iftman.
He advises would-be quitters at times of temptation to remind themselves just why they're quitting: "My children will be so proud of me," or "I want to live to see my grandchildren," for example. Think of a relaxing scene. Imagine how you'll feel tomorrow if you pass this crisis without smoking. Or simply tell yourself, "NO" or "Smoking is not an option."
Coping skills, however, are conspicuously unsuccessful for people who are high in negative affect. Supportive counseling works better. Depression or anxiety may interfere with the ability to use cognitive skills.
One exercise that Brandon teaches patients asks them to inventory—and treat themselves to—things that make them feel good, a substitute for the mood-elevating effect of a cigarette. These might include exercising, being with friends, going to concerts, reading, or taking a nap. "Positive life-style changes that improve mood level" are particularly useful if you use cigarettes to deal with negative emotional states, he says.
Depression treatment is particularly important for those trying to quit smoking. One study found that cognitive therapy significantly improved quit rates for people with a history of depression. Various antidepressants have been effective in small studies, and a large double-blind trial using the drug Zoloft is underway.
Fiore has found that having just one cigarette in the first two weeks of a cessation program predicted about 80 percent of relapses at six months. Even when the withdrawal symptoms are gone, a single lapse can rekindle the urge as much as ever.
In the critical first weeks without cigarettes, a key to relapse prevention is avoiding, or severely limiting, alcohol, which not only blunts inhibitions, but is often powerfully bound to smoking as a habit. Up to one-half of people who try to quit have their first lapse with alcohol on board.
Watch your coffee intake, too. It can trigger the urge to smoke. And nicotine stimulates a liver enzyme that breaks down caffeine, so when you quit, you'll get more bang for each cup, leading to irritability, anxiety, and insomnia—the withdrawal symptoms that undermine quit efforts.
Try to change your routine to break patterns that strengthen addiction: drive to work a different way; don't linger at the table after a meal. And don't try to quit when you're under stress: vacation time might be a good occasion.
And if you do have a lapse? Don't trivialize it, because then you're more likely to have another, says Shiffman. But, "if you make it a catastrophe, you'll reconfirm fears that you'll never be able to quit," a low self-esteem position that could become a self-fulfilling prophecy. "Think of it as a warning, a mistake you'll have to overcome."
Try to learn from the lapse: examine the situation that led up to it, and plan to deal with it better in the future. "And take it as a sign you need to double your efforts," Shiffman says. "Looking back at a lapse, many people find they'd already begun to slack off; early on, they were avoiding situations where they were tempted to smoke, but later got careless."
Don't be discouraged by ups and downs. "It's normal to have it easy for a while, then all of a sudden you're under stress and for 10 minutes you have an intense craving," says Shiftman. "Consider the gain in frequency and duration: the urge to smoke is now coming back for 10 minutes, every two weeks, rather than all the time."
If lapse turns into relapse and you end up smoking regularly, the best antidote to despair is getting ready to try again. "Smoking is a chronic disease, and quitting is a process. Relapse and remission are part of the process," says Fiore. "As long as you're continuing to make progress toward the ultimate goal of being smoke-free, you should feel good about your achievement."
Although the difference between smokers and nonsmokers appears to reflect complex environmental and social factors, genetics apparently plays a role comparable to that observed in alcoholism, responsible for about 30 percent of the propensity. In particular, shared genetics appears to account