Wednesday, August 18, 2010

Our esteemed Overlord has hijacked my train of thought today with this little entry on our News Page:

"Smokers trying to give up -- don't stop thinking about cigarettes!!!"

I added the exclamation points. They need to be there.

It is now 14:45 Central Standard Time***, which means I have not smoked a cigarette in 5.41 days. That's 129 hours and 45 mins. That's 7785 minutes, or 467,100 seconds, or...

OK, you get the picture I'm sure. Almost everyone nowadays knows a smoker who has tried to quit and sadly, very few know an ex-smoker who quit successfully (not counting the final, terminal phase of smoking cessation). I worked for many years in neuropharmacology labs and my former Department Chair is a Pioneer in nicotine addiction research so I've been to plenty of seminars on nicotine addiction*. I'm trying to remember the figure for smoking recidivism and I recall it having a cumulative rate of 95%. That's right, only 1 in 20 attempts to quit smoking are successful. I'm looking for a reference right now, and funnily enough putting "smoking recidivism" into Google Scholar brings are a mass of papers from the 70s and 80s and nothing more recent. Using PubMed I get recent references, but find the usual undetangleable mass of semi-tangential references to welders, Jordanians and dentistry.

Suffice it to say, smoking is very hard to give up. Partly it is the sheer addictiveness of nicotine, the other is that even under the draconian conditions smokers are forced to endure nowadays, in most cases smoking is still socially acceptable. It's not like I'm sitting in my local pub with my works on a Friday night.

The Ban That Never Was

I work, indirectly, for the State and last year our legislature tried to enforce a no-smoking ban in State funded workplaces. Despite initial outrage at being singled out (where's the fat-bloke ban?) I grew to love this idea because I saw they had actually allowed scientific information to inform the policy debate. Every parent knows, or should, that positive reinforcement works better in most cases than negative reinforcement. Telling little Johnny he's being naughty when he throws his crayons lets little Johnny know he gets attention every time he does it. Consequently he becomes an attention seeking little shit. Telling little Johnny not to throw his crayons, but also telling him he's done well when he just puts his crayons away reinforces the attention seeking behavior of compliance. Johnny becomes an obedient little shit (I'm not big on kids. So shot me).

Likewise, telling me I can't smoke on school grounds makes me tell you to go fuck yourself while I fire up a big fat blunt on the main lawn. Telling me I can't smoke on school property, but you'll also help not smoke on school property makes me go, huh, say what? And think about it.

You won't just punish me for doing it. You will reward me for not doing it.

The negative reinforcement was a $50/month fine (taken as a $600/year deduction to heath care).



The positive reinforcement was a refund of your fine if you proved you were smoking free, as well as free smoke cessation counseling for as long a you needed and a $5-10 co-pay on 9 months of smoking cessation products purchased via prescription.



And then it hit the State legislature and it got shat all over because everyone pointed out, for reasons good and bad, "Where's the fat bloke ban?"

Your Brain Doesn't Want to Stop

I've tried to stop a couple of times, but it's a half-arsed effort at best. I had my first cigarette when I was 11 years old. I was smoking pretty regularly by 16 and went Pro in college. So, let's say for 17 years at least I've been a "smoker" in the "grown-up" sense of the word. The first few days after you stop are horrible. I can write about those at length if anyone is interested, but let me tell you it's not just the psycho-social (with psycho being the operative word) effects of dealing of day-to-day life without a stimulant. Humans come fully equipped with three major nervous systems (autonomic, peripheral and central), and everything needs time to reset to a new baseline level of neurotransmitters**. Mood, sleep pattern, dreams, memory, libido...bowels, bladder...etc.

So, needless-to-say, since the non-smoking effort failed to become law I've been puffing away like an inverted dragon, as usual, between 15-20 times everyday, unless I'm in the pub in which case it spikes somewhere between 30-40 times/day.

And then last week I saw the article referenced at the top of this post, and this statement resonated with me, "If trying to avoid thoughts of something in an attempt to give it up actually unwittingly triggers a subsequent increase, it's a poor method of achieving self control. This work may stop people using quitting techniques that are ultimately harmful." Well, of course in the past i avoided thinking about smoking. I tried to not-think about smoking so hard I couldn't help but bloody smoke. And so i started thinking about quitting again. trying again, at least. "They" say you need a quit date, and I guess "They" are right in most cases. But this weekend I just stopped. I had a few left in a pack and my girlfriend hid them after I went to bed. And that has mostly been that.

Run, Tideliar, Run!

So what's my secret? I guess I got bored of smoking. I got bored of watching my hard earned salary get pissed up the barroom wall and ground into the barroom ashtrays every weekend. I figure my long term health is well and truly fucked by now, but in the short term what time I have left I'd like to enjoy without running out of breath talking with someone as we walk across the parking lot.

Because the Gods have nothing if they don't have a cruel and fucked up sense of humour, this week has been the week from hell at work (and it's only Wednesday!), and yet I have managed to avoid smoking...I belong to an awesome gym with cool and supportive staff and I go every night after work. I've avoided alcohol completely - the pub is a cue and alcohol lowers inhibitions allowing me to bum a smoke off someone (yep, spoken from experience).

I'm only five days in but I can feel my breath coming back a little. A cursory glance at the literature shows there isn't as much research as I thought into long term health effects of smoking cessation. I think that'll be another blog post soon. But, right now, I can feel a pang niggling away...the reward for a blog post is a cigarette break. I think it's time to run up and down the 5 flights of stairs at work while thinking very hard about cigarettes.



* - One day, get round to inserting that story about that guy at journal club

** - Anyone want a guided tour of "your brain on drugs" let me know. it might be a fun post sometime.
*** - Or was when I started this. Add 60 minutes to everything for the postage time :)