Why smokers should never give up trying to give up

Just before the Christmas break, The Anglo-Celt sent its apparent smoking correspondent, PAUL NEILAN, to Cavan General Hospital on one of the stormier days of late 2013 to talk to a clinical nurse specialist about ‘smoking cessation’. A cruel assignment by the editor, no doubt. It’s that time of year, though, when the puffers are besieged by both well-meaning hand-wringers and po-faced health-Nazis to give up the habit. The Celt expecting to encounter a mix of shock images, electro-therapy and fire and brimstone tactics, however, met an understanding CARMEL MCGUIGAN about a New Year course that supports those wanting to quit.

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Carmel is the clinical nurse specialist in smoking cessation for Cavan and Monaghan hospitals, she’s based in Monaghan and by the time the Celt arrives we’re over an hour late. She’ll have to drive back in the dark through the worsening storm for another assignment before she clocks off but her enthusiasm brightens up that sterile hospital lighting in a meeting room somewhere in the corridor-maze that is Cavan General Hospital.

From the outset it’s clear that there’s a non-adversarial approach behind all this.
“My role is education and health promotion among tobacco users,” she explains by introduction.
“We advise patients and service users of the benefits of stopping smoking.
“Most of the people we advise and support are in-patients or may have underlying medical conditions caused by smoking.”
Basically, she and her team are here to help you quit. Easier said than done. As a smoker, I’m a dab hand at ignoring the stats, but there are some hardcore unavoidables here, despite the progress made in reducing the number of smokers nationwide.
“Over five and a half thousand people in Ireland die as a direct result of tobacco use.
“About twenty-two per cent of the population are tobacco users... in 2007 it was twenty nine per cent.”
There are a number of factors, never mind the health problems and the price.
“Health, of course. Products are now behind cabinets, as well, so they are out of view of the customer, there’s the advertising ban, of course and pictorial warnings.”
Pictorial warnings are those gross-out tumours the size of a rugby ball on some poor bloke’s neck, or a foot with no toes that now badge packs of 20. The reasoning, and it is mentioned more than once in conversation, is “de-normalisation”. Sub-title: Why do we do this to ourselves at all?

Denial
Carmel McGuigan: “Have you thought about the impact of smoking on your health?”
Anglo-Celt: “No.”
CM “Are you aware that there are seven thousand chemicals in one cigarette?”
AC: “No.”
CM: “That there are sixty cancerous-causing agents in within that one cigarette?”
AC: “No.”
CM: “One in every two people, if they continue to smoke long-term, will die of a smoking-related ailment and this is using the product as the manufacturer intended...”
There’s a stress on ‘intended’ that makes it linger there before a little bit of hope. “It’s never too late to stop smoking,” she adds.
I can’t remember when I started smoking, how or when I got used to it or when nipping out of a warm pub into the rain (in this country) to sate the craving became a perfectly acceptable behaviour. So why do people not stop?
“Nicotine is highly addictive,” comes the simple answer.
“There are very useful nicotine replacements, though, they will double the chance of people becoming non-smokers.”
Patches, sprays, things like that?
“Yes.”
Do people have any idea how addictive smoking is, are they in denial?
“Many who smoke recognise it is addictive. But seventy-five per cent actually want to stop smoking. They might have tried before and lost confidence, though.”
Carmel and her team acknowledge that there are a number of reasons people start and continue to smoke but also that the relapse rates are high before they become ‘life-long non-smokers’.
“Smoking cessation is a cycle of change so people will be at different levels of change. Some people outside the cycle will be pre-contemplating and very often they won’t be attending information sessions around smoking cessation because they haven’t decided to make any decisions as yet.
“People in the cycle, either contemplating; they are thinking about making a lifestyle change; or they could be preparing to make a change and could be very interested, setting a date to quit, or you could have someone recently stopped and coming to gain additional information and support.
“There are a vast array of reasons that people choose to stop smoking. Mostly, due to health - a health scare, a health issue - a lot of people might want to stop to avoid the occurrence of a health scare, others for family reasons, or they might have young children, and some again because of the cost.”

Obstacles
What, though, are the main obstacles to quitting?
“Entrenched addiction, peer pressure, there are many. It’s very important we empower people to recognise that they can manage to do it with supports and education.
It’s important to note that many people will have a number of attempts before they become lifelong non-smokers because the relapse rates are high and we acknowledge that. “Availability, sure, is another one, but with nicotine dependence, the withdrawl symptoms can be overwhelming.”
She points out that there is no quicker delivery - read ‘hit’ - “of any drug in the world” that the nicotine from a common cigarette.
One of the Celt staff’s other halves is a light smoker, planning to give up, but reasoned that there was too much going on at the moment so chose a date three weeks in advance to quit. Is this a long-fingered cop out? Not at all is the answer.
“Preparation is key, if they have their day picked I would encourage them to have their products in advance and look at the trigger factors for smoking.
“What plans can you put in place to avoid triggers in routines that might be associated with smoking? They might also plan to take up a sport to get them moving away from smoking.”

Support
For Cavan General in the New Year there is an information and support group co-ordinated by a colleague of Carmel’s helping those thinking of, or already, quitting.
If I go to class number one, by class number six am I ready to go without?
“It’s an individual process. Maybe not everyone will actually give up but some might go from contemplation to preparation stage, so hopefully at some point in the future.
“The fact that they are here shows they want information. They must want to give up and then we can build around that.
“It’s never to late to stop and stopping is the gold standard in ill health prevention but never give up giving up because it can take a few attempts.”
In short, and it’s different for everyone, the breakdown of quitting is this:
Over two-to-three weeks the cravings subside, with each craving lasting around two or three minutes but “becoming less and less” after that time.
Regardless of how long a person has smoked, oxygen levels in the blood eight hours after stopping return to normal. Within 24 hours carbon monoxide is eliminated and the lungs clear out mucus and debris. Within 72, breathing is easier and energy levels increase. Within 12 weeks circulation improves dramatically and within one year, a key point, risk of heart attack is reduced by 50 per cent.
Is there any defence you’ve seen where people are still justifying smoking to themselves?
“To themselves? That’s a personal decision. If people constantly put up a barrier and come up with reasons it’s an indication that the person is not ready.”
Towards the end of our meeting, we briefly touch on the smoke-free campus at the hospital, which was brought in on November 1, 2013. It’s indicative of the underpinning reasoning: ‘de-normalisation’.
“It’s a hospital policy, a HSE policy - the same as any setting where you have a smoke-free policy. You’d be expected to comply.
“The aim is by 2025 to have less than five per cent smoking. Remember that smoking kills one in two, in one way or another.
“The whole process is about de-normalising tobacco. It’s never to late to give up, and don’t give up on giving up.”
An apology in advance for crankiness: If you are reading this on the morning of Wednesday, January 1, 2014, New Year’s Day this is my first day off the little buggers, be gentle.

The group meets from Wednesday, January 8, from 8-9pm in the Conference Room, Cavan General Hospital and you can just show up on the nights.
For further information telephone the HSE Health Promotion Department on (041) 685 0671.