How to Get Started
The CDC recommends a 5-step approach developed by the U.S. Surgeon General’s Office called “The 5-A’s.” Your doctor’s job is to “Ask” about your smoking (or tobacco use) status; “Advise” you to try to quit; “Assess” your willingness to try; “Assist” you in any way he or she can; and then “Arrange to follow up” so that you stay focused on the importance of quitting.3
Your job is to do everything in your power to work in partnership with your doctor to make this effort a lasting success. Your doctor, friends and family can all help you, but when all is said and done, the power is in your own hands.
If there are special circumstances in your case, such as other addictions or conditions that cause you ongoing pain, your doctor is likely to make recommendations for helping these problems as well, because they can complicate efforts to quit smoking.
Understanding How Change Works
Both you and your doctor can benefit from understanding the ways that people make major changes in their lives, and then applying these ideas to your efforts to stop using tobacco. The most common model used in smoking cessation programs is called “Stages of Change.” Developed by Drs. Prochaska and DiClemente,23 this model is based on their finding that people with addictive behaviors (as you know, nicotine is quite addictive) are at one of the following five stages of the journey toward quitting:
1. Pre-contemplation. In this phase the smoker has no intention of quitting in the near future but is willing to receive information about quitting. If you are in this phase, your doctor might give you a brochure (or open a conversation) about why it would be good for you to consider stopping. In some cases, this information helps people move toward the next stage.
2. Contemplation. In this stage, you may have the intention to quit, but aren’t yet ready to do so. Sensing this, your doctor might try to motivate you to consider an action such as setting a specific date for quitting sometime in the next six months.
3. Preparation. In this stage you are actively making an effort to take action within 30 days. This might include some behavioral changes like reading more about cessation or nicotine replacement therapy (NRT). Your doctor may help you develop a solid action plan that could include setting gradual goals.
4. Action. In this stage, you have already changed your behavior. This might involve putting away all the ashtrays in your home or eliminating all purchases of tobacco. During this time, your doctor or his/her staff will do their best to help you with any problems that may arise, offering support to help you stay on track.
5. Maintenance. In this final stage, you have “maintained” the changed behavior for at least six months. During this time, you and your doctor need to do everything possible to reinforce your commitment and avoid a relapse. For example, smokers tend to smoke more when consuming alcohol or when their spouse is also a smoker. If you are in such a situation, it’s good to think in advance about ways to handle these situations.
Treatment Options: Smoking Cessation Programs and Medication
Paths to success in quitting tobacco vary widely, depending on the individual makeup of the person doing the quitting. Some people can make a decision to quit, apply all of their willpower, and then never again use tobacco for the rest of their lives. Others need assistance of various types.
The key point is to find an approach that works for you. Because nicotine patches and other forms of nicotine replacement therapy require a prescription, it’s usually a good idea for your medical physician to be involved. If you can quit without using the patch, that’s fine. But the most important question is not how you quit, but that you actually succeed at quitting and then maintain your commitment to a tobacco-free life.
Studies show that medications and cessation counseling, along with NRT, offer the greatest chance for success.25-27 A list of area smoking cessation programs (some are free, others charge a fee) can usually be obtained from the local chapter of the American Lung Association or American Cancer Society. Many successful quit attempts are made at the beginning of a new year as a resolution or as part of the Great American Smoke-Out held in November of each year. Taking action at these times may increase your chances for success because you can draw strength from others when you realize you are not alone.
Will Evans, DC, PhD, CHES, is director of Health Promotion Programs for Cleveland Chiropractic College. |
