Connecting Patient/Family Library Patrons to Information, Ideas, and Resources

The Duke Patient/Family Resource Center is:

• A lending library offering books, audio and video tapes, magazines and free brochures dealing with cancer and certain blood disorders and with issues of coping, survivorship, caregiving, and grieving
• Open 8:30 a.m. to 5 p.m. every day the Morris Clinics are open
• Located in the White Zone, first floor, of the Morris Cancer Clinic, Room 15123.
• Our phone number is 919-684-6955. Our e-mail address is FamilyLibrary@mc.duke.edu

Resource Center Coordinator: Harriet Whitehead, PhD
Cancer Patient Education Program Director: Kerry Harwood, RN, MSN

Giving Up Tobacco: Your Time to Quit?

You've heard the one about the smoker who was so horrified by what he was reading about the effects of smoking that he had to give up reading. Yes? Well, we don't want to provoke that reaction in you.

However, around this time of year resolutions become popular, and what more ambitious, noble, and healthful resolution can you make for yourself and those with whom you share your living space then to try to -- at last -- rid yourself of the filthy weed? We are here to support you in that effort.

Rather than dwelling on the dreadful effects of tobacco, let's look at the bright side of attaining freedom from it. First and most importantly, it is never too late to quit smoking. Even if you are a cancer patient, with a non-smoking related cancer, there will be health benefits that start immediately.

• People with cancer who stop smoking, even at the time they are diagnosed with the disease, tend to have a better response to chemotherapy and radiotherapy, survive longer, and have fewer side effects from their treatments.
• If you have surgery, quitting smoking can lessen your chances of having complications and enhance your recovery and healing.
• Quitting smoking lowers your risk of having the cancer come back. It also lessens your risk of getting another tobacco-related cancer.
• Quitting reduces your risk of other smoking-related diseases, such as chronic bronchitis, emphysema, and coronary artery disease.
• Quitting smoking may decrease fatigue and shortness of breath and improve your appetite, sleep, mood, and activity level.
• Gaining control over and breaking the smoking habit can provide you with a sense of accomplishment. It can be particularly encouraging to know that there is something you can do to improve your chances of surviving the disease.

Many quitters will also remark on the unexpected social or financial benefits they reaped when they gave it up.

• More money in one's pockets every month that can be spent on a healthful indulgence, such as a massage or tickets to the game.
• The surprise of finding oneself better liked in social groups -- was it that bad before?
• Getting pats on the back instead of nagging and tut-tuts.
• Never having to worry again over what to do on long flights or whether the restaurant your crowd is heading for will forbid smoking.
• Never having to worry again over whether one has enough cigarettes on leaving the house, or how long one's pack will last when a smoke-bumming friend shows up.
• Tasting food again!
• Actually smelling the roses!

Another important thing to remember is quitting is easier now than ever before. With the nicotine replacement products now available, some of which are actually cheaper over-the-counter than cigarettes, you don't have to experience the willpower-destroying effect of a full-scale nicotine fit ever again.

Make your plan now and give it a shot. You might be surprised, and greatly relieved, to find that this time, quitting actually works.

To the non-smoking friends and relatives of smokers reading this: Nagging doesn't work well as an inducement to quitting, especially when it comes from someone who's never experienced nicotine addiction. Best to join quietly with others in finding resources to help the potential quitter marshal his/her forces for the struggle. There are more and more such resources available, and they do, indeed help. Many are listed below, or detailed on the Web sites we will suggest.

Get Ready!

It helps to sit down and really think about your situation as you approach your quitting attempt. Here are some common discouragers that need to be dispelled.

• You may have failed at quitting in the past, even many times, so you're discouraged about the whole thing. Guess what -- most successful quitters have a history of failed attempts. And yet, in the end, they were successful. You can join them.
• You may have already cut back and you think that's enough. It's a good lead-up to quitting, but for your health, it's not sufficient. First of all, the cutback is not likely to last. Secondly, health statistics only seem to improve among those who quit entirely, not among those who just cut back.
• You're darned if you'll start joining groups and going to meetings like AA and following a bunch of tiresome steps, how could that make much difference? Actually, people who enroll in supportive programs - any supportive programs - quadruple their chances of successfully quitting.
• You've tried the patch, gum, lozenges, inhaler, Zyban, etc., and that didn't work. What's left? No one substance or method is the magic bullet. You need to keep tinkering and trying. Meanwhile, people who manage to shift their addiction to nicotine replacements, like the patch, the gum, etc., have already taken a huge burden off their lungs, their heart, and their gastrointestinal system. And for some reason, it's easier to taper off the replacements than off of straight tobacco. Studies show that people who use these items triple their chances of finally quitting.
• You're afraid you'll gain weight after quitting. This one isn't a myth. One in four people do gain between four and 10 pounds. Medically, this isn't as bad as continuing to smoke, however. Furthermore, studies have shown that after the initial six month stretch is over, most people begin to lose that weight again. The body adjusts. Combining your quitting with an exercise program may help you to avoid the problem altogether. Exercise will also quell cravings.

Get Set!

There are also some common roadblocks to quitting that will need to be managed. Two of the biggest are your social environment and the nerve-wracking demands of your job. A third, alcohol use, poses a challenge for persons with any degree of alcohol addiction. Let's start with the wracked nerves.

There are many nerve-wracking occasions in any person's life, but the ones that usually can't be evaded are the ones that are a routine part of one's employment. The surgeon feels sure the scalpel will slip in his hand if he doesn't have his nicotine fix. The accountant needs that pack handy in order to get the budget to balance. The construction worker envisions slipping off the high beam, if he doesn't have a stogy gripped in his teeth.

But this is exactly what nicotine replacements are for! You need never suffer a true, full-blown nicotine fit again. And you won't, once you work out the dose that's right for you.

Take it from a 16-year-quitter (me) who relied on her faithful little quid of Nicorette gum and Trident Original Flavor for two years before finally kicking nicotine altogether. It was at least five years past that point before my nicotine cravings ceased entirely. This long half-life of addiction is what makes breaking the tobacco habit so hard. But on the few occasions when I ran in desperation to the pharmacy, it was for a Nicorette gum, not for a pack of cigarettes. Even with some gum handy, I found I could never chew as much as I'd smoked. Meanwhile my lungs enjoyed a breather.

The hardest part for most people is going to be the social environment. If the people in your life, the ones that you see on a daily basis and rely on for the emotional necessities of life, are still smoking, you will need to enlist them in your struggle.You will need them to refrain from smoking in your presence, hide their tobacco, and refuse your attempts to bum. You need not go so far as persuading them to try quitting as well. On the contrary, this may make things more complicated for you, since a fellow quitter may turn into a backslider and cause everyone to go lax on the project. But you will need this minimum level of cooperation because the single biggest obstacle to quitting is the sight, sounds, smells and easy availability of the addictive substance.

It may be years before the smells and tastes of tobacco become repulsive to you. But they finally will. When they do, you will realize in retrospect that during all those years of smoking, you yourself were repulsing other people.

Fortunately for the great mass of hopeful quitters in this country, there have gotten to be fewer and fewer places where temptation hits you in the face, and more and more places where any possibility of smoking is ruled out. I attribute my own ability to quit largely to this factor and not to my own flabby will-power.

Finally there is the thorny issue of smoking and drinking. Almost all smokers have one or several favorite beverages that trigger lighting up. Alcoholic beverages are high on the lists of many smokers. The greater the degree of addiction to alcohol, the bigger the roadblock this can turn out to be. Quitting two deeply ingrained addictions at once is a very tall order. In fact Alcoholics Anonymous traditionally discouraged smokers from trying to give up their smoking at the same time they are trying to eliminate their drinking. (Bill W., co-founder of AA was a chain smoker who died of emphysema. The other co-founder, Dr. Bob, smoked cigars and died of throat cancer). This is beginning to change, as new research has shown that smoking raises the craving for an alcoholic drink, even as the drink blows away good intentions and causes people to light up again. The two addictions are -- shall we say -- very co-dependent.

It needs to be added, if you haven't heard it already, that blood alcohol promotes tumor growth, thus chronic smoker-drinkers are at much greater risk for all of the smoking related cancers.

If the smoking-drinking combination is deeply ingrained in your lifestyle, you might be advised to try the new Duke Lifestyle Clinic, recommended below.

Go!

Find yourself a supportive program. You'll need all the additional tips you can get, and you'll need a new set of people to whom you can escape when your resolve wavers. The non-smokers in your life might not appreciate what you're going through, while the smokers are part of the problem. What you need is a group of supportive quitters like yourself.

Look for a program that involves long term follow up -- either months of phone support, or a regular weekly group running for an indefinite period. People aren't over the first hump for several months. After that there's the long half-life of lingering temptation.

Once you have support lined up, set a date to quit. Prepare yourself and your social network. Gather supplies. Then do it!

Don't forget to reward yourself periodically. You'll be saving a lot of money each month that you don't smoke. Treat yourself to something -- a pedicure, a massage, a Hurricanes game at the RBC center, new unsmoky clothes!

Quitting Resources

North Carolinians will do well to start with this Web site:

http://www.quitnownc.org/quitnow.asp

Here you will be encouraged to sign up for telephone support. Studies have shown that simply having a well-informed helper to call when the cravings get too strong greatly increases one's ability to get through the first six months, the months when withdrawal pangs are most acute and during which all the life adjustments must be made. The site also links you to background information, tips on identifying your weak points, tips on keeping up your resolves and studies of a variety of quitting methods.

If you prefer calling, the number will be 1-800-784-8669

For an update on what works and what doesn't, try:

http://www.tobaccofree.org/quitlinks.htm

Inspirational letters, some quite amazing, are available at:

http://www.quitsmokingsupport.com/camelsback.htm

To sign up for an online support group, try:

http://www.quitnet.com

For resources on the national level, try:

www.smokefree.gov

If the smoking-drinking combination is your principle roadblock, try:

http://www.unhooked.com/nosmoke/index.html

If you are a Triangle area resident with a tough quitting problem, consider making an appointment at the Duke Lifestyle Medicine Clinic, at 4020 Roxboro Rd., 919-416-DUKE. Medically guided programs, including ones using the latest prescription drugs, are available here for a range of lifestyle issues. Often one's medical insurance will cover the charges.

Bravo for taking the plunge!