Drive-Thru Smoking Cessation
The standard smoking cessation quit-date timeline is 1-2 weeks. Here’s an example of this kind of blitzkrieg quit-date advice from a 2003 American Cancer Society publication, “Kicking Butts”: “Pick a quit date – about seven to fourteen days from now.” (p. 88)
7 to 14 days? Really?!
Here’s another recent (2008) example of the same: “Setting a definitive quit date […] is one of the surest steps a smoker can take to promote successful quitting. […] We recommend that the quit date be no more than 2 weeks away when set. This gives smokers adequate time for preparation without allowing too much time during which [smokers] can lose motivation to quit” (Perkins, p. 83).
Two weeks are “adequate time” for quitting one of the hardest habits? If that were, indeed, so, why would we see such sky-high relapse rates so early in the recovery process?
“Without allowing too much time during which [smokers] can lose motivation to quit”? Wait a second: if the smoker’s motivation is so frail as to expire within a couple of weeks then what are we doing rushing people into the batting cage of post-quit cravings?
Here’s another example. AHCPR (Agency for Health Care Policy and Research, 1996) recommends: “at least four to seven treatment sessions lasting at least 20 to 30 minutes” (Brigham, 1998, p. 244).
Seriously? Between 80 minutes and 3.5 hours to override one of the most over-conditioned coping behaviors? What are these people smoking themselves? Why the rush? Has anyone empirically established that 1-2 weeks of quit-date prep is actually enough? Obviously not: the relapse rates speak for themselves. Which is why – for all intents and purposes – these relapse rates are meaningless.
Ok, let’s do some math, maybe we are missing something. Let’s just see what you can possibly accomplish in 3 weeks of preparation for a quit date. First of all, we have to shave exactly a third of that time right off the bat – for sleeping. So, all of a sudden the 3 weeks became 2 weeks (21 days – 7 days = 14 days). Now, subtract another week worth of time since most of us spend an average of 8 hours a day working.
So, we are down to 1 week worth of potential prep time. How are you going to spend it? Maybe, just maybe, you’ll log in a few hours with some kind of therapist in a face-to-face training. Maybe, just maybe, you’ll spend a few hours reading over some supplementary materials. And maybe, just maybe, you’ll be diligent enough to spend a few hours practicing craving-control skills (if you’ve been lucky enough to be introduced to them). So, and we are being optimistic here, you might spend a day worth of actual prep time. A day of prep against years of massive conditioning!
Who are we kidding with this?! No wonder, most people in smoking cessation programs don’t stand a chance of succeeding. Clearly, a day worth of prep time, heck, even a full week of prep-time is not enough to combat the massive inertia of the smoking habit.
It is simply clinically naïve to expect any lasting results with so little skills-training.
So, to sum up, we have a major clinical beef with this “2-weeks-to-launch” standard of care.
- First, this isn’t treatment but a drive-through hook-up for a patch or a pill. The timeline is premature and arbitrary.
- Second, this kind of approach gets in the way of rapport since the “2-weeks-to-launch” smoking cessation providers don’t seem to trust you, the smoker, with your motivation and seem to wish to nail you down with some kind of verbal “pinky promise” contract that you’ll quit “as promised.” We’ve seen this silliness first hand, in our training, during feel-good group-quit ceremonies.
- Third, in our analysis, the current “2-weeks-to-launch” quit-date deadline has the stampeding impatience of an anti-smoking crusade.
What’s our solution to this drive-through quit-date approach? A mindful sit-down.
When to Quit: Whenever You Are Skills-Ready
Your past smoking cessation failures say absolutely nothing about your potential for success in the future. Our guess is that you lapsed and relapsed because you have been dramatically underprepared. So, your past quit-data are meaningless. So, how soon should you quit? Whenever you are ready, of course. But not just motivationally ready, but skills-ready! Let us explain.
Motivational Readiness Isn’t Skill Readiness
In trying to make sense of this “2-weeks-to-launch” nonsense, we believe that both clinicians and smokers confuse motivational readiness with skills-readiness. It’s one thing to want something real bad and it’s an entirely different thing to know how to get it. Say, you are getting ready to get married. You set a date for the wedding – in 2 weeks. You are unambiguously in love and you have a very particular vision for the wedding. You want to marry under the wide-open sky, Druid style. So, here it is, the morning of the wedding, you are all laced up in your wedding dress and it’s raining cats and dogs. A dilemma.
On one hand, you want to proceed with the wedding: your motivation is at all times high. On the other hand, with the weather being what it is, you don’t want to get soaked and ruin the event. What to do? As inconvenient as it may be to all the parties involved, you just might have to postpone the date and try it again. How come? Well, because, as motivated as you are, you don’t have the supernatural skill of outmaneuvering raindrops.
Same with smoking: say, you are gung-ho as heck to quit; you are sick and tired of being sick and tired, and all that motivational jazz. Good for you. But here’s the question: what are going to do when it starts raining triggers? Rely on your nicotine patch? Sip some lemonade? Chew a toothpick? White-knuckle it? Might work on your best day. But what about your worst day? Or even just a not-so-good day? What happens to your willpower when you’re stressed out, tired, and all you want to do is smoke?
Skillpower not Willpower
Point is: to quit smoking you need more than willpower; you have to have recovery skill-power. What is important to understand is this: naked motivation is not enough. As motivationally ready as you might be to up and quit all this smoking stuff today, plain fact is that you are not ready. Could you try to prove us wrong? You sure can. Quitting, as Mark Twain has famously noted, is easy, it’s staying quit that’s hard. Could you still prove us wrong, up and quit on sheer will-power? Of course, you can. We’ll readily grant you: mind is a powerful thing. Greater things have been accomplished on nothing but grit and grin. But here’s our guess, smoker: if you are reading this you already gave your willpower a good ol’ college try. This time make it easy on yourself: bank on skill-power, not will-power.
Mindfulness = Skillpower
Habits are automatic behaviors and as such, they are mindless. When you engage in a habitual behavior like smoking, it often happens without thinking. You might have an urge, reach for the pack, pull out a cigarette and light up without ever having a conscious thought to smoke.
Since habits are mindless behaviors, the cultivation of mindfulness is an important skill for combating or changing habits. According to addiction researchers Bowen and Marlatt, the use of mindfulness may help smokers to combat urges “by heightening awareness of craving and habitual reactions and providing new skills to cope with urges to smoke.” (2009, p. 666).
Preliminary research studies are demonstrating the effects of mindfulness practices for quitting smoking (Davis, Fleming, Bonus, Baker, 2007; Bowen and Marlatt, 2009, Rosenqvist & Sand, 2006). Such studies suggest that the use of mindfulness meditative practices changes smokers responses to urges, and is associated not only with abstinence from smoking but also decreased feelings of distress among quitters.
Our program uses mindfulness skillpower in four ways.
- First, we use process mindfulness (mindfulness of the smoking process) to awaken the smoking zombie with the help of awareness-building and pattern-interruption smoking meditations.
- We then use mindfulness-based breath-focused craving control training to arm you with no-nonsense fail-proof skills for maintaining your recovery after you quit smoking.
- Third, for the smoker who is interested in just cutting back as part of a harm reduction approach, we use Process Mindfulness (PM) and Mindfulness based Craving Control (MCC) to help you leverage more out of less as you cut back your daily smoking ration.
- Finally, whether you are quitting altogether or just cutting back, we help you see how to transition your breath-focused infrastructure of self-care that you have built with the help of smoking into a platform of breath-focused meditation and contemplation.
Skillpower = Neuroplasticity
Habitual behaviors like smoking create neural pathways in the brain. Like ruts in a road, these pathways become deeply ingrained over time, so that we naturally follow those pathways and engage in the habitual behavior without thinking. Just like the wheels of the car naturally fall into and follow the ruts, our brain circuits continue to follow the neural pathways that have been established by previous repetitive behaviors. The good news is that our brains have something called “neuroplasticity” which is the ability of our brains to build new pathways even after years of following the same old ruts. Essentially, neuroplasticity is what allows our brain to learn new habits. But just like repairing old roads, changing our neural pathways takes time, and requires the repetition of new, alternative behaviors to create new paths for our brains to follow.
Rick Hanson, neuropsychologist and meditation teacher, and Richard Mendius, a neurologist, write in their book “Buddha’s Brain” that “neurons that fire together wire together,” (2009, p. 18). After years of smoking, your neural pathways are wired so that you experience strong, repetitive urges to smoke followed by a habitual response of smoking. Our program is designed to hijack that process, that is, to rewire that process, so that you respond to urges to smoke by using craving control skills. Eventually, this process rewires your brain, so that you have a new response to cravings, a response that helps you quit and stay quit. For all intents and purposes, when we speak of skillpower, we are speaking of neuroplasticity. But it takes time to develop.
Once again, recognize the following basic fact about how habits modify the brain: unlike in computers, the change in the mind software (mindware) changes the underlying brain hardware. Habit formation is not an act of willpower, but a process of cultivating new brain behavior patterns. You’ve been operating on smoking mindware, and your brain’s hardware reflects that. By learning how to “smoke your lungs” (i.e. how to use craving control skillpower), you are, in a manner of speaking, laying down new neural tracks for your post-smoking life. By coupling (pairing) the urge to smoke with mindfulness-based breath-focused craving control, you are wiring your desire to smoke with your desire to be smoke free.
Conclusion: Sit Down
There is a Russian custom: before you head out on a journey, sit down. So, skip the drive-through and sit down, smoker. Scratch your head, catch your breath, think it through. Solid preparation and timing are everything. So, how much prep time do you, specifically, need? This question is impossible to answer without knowing the specifics of who you are. Impossible for us, that is, but not for you.
In our book, “Smoke-Free Smoke Break,” we detail the skill-set that constitutes the smoking cessation know-how and a systematic program of skills-training. We also offer ideas on how to test your skills-readiness before you quit (not after you quit!). What this all means is that you can keep on smoking until you are skills-ready to quit. But here’s the kicker: you won’t be just smoking and practicing the skills on the side. No. You will be using your smoking to practice the very skills that will help you quit smoking. We have designed a way for you to put your smoking to very good use. In the meantime allow yourself to really soak up this bit of good news. Once again: a) you can keep on smoking until you are skills-ready to quit, and b) from this point on, the meaning of your smoking is fundamentally changing: your smoking, with an unrushed, mindful approach, – as paradoxical as it sounds – can lead to its own cessation.
Somov, P. (2012). Drive-Thru Smoking Cessation. Psych Central. Retrieved on July 25, 2016, from http://blogs.psychcentral.com/mindful-living/2012/08/drive-thru-smoking-cessation/