I started smoking again

Don't give up!

You are not the only one to have restarted smoking after attempting to quit. On average, ex-smokers made 4 serious attempts to stop before finally stopping smoking for good. It is entirely normal to have to try several times.

Be easy on yourself

After restarting smoking, you may sense feelings of regret, guilt, failure or depression. Do not let yourself be overwhelmed by these feelings. Being too hard on yourself will only delay the moment that you try to quit again. Instead, try to look at these things positively: consider your relapse as a learning opportunity.

You can do it!

You were able to stop smoking for a while. This it is a success in itself, it shows that you can live without cigarettes. Do not be discouraged. Re-motivate yourself and quickly plan your next attempt to quit smoking.

What it takes to quit smoking is a learned thing

Above all, avoid thinking that your relapse is due to a lack of willpower on your part or an inability to stop smoking. Many people think that willpower is enough to stop smoking. We disagree: we think that stopping smoking requires specific know-how. In this brochure as well as in the other brochures in this series, we explain exactly what this know-how is.

Think about your relapse

Start by thinking about your relapse. If you draw on the lessons of your experience, you will be better armed in the future. For this, fill out the questionnaire below:

1- During the time when you did not smoke, how did you resist the temptation to smoke?

_____________________________________________________________________

2- Under what circumstances did you start smoking again (date, place, with whom, what you were doing, what mood you were in)? 

_____________________________________________________________________

3- What were you anticipating to get from the cigarette, when you started smoking again?

_____________________________________________________________________

4- Why did you not resist the temptation to smoke in this situation?

_____________________________________________________________________

5- How do you think you can avoid a relapse under similar circumstances in the future?

_____________________________________________________________________

Know how to respond to risky situations

In general, ex-smokers start smoking again because they respond inadequately when they find themselves in high-risk situations. It is very important to recognize these situations in advance and prepare strategies to resist the urge to smoke in each one of them before they come. Many ex-smokers relapse because they do not even try to use these strategies. It is important to know multiple strategies and to put them immediately into work when you think you are about to "crack" for a cigarette. Think carefully about this when you respond to the questions below.

* 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 show you how to resist the urge to smoke under each of these situations. Work carefully through the situations for which you do not have complete confidence in your ability to resist cigarettes, as well as for situations similar to those that have caused your relapse. Identify the strategies that apply to you, then repeat and practice these strategies, like an actor rehearses his or her scenes.

1) In the company of smokers

Because the majority of relapses happen in the presence of other smokers, it is important to think of how to resist the temptation to smoke in this type of situation.

Prepare yourself

Before you go to a place where you think you will be with smokers (parties, dinner at a restaurant, business meetings, etc.), prepare yourself mentally. Picture the situation in advance and prepare strategies to resist cigarettes.

Rehearse the scene

Rehearse the scene where you refuse a cigarette you are offered. Prepare a humorous response, this can diffuse many tense situations.

Assert yourself

When you have stopped smoking, 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:

_________________________________________________________________

_________________________________________________________________

Avoid risky situations

If you aren't sure to be able to resist the temptation to smoke when you are with company, it is better, after just quitting, to avoid the parties and other places where you know you meet smokers.

2) After drinking alcohol

One third of all relapses happen while drinking alcohol. Therefore, avoid drinking alcohol or limit your consumption. If, after drinking alcohol, you feel that you will "crack" for a cigarette, leave the place where you are, and take a walk, for example.

3) In case of an urge to smoke

Over time, the urgent need to smoke disappears. Since the urge to smoke generally lasts for only 3 to 5 minutes, the best thing to do is to just wait until it passes. You can also use diverting activities, such as:

• Drink something.
• Eat some sugarless candy or chew gum.
• Brush your teeth.
• Leave the room where you are and do something else.
• Think of the disadvantages of cigarettes (bad smell, bad breath, "smoker's hack," etc.).
• Tell yourself it would be a shame to ruin all of your efforts.

4) After a meal or a coffee

• To keep from smoking, leave the table immediately after the meal and brush your teeth. Try to find a distracting activity (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 the cigarettes do not make the meal better. Instead, by changing your sense of taste and smell, they interfere with your full enjoyment.
• To prepare yourself to resist cigarettes after a meal, you could rehearse the following exercise for a couple of days: just stay at the table after the meal for 15 minutes without smoking. Rehearsing this scene several times will help you disrupt the association between the end of the meal and the cigarette.  

5) When you are stressed, nervous or fighting with someone

Because many people use cigarettes in order to deal with stress, stress itself is a very frequent cause for relapse. You must find a way to deal with stress other than lighting a cigarette. It is feasible: several ex-smokers told us that after quitting smoking, they felt calmer and had a better sense of self-control.

Attack at the root of the stress

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

Breathe deeply

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

Relax as you change activity

Ease into starting an activity you particularly like. Talk to someone, do some sports or exercise, listen to music, read, etc.

Use a relaxation technique

This can help to manage your stress a little. Enroll in a yoga or sophrology course, or call on a specialist (doctor).

Do more exercise

Exercise and sports are a very good way to release tension. Go for walk, do some sports or work in the garden. Doing sports 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 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.

6) When you are depressed

Since nicotine is a stimulant, you may feel a little down just after you stop smoking. To deal with this problem, be active. 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) When you are bored

To avoid moments of boredom during which the urge to smoke can sneak up on you, always have projects. Plan your time. Always have an interesting book to read, some work to do, plan a sports activity, etc.

8) If you gain weight

• Some people gain weight after they quit smoking. However, this weight gain is generally moderate (6 to 10 pounds on average (3 to 4 kilos)).
• If this happens to you, solve one problem at a time. Concentrate first on quitting smoking first. Later focus on losing weight. Keep in mind that if you succeed at stopping smoking, you can just as easily lose the weight.
• There are many techniques to lose weight. Consult your doctor, a dietician or a good bookstore.
• Start by eating less fatty foods and by doing exercise or sports.
• The use of nicotine-containing products (patch, gum, inhaler, spray) or of the drug bupropion by ex-smokers can limit weight gains, or at least postpone them.

Other techniques to resist cigarettes

Here are more techniques and strategies that can help you to stop smoking and later avoid a relapse. By using several of these strategies at once, you increase your chances of success:

Distract yourself

A good way to resist the urge to smoke consists of immediately using distracting thoughts or activities. For example:

• Focus your attention on something else than the cigarette. Think about your work.
• Breathe deeply and slowly many times.
• Drink a glass of water or eat some fruit.
• Change places or activities; leave where you are.

Make lists

For a few days, try the following exercise: keep 3 lists on you and re-read them every time you feel the urge to smoke:

1. the list of reasons why you want to stop smoking,
2. the list of your personal strategies to resist the urge to smoke in "high risk situations",
3. the list of responses you will give to those who doubt your ability to stop smoking.

Get help from your those around you

You increase your chances of success if your friends and family help you. Let people you trust know that you want to stop smoking, ask for their encouragement, remind them that you appreciate their support. Be careful with smokers, who may be jealous of you and encourage you to smoke.

Abstain absolutely from picking up a cigarette

Very often, the act of taking one cigarette leads to a relapse. After quitting, it is VERY IMPORTANT to avoid to even taking even one drag of a cigarette. It is easier to refuse the first cigarette than is to refuse the second.

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! These rewards can compensate for the loss of the pleasure of smoking. In addition, why not offer a little gift to people around you, who have had to deal with your post-smoking irritability?

Make the list of rewards that you will grant yourself:

___________________    ___________________    ___________________

Keep a smoker's journal

Self-observation through written notes is an effective method for stopping smoking. Many ex-smokers have found that keeping a journal helped them to control and to break their smoking habit. They said that this opened their eyes about a habit they thought they understood. Why not do the following experiments for a few days: keep a photocopy of the journal (see below) in your packet of cigarettes and fill it out before you light each cigarette. Every night, re-read your journal and think about it.

Again, take action

Now that you have thought carefully about the circumstances of your relapse and about the strategies that allow resisting the urge to smoke, why not think about your next attempt to quit smoking?

Read our brochure entitled "It is final, I am quitting smoking." In it, you will find in advice that can increase your chances of successfully quitting.

Be realistic

You should know that about eighty percent of people who quit smoking today start smoking again within a year. On average, ex-smokers had to make 4 serious attempts to quit before they quit for good. It is normal to restart several times. Try repeatedly and you will finally do it for good.

Count the advantages of quitting smoking and the drawbacks of cigarettes

People who successfully stopped smoking had previously profoundly modified their ideas about life without cigarettes and the drawbacks of smoking. Think about this in writing your own ideas in the space below. This may help reinforce your motivation to stop smoking.

The advantages of a life without cigarettes

____________________    ____________________    ____________________

Drawbacks of the smoking habit

____________________    ____________________    ____________________

Ask for professional help

The help of a professional can significantly improve your chances of success. Some possibilities are:

• Asking your doctor. He or she can help you or show you where to go.
• Asking a specialist in smoking cessation.
• Participating in a group-quitting program (e.g., the 5-day Plan).

Make a contract with yourself

It is important to firmly take the engagement to stop smoking. Many ex-smokers have said that the key to their success was this firm commitment. Similarly, the action of fixing the date when you will stop smoking may help you to bridge the gap. The best is to fix a date within the next 30 days. There will never be an "ideal time" where it will be easier to stop smoking, this moment does not exist. Do not wait to become a victim of tobacco-caused disease. Why not sign a contract with yourself like the one proposed below? This may help you to stick with your decision.

Use products that contain nicotine

Nicotine is a drug that causes a physical dependence and unpleasant withdrawal symptoms when you stop absorbing it. Nine out of ten daily smokers are dependent on nicotine and will feel these symptoms when they quit smoking.

By reducing withdrawal symptoms, or even by eliminating them altogether, nicotine-containing products increase your chances of successfully quitting by 2 to 3 times. Many scientific studies have demonstrated the effectiveness of these products. We strongly recommend that you use them. They will render your attempt to quit much more comfortable.

These products exist in 5 different forms. Depending on the country where you live, all forms are not available and some forms are available only with a prescription from a doctor.

• The patch diffuses nicotine slowly through the skin all day long. Use it for the entire time recommended, between 6 and 12 weeks.
• Chewing gums are effective if you follow the instructions strictly (chew with the specified technique, take the number of pieces specified, use for the entire time recommended).
• Nasal sprays immediately relieve withdrawal symptoms and make the need to smoke disappear. They are particularly recommended to heavy smokers.
• Inhaler replaces the smoking rituals (gestures and inhalation).
• Sublingual tablets melt slowly under the tongue.

Here are the reasons given by participants of our survey as to why they prefer not to use these products, as well as responses that we gave to them:

"I do not like the idea of using a medication to help me quit smoking."

• It is not shameful to use a medication to free yourself from a drug - like nicotine - that causes physical dependence.

"These products do not work."

• Though many scientific studies have shown these products are effective, they do not guarantee success. The use of these products does not free you from the efforts of changing your habits.

"I can stop smoking just fine without these products. Willpower is enough."

• A poorly placed sense of pride can lead you to a relapse. These products can double to triple your chances of success. Have as many winning cards on your side as possible!

"These products cost too much."

• It is true that these products are expensive (The patch costs 180 Swiss francs per month). It is, however, much less than what you spend each year to smoke.

"I'm afraid of the side effects of these products."

• These products have very few side effects, and the effects are banal. The patch can trigger itching or temporary, localized reddening of the skin. The spray can cause temporary irritation of the nasal membranes. It is important to know that the nicotine patch, nasal spray, inhaler, sublingual tablet and chewing gum are not dangerous to your health. In particular, the risk of cardiovascular accident is not increased for people who use these products. This also applies to patients with heart disease.

"I'm not dependent on the nicotine."

• These products increase your chances of success even if you smoke only 10 cigarettes per day. Start by accepting the idea that if you smoke more than 5-10 cigarettes per day, you will be dependent on the nicotine. A good way to see if you are dependent is to stop smoking for 24 hours. People who feel absolutely no withdrawal symptoms in the course of these 24 hours are probably not very dependent. Others will benefit a lot from using nicotine-containing product.

"My problem is not the physical dependence, but getting rid of an old habit."

• It will be easier for you to attack the other aspects of your smoking habit if the problem of physical dependence is resolved by using products that contain nicotine.

And now?

• You do certainly not plan to remain a smoker until the end of your days. So why wait longer? Don't wait until you get a smoking-related disease. Plan a new quit attempt right now.
• We know it is not easy to stop smoking, but we also know that you are able of quitting smoking!
• If you wish, we can give you personal counselling to help you quit smoking. To get a personal evaluation report, you should respond to a questionnaire and return it to us. We will send you an individual feedback report based on your personal characteristics. If you wish, you can receive a series of reports over time. 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 in this series at the following address: http://www.stop-tabac.ch. All of this material is free of charge.

To everyone, good luck!

Smoker's Journal

Photocopy and cut out this journal. Over a few days, fill it out before lighting each cigarette. At night, go over it and think about it.

Smoker's Journal

Review of the day of (date): _______________

The situations where the urge to smoke was strongest: ________________________________

The most effective strategies to resist in these situations: _______________________________

* Mood: neutral, worried, stressed, angry, depressed, content, relaxed, tired, bored.

** Intensity of the urge to smoke: none=0, very weak=1, moderate=2, strong=3, extreme=4.

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 Anonymousoffers 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 have recently repased to smoking, 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.