DRHOOK- Cold turkey: For smokers, it may be a lifeline

"Smokin' in the Boys Room" is a pretty popular song. "Everybody knows that smokin' ain't allowed in school." (Didn't the songwriter know "ain't" ain't a word?) 

One of my classmates got caught smoking when he was 10 years old. Do you know what his father did to punish him? He made him smoke two packs of cigarettes in a closed-off room until he was sick, sick, sick. That snuffed out my friend's attraction to tobacco. 

My friend tried smoking because he thought it was cool. Can you blame him, the way the media portrays smoking? Also in my hometown, smoking was like walking– just another part of normal daily life. 

The problem is that tobacco addiction sets in early, so the earlier the age at which people begin to smoke, the more likely they will continue for the rest of their lives.

How does a person quit smoking?

In 2008, 20.6 percent of adult Americans smoked cigarettes, which is better than in 1965, when the figure was 42 percent. Remember, even our adored I Love Lucy (Ball) advertised cigarettes (and later died of congestive heart failure).

One in five deaths in America is related to tobacco use, making it the number-one preventable cause of death. Tobacco use is thought to cost this country $197 billion annually in health care costs and lost productivity. Holy smokes, Batman!

Most smokers wish they had never started, and therefore, many smokers are trying to quit.

Twenty percent of smokers don't smoke every day, and many haven't smoked in the past 24 hours in their attempt to quit. 

How many psychiatrists does it take to change a light bulb? None, because the light bulb has to want to change itself. The same is true of smokers. If you smoke, you have to want to quit– and that takes acknowledging that the negatives outweigh the positives.

So I ask my patients if they're willing to quit. If they say yes, I ask if they think they can quit in the next six months. The reaction I get is either, "Hmm, I can try" or "Run!"

If someone says he thinks he can quit in the next six months, I go further. 

"Can you quit in the next month?" 

For people who smoke more than half a pack a day, that's a big challenge. Usually it's good to taper down to five or fewer cigarettes a day before starting to try to quit. Behavioral changes need to occur, like not lighting up every time you're in the car or after eating, waking up, at a party, etc. 

If a person isn't ready to quit in a month or in six months, I encourage her to think about it and at least try to decrease smoking. Even this is a big challenge. One person I adore said, "I'll give up a good man before I give up my cigarettes."

I also let my patients know that it's okay if they aren't able to quit. It often takes five to seven attempts before the craving is permanently extinguished.

Setting the date: it's like a wedding or graduation. Setting the quit date is very important because we all do better with a deadline (or in this case, a "life" line).

The hard part is maintenance. Friends, relatives, and stress can all trigger the desire to light up again. Most ex-smokers say they think about smoking everyday– but they don't do it. 

There are products to help reduce the effects of nicotine withdrawal, but in my experience, nothing is stronger than going cold turkey (but, warning: no stuffing and no cranberry sauce allowed). 

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Dr. Hook cracks a joke or two, but he's a renowned physician with an interesting website, drjohnhong.com. Email him with your questions.

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