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Section 1
Initiating Tobacco Dependence Treatment

Question 1 | Answer Booklet | Table of Contents | Introduction

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In this section, we will discuss initiating treatment and keys to success.  I have found three steps can affect the initialization of tobacco dependency treatment and breaking smoking patterns.  These three steps are acknowledging addiction, wanting to quit, and identifying the reasons why the client smokes.  You already know about physical and psychological addiction.  But does your client? 

Consider using the "Why Test" in the back of the manual that accompanied this course to identify the reason your client smokes.  After initiating treatment, however, how do you help your client become successful at breaking smoking patterns and ultimately quitting smoking?  You might consider playing this section during your next session with a tobacco dependent client. 

As you listen to this section, consider playing it for your tobacco dependent client.  He or she will have the opportunity to hear about menstrual cycle scheduling, reducing caffeine consumption, inequality in genders, and mental gremlins.  Also, consider your tobacco dependent client in relation to the case studies in this section.  How do these case studies reflect your client’s experiences?

Overcoming Tobacco Dependancy - 4 Keys to Success

♦ #1  The Menstrual Cycle Scheduling Technique
The first key to success regarding overcoming tobacco dependency and breaking smoking patterns is applicable to women.  The first key to success for a female client I feel, is to watch her menstrual cycle.  Research indicates that there is a correlation between smoking patterns and a woman’s menstrual cycle.  You may already know that a number of symptoms associated with the menstrual cycle are identical to smoking withdrawal symptoms.  For example, irritability, anxiety, hunger, and decreased concentration led Jean to mistake normal menstrual symptoms with symptoms of nicotine withdrawal.  Jean failed at her initial quit attempt. 

Jean stated, "I tried quitting during my period.  That was hell!"  Jean found that it was more difficult to quit smoking in the premenstrual phase of her cycle or during her period.  The technique here I have found helpful to my female clients who are trying to quit smoking is scheduling a time to quit in relation to her menstrual cycle.  Therefore, Jean scheduled her next quit attempt at the end of her period, or beginning of her cycle.  Jean later stated, "The withdrawal symptoms weren’t quite as bad this time."  Do you have a Jean?  Could your female client benefit from timing her quit date to be at the end of her period?

♦ #2  Reducing Caffeine Consumption
The second key to success regarding overcoming tobacco dependency and breaking smoking patterns is to reduce caffeine consumption.  If your client is like most smokers, he or she drinks caffeinated beverages such as coffee, tea, or soft drinks.  Conflicting methods regarding caffeine consumption in relation to smoking cessation exist. 

I have found, however, that clients can benefit from reducing caffeine intake by about half.  The reason for this, according to Benowitz, Hall, and Modin, is that cigarettes reduce the effects of caffeine.  The result is that smokers require about twice as much caffeine as a nonsmoker to get the same effect.  When Brian quit smoking, his body began to normalize its response to caffeine.  Brian stated, "I felt like coffee was making me sick.  I got nervous, irritable, and I had a lot of tension."  Brian was experiencing symptoms of caffeine overdose, even though his caffeine intake remained the same as it was before he stopped smoking. 

These symptoms, like a woman’s menstrual cycle, can mimic or increase smoking withdrawal symptoms.  Therefore, would you agree that, by reducing his caffeine consumption, Brian could begin a possibly successful quit attempt?  When Brian drank the same amount of caffeine but had decreased his nicotine intake, he became more irritable, with his irritability from the caffeine, he wanted nicotine.  The technique here is to ask your client how much caffeine he or she intakes via coffee, tea, chocolate, etc.  As they decrease their nicotine intake, ask them to consider decreasing their caffeine intake to avoid creating a nicotine trigger; due to the magnified effects of the caffeine. 

♦ #3  Inequality in Genders
In addition to scheduling a quit date after menstrual cycles and reducing caffeine consumption, the third key to success is to recognize the differences in gender regarding nicotine use.  Have you found, like I have, that women may have a harder time quitting smoking than men?  Although there are a number of behavioral reasons for this, there appear to be biological reasons as well. 

For example, Louise, age 39, didn’t understand why it was so much harder for her to quit than her husband Jim.  Louise stated, "I can’t make it three days without a cigarette.  Jim goes about five or six until I complain so much that we both start smoking again."  I explained to Louise, "Women seem to metabolize nicotine slower than men.  This slower metabolic rate may indicate you have higher levels of nicotine than your husband.  The result is a higher nicotine dependence and more intense withdrawal symptoms for you than Jim." 

By recognizing the differences in gender regarding how nicotine affects the body, Louise was less frustrated when Jim experienced more success.   Do you have a Louise?  Could your tobacco dependent female client benefit from recognizing the differences in gender regarding how nicotine affects the body, especially if they have a partner who is trying to quit as well? 

♦ #4  Mental Gremlins
The fourth key to success is to recognize mental gremlins.  Do your clients, like mine, internalize and blame themselves when they fail to quit?  Your clients may experience negative emotions along with relapse.  Guilt, depression, and anger are common negative affects.  Damon stated, "One thought I had was ‘What will one cigarette hurt!?’"  Damon’s first mental gremlin told him to go ahead and have a cigarette, reassuring him that he would stop at just one. 

Damon continued, "After that cigarette, I started thinking, ‘Everything gives you cancer these days.  It’s even in the water!  So why should I quit smoking!?’"  Damon’s second mental gremlin allowed him to rationalize his habit by minimizing the health consequences of smoking.  The result of listening to these gremlins was relapse.  Had Damon recognized these thoughts as mental gremlins, do you agree that he may have been able to avoid relapse? 

Some mental gremlins can promote continued smoking by providing positive notions about smoking while minimizing the harmful effects.  Consider asking your tobacco dependent client if any of the following positive gremlins sound familiar. 

3 Mental Gremlins Questions to Ask your Tobacco Dependent Client

  • "I enjoy that first cigarette in the morning with my coffee."
  • "There’s nothing in the world as nice as a glass of wine and a cigarette at the end of the day."
  • And "I smoke because I like the taste."

Negative gremlin voices also encourage relapse.  If your client experiences negative gremlins like Damon did, then he or she may have thought that they don’t have the willpower to quit or that they get so irritable when they attempt to quit that people won’t want to be around them anymore.  Is your client faced with mental gremlins?  How does he or she defeat gremlins?  We’ll discuss more gremlins and techniques for defeating them in the next section.

In this section, we have discussed initiating treatment.  Three steps can affect the initialization of tobacco dependency treatment.  These three steps are acknowledging addiction, wanting to quit, and identifying the reasons why the client smokes.   We also discussed the four keys to success.  These four are menstrual cycle scheduling, reducing caffeine consumption, inequality in genders, and mental gremlins.  Do you have a tobacco dependent client that would benefit from listening to this section during your next session?

In the next section, we will discuss defeating mental gremlins.  We will examine early and late relapse gremlins, or mental filters which tobacco dependent clients may use to justify smoking or minimize the harmful effects of tobacco. 
Reviewed 2023

Peer-Reviewed Journal Article References:
Evers-Casey, S., Schnoll, R., Jenssen, B. P., & Leone, F. T. (2019). Implicit attribution of culpability and impact on experience of treating tobacco dependence. Health Psychology, 38(12), 1069–1074.

Hunt, J. J., Cupertino, A. P., Gajewski, B. J., Jiang, Y., Ronzani, T. M., & Richter, K. P. (2014). Staff commitment to providing tobacco dependence in drug treatment: Reliability, validity, and results of a national survey. Psychology of Addictive Behaviors, 28(2), 389–395.

Lape, E. C., LaRowe, L. R., Zale, E. L., Gellis, L. A., Park, A., & Ditre, J. W. (2021). Tobacco cigarette smokers who endorse greater intolerance for nicotine withdrawal also report more severe insomnia symptoms. Experimental and Clinical Psychopharmacology. Advance online publication.

Leventhal, A. M., Conti, D. V., Ray, L. A., Baurley, J. W., Bello, M. S., Cho, J., Zhang, Y., Pester, M. S., Lebovitz, L., Budiarto, A., Mahesworo, B., & Pardamean, B. (2021). A genetic association study of tobacco withdrawal endophenotypes in African Americans. Experimental and Clinical Psychopharmacology.

“Psychiatric disorders in smokers seeking treatment for tobacco dependence: Relations with tobacco dependence and cessation”: Correction to Piper et al. (2010) (2017). Journal of Consulting and Clinical Psychology, 85(9), 853.

QUESTION 1
According to the menstrual cycle scheduling technique, when should female clients plan to quit smoking? To select and enter your answer go to Answer Booklet.

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