Ex-smokers: persevere!

This brochure is designed for people
who have quit smoking for more than 6 months

Print this brochure, rather than read it on the screen

Congratulations on having gone at least 6 months without smoking! You should be proud of your success. However, you are not completely free from the risk of relapse. Stay on guard: 20 percent of ex-smokers who have quit smoking for six months relapse to smoking after one year. Staying an ex-smoker is not just a question of willpower, but demands specific know-how. By reading this brochure, you can acquire the know-how that has allowed many ex-smokers to avoid relapsing.

Four priorities to avoid a relapse

1- Stay motivated

Do not let your guard down. Instead, reaffirm your commitment. For this, make a list of the advantages of having quit smoking.

The advantages of having quit smoking:. By reading this brochure, you can acquire the know-how that has allowed many ex-smokers to avoid relapsing.

1- Stay motivated

Do not let your guard down. Instead, reaffirm your commitment. For this, make a list of the advantages of having quit smoking.

The advantages of having quit smoking:

_____________________   _____________________   _____________________

Here is what some ex-smokers told us about their experience of quitting smoking:

- "I spend less money."

- "I have more energy." "I'm in better shape."

- "I have rediscovered tastes and smells."

- "I feel so much better." "I breathe better."

-  "I am quite proud of myself."

- "I have better breath." "My clothes are not smoky any more"

- "I do not have to be preoccupied with my lungs."

- "I do not cough anymore." "I do not have headaches anymore."

- "You impose less on those around you."

- "My family thinks quite a bit more of me." "My family is very pleased."

2- Abstain absolutely from picking up a cigarette

Very often, taking one or several cigarettes leads to a relapse. It is VERY IMPORTANT to avoid taking even just a drag of a cigarette. It is easier to refuse the first cigarette than the second!

3- Prepare an "emergency plan" in case you pick up some cigarettes again

If it happens, act immediately:

• Above all, avoid starting smoking regularly. Do not buy cigarettes and throw away the cigarettes in your possession.
• Tell yourself that this cigarette was going to be the last one.
• Look back. Analyze the reasons why you smoked.
• Remind yourself of your decision not to smoke.
• Consider this hitch as a normal, learning experience, and not as a failure.
• Do not chastise yourself. Avoid making yourself feel guilty.
• Call on the help of those around you.

4- Think carefully about your possible previous relapses

If, in the past, you have already attempted to quit and relapsed to smoking, a good way to prevent a future relapse consists of reflecting back on the circumstances under which you relapsed in the past.

The last time, under what circumstances did you relapse?

_______________________________________________________________________

The next time, how will you avoid a relapse under similar circumstances?

_______________________________________________________________________

Know how to respond to risky situations

In general, ex-smokers relapse because they do not know how to respond to high-risk situations. It is very important to recognize these situations, to anticipate them and to use strategies to resist cigarettes in each of them. Think carefully about this in responding to following questionnaire:

* Degree of confidence in your capacity to resist smoking in each of these situations:

1 = not at all confident, 2= a little confident, 3 = somewhat confident, 4= totally confident.

The following pages describe strategies for how to resist the urge to smoke in each of these situations. Focus on the situations that you do not feel entirely confident in your ability to resist cigarettes. By using multiple strategies at once, you increase your chances of success.

1) In the company of smokers

The majority of relapses happen in the presence of other smokers. Hence, it is very important that you know how to resist the urge to smoke in this type of situation.

Prepare yourself

Prepare yourself mentally before going to a place where you know you will encounter smokers (party, restaurant, etc.). Visualize the situation ahead of time and prepare strategies to resist cigarettes.

Rehearse the scene like an actor

Play out the scene where you refuse a cigarette you are offered, as well as the scene where you respond to a person who doubts your ability to remain an ex-smoker. Prepare a humorous response, this can diffuse many tense situations.

Assert yourself

It is likely that some smokers will be jealous of your success and might encourage you to take a cigarette. Prepare responses that affirm your new identity as an ex-smoker. Write below what you will answer to people who encourage you to smoke or who doubt of your ability to refrain from smoking:

_________________________________________________________________

_________________________________________________________________

2) After you have been drinking

One third of all relapses happen when ex-smokers drink alcohol. Prepare your personal strategy for this type of situation. Avoid drinking alcohol or limit your consumption. If, after drinking, you think that you will "crack" for a cigarette, leave the place where you are, and take a walk or go and relax.

3) In case of an urge to smoke

Over time, the urgent need to smoke finally disappears. Since these strong urges to smoke last for only a few minutes, the best way to deal with it is to waituntil they pass. You can also use activities that divert your attention, such as:

• Drinking water or eating some fruit.
• Chewing some chewing gum or eating some sugarless candy
• Brushing your teeth.
• Breathing several times deeply and slowly.
• Thinking of the disadvantages of cigarettes (odor, bad breath, cough, etc.).
• Changing places or activities, leaving wherever you are, taking a walk.
• Telling yourself it would be a shame to ruin all of your efforts of the past months.
• Calling your friends or family on the telephone for news.

4) After a meal or a coffee

To avoid being tempted to smoke, leave the table immediately after you finish your meal and brush your teeth. Find something else to do (e.g., take a walk or wash the dishes). If coffee gives you the urge to smoke, replace it with another drink (e.g., fruit juice). Remind yourself that cigarettes do not make the meal better. Instead, they reduce your sense of taste and smell; they interfere with your full enjoyment.

5) When stressed, nervous, or in an argument

Stress is often a cause of relapse in people who, like you, are in the "Maintenance" stage of change. It is therefore important to know how to face stress without smoking.

Attack at the cause of the stress

Try to understand what causes the stress, then attack at the root of the problem. It is true that this may take some time. Between now and then, find ways to respond to stress other than smoking. The following questionnaire can help you:

Learn how to react without getting agitated

It is possible under some circumstances that your first reactions will be to become agitated. Take things calmly. Like an actor rehearses his or her role, play the scene for yourself where you respond to stress calmly and collectedly. Tell yourself for example: "In every way, a cigarette does not improve this situation."

Breathe deeply

Breathe several times deeply and slowly. This will help you stay calm. This technique has the advantage of being able to be used in any situation.

Calm yourself by changing activities

To calm down, start a new activity that you particularly like, like taking with someone, doing sports or exercise, listening to music, reading, etc.

Use a relaxation technique

This can help you to manage your stress better. Enroll in a yoga, sophrology or stress management course.

Do more exercise

Physical activity is a very good way to release tension. Calm yourself by walking, swimming, gardening or doing some sports. Doing sports increases the self-esteem and reinforces your identity as a person who cares about being healthy. Doing sports also generates endorphine, the pleasure hormone. This is a pleasant and effective way to prevent a relapse!

Express your feelings

It is much easier to cope if you talk about your emotions. Openly and calmly express what you feel. Find someone you can trust who knows that you are making efforts not to smoke anymore and with whom you can speak of your problems.

Manage your time better

Instead of just doing tasks as they present themselves, establish priorities. Get to know your most productive hours and use them for your priority activities. Control your interruption better (telephone, visits, etc.). Learn to say no. Avoid perfectionism. Foresee activities of relaxation to "recharge your batteries."

6) When you are feeling depressed

Since nicotine is a stimulant, many ex-smokers feel a little down after having stopped smoking. With time, this feeling should disappear. Be proactive to deal with this problem; go to see others. If the depression does not pass, take it seriously and call on a doctor or a psychiatrist. They can help you.

7) If you gain weight

After they stop smoking, certain people gain weight. This weight gain is usually moderate (3 to 4 kilos, or 8 to 10 pounds, on average). Some tell themselves that the only way to lose to the weight is to start smoking again. This is not sound reasoning. Actually, a relapse can make you depressed, and depression may lead you to eat more and gain weight. Remind yourself that if you were capable of not smoking for many months, you are just as capable of losing a few pounds or kilograms. To lose the weight, use the same techniques you used to stop smoking. Start by modifying your eating habits and by doing more exercise.

Control what you eat

Eat less fatty foods (butter, meat, sauces, chocolate) and more fruits and vegetables.

Do more exercise and sports

This is a pleasant and effective way to lose weight. Take the stairs instead of the elevator. Get off the bus one stop earlier and walk to your house. Go by bike or walk instead of driving your car.

Call a professional

If you cannot lose weight, do not hesitate to call on specialized help. Ask your doctor or a dietician. Ask for the advice of a doctor before you use drugs to lose weight, since many of these drugs are ineffective.

Other effective techniques to avoid a relapse

Get help from your those around you

Several ex-smokers told us that the help of those around them was a big aid to avoiding a relapse. Let people you trust know that you stopped smoking, and ask for their help. Limit your interactions with smokers that may be envious of your success and incite you to pick up a cigarette

Interpret the urge to smoke as a signal

Even a long time after you stop smoking, you may feel the urge to smoke. Do not consider this urge to smoke like a failure: Rather, see it as a warning signal that is telling you that it is time to use the strategies and techniques described in this booklet.

Reward yourself

Buy yourself presents with the money you saved on cigarettes: you deserve it! This system of rewards has encouraged many ex-smokers to stay off cigarettes! Rewards act as a compensation for the lost pleasure of smoking. Moreover, why not offer a little gift to your friends or family, who may have had to deal with your post-smoking irritability?

Make the list of rewards that you will grant yourself:

___________________    ___________________    ___________________

Change your environment

Avoid keeping things around that may tempt you to smoke. Throw away all your packages of cigarettes; store the ashtrays and lighters.

Do more sports or exercise

Sports release tensions and allows to reduces the urge to smoke. Doing sports increases the self-esteem and reinforces your new identity as someone who cares about one's health. It is a good way to prevent a relapse.

Be active

To avoid moments of boredom during which the urge to smoke can creep up on you, always have projects (e.g., some work to do, an interesting book to read, a sports activity, a movie).

Be positive

Avoid negative thoughts and doubt. Use positive thoughts like those suggested by the ex-smokers who participated in our surveys:

• "I am very proud of having stopped smoking, as I showed that I have the willpower to deal with major difficulty. In fact, for 18 years, I had believed it was impossible."
• "I am more sure of myself and of my ability to change my own habits."

Set an example for others

Encourage smokers around you to stop smoking like you . Relate your experience. This will reinforce your identity as an ex-smoker, which in turn will decrease your risk of starting smoking again. Each year, one smoker out of 5 attempts to quit smoking. Many smokers are motivated to stop and will be inspired by your experience. What is more, if those around you stop smoking, you will have even less of a chance of starting smoking again.

If doubt gets the better of you

If you are reconsidering smoking again, prepare responses that will allow you to avoid taking a cigarette:

If you pick up some cigarettes

• Do not jump ship!
• Put your "emergency plan" to work immediately (page 1).
• Do not think that you have failed and that you have returned to smoking. Most of all, you should avoid feeling discouraged. Do not scold yourself or make yourself feel guilty.
• The exact same accidents have happened to many other people. Like millions of other ex-smokers, you are completely capable of surmounting this difficulty and stopping smoking.
• If you have picked up one or a few cigarettes, it is assuredly not that you lack willpower, but because a certain situation appeared that you were ill-prepared to deal with.
• Consider this accident like a warning and a signal that you should respond earlier. Take the lesson from this experience to better prepare yourself for the next time. For this, respond to the following questions:

1- In what situation did you take a cigarette (where, with whom, what activity, what was your mood)?

____________________________________________________________________

2- Why have you not resisted to the urge to smoke in this situation?

____________________________________________________________________

3- The next time, how will you resist the urge to smoke under similar circumstances?

_____________________________________________________________________

If you have started smoking regularly again:

Do not be discouraged. Instead, look at it as a positive thing. Remind yourself that your attempt to stop smoking has given you the insight you need to be successful the next time you try to quit.

• It is normal to start smoking again several times. On average, ex-smokers try 4 times to quit before they actually quit for good.
• Starting smoking again does not mean you are incapable of stop smoking. You were capable of going several months without cigarettes. This in itself proves that you are completely capable of succeeding. Your relapse is most likely explained because you did not adequately react in a tempting situation.
• Start by reflecting about the reasons why you relapsed and how you can better resist cigarettes in the future. This will help you to have more success as well as you next attempt. For this, fill out our questionnaire on the previous page.
• Indeed, persist in your efforts to quit smoking. Be tenacious! Plan a new attempt to quit right now. The best is to set a quit date in the next 30 days: try again and again to stop smoking, and your efforts will be rewarded.
• Read our brochure entitled "I started smoking again". In it you will find advice that can help you cope with the present situation and prepare your next quit attempt.

What now?

Just like a million Swiss and 8 million French, you are perfectly capable of remaining an ex-smoker! Do not let down your guard. Instead, follow the advice in this brochure. If you would like, we can give you individualized advice to help you stay an ex-smoker. To do this, just respond to our questionnaire and return it to us. You will receive, in return, an evaluation of your personal characteristics. You can order this questionnaire from the address found on the first page. If you have access to the Internet, you can obtain the questionnaire and the other brochures of this series at the following address: ../../index.html. All of our material is free of charge.

To everyone, good luck!

Where to find help and information about quitting smoking?

Internet

• Individualized advice given by a system-expert: http://www.stop-tabac.ch.
• The Center for Disease Control's Tobacco Information and Source Page is put out by the Office on Smoking and Health.
• The QuitNet is an online resource and support center for smokers struggling to quit and for those ex-smokers working to stay quit. http://www.quitnet.org/
• Nicotine Anonymous offers meeting information, a twelve step program, and motivational slogans. A great thing is that there are no fees for joining. http://rampages.onramp.net/~nica/

Additional Internet Links

GENERAL LINKS

• Tobacco BBS
• Smoking From All Sides
• NicNet: Nicotine and Tobacco Network
• A Capsule History of Tobacco

HEALTH-RELATED LINKS

• The Centers for Disease Control and Prevention
• CDC Tobacco Use and Prevention Information
• Food and Drug Administration
• American Cancer Society
• American Lung Association
• American Lung Association: Smoking and Tobacco Control

DOCUMENTS AND LITIGATION

• CourtTV Tobacco Cases
• Tobacco Control Archives - The Brown & Williamson Collection
• Tobacco Litigation (The Wilmington Institute)
• Andrews' Publications: Tobacco Industry Litigation Reporter
• Tobacco on Trial: The Newsletter of the Tobacco Control Movement

ANTI-SMOKING SITES

• The Master Anti-Smoking Page
• The Foundation for a Smoke-free America
• Nicotine Anonymous
• Americans for Nonsmokers' Rights
• ASH - Action on Smoking and Health
• National Center for Tobacco Free Kids

NEWSGROUPS

• alt.smokers
• alt.support.stop-smoking
• alt.support.non-smokers
• alt.support.non-smokers.moderated

Articles and Publications

• Major Depression Linked To Stages Of Smoking - MHN Reading Room
• Psychiatrists use Antidepressants to Treat Smoking Addiction - MHN Reading Room
• Smoking As Drug Dependence - The Harvard Medical School Mental Health Letter
• Smoking Contributes to Mental Decline in Elderly - MHN Reading Room
• Smoking Found to Increase Sight Risk - USA Today

Products For Sale

• LifeSign - Smoking cessation program.
• The Quit Smoking Company
• Quit'em - Stop smoking focus cards

Software

• Smoke Free Stats - Free software to help you quit cigarettes.

Treatment & Support Services

• Addiction Alternatives - Dr. Marc Kern
• Neighborhood Tobacco Recovery Network - Calgary, Alberta, Canada

Video

• Message to Youth - A NEW VIDEO
• Straight Talk About Tobacco, a live talk by Patrick Reynolds, was recently made available on video. Filmed before 2,000 middle and high school students, this powerful, multimedia presentation helps motivate youth to stay tobacco free, and to resist the onslaught of tobacco advertising and peer pressure.

The stages of change

• Most smokers pass through 5 steps (or stages) before they become confirmed ex-smokers.
• We have designed a brochure for each of these 5 stages, as well as a brochure for those who have restarted smoking after trying to quit (relapse).
• These brochures can be ordered from the address located on the first page.
• If you are in the Maintenance stage (you have quit smoking for more than 6 months), this is the brochure you should read first.
• You get the most out of these brochures if you make notes on them, if you underline the important passages and if you take note of the main points.

This brochure was created at the Institute of Social and Preventative Medicine of the University of Geneva, with the support of the Swiss Cancer League, the Swiss National Science Foundation, the Swiss-Romande Lottery, the Geneva Department of Social Action and Health, the Swiss Federal Office of Public Health, The Swiss Foundation for Health Promotion, Pharmacia & Upjohn, the Swiss Pulmonary League, the Cipret-Genève and the Jura Canton Health Service. We thank the Swiss Association for Smoking Prevention (at) for it help and support.

Copyright (c) Jean-François Etter 1999. All rights reserved.

Author: Jean-François Etter

Translated from French into English 1 March, 1999 by MCART.org

Your donations will allow us to distribute these brochures and to pursue our prevention programs and our research on smoking prevention. Send donations to the Postal Account CCP 12-7003-9, Faculté de médecine, CH-1211 Geneva 4, Switzerland. Do not forget to indicate: "Fonds 2428 - IMSP."

If you have an Internet site, we appreciate your linking to the site http://www.stop-tabac.ch.