A Love Story

I have a sixty-eight year old patient named Carmen who has been smoking for the past forty years. I’ve been trying to convince her to stop smoking for the last two years that I’ve known her. She already has emphysema, COPD (chronic obstructive pulmonary disease), CAD (coronary artery disease), PAD (peripheral arterial disease) and she has a history of breast cancer that resulted in a mastectomy. In addition, she has some renal insufficiency and anxiety related issues. Every visit, I ask her, “are you ready to quit?” And every time I ask her, she tells me, “still thinking about it.”

I liken smoking, and any other addiction for that matter, to a torrid, taboo, love story. And like any good love story, it starts with a curiosity. First, it begins like a passing thought with a mild interest, but for whatever reason, despite knowing how bad it is for you, you are drawn to it. Then it turns into a conversation, where you try to ease that curiosity. All of a sudden, you’re drawn further into this abyss, beginning with the first taboo kiss, that’s hot, burning even. You know it’s bad for you, but you can’t help yourself. You tell yourself it’s just going to be the one time. But then you go the party, and there it is waiting for you. Your friends seem to be hanging out with this strange lover all the time and before you know it, you’re hooked. The love continues to to smolder; it’s an abusive relationship where each lover is hurt. Eventually, the love begins to fade, leaving only a trail of smoke in it’s wake. But the damage in done, and now, you need to pick up the pieces and move on.

Of course, in the case of smoking, only the smoker gets hurt, if not killed in the process. For people that smoke, they know it’s killing them. It’s written right on the box in the surgeon general’s warning. And if they were illiterate, there’s a huge anti smoking campaign out there that’s pretty effective in getting the word out about how dangerous it is to you. Yet, there are new smokers being made everyday. And it’s still legal. When I ask Carmen why she continues to smoke, she tells me, “it’s the only vice I have and it helps me with my stress.” Smoking is an addiction and like any other habit, or like a lover, we make excuses for it. “She only cheated on me the one time” or “he only lashed out at you because you provoked him.” Unfortunately, we can’t make our friends see what we do until they are ready to.

Like any addiction, smoking has three parts. If you are going to be successful at quitting, you need to address all three. The first part is the cue. What is it that cues you to smoke? For some people, it’s going out with their friends or having a drink. For others, it’s after waking up or after sex. The second part is the ritual. It’s the actual act of bringing the cigarette to your lips, taking in a toke and exhaling. The third part is the reward. This is the high that a person gets when they have the nicotine hit their blood stream. For some people, it calms them and for others it energizes them.

So how can we quit? First, you need to commit. Getting out of any abusive relationship requires a commitment to do what is difficult. If you need inspiration, think about your kids or your grandkids and how they’re bugging you to quit. Think about your health and how difficult it’s become for you to walk up a flight of stairs or that cancer/heart attack scare you had. Think about all the people around you that give you that dirty look when you start to light up. Next, try to address the parts of the addiction. Try to avoid the cues. If you find that drinking with your friends cues you to smoke, try hanging out with them in a different context, like getting coffee or exercising together. Try to supplant the ritual with a new one. Instead of smoking, chew on that gum or try those breathing exercises that you picked up at yoga. Finally, replace the reward. There are a lot of ways to get “high” without a smoking aid. For some people, exercise can give you a high. For others, walking in nature will do it. If you must, replace the nicotine high from smoking with a nicotine high from gum or a patch.

If these things fail, you have resources. The tobacco free Florida website is a great resource where they will actually give you some free samples of nicotine substitutes to help. Support groups help. Hypnotism also helps.Talk to your doctor about medical options that may help. But remember, none of this will work unless you are ready to commit. In reality, we are all married to our health, for better or worse, in sickness and health, till death do us part. And like any really good marriage, commitment is the cornerstone needed to succeed. We want there to be a long, happy, fairytale ending, not one that ends up on a ventilator.

By: Dr. Juan Borja
Original post: https://yourdoctordad.com/a-love-story/

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