ED 299 530 CG 021 176

TITLE Clearing the Air: How to Quit Smoking...and Quit forKeeps.

INSTITUTION National Cancer Inst. (NIH), Bethesda, Md.REPORT NO NIH-87-1647PUB DATE Jun 87NOTE 48p.

PUB TYPE Guides - General (050)

EDRS PRICE MF01/PCO2 Plus Postage.DESCRIPTORS *Drug Rehabilitation; Health Education; *Smoking;

*Tobacco

ABSTRACTThis document is a self-help booklet designed to help

individuals quit smoking. Information, as well as inspiration, isprovided in the form of pointers under these topics: (1) preparingyourself for quitting; (2) knowing what to expect; (3) involvingsomeone else; (4) ways of quitting, including switching brands,cutting down on the number of cigarettes smoked, not smokingautomatically, and making smoking inconvenient and unpleasant; (5)things to do just before and on the day of quitting; (6) things to doimmediately after quitting, including avoiding temptation, findingnew habits, what to do when the ex-smoker gets the "crazies," andfacts about gaining weight; (7) what happens after you quit smoking,including immediate rewards and effects, long-range benefits,withdrawal symptoms and activities tha'- might help; (8) quitting forkeeps, including dealing with and dampening urges, not-smoking ashabit-forming, and relapse; (9) marking progress; and (10) commonrationalizations. A snack calorie chart and addresses and telephonenumbers of organizations which provide assistance to smokers aboutquitting are provided. (ABL)

********************************************************************

Reproductions supplied by EDRS are the best that can be madefrom the original document.

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Fi the AirHow To Quit Smoking . . .

and Quit for Keeps

U.S. DEPARTMENT OF EDUCATIONOffice of Educations] Research and Improvement

IUCATIONAL RESOURCES INFORMATIONCENTER (ERIC)

This document has been reproduced asreceived from the person or organizationoriginating it.

0 Minor changes have been made to improvereproduction quality

PO/nts Of view or opinions stated in ars doorment do not necessarily represent officialOERI position or policy

coU.S. DEPARTMENT OF

HEALTH AND HUMAN SERVICESPublic Health Ssrvice

National Institutes of Health

2

Prepared by:

Office of Cancer CommunicationsNational Cancer InstituteBethesda, Maryland 20892

3

Contents PageIntroduction 3`Preparing yourself for quitting 4'Knowing what to expect 6Iiivolving someone else 7-Ways of quitting 8

Switch brands 8Cut down the number of cigarettes you smoke 9

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13

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15

16

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202224262831

31

31

32might help .. 33

34343436

Don't smoke "automatically"Make smoking inconvenientMake smoking unpleasant

Just before quittingOn the day you quitImmediately after quitting

Avoid temptationFind new habitsWhen you get the craziesAbout gaining weight

Snack calorie chartWhat happens after you quit smoking

Immediate rewardsImmediate effectsLong-range benefits

'Withdrawal symptoms and activities tQuitting for keeps

CongratulationsKeep your guard upHow to dampen that urgeNot smoking is habit-forming 40Relapse: If you do smoke again 40

Marking progressCommon rationalizationsFor further information 44

4142

41

introductionThis booklet guides you from thinking about stop-

ping smoking through actually doing itfrom the dayyou quit to quitting for keeps. It gives tips on fightingtemptationand what to do if you give inand onavoiding weight gain (a handy Snack Calorie Chart isincluded). By telling you what to expect, it can helpyou through the day-by-day process LA' becoming andremaining a nonsmoker.

In this booklet, you'll find a variety of tips andhelpful hints on kicking your smoking habit. Take afew moments to look at each suggestion carefully.Pick those you feel comfortable with, and decide to-day that you're going to use them to quit. It may takea while to find the combination that's right for you,but you can quit for good, even if you've tried to quitbefore.

Many smokers have successfully given up cigarettesby replacing them with ne habits, without quitting"cold turkey," planning a special program, or seekingprofessional help.

The following approaches include many of thosemost popular with ex-smokers. Remember that suc-cessful methods are as different as the people whouse them. What may seem silly to others may be justwhat you need to quitso don't be embarrassed totry something new. These methods can make yourown personal efforts a little easier.

Pick the ideas that make sense to you. And thenfollow throughyou'll have a much better chance ofsuccess.

5 3

_ - - --_---

-Preparing yourselffor quitting . . .

Decide positively that you want to quit. Try toavoid negative thoughts about how difficult itmight be.List all the reasons you want to quit. Every nightbefore going to bed, repeat one of the reasons 10times.Develop strong personal reasons in addition toyour health and obligations to others. For exam-ple, think of all the time you waste takingcigarette breaks, rushing out to buy a pack, hunt-ing for a light, etc.Begin to condition yourself physically: Start amodest exercise program; drink more fluids; getplenty of rest; and avoid fatigue.Set a target dr.; for quittingperhaps a specialday such as yiur birthday, your anniversary, or theGreat American Smokeout. If you smoke heavily atwork, quit during your vacation so that you'realready committed to quitting when you return.Make the date sacred, and don't let anythingchange it. This will make it easy for you to keeptrack of the day you became a nonsmoker and tocelebrate that date, every year.

Set a target,clate .

Knowing what to expect . . .

O Have realistic expectationsquitting isn't easy,but it's not impossible either. More than 3million Americans quit every year.

O Understand that withdrawal symptoms are tem-porary. They usually last only 1-2 weeks.

O Know that most relapses occur in the first weekafter quitting, when withdrawal symptoms arestrongest and your body is still dependent onnicotine. Be aware that this will be your hardesttime, and use all your personal resourceswillpower, family, friends, and the tips in thisbookletto get you through this critical periodsuccessfully.

O Know that most other relapses occur in the first 3months after quitting, when situational triggers-sucii as a particularly stressful eventoccur unex-pectedly. These are the times when people reachfor cigarettes automatically, because theyassociate smoking with relaxing. This is the kindof situation that's hard to prepare yourself for un-til it happens, so it's especially important torecognize it if it does happen. Remember thatsmoking is a habit, but a habit you can break.

O Realize that most successful ex-smokers quit forgood only after several attempts. You may be oneof those who can quit your first try. But if you'renot, don't give up. Try again.

8

rt

Ash your spouse or a friend . . .

Involving someone else . . .

O Bet a friend you can quit on your target date. Putyour cigarette money aside for every day, andforfeit it if you smoke. (But if you do smoke,don't give up. Simply strengthen your resolve andtry again.)

o Ask your spouse or a friend to quit with you.o Tell your family and friends that you're quitting

and when. They can be an important source ofsupport, both before and after you quit.

9

Ways of quitting . . .

Switch brands . . .

: Switch to a brand you find distasteful.Change to a brand that's low in tar and nicotine acouple of weeks before your target date. This willhelp change your smoking behavior. However, donot smoke more cigarettes, inhale them moreoften or more deeply, or place your fingertipsover the holes in the filters. All of these will in-crease your nicotine intake, and the idea is to getyour body used to functioning without nicotine.

Switch to a brand

Cut down the number ofcigarettes you smoke . . .

Smoke only half of each cigarette.Each day, postpone lighting your first cigarette1 hour.

Decide you'll smoke only during odd or evenhours of the day.Decide beforehand how many cigarettes you'llsmoke during the day. For each additionalcigarette, give a dollar to your favorite charity.Change your eating habits to help you cut down.For example, drink milk, which many peopleconsider incompatible with smoking. End mealsor snacks with something that won't lead to acigarette.Reach for a glass of juice instead of a cigarettefor a "pick-me-up."Remember: Cutting down can help you quit, butit's not a substitute for quitting. If you're down toabout seven cigarettes a day, it's time to set yourtarget quit date and get ready to stick to it.

11

12Pjstpore lighting your first cigarette . . .

:met

Don't smoke "automatically" . . .

Smoke only those cigarettes you really want.Catch yourself before you light up a cigarette outof pure habit.

-0 Don't empty your ashtrays. This will remind youof how many cigarettes you've smthed each day,and the sight and smell of stale butts will be veryunpleasant.Make yourself aware of each cigarette by usingthe opposite hand or putting cigarettes in an un-familiar location or a different pocket to break theautomatic reach.If you light up many times during the day withouteven thinking about it, try to look in a mirroreach time you put a match to your cigaretteyoumay decide you don't need it.

4,36

't0.: vosirtgirb

CV14Don't empty your ashtrays.. .

Make smoking inconvenient . . .

O Stop buying cigarettes by the carton. Wait untilone pack is empty before you buy another.

O Stop carrying cigare.tes with you at home and atwork. Make them difficult to get to.

Make smoking unpleasant . . .

O Smoke only under circumstances that aren'tespecially pleasurable for you. If you like tosmoke with others, smoke alone. Ilim your chairtoward an empty corner and focus only on thecigarette you are smoking and its many negativeeffects.

O Collect all your cigarette butts in one large glasscontainer as a visual reminder of the filth smok-ing represents.

1513

Practice going without cigarettes . . .

1

Just before quitting . . .

Practice going without cigarettes.Don't think of never smoking again. Think ofquitting in terms of 1 day at a time.Tell yourself you won't smoke today, and thendon't.Clean your clothes to rid them of the cigarettesmell, which can linger a long time.

1,715

On the day you quit . . .

O Throw away all your cigarettes and matches. Hideyour lighters and ashtrays.

O Visit the dentist and have your teeth cleaned toget rid of tobacco stains. Notice how nice theylook, and resolve to keep them that way.

O Make a list of things you'd like to buy foryourself or someone else. Estimate the cost interms of packs of cigarettes, and put the moneyaside to buy these presents.

O Keep very busy on the big day. Go to themovies, exercise, take long walks, go bike riding.

O Remind your family and friends that this is yourquit date, and ask them to help you over therough spots of the first couple of days and weeks.

O Buy yourself a treat or do something special tocelebrate.

Buy yourself a treat . . . I9:

mmediately after q u i t t i n g . . .

1;3 Develop a clean, fresh, nonsmoking environmentaround yourselfat work and at home. Buyyourself flowersyou may be surprised howmuch you can enjoy their scent now.

n The first few days after you quit, spend as muchfree time as possible in places where smokingisn't allowed, such as libraries, museums,theaters, department stores, and churches.

-0 Drink large quantities of water and fruit juice (butavoid sodas that contain caffeine).Try to avoid alcohol, coffee, and other beveragesthat you associate with cigarette smoking.

-0 Strike up a conversation instead of a match for acigarette.

[3 If you miss the sensation of having a cigarette inyour 'land, play with something elsea pencil, apaper clip, a marble.

'0 If you miss having something in your mouth, trytoothpicks or a fake cigarette.

18

20

Drink large quantitieg of water . . ..-

Avoid temptation . . .

rC Instead of smoking after meals , get up from thetable and brush your teeth or go for a walk.

;0 If you always smoke while driving, lister to aparticularly interesting radio program or yourfavorite music, or take public transportation for awhile, if you can.For the first 1-3 weeks, avoid situations youstrongly associate with the pleasurable aspects ofsmoking, such as watching your favorite TV pro-gram, sitting in your favorite chair, or having acocktail before dinner.Until you're confident of your ability to stay offcigarettes, limit your socializing to healthful, out-door activities or situations where smoking isn'tallowed.

-;,0 If you must be in a situation where you'll betempted to smoke (such as a cocktail or dinnerparty), try to associate with the nonsmokers there.

0 Try to analyze cigarette ads to understand howthey attempt to "sell" you on individual brands.

20 22

Develop a clean, nonsmoking environment . . .....1. ...I,

Find new habits . .

O Change your habits to make smoking difficult,

impossible, or unnecessary. For example, it's

hard to smoke when you're swimming, jogging,

or playing tennis or handball. When your desire

for a cigarette is intense, wash your hands or the

dishes, or try new recipes.O Do things that require you to use your hands. Try

crossword puzzles, needlework, gardening, or

household chores. Go bike riding; take the dog

for a walk; give yourself a manicure; write

letters.O Enjoy having a clean -mouth taste and maintain it

by brushing your teeth frequently and using a

mouthwash.O Stretch a lot.O Get plenty of rest.O Pay attention to ycur appearance. Look and feel

sharp.O Try to find time for the activities that are the

most meaningful, satisfying, and important to

you.

22 24

i

Do things that require you to...,use your hands . . .

25

When you get the crazies . . .

qo Keep oral substitutes handytry carrots, pickles,sunflower :-,eeds, apples, celery, raisins, orsugarless gum instead of a cigarette.

'0 Take 10 deep breaths and hold the last one whilelighting a match. Exhale slowly and blow out thematch. Pretend it's a cigarette and crush it out inan ashtray.Take a shower or bath if possibie..

0 Learn to rzlax quickly and deeply. Make yourselflimp, visualize a soothing, pleasing situation, andget away from it all for a moment. Concentrateon that peaceful image and nothing else.

:P Light incense or a candle instead of a cigarette."0 Never Alow yourself to think that "one won't

hurt"it will.

26

About gaining weight . . .

Many people who're considering quitting are veryconcerned about gaining weight. If you're concernedabout weight gain, keep these points in mind:

Quitting doesn't mean you'll automatically gainweight. When people gain, most of the time it'sbecause they eat more once they quit.The benefits of giving up cigarettes far outweighthe drawbacks of adding a few extra pounds.You'd have to gain a very large amount of weightto offset the many substantial health benefits thata normal smoker gains by quitting. Watch whatyou eat, and if you're concerned about gainingweight, consider the following tips:

Tips to help you avoid weight gain . . .

Make sure you have a well-balanced diet,with the proper amounts of protein, car-bohydrates, and fat.Don't set a target date for a holiday, whenthe temptation of high-calorie food and drinksmay be too hard to resist.Drink a glass of water before your meals.Weigh yourself weekly.Chew sugarless gum when you want sweetfoods.Plan menus carefully, and count calories.Don't try to lose weightjust try tomaintain your prequittini, weight.Have low-calorie foods on hand for nibbling.Use the Snack Calorie Chart to choose foodsthat are both nutritious and low in calories.Some good choices are fresh fruits andvegetables, fruit and vegetable juices, low-fatcottage cheese, and air-popped popcornwithout butter.Take time for daily exercise, or join anorganized exercise group.

26

28

Benefits outweigh drawbacks. . .

Snack calorie chart

Snacks Calories

BEVERAGES

Carbonated (per 8-ounce glass)Cola-type 95Fruit flavors (10-13% sugar) 115Ginger ale 75

Fruit drinks (per 1/2 cup)Apricot nectar 70Cranberry juice 80Grape drink 70Lemonade (frozen) 55

Fruit juices (per 1/2 cup)Apple juice, canned a,:Grape juice, bottled 80

"Grapefruit juice, canned, unsweetened 50Orange juice, canned, unswwtened 55Pineapple juice, canned, unsweetened 70Prune juice, canned 100

Vegetable juices (per 1/2 cup)Tomato juice 25Vegetable juice cocktail 20

Coffee and teaCoffee, black 3-5

. with 1 tsp. sugar 18-20with 1 tsp. cream 13-15Tea, plain 0-1with 1 tsp. sugar 15-16

CANDY, CHIPS, AND PRETZELSCandy (per ounce)

Hard candy 110Jelly beans 105Marshmallows 90Gumdrops 100

Chips (per cup)Corn chips 230Potato chips 115

'Popcorn (air-popped, without butter) 25

=PretzelsDutch, 1 twisted 60Stick, 5 regular 10

Data from published sources References are available upon request.

28 30

-Snacks Calories*

CHEESE (PER OUNCE)American, processed 105

Cottage, creamed 30Cottage, low-fat (2%) 25Swiss, natural 105.

CRACKERSButter, 2-inch diameter 15

Graham, 2-1/2 inches square, 2 55

Matzoh, 6-inch diameter 80-Rye 45

Saltine 50

FRUITS (RAW)Apple, 1 mediumApricots, fresh, 3 mediumApricots, dried, 5 halvesBanana, 1 mediumBlackberries, 1/2 cupBlueberries, 1/2 cup

Cherries, 10Dates, dried, 3Fig, dried, 1 mediumGrapefruit, 1/2Grapes, 20Orange, 1 mediumPeach, 1 mediumPear, 1 mediumPineapple, 1/2 cupPrunes, dried, 3Raisins, 1/4 cupStrawberries, 1 cupWatermelon, 1 cup

NUTS (PER 2 TABLESPOONS)AlmondsBrazil nutsCashewsPeanutsPecans, halves

805040

105

354050507050403n6035

1004060

1104550

105

115

100105

95

VEGETABLES (RAW)

Carrots, 7-1/2 x 1-1/8 inch 30Carrots, 1/2 cup grated 25

Celery, 5-inch stalks, 3 10

Pickle, 1 15-20

29

31

The repair begins. . .

32

What happens afteryou quit smoking . . .

Immediate rewards . . .

Within 12 hours after you have your last cigarette,your body will begin to heal itself. The levels of car-bon monoxide and nicotine in your system willdecline rapidly, and your heart and lungs will beginto repair the damage caused by cigarette smoke.

Within a few days, you'll probably begin to noticesome remarkable changes in your body. Your senseof smell and taste may improve. You'll breatheeasier, and your smoker's hack will begin to disap-pear, although you may notice that you still cough fora while. And you'll be free from the mess, smell, in-convenience, expense, and dependence of cigarettesmoking.

Immediate effects . . .

As your body begins to repair itself, instead offeeling better right away, you may feel worse for awhile. It's important to understand that healing is aprocessit begins immediately, but it continues overtime. These "withdrawal pangs" are really symptomsof the recovery process (see Withdrawal Symptomsand Activities That Might Help).

Immediately after quitting, many ex-smokers ex-perience "symptoms of recovery" such as temporaryweight gain caused by fluid retention, irregularity,and dry, sore gums or tongue. You may feel edgy,hungry, more tired, and more short-tempered thanusual and have strong cravings for a cigarette. Youmay also have trouble sleeping and notice that you'recoughing a lot. These symptoms are the result ofyour body clearing itself of nicotine, a powerful ad-dictive chemical. Most nicotine is gone from the bodyin 2-3 days.

33 31

Improved chances for a longer life . . .

Long-range benefits . . .

It's important to understand that the unpleasant after-

effects of quitting are only temporary and signal the

beginning of a healthier life. Now that you've quit,

you've added a num'c.4. of healthy productive days to

each year of your life. Most important, you've great-

ly improved your chances for a longer life. You'vesignificantly reduced your risk of death from heart

disease, stroke, chronic bronchitis, emphysema, and

several kinds of cancernot just lung cancer.(Cigarette smoking is responsible every year for ap-

proximately 130,000 deaths from cancer, 170,000

deaths from heart disease, and 50,000 deaths from

lung disease.)

32 34

Withdrawal symptoms andactivities that might help*.Symptom

Dry mouth; sore throat,gums, or tongue

Headaches

Trouble sleeping

Irregularity

Fatigue

Hunger

Tenseness, irritability

Coughing

Activity

Sip ice-cold water or fruit juice, orchew gum.

Take a warm bath or shower. Tryrelaxation or meditation techniques.

Don't drink coffee, ea, or sodawith caffeine after 6:00 p.m.Again, try relaxation or meditationtechniques.

Add roughage to your diet, such asraw fruit, vegetables, and whole-grain cereals. Drink 6-8 glasses ofwater a day.

Take a nap. Try not to push yourselfduring this time; don't expect toomuch of your body until it's had achance to begin to heal itself over acouple of weeks.

Drink water or low-calorie liquids.Eat low-fat, low-calorie snacks (seeSnack Calorie Chan).

Take a walk, soak in a hot bath, try'relaxation or meditation techniques.

Sip warm herbal PA. Suck on coughdrops or sugarless hard candy.

*Adapted from Quitting 7Imes: A Magazine for Women Who Smoke,funded by the Pennsylvania Department of Health, prepared by FoxChase Cancer Center, Philadelphia.

35 33,

Quitting for keeps . . .

congratulations!

,Now you're ready to develop a new habitnot'smoking. Like any other habit, it takes time tobecome a part of you; unlike most other habits,though, not smoking will take some conscious effortand practice. This section of the booklet can be a bighelp. You'll find many techniques to use for develop-ing the nonsmoking habit and holding on to it.

By reading this section of the booklet carefully andreviewing it often, you'll become more aware of theplaces and situations that prompt the desire for acigarette. You'll also learn about many nonsmokingways to deal with the urge to smoke. These are calledcoping skills. Finally, you'll learn what to do in caseyou do slip and give in to that urge.

Keep your guard up . . .

The key to living as a nonsmoker is to avoid lettingyour urges or cravings for a cigarette lead you tosmoke. Don't kid yourselfeven though you've madea commitment not to smoke, you will sometimes betempted. But instead of giving in to the urge, you canuse it as a learning experience.

First, remind yourself that you've quit and you're anonsmoker. Then, look closely at your urge to smokeand ask yourself:

Where was I when I got the urge?What was I doing at the time?Whom was I with?What was I thinking?

The urge to smoke after you've quit .often hits atpredictable times. The trick is to anticipate thosetimes and find ways to cope with themwithoutsmoking. Naturally, it won't be easy at first. In fact,you may continue to want a cigarette at times. Butremember, even if you slip, it doesn't mean an end tothe nonsmoking you. It does mean that you should tryto identify what triggered your slip, strengthen yourcommitment to quitting, and try again.

`34' 36

m

Nonsmoking takes practice . . .

Look at the following list of typical triggers. Doesany of them ring a bell with you? Check off thosethat might trigger an urge to smoke, and add anyothers you can think of:

Working under pressure.O Feeling blue.O Talking on the telephone.O Having a drink.ci Watching television.O Driving your car.O Finishing a meal.O Playing cards.O Drinking coffee.O Watching someone else smoke.

If you're like many new nonsmokers, the most dif-ficult place to resist the urge to smoke is the mostfamiliar: home. The activities most closely associatedwith smoking urges are eating, partying, and drink-ing. And, not surprisingly, most urges occur when asmoker is present.

37 35

How to dampen that urge . . .

There are seven major coping skills to help youfight the urge to smoke. These tips are designed foryou, the new nonsmoker, to help you nurture thenonsmoking habit.

1. Think about why you quitGo back to your list of reasons for quitting. Look

at this list several times a dayespecially whenyou're hit with an urge to smoke. The best reasonsyou could have for quitting are very personally yours,and these are also your best reasons for staying anonsmoker.

2. Know when you're rationalizingIt's easy to rationalize yourself back into smoking

(see Common Rationalizations). Don't talk yourselfinto smoking again. A new nonsmoker in a tensesituation may think, "I'll just have one cigarette tocalm myself down." If thoughts like this pop intoyour head, stop and think again! You know betterways to relaxnonsmokers' ways, such as taking awalk or doing breathing exercises.

Concern about gaining weight may also lead torationalizations. Learn to counter thoughts such as"I'd rather be thin, even if it means smoking."Remember that a slight weight gain is not likely toendanger your health as much as smoking would(cigarette smokers have about a 70-percent higherrate of premature death than nommokers). Andreview the list of healthy, low-calorie snacks thatyou used when quitting.

3. Anticipate triggers and prepare to avoid themBy now you know which situations, people, and

feelings are likely to tempt you to smoke. Beprepared to meet these triggers head on andcounteract them. Keep using the skills that helped youcope in cutting down and quitting:

0 Keep your hands busydoodle, knit, type aletter.

0 Avoid people who smoke; spend more time withnonsmoking friends.

36

In a tense situation . . .

Find activities that make smoking difficult(gardening, washing the car, taking a shower).Exercise to help knock out that urge; it will helpyou to feel and look good as well.Put something other than a cigarette in yourmouth. Chew sugarless gum or nibble on a carrotor celery stick.Avoid places where smoking is permitted Sit inthe nonsmoking section in restaurants, trains, andplanes.Reduce your consumption of alcohol, which oftenstimulates the desire to smoke. Try to have nomore than one or two drinks at a party. Betteryet, have a glass of juice, soda, or mineral waterwith a celery stick to nibble on.

3 37

Give yourself a reward . . .

38 4 0

4. Reward yourself for not smoking-Congratulations are in order each time you get

through the day without smoking. After a week, giveyourself a pat on the back and a reward of somekind. Buy a new record or treat yourself to a movieor- concert. No matter how you do it, make sure youreward yourself in some way. It helps to remindyourself that what you're doing is important.

5. Use positive thoughtsIf self-defeating thoughts start to creep in, remind

yourself again that you're a nonsmoker, that youdon't want to smoke, and that you have good reasonsfor it. Putting yourself down and trying to holdout through willpower alone art not effective copingtechniques. Mobilize the power of positive thinking!

6. Use relaxation techniquesBreathing exercises help to reduce tension. Instead

of haying a cigarette, take a long deep breath, countto 10, and release it. Repeat this five times. See howmuch more relaxed you feel?

7. Get social supportThe commitment to remain a nonsmoker can be

made easier by talking about it with friends andrelatives. They can congratulate you as you check offanother day, week, and month as a nonsmoker. Tellthe people close to you that you might be tense for awhile, so they know what to expect. They'll be sym-pathetic when you have an urge to smoke and can becounted on to help you resist it. Remember to call onyour friends when ycu're lonely or you feel an urgeto smoke. A buddy system is a great technique.

4139

Not smoking is habit-forming . . .Good for you! You've made a commitment not to

piok^ and by using this booklet, you know what todo if you're tempted to forget that commitment. It'sdifficult to stay a nonsmoker once you've had acigarette, so do everything possible to avoid it.

If you follow the advice in this booklet and use atleast one coping skill whenever you have an urge tosmoke, you will have quit for keeps!

Relapse: If you do smoke again . . .

If you do smoke againand many successful ex-smokers relapse at least once before they quit for;good- here's what to do:O Recognize that you've had a slip. A slip means

you've had a small setback and smoked acigarette or two. But your first cigarette or twodidn't male you a smoker to start with, and asmall setback doesn't make you a smoker again..Don't be too hard on yourself. On slip doesn'tmean you're a failure or that you can't be anonsmoker, but it's important to get yourself backon the nonsmoking track immediately.Identify the trigger: Exactly what was it thatprompted you to smoke? Be aware of the triggerand decide now about how you'll cope with it

when it comes up again.O Know and use the coping skills described above.

People who know at least one coping skill aremore likely to remain nonsmokers than those whodon't know any.Sign a contract with yourself to remain anonsmoker.

O If you think you need professional help, see yourdoctor. He or she can provide extra motivation for

you to stop smoking. Your doctor also mayprescribe nicotine gum as an alternative source ofnicotine while you break the habit of smoking.

42

Periodically, write down new reasons . . .

Marking prigress . .

O Each month, a the anniversary of your quit date,plan a special celebration.

O Periodically, write down new reasons you're gladyou quit, and post these reasons where you'll besure to see them.

O Make up a calendar for the first 90 days. Crossoff each day and indicate the money you saved bynot smoking.Set other, intermediate target dates, and dosomething special with the money you've saved.

Common rationalizations*-Rationalization Response

I'm under a lot of stress,and smoking relaxes me.

Smoking makes me moreeffective in my work.

I've already cut down to asafe level.

Your body's used to nicotine, so younaturally feel more relaxed when yougive your body a substance it's cometo depend on. But nicotine really is astimulantit raises your heart rate,blood pressure, and adrenaline level.Most ex-smokers feel much less ner-vous just a few weeks after quitting.

Trouble concentrating can be a short-term symptom of quitting, but smok-ing actually deprives your brain ofoxygen.

Cutting down is a good first step,but there's a big difference in thebenefits to you between smoking alittle and not smoking at all. Besides,smokers who cut back often inhalemore often and more deeplynegating many of the benefits of cut-ting back. After you've cut back toabout seven cigarettes a day, it's timeto set a quit date.

I smoke only safe, low- These cigarettes still contain harmfultar/low-nicotine cigarettes. substances, and many smokers who

use them inhale more often and moredeeply to maintain their nicotine in-take. Also, carbon monoxide intakeoften increases with a switch to low-tar cigarettes.

It's too hard to quit. I don't Quitting and staying away fromhave the willpower, cigarettes is hard, but it's not im-

possible. More than 3 millionAmericans quit every year. It's im-portant for you to remember thatmany people have had to try morethan once, and try more than onemethod, before they become ex-smokers, but they have done it, andso can you.

I m worried about gaining Most smokers who gain more thanweight. 5-10 pounds are eating more. Gain-

ing weight isn't inevitablethere arecertain things you can do to helpkeep your weight stable. (See TipsTo Help You Avoid Weight Gain.)

::Rationalization

-4 don't know what to dowith my hands.

Response

That's a common complaint amongex-smokers. You can keep yourhands busy in other waysit's just amatter of getting used to the change,of not holding a cigarette. Tryholding something else, such as apencil, paper clip, or marble. Prac-tice simply keeping your handsclasped together. If you're at home,think of an the things you wish youhad time to do, make a list, and con-sult the list for alternatives to smok-ing whenever your hands feelrestless.

Sometimes I have an almost This is a common feeling, especiallyirresistible urge to have a within the first 1-3 weeks. Thecigarette. longer you're off cigarettes, the

more your urges probably will comeat times when you smoked before,such as when you're drinking coffeeor alcohol or are at a cocktail partywhere other people are smoking.These are high-risk situations, andyou can help yourself by avoidingthem whenever possible. If you can'tavoid them, you can try to visualizein advance how you'll handle thedesire for a cigarette if it arises inthose situations.

I blew it. I smoked a Smoking one, or even a few, ciga-cigarette. reties doesn't mean you've "blown

it." It does mean that you have tostrengthen your determination toquit, and try againharder. Don'tforget that you got through severaldays, perhaps even weeks or months,without a cigarette. This shows thatyou don't need cigarettes and thatyou can be a successful quitter.

*Adapted from Clinical Opportunities for Smoking InterventionAGuide for the Busy Physician, National Heart, Lung, and Blood-Institute. NIH Pub. No. 86-2178, August 1986.

4 5 43

For further information . . .

The National Cancer Institute operates a toll-free

=Cancer Information Service (CIS) with trained per-

sonnel to help you. Call 1-800-4-CANCER* to reach

the CIS office serving your area, or write: Office of

Cancer Communications, National Cancer Institute,

National Institutes of Health, Building 31, Room

10A24, Bethesda, MD 20892.The following organizations also can help you.

Contact them to learn more about quitting for keeps.

American Cancer Society t90 Park AvenueNew York, NY 10016(212) 736-3030

The American Cancer Society (ACS) is a voluntary

organization composed of 58 divisions and 3,100

local units. Through "The Great AmericanSmokeout' in November, the annual -dicer Crusade

in April, and numerous educational materials, ACS

helps people learn about the health hazards of smok-

ing and become successful ex-smokers.

American Heart Association:t

7320 Greenville AvenueDallas, TX 75231(214) 750-5300

The American Heart Association (AHA) is a volun-

tary organization with 130,000 members (physicians,scientists, and laypersons) in 55 state and regional

groups. AHA produces a variety of publications and

audiovisual materials about the effects of smoking on

the heart. AHA also has developed a guidebook for

incorporating a weight-control component into smok-

ing cessation programs.

44

46

GPO : 1987 - 178 -924: QL 2

,American Lung Associationt1740 BroadwayNew York, NY 10019

:(212) 245-8000

A voluntary organization of 7,500 members (physi-cians, nurses, and laypersons), the American LungAssociation (ALA) conducts numerous public infor-

matiln programs about the health effects of smoking.ALA has 59 state and 85 local units. The organiza-tion actively supports legislation and information

--campaigns for nonsmokers' rights and provides helpfor smokers who want to quit, for example, through"Freedom From Smoking," a self-help smokingcessation program.

Office on Smoking and HealthU.S. Department of Health and

Human Services5600 Fishers LanePark Building, Room 110Rockville, MD 20857

The Office on Smoking and Health (OSH) is theDepartment of Health and Human Services' leadagency in smoking control. OSH has sponsoreddistribution of publications on smoking-related topics,such as free flyers on relapse after initial quitting,helping a friend or family member quit smoking, thehealth hazards of smoking, and the effects of parentalsmoking on teenagers.

In Alaska call 1- 800.638 -6070; in Hawaii, on Oahu call 52442:4(call collect from neighboring islands).

Spanish-speaking staff members are available during daytime hoursto callers from the following areas: California, Florida, Georgia,Illinois, northern New Jersey, New York, and Texas.(Consult your local telephone directory for listings of local chapters.

J1