Why Quitting Smoking is Hard to Do
I attended a conference the other day given by Dr. David L. Katz, a well-known primary care doctor who regularly works with Oprah, ABC news, as well as other major news organizations (www.davidkatzmd.com). He is well known for his advice on helping people lose weight by identifying which elements of their lifestyles need change to encourage better eating and more exercise.
Recently, he has been applying the same ideas to help people quit smoking. In his system, people who are trying to quit smoking go through several stages:
- Precontemplation: people who have not yet tried to quit and haven’t thought about quitting seriously
- Contemplation (Preparation): people who have not yet tried to quit and have begun to think seriously about quitting
- Action/Maintenance: people making changes to quit smoking
- Lapse: people who begin smoking again despite trying to quit
- Burnout: people who go back to the precontemplation or contemplation stage because they are frustrated at “failing” to quit.
I put “failing” in quotation marks because Dr. Katz believes (and I agree) that relapsing into smoking is not about personal failure alone. It is more about seeing smoking in a context of other pressures and circumstances that encourage smoking behavior, and working to identify and changes those pressures and circumstances to make quitting smoking easier.
The most common factors that make quitting smoking difficult are:
- nicotine dependence (the need to use nicotine for its physiological effects)
- chemical codependency (dependence or addiction to another substance, such as alcohol or drugs)
- concern about weight gain
- and the presence of at least one other smoker in the household
These factors imply that cigarette smoking does not exist in a vacuum. Rather, it is part of a complex mixture of issues, and all of these issues need to be addressed in order for the quitting process to have the best chance of success. This complicates the process of quitting, because the presence of these factors contributes to failure, which in turn leads to frustration on the part of the person who wants to quit. The good news is that these factors can be overcome! For example, nicotine dependence, anxiety and depression have good medical treatments available. Counseling can overcome other addictions, stress and lead to dietary changes that stop weight gain. Though getting the other smokers in the household to quit doesn’t have an easy solution, convincing those people to quit multiplies the benefits!
Dr. Katz is working on methods to help doctors, especially primary doctors, work with patients to identify and start to treat cigarette smoking as a part of a complex set of conditions. In the next blog, I will discuss other aspects of the plan and help you identify tools that you can use with your health care provider to make steps towards quitting smoking.