ANNE PENMAN STOP SMOKING PROGRAM

Plan to quit and stay stopped

Name :______

I’ve been smoking since______My quit date: ______

I smoke ______cigarettes a day

I spend ______a week on cigarettes

Most smokers have triggers for “lighting up”; after a meal; a coffee break at work; making a telephone call; meeting friends.... Keeping a Smoking Diary for a couple of weeks before your quit date, of where, when and why you smoke, can help you understand your smoking behaviour. This will then help you plan for how you will deal with those triggers when you’ve stopped. Once you’ve stopped you may then use the diary to help you stay stopped by making a note about how you’re feeling in terms of the benefits of being a non- smoker.

Keep track of what you’re doing, who you’re with and when you have the urge to smoke.

A – Smoking Diary

Reason for Smoking
/
Time
/
Where
/
Doing What
/
With Whom
/
How Many
/
*Levels of Desire 1-4
  1. Reason for smoking: Please write down your reasons for smoking. Some examples are, having a craving, feeling stressed, bored, sad, happy, or with friends.
  1. When: Please write down when you smoked.
  1. Where: Please write down where you smoked. Some examples are: in the car, at work, at home, in a restaurant, bar or cafe.
  1. Doing What: Please note what you were doing at the time you smoked. Some examples are working, watching television, driving, emotional (crying).
  1. With Whom: Please write down who you were with when you were smoking. For example, with your spouse, with a work colleague, on your own, with friends.
  1. How Many: Please write down how many cigarettes you smoked each time.
  1. Levels of Desire: Please enter a number between 1 and 4 according to the information below.

Level 1: You had a ‘little desire’ to smoke

Level 2: You had a ‘desire’ to smoke

Level 3: You had a ‘strong desire’ to smoke

Level 4: You had a ‘very strong desire’ to smoke

B – My Reasons for Quitting Smoking

Level of Importance* / Reason
1
2
3
4
5
6
7
8
9
10

*Please put the most important reason for quitting smoking first, and the least important at the end.

C - People Who Will Support Me During The Quitting Process

Name / Relationship / Telephone No.