SESSION 2, ACTIVITY 2: LEARNING NOT TO SMOKE
Refer to page 60 in the Facilitators Binder
Sample Script:
The first step in the decision to quit smoking is to believe there is a way for you to quit. Every person is an individual. When you know your individual pattern, you can make a personal plan to quit.
Smoking can be very complex. There are many different reasons why you smoke. Your reasons won’t always be the same as a friend’s. Your reasons will change from day to day, maybe even hour to hour. Let’s take a look at how smoking came to play such an important part in your daily life. What was your last quit attempt like for you? Would anyone like to share their story?
First, smoking is a learned behavior. Smoking is not a natural act. You had to learn how to smoke. When you began smoking, it was probably awkward. How many of you felt sick or nauseated? It may have taken a while, but you worked at it and overcame the sick feeling. You had a strong desire to practice and to learn. You persevered and conditioned your body to expect the cigarette’s nicotine and the assault of harmful chemicals in cigarette smoke.
Most people learn to smoke to fill a certain need. For many, the need was acceptance by their peers, or a desire to feel “grown-up.” Each time you smoked and felt accepted or grown-up, you practiced and strengthened your behavior. Just think about how many times you have lifted a cigarette to your mouth and practiced. For example, what if you have smoked one pack a day for 20 years?
Write these figures on a blackboard or flipchart:
- Each cigarette is about 10 inhalations.
- Ten inhalations times 20 cigarettes is 200 practices a day.
- Multiply that by 365 days and you have practiced 73,000 times a year.
- Multiply that times 20 years and you have nearly 1.5 million times that you have practiced and strengthened your smoking pattern.
Encourage everyone to take some time now to figure out their own pattern and how often they’ve strengthened it.
Second, smoking is a triggered behavior. As you perfected your smoking, you began to bring your cigarettes into other situations. You then began to experience other positive results. You may have found it gave you something to do with your hands when you were on the phone or at a party. You found it helped you to slow down and take a break when you needed to relax.
Each time you smoked in these situations, you reinforced your behavior. Additionally, you began to connect the act of smoking with these activities and emotions. You no longer needed to think about something to do with your hands. Instead, you just smoked when you were on the telephone, sitting in traffic, or engaged in other activities. The situations became triggers, or cues to light up.
It is not only a “triggered” behavior, but an automatic behavior as well. As you probably saw from the Pack Track activity, most of you have smoked for so long that you don’t even think about the reason to smoke anymore. You don’t think about the trigger, or how important it is. This is because smoking has become an automatic behavior in dealing with difficult situations in life. You don’t think about the cigarettes you smoke; you just smoke them. It’s like being on automatic pilot. Sometimes, people light up a cigarette and then realize they already have one lit in the ashtray. To stop this smoking behavior, you have to take it out of automatic gear.
Third, smoking is a social behavior. Tobacco use becomes a part of daily activities and rituals. Most of the people who smoke started before they were eighteen. It is the common element among many groups of people who would otherwise be quite different.
Triggers can be many things. They can be associated with good or bad situations. Different people have different triggers. For some, waking is a trigger [this may be due to low levels of nicotine in the individual’s blood because of abstinence while sleeping2]. For others it is not. Some triggers are more important than others. Some activities are so strongly connected to smoking that you cannot imagine doing them without a cigarette such as drinking coffee or an alcoholic beverage.
Let’s reflect on your triggers to help determine your smoking pattern by looking at your Pack Tracks. How many people did the Pack Track activity? What did you learn about your smoking pattern? Do you smoke more than you thought, or less? What was the mood that showed up most often on your cards? How many times was the need really high? In what situation (or thoughts) did you find yourself most of the time?
If you circled mostly “happy faces,” it’s likely that you smoke to relax, feel good, enjoy good times. Think about where and when you smoke. Do you smoke when you’re with friends, at bars and restaurants? Where else do you smoke when you’re happy? Take a few minutes and think about your “happy” cigarettes. That will help you figure out what activities to substitute.
If you checked a lot of the “blah” faces, it is likely that you smoke out of boredom or without necessarily wanting a cigarette. Maybe you like having something in your hand. You may not even realize that you’re smoking. Think about where and when you smoke your “boredom” cigarettes.
If you circled mostly “unhappy” faces, it’s likely that you smoke when you’re tense, angry or upset. “Unhappy” cigarettes are hard to give up, but you can do it. Many people who quit say they learned that smoking really did not help them deal with unhappy feelings. After quitting, they found better ways. Think about where and when you smoke your “unhappy” cigarettes.
Turn to page 64 in the Facilitators Binder for the next Activity
SESSION 2, ACTIVITY 8: NICOTINE ADDICTION & MEDICATIONS TO HELP YOU QUIT
Refer to page 77 in the Facilitators Binder
Sample Script:
We mentioned using medication to quit smoking last week. There are currently seven FDA-approved medications to quit smoking. They are:
· Nicotine gum
· Nicotine patch
· Nicotine lozenge
· Nicotine nasal spray
· Nicotine inhaler
· Bupropion SR ( sold under the brand name Zyban®)
· Varenicline (sold under the brand name Chantix®)
Nicotine is a drug that produces physical symptoms in most people when they stop using it. These symptoms may last a few days to a few weeks. An individual who is more dependent on nicotine may have greater difficulty quitting smoking! The “Are You Addicted to Cigarettes?” quiz helps you begin to look at your own personal smoking. Are there any questions you don’t understand or had trouble answering?
Allow participants time to review their “Are You Addicted to Cigarettes?” quiz (page 21 in the Participant Workbook)
Lets review the scoring system---the greater the score, the greater your likelihood of nicotine dependence. In other words, a higher score indicates the possibility of more intense withdrawal symptoms when you quit smoking. Lets not get discouraged with this, however. Lets use this information to prepare our quit plan. Most smokers will benefit from using nicotine replacement therapy but if you score in the High (6-7) or Very High (8-10) level, research strongly recommends using nicotine replacement.28, 29 Using the medication will ease the withdrawal symptoms you feel when you quit smoking and increase your chances of staying quit.
If you choose to use medication to quit smoking, either purchase it now or get the prescription now and be ready to use it on Quit Day. Some forms of nicotine replacement, like nicotine gum and most nicotine patches and the nicotine lozenge, are available over the counter (OTC). Others, like one nicotine patch, the nicotine inhaler and nicotine nasal spray, are available only by prescription. The non-nicotine products, Zyban® and Chantix®, are only available with a prescription. If you’re planning to use either of those, you’ll need to see your doctor soon to discuss if they’re right for you. People taking Chantix® should start on the medication one week for Quit Day and people taking Zyban® should start 8-14 days before Quit Day.
At the moment, the U.S. Food and Drug Administration (FDA) has not approved using these medications in combination. Under medical supervision, researchers are currently combining bupropion (Zyban®) and the nicotine patch along with behavioral counseling. Preliminary findings are that this combination treatment is relatively safe and more people quit for longer periods of time. However, this finding is not significantly better than with bupropion (Zyban®) alone.30
A few important things to consider when using medication to quit are their identified side effects and the Special Circumstances under which some people may not be able to use them. If you are under any of the Special Circumstances categories, contact your doctor to find out if the medication to quit smoking is right for you.
Refer to the “Special Circumstances and Identified Side Effects” handout. (page 31 of the Participants Workbook)
Special Circumstances26
- Patients who smoke less than 10 cigarettes per day
- Adolescents (under 18 years of age)
- Pregnant or breast-feeding women
- Patients with serious medical conditions, such as history of cardiovascular disease, serious arrhythmias, severe or unstable angina, recent myocardial infarction (< 2 weeks), uncontrolled hypertension, or concurrent use of prescription medication for depression or asthma.
The identified side effects and instructions for using each medication are listed on the Medication Cards. These information cards are not comprehensive. Please see the medication package insert for additional information.
Some people say that these medications are very expensive. It can seem like a lot of money when you first look at the price tag but don’t say no to using a medication right away. Some types of nicotine replacement therapy cost less than others. Some of the medicines we’ve talked about are also available in a cheaper generic form. If you have health insurance, you might be able to get your medication at a lower price or even free. Finally, think about how much you spend on cigarettes over a month or a year. Is it cheaper to keep smoking or to buy the medication that helps you quit for good?
We’ll talk more about these products at each session. You can also visit www.lungusa.org “Smoking Cessation Support” under Quit Smoking for specifics on the medications currently available to stop smoking.
Turn to page 85 in the Facilitators Binder for the next Activity