Nicotine Addiction 2:
Psychological Strategies
Nicotine addiction is arguably the most difficult addiction to overcome. Having worked with people with a variety of drug addictions, each person has told me that breaking a cigarette addiction is far more difficult than getting off heroine or cocaine. My last column was about repairing brain chemistry through nutritional therapies. I suggested that people trying to quit smoking give themselves a month of nutritional therapy before making a decision to quit. I’ll briefly review those nutrients at the end of this article, which deals with mental/emotional strategies to help in quitting - forever.
Baby Steps
While people are rebuilding their brain chemistry and restoring normal neurotransmitter levels, I make some nonmedical recommendations. You may not be ready to quit smoking today, but there is something you can change today that will begin your recovery process. Commercial cigarettes contain around 4,000 chemicals. As long as you are smoking, switch to American Spirit cigarettes, which contain no additives. With this one simple step, you can at least decrease the health risks. Native American spirituality regards tobacco as sacred, hence the use of tobacco in ceremonies that involve the Sacred Pipe (incorrectly referred to as a Peace Pipe). Each time you take a puff of your American Spirit cigarette, offer the smoke to Great Spirit. It may sound odd to some people to link a dangerous habit with a spiritual practice, but please stay open-minded. After all, in this early phase I’m not even telling people to quit smoking. By smoking as an offering to Great Spirit, you totally change your self-talk about smoking. On some level, every smoker knows that it’s potentially dangerous. Because of growing social stigma, some people smoke cigarettes while quietly telling themselves how weak they are. Change that mindset. By making smoking a spiritual offering, you transform the entire process of smoking. Spiritualizing smoking will weaken the grip of this addiction.
When, Where, Why, How?
People go through life largely unaware of the complexities of any habit. The first big step toward quitting is about becoming aware of the details of the habit. It is much easier to change a habit if we are aware of the details. Once you are aware of the details of your habit, you are empowered to quit. Get out a note pad so you can begin writing down the subtle details of the smoking habit.
1. The Pleasure of Smoking. If you’ve smoked for a long time, cigarettes are woven into the fabric of your life. Cigarettes have provided you temporary relief from anxiety, stress, sadness, loneliness, and boredom. It activates the pleasure centers, raises brain dopamine levels, and provides a pleasurable, calming effect. Write down what benefits cigarettes give you.
2. Are you mainly a social smoker?
3. Is your addiction severe (more than a pack a day)?
4. Do you have other addictions linked to nicotine?
5. Which moments or events call for a cigarette?
6. Do you crave nicotine after drinking with friends?
7. Do you crave a cigarette any time you have an alcoholic beverage, or with a cup of coffee?
8. What triggers you to reach for a cigarette?
9. Do you smoke while driving…while watching TV…or talking on the phone?
10. Do you like to smoke after you finish a meal?
11. When do you tend to smoke?
12. Where do you smoke? Which locations?
Why Should You Quit?
Part of your self-assessment includes, “Why should I quit?” Remember that the goal of overcoming nicotine addiction is to break the habit totally and completely, so that you are smoking no cigarettes.
“I should quit because:”
1. It’s harmful or dangerous to my health.
2. I don’t like being dependent on cigarettes.
3. I’m getting wrinkled skin.
4. My teeth are discolored from smoking.
5. I’ve lost my sense of smell.
6. Many of my friends are smokers. I’ve been losing contact with my non-smoking friends.
7. People tell me that my clothing smells like cigarettes.
8. I realize that second-hand smoke can be harmful to others.
9. Cigarettes cost me too much money. (Depending on where you live, a pack a day habit can cost you $1800 a year).
10. My life and health insurance premiums have increased because of smoking.
11. I’ve burned holes in my clothing.
12. I have cigarette stains on my fingers.
13. Cigarettes increase my risk of cancer, especially lung cancer.
Identify Your Smoking Pattern
You’ve just read a couple of lists to help you begin to understand why, when, and where you smoke. Next, write down all the steps you take every time you smoke. People generally think of smoking a cigarette as a single event. It’s not.
Here is an example of one possible smoking pattern:
1) Reach for your purse,
2) Locate a pack of cigarettes and a lighter in your purse,
3) Set the lighter down on a table,
4) Hold the pack in one hand,
5) Tap the bottom of the pack so that one cigarette becomes easier to grab,
6) Pull out one cigarette. (At this point, which hand is holding the cigarette?),
7) Perhaps you’ll transfer the cigarette from your right hand to your left hand,
8) Pick up the lighter or match,
9) Holding the lighter in your right or left hand, ignite the flame,
10) Bring the lighter over to the hand holding the cigarette, and hold the flame close to the end of the cigarette,
11) Inhale until the cigarette is burning,
12) Put out the flame of the lighter,
13) Put the lighter back into your purse,
14) Close your purse,
15) Put your purse back down, or wherever you want it,
16) Do you now switch your cigarette from left to right or right to left? Which hand do you generally smoke with?
17) Inhale, bringing smoke into your lungs,
18) After a puff, move your hand and the cigarette away from your mouth,
19) After a few puffs flick the ashes into an ashtray,
20) Notice how many puffs you take each time you smoke,
21) How long is your average “cigarette break?”
22) When you’ve finished smoking, put out the cigarette in an ashtray.
Strategic Pattern Intervention
We are identifying each and every step involved with smoking. We’re identifying the “pattern.” This habit remains about the same regardless of when, where, and why you smoke.” You’ve just seen that the simple act of smoking can take more than 20 steps. By changing or interrupting any step in the pattern, you begin to break up the pattern. Think of smoking as a long chain of steps, each one essential to having a lit cigarette in your hand. Each step is a link in a long chain. You can change, move, or remove one step or several steps, and your pattern will be broken.
The biology of addiction is complicated. Part of the addiction is the pattern, which has become deeply wired into your brain. If you repeat one thought over and over again, the flow of electrical impulses and neurotransmitters creates a “channel” that holds the habit or the addiction. Likewise, the long chain in your cigarette pattern has a deep brain groove, metaphorically. But that habit groove is not irreversible. If you interrupt the pattern, you immediately begin to alter how the habit pattern is wired in your brain.
More than 20 years ago I worked at the VA Hospital outpatient clinic in San Diego. These are clinics where a doctor sees a patient every 3 months. One patient, apart from being depressed, had a long-term nicotine addiction. I asked him which hand he used to hold a cigarette. It was his right hand. I asked him to smoke with only his left hand, and report the changes to me in 3 months. I wanted to interrupt his habit pattern. At the next visit he reported that he had been free of cigarettes for 2 months. Breaking the habit pattern broke the habit, and the change was permanent. This is a good place for you to start. Switch the hand you use to hold your cigarettes. The broken habit pattern will lead to a change in the brain. The wiring of that habit has been partially broken. This can be real magic, but do not give up if this one step doesn’t cure you. In fact, once you’ve decided to quit smoking, set a date for quitting and stick to it. Tell close friends and family about your decision. You’ll want their support.
As with any addiction, relapse is part of the process of recovery. As football coach Vince Lombardi said, “It doesn’t matter how many times you fall down. It only matters how many times you pick yourself up.” A relapse is not failure. It’s part of the process of quitting. With that said, I want to make it clear that Strategic Pattern Intervention is very powerful, and not just for a cigarette habit.
At this point, you have a better idea of when and where you smoke. You know most of the reasons motivating you to quit. And you know your unique smoking pattern. You know your smoking ritual, including the triggers for smoking.
Grieving and Moving On
Because smoking becomes fully integrated into your life, you may find yourself grieving cigarettes after you quit. It’s an old friend. Your grief could take you through emotions that are part of the grief process, such as: denial, bargaining, anger, sadness, guilt, and acceptance. Let yourself feel whatever you are feeling and identify key areas you’ll need help with. Those include:
1) something to help you relax;
2) something to stimulate you;
3) something to help with cravings; and
4) something to help with physical withdrawal symptoms.
Tapping the Power of Mental Imagery
There are dozens of mental imagery techniques that can help with a variety of nicotine-related issues. I’ll share one.
Close your eyes and picture yourself walking along a path out in nature. After awhile, you see something in the distance on your path. As you get closer, you see that it’s a hole. When you reach the hole, pick up a twig or a stone and drop it into the hole. This particular hole goes to the center of the earth. When you drop the rock in the hole, you don’t hear it reach bottom, because the hole is bottomless.
All the cigarettes on the planet come flying toward the hole, disappearing down the hole. After awhile you don’t see any more cigarettes flying toward the hole. There are no cigarettes left on the planet. Take the pack of cigarettes that you’re carrying and toss it into the hole. You are now living in a world where cigarette addiction no longer exists, because there are no cigarettes.
As you practice this imagery, your worldview about cigarettes will change. You now must make changes. You could live in a world without cigarettes.
Nutritional Supplements
In last month’s TLC article, we looked at nutritional supplements that will help rebuild damaged brain neurotransmitters. Please re-read that article after finishing this one. Let’s briefly review these supplements. They are an essential part of your nicotine recovery and should be taken for several months. Dopamine chemistry is the main problem caused by nicotine. To build dopamine, supplement with the amino acid L-tyrosine. For adults 1000 mg twice a day will work. Take 40 mg of P-5-P (pyridoxal-5-phosphate, the active form of Vitamin B6) to activate tyrosine.
To restore brain serotonin levels, take the amino acid L-tryptophan. Take P-5-P to allow tryptophan to convert into serotonin. GABA is our calming neurotransmitter. Take 1000 mg 2 to 3 times a day.
Include a multiple B vitamin, Vitamin C, omega-3 fatty acids (fish oil), niacin, and antioxidants.
In addition to knowing about important nutritional support, you now can use ground level psychological tools. Next month you’ll learn more mental fitness techniques to help you target specific withdrawal symptoms, tools that will become part of your total winning game plan.
David Gersten, M.D. practices Nutritional Medicine and Integrative Psychiatry out of his Encinitas office and can be reached at 760-633-3063. Please feel free to access 1,000 on-line pages about holistic health, amino acids, and nutritional therapy at www.aminoacidpower.com and www.imagerynet.com.