nerve endings in nose and mouth begin to re-grow.
2-3 months
■ Circulation improves.
■ Lung function increases up to 30 percent.
1 year
■ Coughing decreases.
■ Sinus congestion, fatigue and shortness of breath decrease.
■ Added risk of heart disease drops by 50 percent.
■ Increased ability to clean lungs and reduce infection.
5-15 years
■ Risk of stroke drops to that of people who have never smoked.
10 years
■ Risk of cancer of the lung, mouth, throat, esophagus, bladder, kidney and pancreas decreases as the body replaces pre-cancerous cells with normal cells.
15 years
■ Risk of coronary heart disease is now similar to that of people who have never smoked.
■ Risk of death returns to nearly the level of people who have never smoked.
Other Uses for Your Tobacco Money
What else could you do with the money that you spend each week, month or year on tobacco?
If you’re ready to seriously consider quitting, read on.
How could you use this money to reward yourself for quitting tobacco? For some ideas, see the section on rewarding yourself in Chapter 5.
“I fi nally realized that I’m the one in charge. I CHOOSE not to smoke.”
– Manzar, tobacco-free for 20 years
10. See Appendix 6 on page 34.
10
Make a list of the pros and cons of using tobacco. This will help you decide if the things that are really important to you – your personal
values – are in line with the behaviors you choose. For example, maybe you want to set a good example for your children to make healthy choices. But
what message are you sending if you still smoke in front of them? Use the chart below to help get you started:
CHAPTER 3
Thinking About Quitting
Your Previous Experiences With Quitting
If you’ve tried to quit in the past, what did you fi nd that worked for you?
What didn’t work?
Pros Cons
Special Concerns
People who are thinking about quitting their tobacco habit often have many concerns and questions about the eff ects that quitting will have on them. Two of the most common concerns are weight gain and managing stress.
Weight Gain
While not all people gain weight when they quit tobacco, some do.
If you quit, you may fi nd that your appetite increases and that you eat more. It’s important to remember that if you gain weight, the health benefi ts you’ll have from quitting tobacco will far surpass the drawbacks of gaining a few pounds. By eating healthfully and exercising, you can minimize the amount of weight you gain. If you’re concerned about the possibility of gaining weight, refer to Appendix 3 on page 31 and Appendix 4: Self
Care on page 32 for tips on how to minimize any weight gain.
Managing Stress
Stressful situations often lead people to use tobacco. In fact, stress is the leading cause of relapse. By learning techniques to help you deal with stress, you’ll be less likely to turn to tobacco as a way to relax. Refer to the section on stress on pages 24-25 in Chapter 6 for ways to reduce the amount of stress in your life.
Did you know…
✔ About half of all Americans who continue to use tobacco will die because of their habit.1
✔ Children raised in a household where there is smoking are more likely to have health problems, such as ear infections and asthma.1
1. See Appendix 6 on page 34.
11
Why Do You Want to Stop Using Tobacco?
The reasons for quitting tobacco vary greatly from one person to another. What motivates one person to quit may not be something that matters to another person. When thinking about quitting tobacco, it’s important to decide what matters to you.
Write down some other reasons why quitting is important to you:
Track Your Tobacco Use
Tracking your tobacco use is a good way to increase your awareness of your tobacco habit and to identify situations where you’re most likely to relapse. It will also help you measure your progress throughout your journey. Start tracking your tobacco use now by using the Tobacco Journal at the end of this workbook.
“I have a child now who would be exposed to second-hand smoke,
and I couldn’t do that to her.”– Tanya, tobacco-free for 1 year
Start by asking yourself why you want to stop using tobacco. Use the worksheet on this page to help you to make a list of the reasons you want to quit. Make copies of your completed list and put them in places where you would look when you want to use tobacco – for example, in your car or purse.
Why I Want to Stop Using Tobacco
❏ I will be healthier. I will lower my risk of cancer, heart attack, stroke and many other health problems.
❏ Those who care about me will be proud of me.
❏ I will not expose those around me to second-hand smoke.
❏ I will smell better and have fresher breath.
❏ I will set a better example for my children, grandchildren and the other children in my life.
❏ I will look better. My teeth and fi ngernails will be whiter and I will prevent further premature wrinkling of my skin.
❏ I will have more money to spend or save. Use the cost-savings calculator in Chapter 2 to fi gure out how much you can save.
❏ I will breathe easier. I will not run out of breath while doing normal, daily activities.
❏ My children will have fewer coughs, colds and earaches.1
❏ My life will be more convenient. I won’t have the hassle of always having to make sure that I have tobacco; I won’t have to fi nd the time to take a break to smoke or chew.
❏ My sense of taste will improve.
❏ If I become pregnant, I will give my baby a much better chance at being healthy.11, 12
1, 11, 12. See Appendix 6 on page 34.
12
When you’re ready to quit using tobacco, it’s important to make a plan. There is no “magic cure” for your tobacco addiction. However, by developing a Quit Day Plan, you’ll have a specifi c set of steps to follow to achieve your goal. You’ll also be better prepared for any challenges you may encounter along your journey to becoming tobacco-free. Research has shown that the most successful method for overcoming tobacco dependence includes a combination of medication and behavior change techniques.4
Your Quit Day Plan
Develop your personal Quit Day Plan by using the following steps:
Step 1: Determine How You’ll QuitWill you quit tobacco gradually or will you quit all at once?
Diff erent methods of quitting work for diff erent people. Some people feel that quitting all at once is the only way to stop, while others prefer to reduce the amount of tobacco they use gradually. This method is known as “nicotine fading.” Use the method that works for you. Whichever method you choose, the eventual goal is to completely eliminate tobacco from your life.
Nicotine Replacement Therapy (NRT)
Nicotine Replacement Therapy (NRT) won’t cure your tobacco habit, but it can help you manage your nicotine cravings and withdrawal symptoms. NRT helps control your cravings by replacing the nicotine that you’ve been getting from tobacco. People using NRT should not use tobacco because of the risk of overdosing on nicotine. The following are some diff erent types of NRT and possible side eff ects:
Types of Nicotine Replacement Therapy (NRT)
Type of NRT What It Is Possible Side Eff ects
Nicotine gum “Bite and park” gum; available OTC*Mouth soreness; indigestion; burning in throat; dental problems
Nicotine patchPatch placed on skin daily; available by prescription and OTC
Skin irritation; insomnia
Nicotine nasal spray Available by prescription only Nasal irritation
Nicotine inhalerCigarette-like device; available by prescription only
Irritation of mouth and throat
Nicotine lozenge Dissolvable lozenge; available OTC Nausea; coughing
*OTC – Over-the-counter
Medications that reduce nicotine cravings
Instead of replacing nicotine, some prescription medications help reduce your nicotine cravings.
NOTE: As with most over-the-counter and prescription drugs, NRT and medications that reduce nicotine cravings can have numerous side eff ects. Before using any of these products, talk with your doctor to determine if one of these products is right for you, especially if you are pregnant or nursing, or if you have recently had a heart attack.
CHAPTER 4
Planning to Quit
Did you know…
✔ The more strategies you use to quit, the higher your odds are of remaining tobacco-free.7
✔ Using nicotine replacement therapy could double your odds of quitting tobacco.6
7, 6. See Appendix 6 on page 34.
13
Step 2: Choose Your Quit Date
My Quit Date is:___________________
On your quit day…
■ Keep busy to prevent yourself from giving into boredom or temptations.
■ Spend time in places where tobacco use is not allowed.
■ Make sure you drink plenty of water.
■ Refrain from using alcohol (alcohol use causes many people to relapse).
■ Make use of your support system. See Step 4 on page 16 for information on how to develop your support network.
■ Replace negative thoughts with positive thoughts. See “Strategies for Managing Stress and Your Moods” on pages 19-22 in Chapter 5.
■ Remember…the urge to use tobacco only lasts 3 to 5 minutes! Try to wait it out.
■ Take steps to deal with stressful or upsetting situations. See the tips for lowering stress on page 25 in Chapter 6.
■ Keep your hands and mouth busy. To help with cravings, keep a supply of small snacks, such as sunfl ower seeds or carrot sticks, available. Hold a paper clip or pen in your hand to keep yourself busy.
Use the Quit Day Calendar that follows to plan your quit day. By planning to keep busy, you won’t be as tempted to use tobacco out of boredom. If you fi nd the calendar to be helpful, make copies of it to use to plan your days as far in advance as you wish.
Think about the following questions when fi lling out your calendar:
■ What are the times of my most “important” cigarettes of the day? What can I do instead of smoking or chewing tobacco during these times?
■ What do I plan to do in the morning of my quit day? The afternoon? The evening? The night?
IN CASE OF EMERGENCY
REMEMBER… The urge to use tobacco only lasts three to fi ve minutes!
■ Call someone who can support you.
■ Take a few deep breaths.
■ Eat a healthy snack to keep you busy.
■ Try a change of scenery.
■ Do something to distract yourself.
■ Do a relaxation exercise.
■ Remember your reasons for quitting!
Copy the emergency card below and carry it with you so you can refer to it if you’re having a craving.
14
My Quit Day Calendar
Time Current Activity Alternate Activity
6:00 a.m.
7:00 a.m.
8:00 a.m.
9:00 a.m.
10:00 a.m.
11:00 a.m.
12:00 p.m.
1:00 p.m.
2:00 p.m.
3:00 p.m.
4:00 p.m.
5:00 p.m.
6:00 p.m.
7:00 p.m.
8:00 p.m.
9:00 p.m.
10:00 p.m.
11:00 p.m.
12:00 a.m.
1:00 a.m.
2:00 a.m.
3:00 a.m.
4:00 a.m.
5:00 a.m.
15
Step 3: Make Plans to Deal With Triggers
A trigger is anything in your environment that causes you to respond in a particular way. It’s important to remember that triggers are unique to each person and cause diff erent responses in each person. Think about what kinds of triggers lead you to use tobacco as you consider the following examples:
n Places – taking a break at work, bars, driving.
n People – partner who smokes, friends, large groups of people.
n Time – fi rst thing in the morning, weekends, after eating a meal.
n Situations – stress at work, feeling angry or bored, watching TV.
n Change – getting a new job, dealing with the death of a loved one.
Feeling down? Stressed out?
If stress, anger or depression are triggers that lead to your use of tobacco, see the section on dealing with stress on pages 24-25 in Chapter 6.
WHAT ARE YOUR TRIGGERS?What Are Your Triggers?
Think about the situations in which you are likely to use tobacco. What could you do instead during these times?
My triggers How can I deal with my triggers?
Examples: Examples:
Feeling stressed out Take a walk
Drinking coff ee in the morning Drink juice, take a few deep breath
16
Step 4: Build Your Support System
We all need help at times, but for some of us, the hardest part of developing a support system is asking for help. Use this worksheet to write down the names of the
people in your life whom you trust and feel would be there if you needed them. Keep this list in a convenient location so that you can refer to it often. Remember you’re not alone. If you feel as if you need support, reach out and call one of these people.
My Support System
Example:
Name _______________________________________________________________________________________
Phone _______________________________________________________________________________________
When to call _______________________________________________________________________________________
Name _______________________________________________________________________________________
Phone _______________________________________________________________________________________
When to call _______________________________________________________________________________________
Name _______________________________________________________________________________________
Phone _______________________________________________________________________________________
When to call _______________________________________________________________________________________
Name _______________________________________________________________________________________
Phone _______________________________________________________________________________________
When to call _______________________________________________________________________________________
Name _______________________________________________________________________________________
Phone _______________________________________________________________________________________
When to call _______________________________________________________________________________________
Name _______________________________________________________________________________________
Phone _______________________________________________________________________________________
When to call _______________________________________________________________________________________
Name _______________________________________________________________________________________
Phone _______________________________________________________________________________________
When to call _______________________________________________________________________________________
Joe
555-1624
feeling bored, need to relax
17
To make the most of your support system, tell people that you’re going to quit using tobacco. Ask them not to smoke or chew tobacco around you so you won’t have to try to resist temptation. You can also use people in your support system to help provide you with incentives to quit. For example, making a deal with a friend that if you smoke within the next week, you have to buy your friend dinner. This will not only hold you accountable, but will also provide you with a greater sense of motivation to stick with your goal.
Step 5: Begin to Take Steps Toward Quitting
Practice makes perfect! As you gear up for your quit date, start taking steps to quit now! Taking these steps can decrease your withdrawal symptoms and make your transition to living a tobacco-free life easier. Here are some tips on what you can do to practice living tobacco-free:
■ Stop using tobacco at a certain time when you typically would smoke or chew. For example, if you always have a cigarette after dinner, try taking a walk instead.
■ Stop using tobacco in a certain place where you typically would smoke or chew. If you typically smoke in the car, try to make that the one place you don’t smoke. Wash your car and put an air freshener in it to help prevent you from having the urge to smoke.
■ If you have an urge to use tobacco, try to distract yourself and do something else instead.
■ Try switching your usual brand to one that you don’t enjoy as much.
■ Switch to a cigarette with a lower nicotine level. For example, if you smoke “Regular” cigarettes, try switching to “Lights” or “Ultra-Lights.”
“Since I smoked more on the weekends, I told myself that if I can go through a whole weekend without
smoking, then I can make it…and I did!”– Sheri, tobacco-free for 2 years
18
CHAPTER 5
Putting Your Quit Plan into Action
Congratulations! You’ve reached your quit day! On this important day, refer to your Quit Day Plan often and use the following tips to help you to stick with your plan:
Remove all temptations to use tobacco. This includes cigarettes, ashtrays, chew tins and whatever else you may have in your household that may tempt you to use tobacco.
Do something you enjoy. Take part in an activity you enjoy that does not involve tobacco, or fi nd a new hobby that gives you pleasure.
Change your routines. Take a diff erent route to work, or take a walk instead of a coff ee break, if these are activities you normally associate with tobacco use.
Refrain from using alcohol. Many relapses occur when people use alcohol, because they associate tobacco use with drinking.
AVOID situations that make you want to use tobacco. Prepare yourself for the time when you encounter one of
those situations again, so you can approach it carefully and follow through with your plan.
Use methods to deal with your feelings of anger or stress. The relaxation exercises on pages 21-22 in Chapter 5 can help you deal with these feelings. Also, refer to pages 24-25 in Chapter 6 for information about dealing with stress.
Reward yourself. Congratulate yourself on how far you’ve come. You deserve it!
The First Days: What You Can Expect
At the same time that you are going through the process of quitting tobacco, your body is going through a process of withdrawal. Although withdrawal symptoms can be bothersome, they are your body’s way of beginning to heal itself. Not everyone experiences withdrawal symptoms in the same way. Typically, symptoms are the worst 2 to 3 days after you stop using tobacco. The illustration that follows lists the most common withdrawal symptoms and some suggestions for relieving them.
Withdrawal Symptoms
Depression■ Think positively.■ Access your support system.
Headache■ Take mild pain relievers.■ Get plenty of rest.■ Avoid caff eine.
Worsening cough (caused by mucous clearing the airways)■ Drink plenty of fl uids.
Sleep Disturbances■ Avoid caff eine before bed.■ Try relaxation exercises
before bed.Increased Appetite■ Eat a well-balanced diet.■ Exercise regularly.■ Eat healthy snacks.
Feelings of frustration, anger and irritability■ Try a change of scenery.■ Take a few deep breaths.■ Use relaxation techniques.
Diffi culty concentrating■ Don’t overload yourself.■ Break projects into small tasks.■ Take frequent breaks.■ Get plenty of rest.
Dizziness (caused by extra oxygen)■ Sit down until it passes.■ Get plenty of rest.
Did you know…
✔ A tobacco craving only lasts 3 to 5 minutes.
✔ Your body starts to recover 20 minutes after your last cigarette.1
1. See Appendix 6 on page 34.
19
Strategies for Managing Stress and Your Moods
Your emotions and automatic thoughts can trigger your use of tobacco. By becoming aware of your thoughts and beliefs, you can have more control over them and make decisions more consciously about using tobacco.
Becoming Aware of Your Automatic Thoughts
Automatic thoughts are thoughts that enter your mind without any eff ort on your part. These thoughts are so much a part of your thinking process that you may not even be aware that you’re having them. Although they may seem completely valid as they’re running through your head, automatic thoughts can be deceptive. Becoming more aware of your automatic thoughts can help you consciously choose how you react to a situation.
Identifying Negative Thoughts and Irrational Beliefs
Many of the automatic thoughts that enter our minds are negative thoughts or irrational beliefs. Irrational beliefs are beliefs that are unrealistic, incorrect and are lacking evidence.
To change your negative thoughts and irrational beliefs, you must fi rst be able to identify them. The next time you’re feeling upset, try to fi gure out exactly what you’re feeling. Is it anger? Hurt? Sadness? Ask yourself why you’re feeling this way. Once you identify the thoughts behind your feelings, you’ll be able to determine the diff erence between rational and irrational thoughts.
Consider the following example:
As Randy walks into the kitchen, his wife, Sue, mentions that he forgot to take out the garbage. Randy becomes very angry, yells at Sue that he’s tired of her thinking he’s a failure, and storms out of the kitchen. He thinks, “I can’t do anything right. I don’t even know why I bother to try to quit smoking. I’ll just fail at that too.” He gets into his car and drives to the gas station to buy a pack of cigarettes.
After stopping to ask himself why he feels that Sue thinks he’s a failure, Randy realizes that he really doesn’t feel that way at all. Because he hadn’t been able to make a sale all day at work, he was feeling inadequate. He allowed those feelings of inadequacy to stick with him, and naturally assumed that Sue also viewed him as a failure.
Although Randy was still upset about not making a sale, he was able to see that he wasn’t viewing the situation realistically. Sue didn’t actually think of him as a failure. And he was also minimizing the fact that, although he didn’t make a sale that day, he’s the leading salesperson in the company.
Being able to identify and challenge negative or irrational thoughts is a key part of the process of overcoming tobacco dependence. If you don’t recognize these thoughts for what they are, you can start to have feelings of frustration, anger and defeat, which can lead you to act impulsively and slip into relapse.
I didn’t smoke for 3 days, then 4, then 5. I was taking it a day at a time.
Soon I wasn’t even counting.”
– Greg, tobacco-free for 20 years
20
Challenging Your Automatic Thoughts
You can challenge your automatic thoughts by identifying situations where you’ve experienced automatic, negative or destructive thoughts, and then replacing those thoughts with more realistic or rational thoughts. The log that follows shows an example of how to challenge negative thoughts with rational thoughts. Use the log to challenge a few of your own recent automatic thoughts. Be sure to make your rational thought realistic and believable, so it can reveal your automatic thought as invalid.
Identifying Your Automatic Thoughts
Activity/Situation/
Trigger
Mood/Feeling Automatic Thought Rational Thought
Example:Failure to meet a deadline
Example:Defeated; hopeless
Example:I’m such a loser. I fail at everything I do. Trying to stop smoking is just a waste of my time.
Example:I wasn’t able to meet the deadline this time. But this is a big project, and I shouldn’t be so hard on myself. I’m doing my best.
Reward Yourself…The Healthy Way
When quitting tobacco, it’s important not to replace your habit with another unhealthy behavior. Instead, choose healthy behaviors that will have a positive eff ect on your well-being. Here are some healthy examples of how you can reward yourself:
n Get a massage.
n Have lunch with a friend.
n Go for a walk.
n Read a book.
n Put the money you save from not buying tobacco into a jar and spend it on a vacation.
21
Relaxation Techniques
There are many diff erent ways to relax your mind and body when you’re in a stressful situation. Think about how you cope with day-to-day stress, and how you feel when you’re sitting in traffi c, standing in line at the grocery store or waiting for someone. Using the following relaxation techniques can be a refreshing and powerful way to help you get through these everyday situations without feeling stressed:
■ Take a deep breath in through your nose. Hold it for several seconds. Slowly breathe out through your mouth as you think about your tension, stress and problems leaving your body. Repeat as often as needed until you feel relaxed.
■ Start by focusing on your breathing. As you slowly breathe in, say the words “I AM.” Hold that breath for a second, and then slowly breathe out and say the word “CALM.” As you repeat this process, you may be able to continue the breathing with no thinking at all.
■ Close your eyes and take a few deep breaths. Tighten the muscles that you would like to relax. Focus on and feel the tension in the area that you’ve tightened. Now let the muscle become loose and limp. Take another breath in and slowly blow it out as you relax.
■ Let go of your worries using the following 10-step relaxation exercise:
1. Find a quiet place where you won’t be disturbed.
2. Sit in a comfortable position with your arms and legs uncrossed and relax your body.
3. Close your eyes, focusing only on what is happening in the present moment.
4. Tell yourself that you’re going to spend the next few minutes concentrating and relaxing.
5. Take a slow, deep breath. As you inhale, say the word “RELAX” to yourself.
6. As you exhale, say the word “CALM” to yourself.
7. Notice how the air moves in and out of your body as you continue to breathe slowly.
8. If your mind begins to wander, imagine your thoughts disappearing into the air, and then simply return your focus onto your breathing.
9. Continue this process for as long as you feel necessary.
10. When you feel relaxed, slowly open your eyes and bring your thoughts back to your present environment.
“When a craving came on, I took slow, deep breaths for a minute or so until it subsided.”
– Kim, tobacco-free for 2½ years
Tips for Practicing the Relaxation Exercises
■ Find a comfortable position where there will be no distractions or interruptions.
■ Pay attention to the present moment. Notice sounds, sensations, thoughts, tastes, smells, sights and images. Be aware of all the sensations you’re experiencing.
■ Start by doing only one relaxation exercise at a time. Over time, you’ll build the strength to be able to relax for longer periods.
■ Expect your mind to resist focusing on the present moment. It wants to do what is familiar, which may come in the form of boredom, inattention, restlessness or sleepiness.
■ If your mind wanders, recognize what has happened without judgment and bring your thoughts back to the present moment.
■ Trust yourself to be able to focus your attention on your breath and body.
■ If feelings of fear, panic, anxiety, stress or pain arise, let them be. Remain calm even under distress.
■ As you practice over time, you can sharpen your focus. Be patient with yourself and keep practicing.
22
Stop, BREATHE, Refl ect, Choose
Another way to relax in a stressful situation is by practicing the “Stop, BREATHE, Refl ect, Choose” technique. Researchers at Harvard Medical School and its teaching hospital developed the technique after years of stress research. Here’s how to use it to help yourself resist tobacco in a stressful situation:
Stop: When you encounter a trigger or a stressful situation, STOP before your thoughts turn negative, and temptation takes over. By saying the word “Stop!” you can interrupt your automatic thoughts. At fi rst, you may need to actually say the word out loud when a situation arises.
Then…
BREATHE: Take a deep breath and release. As you release your breath, physical tension will also release. Taking a deep breath and concentrating on it will bring your attention away from your automatic thoughts and reactions and will allow you to focus on the trigger.
Then…
Refl ect: Once you’ve stopped and taken a deep, relaxing breath, you’ll be able to focus on the trigger or situation and refl ect. Ask yourself:
■ What negative pattern am I about to fall into?
■ How is my body reacting?
■ How is my mood?
Then…
Choose: Now that you’ve stopped; taken a deep, relaxing breath; and refl ected on the trigger and your thoughts, you’re in a better place to make a choice as to how to respond. Ask yourself:
■ What do I want?
■ What can I do?
■ Do I need a few minutes to get my emotions in check so that I can react appropriately?
■ What is possible?
23
Take Time to Evaluate Your Plan
Take some time to record your thoughts about how well your plan to quit using tobacco is working. Review them and then modify your plan as necessary.
How do you feel you’re doing?
What do you fi nd most diffi cult?
What’s helping you?
What isn’t helping?
How can you modify your plan to make things easier?
“To deal with my cravings, I pictured myself in a wheelchair with an oxygen tube.
That’s what worked for me!”
– Patty, tobacco-free for 1½ years
24
If you’ve made it this far, congratulate yourself! You’ve come a long way in your journey. Although you’ve made great strides in increasing your freedom from tobacco, you should be aware that overcoming an addiction is a continuous journey that will require an ongoing and conscious eff ort on your part. But don’t give up! Many people have managed to keep tobacco out of their lives for good, and you can, too. If you need some inspiration, refer to Appendix 1 for some real-life success stories.
CHAPTER 6
Living Tobacco-Free
Dealing With Stress
What is stress?
Stress is your body’s physical and emotional response to change and challenging situations. Everyone experiences it at one time or another. Some stress can be healthy because it can help you to concentrate and perform. However, too much stress can be harmful. Experiencing stress regularly can aff ect your health and well-being. Stress can also cause you to return to using tobacco. It’s important to learn how to manage stress eff ectively.
Keep Up Your Eff orts
Continue to use the skills that have gotten you this far, such as:
■ Making use of your support system.
■ Rewarding yourself in a healthy way.
■ Replacing unhealthy behaviors with healthy behaviors.
Your Progress So Far
Take time to refl ect on your progress. In what ways is your life better since you’ve stopped using tobacco?
Common Signs of Stress
Mental Symptoms of Stress
■ Depression
■ Anxiety
■ Irritability
■ Rapid mood swings
■ Feelings of anger or frustration
■ Feelings of being “overwhelmed”
Physical Symptoms of Stress
■ Diffi culty sleeping (insomnia)
■ Low energy (fatigue)
■ Headaches
■ Upset stomach
■ Muscle aches
■ Low immune system function
■ High blood pressure
Did you know…
✔ Smokers die an average of 14 years earlier than non-smokers.1
✔ Avoiding “triggers” to use tobacco doubles your chances of remaining tobacco-free.10, 13
1, 10, 13. See Appendix 6 on page 34.
25
What causes stress?
Many people believe that certain “things” cause stress, such as a new job, relationship problems, holidays, fi nancial diffi culties, health problems or a bad day at work. Others defi ne stress as how they feel, such as pressured, angry or tense. Actually, stress is the perception of a threat to one’s well-being or the perception that one is unable to cope with a certain situation or feeling. As with all perceptions, stress can vary greatly from person to person. For example, one person may fi nd the morning drive to work to be very stressful, while another person may enjoy the time alone.
How can you decrease stress?
You can decrease the amount of stress in your life. The relaxation exercises in Chapter 5 can be very helpful in reducing your stress. Use the techniques you’ve learned to respond to your stress rationally.
Here are some tips on what else you can do to lower the amount of stress in your life:
Know when you’re stressed. Learning to recognize when you’re experiencing stress is an important step in being able to deal with it. Look out for the common physical and mental signs of stress.
Know why you’re stressed. Try to identify what’s causing your stress, and then take steps to deal with the issue. By not dealing with it, you’re only adding to your stress level. Sometimes you can experience stress without even knowing why – this is completely normal.
Try to reduce the amount of stress in your life. Take steps to avoid stress when you can. If being stuck in traffi c adds to your stress, try taking a diff erent route or leaving at a diff erent time. If you feel stressed about your fi nances, try making a budget to take off some of the strain. If your relationship with your spouse is causing you stress, consider talking to a counselor.
Take a break. Read a book. Take a nap. Get some exercise. Take part in a hobby. Write your thoughts down in a journal. Give yourself a “time-out.” Make it a priority to fi nd time to do the things you enjoy.
Take care of yourself. Exercise regularly, eat a well-balanced diet and get enough sleep. If your body isn’t healthy, it’s more diffi cult for your mind to be healthy.
Get some support. Seek out family and friends for support. If you need additional help, consult a mental health professional.
Vent. Let your frustrations out.
Think positively. Negative thoughts can lead to higher amounts of stress. When times get tough, remind yourself of the positive areas of your life.
Be realistic. Learn to accept what you cannot change. Don’t set unreasonable goals for yourself or others. If you need help, ask for it!
Time management skills. Get organized! Build extra time into your schedule, so you’re able to deal with whatever situations may come up without the added stress.
Laugh! Using humor is a great way to lower tension. Learn how to make light of a situation.
“I remind myself that my cravings will go away as quickly as they came on.”
– Sheri, tobacco-free for 2 years
26
Preventing Relapse
Relapse is a normal part of the process of change. In fact, it is much more common to relapse than not. The temptation to use tobacco doesn’t always disappear completely, and most people relapse at least once before quitting tobacco for good. You can prepare yourself for this possibility by developing a plan for how you’ll deal with relapse if it occurs. Your plan will help to get you back on track.
CHAPTER 7
Preventing/Dealing With Relapse
Common Factors Associated With Relapse
There are certain factors that are typically associated with relapse. By being aware of these factors, you can be better prepared to recognize and deal with them. They include:
■ Alcohol or drug use.
■ Negative and irrational thoughts.
■ Lack of support.
■ Negative mood or depression.
■ Being around other smokers.
■ Prolonged or severe withdrawal symptoms.
■ High-stress situations.
■ Following a strict diet.
■ Diffi culties with NRT or medications that reduce nicotine cravings.
If You’ve Had a Relapse
If you’ve relapsed, don’t punish yourself or think that you’re not able to stop using tobacco. Instead of blaming yourself, blame the situation. Take this opportunity to learn from your experience, and evaluate your plan to prevent another relapse. And remember…one slip doesn’t have to turn into a full relapse.
Sometimes, stressful, upsetting or unexpected situations can cause you to return to old habits. If you start using tobacco again, you might also start feeling frustrated and angry with yourself. You may also have feelings of failure or guilt, and you may experience a lowered self-esteem. In these situations, remember that you’re not alone. Use your support network to discuss the situation. And don’t give up!
How to Prevent Another Relapse
The leading cause of relapse is stress. If you need help dealing with stress, refer to the section on dealing with stress on pages 24-25 in Chapter 6. Here are some additional tips on what you can do to prevent another relapse:
■ Identify the situation that triggered your relapse.
■ Turn your “negative” relapse into a positive learning experience.
My Plan for Dealing With Relapse
What steps will you take to prevent relapse?
What situations will tempt you to use tobacco?
How will you deal with these temptations?
Did you know…
✔ For every day you remain tobacco-free, your immune system improves.9
✔ The weight gain reported by some ex-smokers often reverses itself over time.10
9, 10. See Appendix 6 on page 34.
27
■ Make sure you put time and energy into achieving your goals.
■ Continue to reward yourself.
■ Keep making use of your support system.
■ Prepare for complications.
Learning to Forgive
One of the keys to dealing with relapse is to be able to forgive yourself and other people. Many people fi nd it harder to forgive themselves than to forgive others. Extend the same compassion to yourself that you would to a friend. Forgiveness will help you to:
■ Accept that mistakes happen.
■ Be able to let go of your self-anger for failures, errors and mistakes.
■ No longer struggle with feelings of guilt.
■ Let go of the need to make up for your past off enses.
Congratulations! You’ve made great strides over the past several weeks in taking charge of your health and well-being. By participating in the tobacco cessation program, you’ve demonstrated your commitment to making positive changes in your life. The tobacco cessation program has provided you with tools that will continue to help you tackle new issues and concerns. Remember, you don’t have to do this alone. Through your support system and ongoing support from this program, you’ll be able to move successfully toward your goal of giving up your tobacco habit. Let this mark the beginning of your journey to emotional and physical well-being.
Preventing Another Relapse
What do you think it was that made you relapse?
What can you do to prevent it from happening again?
“There are still days when I would really love to go sit on my deck and smoke, but now I go sit on the
deck and watch the birds instead.”
– Patty, tobacco-free for 1½ years
28
APPENDIX 1
Real-Life Success Stories
Carole: tobacco-free for 21 years
The last day I ever had a cigarette was 20 years ago. At that time, I had worked up to smoking nearly three packs a day.
I worked at a company that was going non-smoking. Employees would not be allowed to smoke anywhere on site, not even in their cars parked in the attached parking ramp. I was addicted badly enough that I knew I would either have to stop smoking entirely or quit my job. I was so addicted that I contemplated leaving my wonderful job of nine years. I also liked smoking!
When I was at home, I would have a cigarette going in an ashtray upstairs. Then I’d run down to the basement to do some laundry, and I’d have to light up another one down there. At times, I’d have three going at the same time in various areas of the house. On occasion, I’d get to my offi ce and wonder if I had left a lit cigarette back at home. I’d call my own home phone number and fi gured that if it rang, that meant the house hadn’t burned down. Then one day a local store burned down, and I dialed their phone number. It rang as if the store were still there even though I had seen on the evening news that the store was just a pile of rubble. After that, I had to drive all the way back home to check to see if I had left any cigarettes lit.
I tried everything I could think of to resist the urge to smoke. I set a clear, glass jar half fi lled with water, cigarette butts and ashes on top of my desk at work, and every time I felt an urge to smoke, I unscrewed the lid and took a big whiff – whew! I left the table directly after eating and took a short walk; I did crossword puzzles or needlework while watching TV just to keep my hands busy; I chewed sugar-free peppermint or spearmint gum or sucked on mints.
Quitting smoking was the hardest thing I had done in my life up to that point, but the diffi culty only lasted a short time. I didn’t think it would really be that hard to quit once I set my mind to it, so it surprised me that it had such a hold on me. I developed headaches for about a week after quitting, and I developed a really crabby disposition for about two weeks. I skipped a Halloween party because I knew there would be a houseful of smokers there.
In just a couple of months, I noticed breathing became easier. I wasn’t huffi ng and puffi ng, and walking actually began to be fun. My hair and fi ngers no longer smelled like
stale tobacco. I cleaned every inside window in the house and car to get all the yellow residue off them. I washed curtains and blankets and replaced our home’s carpeting. My clothes and coats went in the washer or to the dry cleaners.
For me, quitting smoking has been a wonderful accomplishment, and it still feels great not to be tied to (or smell like) an ashtray. I am not one of those people who have a celebration puff each year on my quit date anniversary. In my case, I know that could possibly be trouble, and I don’t have a desire to go back to living like that.
I lost my brother in 1994 and my mother-in-law in 2000, both to lung cancer as a result of smoking. It’s a disease that’s so easily prevented.
Andy: tobacco-free for 30 years
I tried to quit seemingly hundreds of times for many years. I would do everything available at that time outside of clinics. No patches were available in those days, and I don’t even think that nicotine gum was around. I would get grouchy, anxious, and restless when I quit, and soon give in to the urge. I tried a pipe instead of cigarettes, but soon was smoking both cigarettes and a pipe.
I bargained with myself, tried cutting down, and I even tried rolling my own cigarettes to slow me down, but all to no avail. No matter what I did, I would be back to my prior smoking level within a few days to a week. I felt ashamed. I thought I was weak because I couldn’t stop, and my self-esteem diminished with each unsuccessful eff ort. It seemed like each time I quit, I would also increase my smoking quantity soon after restarting. At the end of my “career,” I was smoking about three packs a day. I was getting hopeless and believed that cigarettes were going to win.
Smoking at this quantity was beginning to feel like a full time job, and I was physically getting sick. I was winded; I always had a dry, yucky mouth; I coughed a lot; and I was queasy and nauseous at times. Finally I decided that I would not be able to quit if I did it with any half measures. I decided that I needed to quit cold turkey and make a decision. I decided that I could never even take a drag of a
29
cigarette again in my life. I knew if I took a puff , I would soon be up to my full smoking. I knew this because I had proved it to myself countless times. So I made a decision to put a cork in the bottle.
To this day, I still occasionally get the notion that I might be able to smoke a cigar (no inhaling - but it looks like fun), but I quickly come to my senses and realize that this is the nicotine receptor sites in my brain speaking to my addiction. I do believe that they never go away. Just the other day, I was on the freeway behind a car. The driver had just lit a cigarette (oh, that fi rst drag was always sweet), and my fi rst thought was, “ooh that smells good.” I always need to be vigilant in those moments and remember what it was like when I was a slave to cigarettes, and how I felt smoking three packs a day.
Now I exercise, eat right and try to quell those occasional nagging fears that I have set my lungs ripe for the breeding of cancer cells. Fortunately, it has been about 30 years since I’ve quit smoking, and I’m so glad that I was able to conquer that addiction.
Sue: tobacco-free for 1½ years
I quit smoking a year and half ago after 30 years of smoking.
As I got older, I became increasingly concerned about developing lung cancer. I noticed that every year when I got my “winter cold,” it would take longer and longer to get rid of it. I quit smoking every year in December (sometimes only for a day or two, sometimes only for an hour or two). Over the past few years, it was taking longer and longer to get over my cold and get rid of my yearly cough that developed as well. I fi nally decided that I HAD to quit – I didn’t want to be hooked up to oxygen in 10 years and have emphysema. I quit when I was in the middle of my yearly sickness so I already didn’t feel well.
I used a nicotine inhaler for 2 weeks to help me when I drove in my car. It was tough to not smoke when I started feeling better, but I stuck with it. The fi rst couple of months were pretty tough. I went through a grieving process and felt like I had a friend who died. I couldn’t watch TV shows with people smoking and had to change my habits (like have tea instead of coff ee in the morning). I couldn’t drive
long distances. But each day got a little better and here I am – 18 months smoke free! I can breathe easier, and I am able to work out. Quitting smoking was one of the hardest things I have done, but I did it to save my life.
Lisa: tobacco-free for 10 years
I started smoking when I started a new job in college. All of my coworkers smoked and I wanted to be cool, so I started smoking. It wasn’t long before I found myself fully addicted and unable to stop.
I smoked a pack and a half a day for 8 years. I tried to quit for the last 2 of those years. I tried all the various methods, including the nicotine patch, cold turkey and nicotine gum. I’d make it for about a month and then start up again. Then I started exercising at the gym. The exercise felt great, but I wasn’t able to advance and work up to my peak, because I would get so short-winded. I knew that if I wanted to continue to improve my fi tness level, I’d have to quit smoking once and for all.
Since I’d tried to quit so many times and was such a heavy smoker, I knew that I would have harsh physical withdrawals. But I also knew that the physical eff ects of nicotine would be fl ushed from my body in about 24 hours and then the battle would be completely emotional. To combat the physical withdrawal, I chewed nicotine gum for the fi rst day. I had a killer headache and felt awful, but the gum took the edge off , and I took aspirin for the headache.
Once I got past the physical withdrawal, I knew that I needed something to replace the habit of smoking, so every time I got a really strong craving, I went to the gym to exercise. This was to remind me why I had wanted to quit smoking in the fi rst place and to substitute smoking with something healthy and life affi rming.
With time, my lungs cleared, and my fi tness level improved. I still craved cigarettes for about a year, so you can imagine how much I went to the gym and what great shape I was in! However, after a year, the craving for cigarettes subsided signifi cantly, and after 2 years, it was gone for good. Now nearly 10 years later, I’m still smoke free and so happy about it.
30
APPENDIX 2
Example: Cost-Savings Calculator
Cost-Savings Calculator
How much does your tobacco habit cost you? It may be more than you think. Use this calculator to see the fi nancial impact that tobacco has on your life.
Number of packs/tins used per week Cost per pack/tin
5 x $4.00 = $20.00 Cost/week
Enter your cost/week $20.00 x 4 = $80.00 Cost/month
Enter your cost/month $80.00 x 12 = $960.00 Cost/year
Enter your cost/year $960.00 x 5 = $4,800.00 Cost/5 years
Enter your cost/year $960.00 x 15 = $4,400.00 Cost/15 years
Enter your cost/year $960.00 x 30 = $28,800.00 Cost/30 years
31
Many people are afraid that if they stop using tobacco, they will gain weight. While some people gain weight, many people do not. For those who do gain weight, the amount is usually minimal. If you’re afraid of gaining weight, consider that the consequences of using tobacco are much greater than the consequences of gaining a few extra pounds. Additionally, by eating healthfully and exercising regularly, you can minimize the amount of weight you gain.
Here are some tips on what you can do to keep weight gain to a minimum:
■ Don’t begin a new diet or exercise program at the same time you quit using tobacco. Kicking your tobacco habit requires a lot of eff ort on your part – by trying to change your diet or exercise at the same time, you’ll be putting extra pressure on yourself. Begin to change your eating habits either before your quit date or after you’ve successfully quit using tobacco.
■ Exercise regularly. Not only will exercise make you healthier, it will also help you to keep off extra pounds. Making an exercise plan can increase your chances of sticking with it.
■ Drink plenty of liquids.
■ Eat a well-balanced diet. Planning your meals ahead of time can prevent you from being tempted to eat unhealthfully.
■ Refrain from using alcohol. Alcohol is high in calories, and it puts you at a higher risk for relapse.
■ Carry healthy snacks with you when you’re away from home, so you aren’t tempted to eat snacks that are high in calories and sugar.
■ Don’t eat out of boredom. Keep yourself busy, so you don’t replace your tobacco habit with unhealthy eating behaviors.
■ Eat healthy snacks instead of snacks that are high in fat or sugar. Add other healthy snack choices you like to the list on this page.
■ Use the time that you would have spent using tobacco to exercise at the gym or take a walk with a friend. Add your own alternative activities to the list on this page.
Healthy Snack Options
❏ Sunfl ower seeds
❏ Fruits
❏ Raw vegetables
❏ Sugarless gum and candy
❏ Others:
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
Alternative Activities to Using Tobacco
❏ Going to the gym
❏ Walking with a friend
❏ Walking the dog
❏ Others:
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
APPENDIX 3
Weight Gain
32
Why is self-care important?Improving your sleeping and eating habits and increasing your level of physical activity can help you improve your physical health, which can help you begin to feel better.
How healthful is your eating?Taking care of your body is an important part of self care. Making sure that your body is well nourished is one of the fi rst steps you can take. Remember that food is our body’s source of energy, much like gas is energy for a car.
APPENDIX 4
Self-Care
How well are you sleeping?Sleep is important to good health. When we sleep too much or too little, our mood, physical health and energy level can decrease.
What is your level of physical activity?Some research suggests that exercise can help you feel better and improve your mood. Sometimes just getting outside for a walk in the fresh air is all it takes. Before beginning any exercise program, however, be sure to consult with your health care provider about any physical limitations you may have while exercising.
Self-Care Log
For each day of the week, place a checkmark (✔) inside the box that applies to your activity level, eating and sleeping pattern for that day. This gives you a way to monitor how well you are taking care of yourself and how consistent you are in your progress as the weeks pass.
Physical Activity Healthy Eating(Eat only when hungry, not when stressed, bored, etc.)
Sleeping(Got enough sleep; didn’t over sleep or under sleep)
Yes No 2 dairy 5 vegs 3 fruits 2 protein 6 bread/cereal
Avoid sweets?
Slept thru the
night
Woke up 1x or
more
Felt refreshed
in the a.m.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
33
APPENDIX 5
Additional Resources
Helpful Websites
American Cancer Societywww.cancer.org
American Heart Associationwww.americanheart.org
American Lung Associationwww.lungusa.org
Centers for Disease Control and Preventionwww.cdc.gov
Nicotine Anonymouswww.nicotine-anonymous.org
34
1. American Cancer Society. February 2006. Cigarette Smoking. Retrieved May 23, 2006 from the World Wide Web: http://www.cancer.org/docroot/PED/content/PED_10_2X_Cigarette_Smoking.asp?sitarea=PED
2. Benson, H., & Stuart, E.M. (1992). The Wellness Book: The Comprehensive Guide to Maintaining Health and Treating Stress-Related Illness. Fireside, New York.
3. Curry, SJ. 1993. Self-help interventions for smoking cessation. Journal of Consulting and Clinical Psychology. 61(5):790-803
4. Fiore MC, Bailey WC, Cohen SJ, et al. Treating Tobacco Use and Dependence. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. June 2000.
5. Froom, P; Kristal-Boneh, E; Melamed, S; Gofer, D; Benbassat, J: Ribak, J. 1999. Smoking cessation and body mass index of occupationally active men: the Israeli CORDIS Study. American Journal of Public Health. 89(5):718-22.
6. Hatsukami, D; Mooney, M. 1999. Pharmacological and behavioral strategies for smoking cessation. Journal of Clinical Psychology in Medical Settings. V6(1):11-38.
7. Pederson, L: Bull, SB; Ashley, MJ; Mac Donald, JK. 1996. Quitting smoking: why, how, and what might help. Tobacco Control. V5:209-214.
APPENDIX 6
References
8. Prochaska, J., Norcross, J., and DiClemente, C. (1995). Changing For Good: A Revolutionary Six-Stage Program for Overcoming Bad Habits and Moving Your Life Positively Forward. Avon Books, New York.
9. Sopori, ML; Kozak, W. 1998. Immunomodulatory eff ects of cigarette smoke. Journal of Neuroimmunology. 83(1-2):148-56.
10. U.S. Department of Health and Human Services. Reducing Tobacco Use: A Report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Offi ce on Smoking and Health, 2000.
11. U.S. Department of Health and Human Services. Smoking and Tobacco Control Monograph 10: Health Eff ects of Exposure to Environmental Tobacco Smoke. National Cancer Institute, August 1999.
12. U.S. Department of Health and Human Services. Women and Smoking: A Report of the Surgeon General, 2001.
13. Velicer, WF; Prochaska, JO. 1999. An expert system intervention for smoking cessation. Patient Education & Counseling. V36(2):119-129.
35
When was it? Where were you?What were you doing?
How were you feeling?
Level of desire
Example:
6:30 am; just after waking up
Example:
At the kitchen table
Example:
Drinking coff ee
Example:
Tired
Example:
High
Example:
7:30 am
Example:
In the car
Example:
Driving to work
Example:
Frustrated
Example:
Very high
Example:
7:50 am
Example:
In the car
Example:
Sitting in the parking lot at work
Example:
Ready to start the day
Example:
Low
MY TOBACCO JOURNAL: EXAMPLE
36
When was it? Where were you?What were you doing?
How were you feeling?
Level of desire
Before beginning, photocopy this page, so you’ll have blank Journal pages to use later. Leave the original blank, so you can make additional copies.
MY TOBACCO JOURNAL
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