Help to Stop Smoking

Dear Dr. Mahler: Do you have any advice on helping me stop smoking?  I have quit many times, and have used the patch, gum, Chantix, and finally tried hypnosis. The longest time that I quit was for 3 weeks, but then I craved a cigarette after going out with my friends for dinner. Now I smoke a pack most days. My doctor diagnosed me with COPD six months ago, and I take an inhaler twice a day. My father had emphysema and died of a heart attack.   Carl from Bend, OR Dear Carl, As you know, nicotine in cigarette smoke can be addicting for my people. This addicting feature is evident at many medical centers where you can see employees standing outside in the rain, snow, and/or cold while smoking in designated areas. In the United States, about 18% of adults smoke cigarettes daily.
Two women smoking outdoors during winter

Two women smoking outdoors during winter

Man smoking outdoors in the winter

Man smoking outdoors in the winter

          Here are parts of a letter sent to me from a friend and former patient. He grew up in the United Kingdom, and now lives in the US. His comments provide a message for anyone facing the challenge of quitting smoking. He gave me permission to share what worked for him in the hope that it may help others. “As one who smoked from an early age in my teens in England, I made various attempts to give up this very addictive, legalized, tax generating, drug. When in 2000 I finally did after 40+ years of smoking, I tried an approach which may be helpful to pass on, via you, to others. My previous attempts to stop were all based on stopping ‘tomorrow.’ All failed. With the tomorrow approach, the addict usually smokes heavily the night before trying to stop smoking. Even using patches, he “needs” his tobacco fix next morning, usually upon waking, that is when the withdrawal starts of course.
  I was to head off on two flights to the U.S. West Coast and I had decided to enjoy my last morning pipe/fix before the taxi came to take me to the airport and the ‘no smoking’ environment that entails. Taxi arrived, pipes consigned to the trash bin, I set off.
At the airport, I learned at the pharmacy there, that it would likely cost me around $400 in patches to give up the native American weed. No way was I going to spend that sort of money, however good the cause was, that’s a lot of golf balls !
Instead, every time I reached for my pipe, I said to myself, sometimes aloud, ” I don’t smoke do I!” Breaking my journey in Newark Airport, NJ, I refrained from accepting my traveling colleague’s tempting offer to wait for me, if I wanted to use the then available smoking bar. Instead I boarded the flight to San Francisco, muttering to myself through gritted teeth, ‘I don’t smoke do I!!’
Once on the West Coast almost a day had past and ready for bed I went smoke free, day one. By staying for the most part in non smoking environments, I continued as the cold turkey effects came one , but remembering to say, I don’t smoke, when the urge for my soothing pipe grew strong. Having the odd strip of sugar free gum helped too.
 It was not easy, but day by day it became normal to be a non smoker, my sense of smell and taste became more pleasingly acute, and then, secondhand smoke became abhorrent to me. About that time I too realized that as even a pipe smoker, one smells akin to an ash can to non smokers. Saving lots of money by not buying expensive, highly taxed tobacco in the UK, then paid for my annual dues at a local golf club, and my health was improving too.
To stop smoking and save money and your health ; The secret being, get the morning fix, then get into a non smoking space to stop smoking forever. Remember, ‘I don’t smoke do I.’ After all, we were not born as nicotine addicts.”
I hope that these comments are helpful.
Donald A. Mahler, M.D.

Donald A. Mahler, M.D. is Emeritus Professor of Medicine at Geisel School of Medicine at Dartmouth in Hanover, New Hampshire. He works as a pulmonary physician at Valley Regional Hospital in Claremont, NH, where he is Director of Respiratory Services.