 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 for the link between smoking and depression, according to data collected on nearly 1,500 pairs of female twins. "The twin data show that whatever gene puts you at risk for depression, the same gene puts you at risk for smoking," says Alexander Glassman.
Further evidence for this conclusion comes from a prospective epidemiological study, in which 1,200 people in their twenties were surveyed twice; 18 months to two years apart. Nonsmokers who were depressed at the first interview were more likely to be smoking at the time of the second, while nondepressed smokers were more likely to have become depressed by then.
Genetics may even play a role in how you smoke. Shiftman studied a group of people who had smoked regularly but lightly, five cigarettes or less, four days or more a week, for several years at least. Says Saul Shiftman: "They had ample opportunity to become addicted—on average, they'd smoked 46,000 cigarettes, but we found not the slightest evidence of dependence: they showed no signs of withdrawal when abstinent. They really could casually take smoking or leave it."
Such nonaddicted users—chippers," in drug culture parlance—are also seen among consumers of hard drugs. "We didn't delve deeply into what made these smokers different," says Shiftman. "But we did find evidence that they also had relatives who smoked with little dependence, who followed the same pattern. This makes it plausible, although it doesn't prove that these folks are biologically different." With rare exceptions, chippers have always smoked that way, he points out. For a once-addicted smoker to try to become a chipper is "a risky business" that's probably doomed to failure.
Smoking just doesn't have the cachet it once did. Instead of a mark of worldliness and joie de vivre, it's become something of a social disease. Except on billboards and in magazine ads, the smoker him- or herself is less likely to be the object of admiration than of pity and contempt.
The change in smoking's status is no doubt in part responsible for the 40 percent