To be continued

Well, it's been a while since I've managed a new post dear reader, and for that I apologize.  I've been tinkering with this post for a while now, and releasing it for unlucky week 13 seemed an appropriate gesture. 

What was the worst part?

I often wondered before I quit what the worst part would be.  I pictured my trainspotting nightmares; I imagined my road rage.

I've thought about that question a lot now that I feel like I'm over the hump.  I look back at those first few days, those first few weeks, and I ask myself what was the worst, what was the closest I came to smoking.

I have a few moments to chose from.  I have the wake of a friend who died about 10 days after I quit.  I have the funeral of a dear friend's father a few days after that.  I have angry moments dealing with a particularly impossible wood supplier.  I have a sequence of fairly emotional events that you'd think would provide my "worst day" scenario.

They don't.

My worst day is so much more banal.  There's an important truth in that: sometimes, it really is banal to quit.

My worst day was somewhere between day 5 and 6 (it was hard to determine exactly which day counted as which, since I stopped smoking on GDT and promptly returned to MDT).  I was at work, sitting at my desk, thinking about how easy it would be to walk to the corner, buy a pack of smokes, and just put this whole thing to rest.  At that point, no one knew that I was trying to quit: I hadn't told my friends or colleagues, and my partner was safely tucked away in Australia for 2 weeks in case I turned into a monster.  I told myself over and over again: no one will know.  You can try it again later.  Next week.  Next month. No one will know.

I scoured the internet looking for information and help on how to resist my diabolical rationalizations.  I found all of the predictable materials: breathe deeply (are you kidding me??); get some exercise (pffft...); have a glass of water (oh, f*&k right off).

Somehow, in reading all of that advice, I realized that I could not trick myself out of this particular craving.  Trickery might be a great strategy that could work in any number of contexts, but it was far too weak for what was going on in my body and my mind.  All of those strategies were nothing but cheap tricks.  The sleight of hand was not going to succeed this time.  I would need to understand this before I could fight it.

So I thought about what was going in my mind: what kinds of excuses was I making?  What did that excuse try to cover over?  What were my excuses obscuring?

Here's what I figured out.  I had somehow imagined quitting smoking to be an event.  In preparing myself for it, thinking through it in advance, coming up to the actual moment when I put out my last cigarette, all of that time, and for about 5 days afterward, I had thought about it an event.  It was something I would do at the appointed time.

But here's the rub.  After 5 days, all I could think was: okay, I did it.  That was nice.  I'm done now.

I did not think of it, or prepare for it, as something I would be stuck with forever.  (The addiction platitudes chirpily tell me to do it one day at a time.  I call b*&lsh*t.  That's a cheap street trick and I'm not falling for it.) Yes, this thing I had done, I was stuck with it for-e-ver.  Suddenly it was like an ill-advised one-night stand.  It seemed like a good enough idea at the time, but now it's morning and I don't want breakfast, I want you to call a cab. 

Now maybe if I had thought through this particular wrinkle I wouldn't have had the kahones to quit in the first place.  If I had thought soberly, in the clear light of day, that I would need to do this every single day, every god-damned day, in perpetuity, perhaps my resolve would have faded, my courage abated: the endless string of days, stretched out before me, each  just like the last. You will never smoke again. You are stuck with this forever.

So, you ask, how did you make it through that feeling?  I told myself that if I really wanted to, all I needed to do was reach into my pocket for some nicotine gum.  If I really needed a cigarette, I could have a piece.  I took it out, turned it over in my fingers, thought about how it would feel and what I would get out of it.

And then I put it back in my pocket -- not because I wanted to stay nicotine free, but because I finally understood.  The need I was feeling was not a need to smoke.  I couldn't stem the feeling with some nicotine and move on.  Instead, I finally saw that the need I was feeling was the need to be a smoker.  I was feeling my lost future.  I was longing for all of the  cigarettes in my life I wouldn't smoke.

That loss was too huge to contemplate before I quit.  It is still huge to contemplate.  But I think it marks a tipping point: the point where we can extrapolate from individual cigarettes, cravings, habits, and really think about what it might mean to be a non-smoker.  To be something different.

I've been something different now for thirteen weeks.  I don't miss the actual smoking anymore.  In truth though, I still miss being a smoker.  But I'm working on it.

Suckage Part 2

If you missed my post on gaining weight as one of the things that sucked when I quit smoking, I highly recommend reading it before this post.  Not to brag, but it does such a nice job of setting up the indignant, slightly bitter tone that the whole "suckage" theme is going to draw on.  The truth is that, about some things at least, I am indignant; I am bitter.

The glorious narratives of quitting put stars in my eyes.  Everything would be better when I quit.  Everything.  Everything. I feel a bit like Dorothy as she approached the Emerald City: the beautiful promise shimmering on the horizon, luring me, when all of a sudden, bam!  Poisoned poppies.  Crazy flying monkeys.  Witches castles.  Not so fast my pretty, not so fast.

The ugly truth is that I don't really feel any different.

You heard me.  I don't really feel any different, and that sucks.

Now I can hear what's going through your mind. Many of you are feeling the need to encourage me anyway, tell me that I will feel better, that I need to give it time.  Please resist that urge.  PLEASE.  I do not reveal this particular truth as a way of soliciting sympathy or encouragement.  (In fact, I can be very good at asking for sympathy and encouragement  quite directly when I need them.)  I'm not interested in sugarcoating this and lying to myself or others. I appreciate that when other humans are experiencing suckage our natural reaction is to try and make things better.  That's not what I'm after and I implore you to resist.  What I want in this space is to be simply and brutally honest, especially about what sucks.

The truth: I don't feel any different.  I'm slightly more fidgety I hear; I'm also a little more chatty if various reports are to be believed.  So, it's not that there has been no change whatsoever -- it's just that the changes have not been of the physical variety.  Now perhaps my expectations were too lofty, but I had expected to feel, well, something.  (I mean, I'm supposed to be growing new cilia by now for god's sake!)  I thought I might have more energy; I thought I might not get winded as quickly climbing stairs; I thought my skin would improve.

But no.  Nada.  Nothing.  Eleven weeks along and the only difference is that my occasional morning smoker's cough has vanished. More energy? I could use a nap right now and it's not even lunch time.  Increased lung capacity? Hockey practice continues to turn my lungs inside out. Improved skin? The forty-something I-want-wrinkles-and-zits-and-age-spots-all-in-the-same-place mockery continues unabated.

So I continue to wait patiently for the promised improvements to my body.  At my most philosophical, I think that perhaps I will just stay the same, and my eventual middle-aged decline will simply be slower than it might otherwise have been. I remind myself that increased energy is just a bonus and that reducing my risk of lung cancer is the real benefit.  I think about having the heart of a non-smoker within 10 years and my skin doesn't seem so monumental.

But it's hard to be philosophical all the time.  After all, I haven't even noticed my teeth getting whiter. 

Two months and my teeth aren't even getting whiter?

Dude, that's just mean.

Cool Turkey

If you're a regular reader of my blog, you'll know that I quit essentially cold turkey, though I hadn't really planned it that way.  Yes, "essentially."  By essentially, I mean that I chewed two pieces of nicotine gum in the first two days of quitting.  At the time, I didn't really have a strong opinion about whether I was going to use the gum or not.  I always had some around for long flights, so I didn't need to actually choose to get some.  The first piece got me through the 11 hours of travel on day 1.  The second piece got me through day 2 at my desk.  That's when I decided that I wanted to go without.  I had read that the nicotine essentially leaves your body after 3 days, and I thought, well, if I keep on with the gum, 3 days will never get here, so I'll give it a try.

My deal with myself was simple: carry the gum with you; if you're tempted to actually smoke, then chew some (I haven't yet).  After about two weeks I stopped carrying the gum with me.  It has now been two months and it still sits on my dresser, just in case.  I promise I'll blog about it if/when I throw it away.  It's sitting right on top of my prescription for Champex, which I also obtained before quitting as a backup plan, just in case. 

There's a lot of "just in case" in my story of quitting; there are a lot of deals that I've made with myself.

Why, exactly?

Because I'm old enough to know that plans fail.  Simple as that.  Like relationships, governments, or the banking industry, sometimes plans just fail.  Being able to redirect in those moments of failure, though, that's the key to getting through.  The truth is that I wanted to quit smoking.  I didn't really care how I did it, as long as it was the easiest route that was available to me at the time.  It's like navigating in a strange city: you look at the map and you figure out a reasonable route from Point A to Point B.  Sometimes your route works like a charm; sometimes though, you need to improvise on the way because the map only tells part of the story.  I had an idea about how to get from Point A (smoker) to Point B (non-smoker), but I needed to know that I could change my route if I suddenly found myself  trying to cross a freeway on foot.

It's not just that plans fail though.  I needed my Plan Bs and my Plan Cs and all of my deals with myself as a way of preserving a sense of choice.  I'm a woman who likes to feel like she's in control of her own destiny, and creating options is one way to do that.  You see, I need to know that I can, and then I can choose that I won't.  Can't just doesn't work for me.  Never has.  I know myself well enough to know that my immediate, visceral reaction to "you can't" is "watch me."  Right or wrong, pleasant or unpleasant, that's just who I am and that's what I had to work with.

So instead, I created a world of "you can"s.  If you need to, you can do this.  If you need to, you can do that.

Twice, I needed to.  Twice I did.  Big deal.

I'm not invested in exactly how cold my turkey was.  I'm just invested in creating the conditions that make it easier for me not to smoke. The way I figure it, the more conditions I create, the better my odds are.

The Shape of the Relapse Curve

Huh? The shape of the what??

The shape of the "relapse curve" my friends.  That's medical-speak for "when do people cave?"

I don't know about you, but that question was hugely important to me in the first few weeks after quitting.  Particularly in the first two weeks, when I was obsessively looking for any scrap of information that would explain things to me, I wanted desperately to know where I stood.  I still think it's a reasonable thing to want to know.  Here is the information that is easy to find: 95% of people who try to quit smoking on their own are unsuccessful.  Ouch.  But that raises a pretty basic question in a quitter's mind: When does that happen?  Do 50% of people give in on day 1?  Do 75% of people make it for a month before they can't take it anymore?  If I make it through day 3 (when the nicotine is actually gone from my bloodstream) am I well on my way?  What are my odds of success right now?

Please read those questions again.  They make sense, right?  They are not the musings of some mad genius, nor are they the product of deeply held ignorance?  They mark me as neither an idiot savant nor an idiot proper?  I'll assume your silence means that you agree.  They seem to me painfully obvious questions.

Apparently though, no one has actually asked them in any systematic way.  Yes, you read that right.  No one.  Trust me, I have the advanced research skills that come with graduate degrees.  I also have access to the second largest research library in Canada, a library that serves both a medical school and a university hospital.  The dearth of information is downright shocking.  (Note to medical researchers everywhere: there's a big comprehensive, well funded study here just waiting to happen).

Here is what I did manage to find.  One article:  "Shape of the relapse curve and long-term abstinence  among untreated smokers."  I won't quote at length from the article, but I'll share the two most important results: "There is a paucity of studies reporting relapse curves of self-quitters" and "Cessation studies should report relapse curves."

It's actually an interesting read for the information it does manage to collect, as well as for the gaping holes it identifies in smoking cessation research.  The authors did what is called a meta-study -- that is, they took a bunch of data from other large-scale studies, mashed it together, and asked a new question of it.  The article largely focuses on what they were unable to find.

For one, not a single one of the studies they identified actually started with a group of smokers who intended to quit, and then followed them through the process.  Each study relied on a retrospective report from its subjects.  More alarmingly though, there was no standard definition among the studies of what constituted a "relapse."  Some defined it as any nicotine use, even if that meant one drag, once, in the course of an entire year.  Others defined it as a relapse to "regular" smoking.  (I have since learned that there is an entire ideological firestorm surrounding what might constitute success, or a relapse.  Stay tuned for my take on that whole load of baggage.)

Rumour has it that smoking related illness costs billions of dollars a year in health care costs alone.  I can't quote you figures, but it's common knowledge that huge amounts of money are spent studying smoking cessation.  How is it even conceivable that this fundamental question has not been asked: when do the odds tip in my favour?  This is such a colossal oversight that it tempts me to conspiracy theories.  What is it that the NRT industry doesn't want me to know?

What they don't want you to know is that the relapse curve is more like a relapse cliff.  According to this study, approximately 90% of smokers who relapse do so within the first 8 days.  8 days!  The remaining 10% of relapsers adopt a leisurely pace and spread themselves fairly evenly from day 8 to day 180.

Now, if there was a true and deeply felt desire to actually help people quit smoking (on the part of anyone -- government, non-profits, big pharma, whatever), would you not lead with that?

If you can make it through 8 lousy days, your chance of success is 90%.

8 days.

90%

Ninety freakin' percent!!!

Now why do you suppose the statistic we're bombarded with most often is that 95% of people who try to quit on their own will not succeed?

You can have your 95%.  I'm very satisfied with my 90 thank you very much.

Ain't it Grand?

1000 cigarettes not smoked.

In case you're curious, this is what 1000 butts looks like.

Sometimes it just sucks

Mostly this had been a bit of a feel good blog.  It has traced the ways that quitting smoking has been easier than I had imagined; it has analyzed some of the lucky habits I developed before quitting that were a significant help to me.  But I'm no Pollyanna and I promised you the truth in this blog.  The truth is: sometimes it sucks -- deeply, thoroughly, and wholeheartedly sucks.

There is so much significant suckage when you quit smoking that it's hard to know where to start.  So, let's start with the big one: gaining weight.  It is a fact, and if you're not prepared for that fact then you're seriously damaging your chances of success.  I was only partly prepared for it (you'll sense my bitterness over this as the post progresses), but I'm still persuaded that quitting was worth it.  After all, I can easily begin the gradual plan to take the weight off (I'm big on the gradual plan).  Still, right now, I'm coming to the sad and inevitable conclusion that I was no exception to the rule.  I am not special.  I am not exceptional.  In this regard, I am brutally normal.  And that truth sucks.

Now, perhaps you're one of those one-in-a-thousand freaks who doesn't gain weight when they quit smoking.  If that's you, please go back to your gym-bunny life and feel as smug as you like.  We're all happy for you (not).  For the rest of us though, the truth hurts.  My weight gain has pushed significantly into the double digits (with no plateau in sight).  I now have only spotty access to most of my favourite pants.  Sure this is partly an issue of vanity, but it's also an issue of economics.  I can't afford to outfit myself in a new professional wardrobe a size or two larger.  Or at least that's what I tell myself when i can't stand my own vanity for another moment.

There are both physical and behavioural reasons for gaining weight when you quit smoking.  The physical reason is the lack of nicotine in your system.  Removing the constant stimulant from your body simply slows everything down.  There's nothing you can do about that except try to speed it up again with exercise.  If everything else remains identical, you will gain weight when you quit smoking because of this.

But everything else doesn't exactly remain identical. I was seized by the munchies when I quit smoking.  Not hunger, not a desire for hand-to-mouth action as I had read about elsewhere, but serious, full scale munchies.  True munchie connoisseurs understand that munchies are not about eating, they are about chewing -- about feeling the never ending flavour and texture of something not just in your mouth but between your teeth.  There is no satisfaction quite like the feeling when your teeth actually itch.  I was prepared for hunger and habit, but who can resist a full-on onslaught of the munchies?

I made a deal with myself that for the first week or so after I quit I could eat whatever I wanted.  Anything to push me over the hump was going to be fine by me.  Unfortunately, I ended up at Costco a mere two days after quitting.  Aisle upon aisle of bulk candy, in massive quantities, of every type.  I've managed to block out much of the bulk eating I did in order to satisfy my munchies.  What I can tell you with certainty though is that I left Costco that day with a box of Mentos (containing 24 individual rolls) and two 1 kg bags of dried mangoes.

I think they lasted a week.

I have since branched out though, into such treats as Smartfood (I think I'm averaging a half bag a day), scotch mints (a kilo bag, gone in about 4 days), chocolate bars (too numerous to count), and endless pots of yogurt when I'm trying to be "good."  When I run out of snack food, I turn to cereal, or toast and jam, or even, in desperation, entire boxes of crackers.  I laugh at the suggestion of healthy snacks.  Crunchy carrots?  Seriously?  Do you think my munchies are that stupid?

This has now been going on for 2 months and something will need to give.  I keep hearing George Clooney's voice from Up in the Air saying "I have a number in mind but I haven't reached it yet."  Well, I have a number in mind and I have surpassed it.  (It shouldn't surprise you to learn that I'm writing this with a butterscotch sucker in my mouth.)

I have no strategy but patience to deal with this particular phenomenon.  So far, the munchies have outsmarted me.  I don't have enough willpower to watch what I eat, or to dedicate myself to getting enough exercise to make a difference.  Sorry hips, but my willpower is otherwise occupied.  It sucks, but you'll just have to get used it.

One day, hopefully sooner rather than later, I'll get as fed up with the snacking as I did with the smoking and I'll make it stop.  In the meantime though, I did resist the giant bucket of Cow's toffees when I was at Costco last week.  Sure, I bought two more kilos of mangoes, but it's progress right?

Breaking the habit

We all know that quitting smoking is both chemical and behavioral.  On the one hand, our bodies are addicted to nicotine and the countless other chemicals cigarettes contain.  On the other hand, we smoke in routinized and predictable way.  Smoking makes us feel things because we've taught ourselves to feel them as we smoke.  The combination of chemical addiction and behavioural habit makes quitting smoking hard; deal with both of them or you're in trouble.

I might have titled this post "Sometimes you get lucky II" because again, dumb luck set me up for some good success on the behavioral front.  Here's what I mean.

For a long time I thought I might just gradually quit smoking.  I'd cut down slowly until eventually the habit and the addiction would just fade away and I'd never smoke again.  And by gradually, I mean gradually.  You have no idea how deeply patient I am.  This was not a week-by-week plan.  It was not even a month-by-month plan. My idea of quitting gradually was implemented over something of an 8-year span.  Yes, you read that right: 8 years.  The plan seemed logical to me, except that by the time I got down to a half a pack a day I hit my final plateau and couldn't continue on that slow, steady decline.  I still think this method might have worked eventually, but after 8 years even my patience had run thin.

But there were other things I did on the gradual slope that actually created new habits and new behaviours that really helped when I did finally quit.

Somewhere around 10 years ago, I decided that I would I would only smoke in my study, not in any of the other rooms in the house.  About 6 years ago, I decided I wouldn't smoke in the house any more at all.  A variety of other factors (non-smoking friends, city bylaws, etc.) meant that smoking had become a completely outdoor activity.  And along with it becoming an outdoor activity, it became a solitary one.  99% of time, I smoked alone.  There was nothing social left about smoking for me.  I had to stop what I was doing, bundle up if it was winter, go outside, and smoke.  This also means that I didn't do anything else while I smoked.  I didn't smoke and watch TV.  I didn't smoke and talk on the phone.  I didn't smoke and write.

I smoked.  Full stop.  It was an activity of its own, fully detached from anything else in my life.

I didn't imagine how helpful that 6-year habit would be until I quit.  My behavioural associations with smoking are significantly fewer than many people's.  Where I do have them, they are sequential not simultaneous.  I don't need to smoke with my morning coffee, so my morning coffee has not become a site of almost irresistible temptation.  I may want to smoke before my coffee, or after it, but the thing itself has not been poisoned for me.  I don't pine for cold rainy fall days on the back porch, shivering while had a quick smoke.  In fact, because smoking was such a detached and solitary activity for me, the worst cravings arise when I really want to be alone, when I want to escape from the demands of the world and just be left to myself. I'm figuring out how to manage that one, but I think it's easier than managing coffee, or friendship, as triggers.

I didn't realize at the time how smart it was to slowly isolate smoking from the rest of my life, or how habituated I would become to that.  Sure, it took 8 years.  That's okay.  I'm a very patient woman.