Psychological Self-Help

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spite of the belief that "I need cigarettes to relax," smokers are
generally more anxious than non-smokers and more anxious than they
will be if they quit. 
Note: Smoking is another addiction that is being "demonized." The
statistics just cited, for instance, would seem to be demeaning to
smokers by implying they are less educated and "lower class." This is
not my intention. We must guard against the mental put-down of
persons suffering a powerful habit and a physiological addiction.
Unfortunately, society more and more is seeing smoking, like over-
weight, as being due to laziness, a weak will, weak character,
stupidity, or slovenliness. This does not help people change; it makes
them more self-critical and unhappy. Very few of us have mastered all
bad habits, so we should be especially sympathetic with smokers who
have, as we will see, innocently acquired an extremely persistent
behavior. Let's not blame the victim! 
Partly because of the national anti-smoking campaign and the
massive amounts of profit involved in helping people quit, there has
been much research published in the last few years. Current findings
suggest the following combination of treatments: (1) an anti-
depressant, usually Zyban, (2) a nicotine replacement (first a spray
and/or patch, then gum for a few more weeks), and (3) counseling or
a psychoeducational program for 6 to 8 weeks. Such a program has
been proposed and tested by Dr. Linda Ferry at the VA Med. Center in
Loma Linda, CA. Smoking is a very strong addiction; it requires
serious, concentrated, multiple treatments to stop it. Going "cold
turkey" succeeds only 5% to 10% of the time. Any one of these three
treatments alone will be successful only 10% to 25% of the time, but
taken together the smoker successfully stops about 50% of the time,
according to Dr. Ferry. For this habit, 50% is a very good success rate.
Unfortunately, this is an expensive program: about $100 per month
for the anti-depressant (plus the cost of the prescription), between
$100 and $150 per month for the nicotine (may need another
prescription but some available over the counter), and maybe $20 to
$50 a session or $80 to $200 per month for a counseling/educational
smoking group (perhaps self-help or American Lung Association clinics
can be substituted). In some cases, health insurance may pay for the
treatment. Of course, it is worth the expense for a life-time of better
health and the saving of $100+ a month for cigarettes. 
The counseling/psychoeducational component consists of basic
information given before quitting about smoking, its causes, and the
quitting process (see this chapter). The class or perhaps an online
group can also provide individual support and encouragement for
several weeks. It is important that the smoker learn to meet his/her
psychological needs in other ways rather than by smoking and being
with other smokers. For instance, if smoking is a temporary relaxant-
when-stressed for you, other ways of managing stress must be
learned and put into practice daily or hourly (like cigarettes were). See
chapters 5 and 12. If cigarettes and nicotine helped reduce your
depression, other methods for elevating your mood must be found
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