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Section 3
Steps to Overcoming Tobacco Dependence

Question 3 | Answer Booklet | Table of Contents

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In the last section, we discussed defeating mental gremlins.  We examined early and late relapse gremlins, or mental filters which tobacco dependent clients may use to justify smoking or minimize the harmful effects of tobacco.

In this section, we will discuss preparing to quit.  Eric, age 38, spent several weeks preparing to quit smoking.  There are three basic steps that Eric took in preparing to successfully overcome tobacco dependence.  These three steps were self-monitoring smoking habits, devising a quitting plan, and committing to a quit date. 

Clearly, everyone is different and therefore will respond differently to a number of treatment plans.  So, as you listen to this section, consider how Eric is different from the client you are currently treating.  How are they similar?  Good! If Eric’s steps for preparing to quit might work for your client, consider playing this section during one of your sessions. Otherwise, you might consider adapting Eric’s techniques for use with your client.  You might also consider playing this section during your next session with a tobacco dependent client. 

Three Basic Steps to Successfully Overcome Tobacco Dependence

♦ #1  Self-Monitoring Smoking Habits
First, let’s discuss self-monitoring smoking habits.  Eric knew that he often smoked but didn’t realize how frequently he lit up.  Before Eric was ready to break his smoking patterns, he needed to understand them.  I stated, "Try monitoring your smoking habits for a week without consciously altering your levels of intake." 

Eric used a monitoring sheet to record his habits.  Eric’s monitoring sheets included the time of day given in fifteen minute intervals next to which he could record the number of cigarettes smoked in that time period.  Also, Eric kept track of his behavior associated with each cigarette.  For example, Eric stated, "If I smoke while drinking a beer, I put a ‘B’ next to the tally mark for that cigarette."  Other examples of Eric’s behavior tracking were a ‘C’ for coffee and an ‘M’ for after a meal. 

During the session following Eric’s week of monitoring, he stated, "Writing down every single cigarette I smoke makes me conscious of smoking.  I can’t believe I smoke this much!"  Think of your Eric.  Could self-monitoring smoking habits help your client begin the process of being in control of cigarettes rather than cigarettes being in control of them?  A reproduction of Eric’s monitoring sheet is included in your client worksheets.

♦ #2 Devising a Quitting Plan
After Eric spent a week self-monitoring his smoking habits, he began devising a quitting plan.  Eric chose a combination of methods to quit smoking.  These methods included nicotine replacement therapy.  Could your client benefit from nicotine replacement therapy?  Eric combined the methods he would use to stop smoking with other crucial factors and committed to trying them by writing them down in a quitting plan. 

First, Eric chose to quit cold turkey rather than cutting down.  Clearly, the benefits of cutting down versus going cold turkey are debatable.  However, what works for some may not work for others. 

Next, Eric chose a quit date.  Eric chose his birthday, which was three weeks away.  In addition to deciding how to quit and choosing a date, the third step for Eric was asking for help.  Eric asked a few close friends and family members if he could turn to them to talk him out of smoking if he started to lose control. 

For example, Eric asked his friend Ahmed for help.  When Ahmed agreed to help Eric if he began to relapse, Eric explained to Ahmed how he could help.  Eric asked Ahmed to remind him that he wanted to travel with the money that he could save by not smoking.  Ahmed was astounded when Eric told him that he would be saving just over two thousand dollars!  How much could your client save by not smoking?  What would type of quitting plan might help your Eric?

♦ #3 Committing to a Quit Date
In addition to self-monitoring smoking habits and devising a quitting plan, Eric’s third step in his attempt to successfully overcome tobacco dependence was committing to a quit date.  While devising a quitting plan, Eric chose a quit date.  Eric’s quit date was three weeks away.  I stated to Eric, "Choosing a quit date is a simple step in overcoming tobacco dependency.  But sticking to that date by making a strong commitment can be more difficult." 

3 Techniques Eric Used to Enforce his Commitment to his Quit Date:
-- First, Eric decided to spend thirty minutes a day focusing on why he wanted to quit.  Eric’s reasons were financial and health related. 
-- Next, Eric let his family and friends know about his quit date.  Eric stated, "I told my mom, and she was so happy.  Now I can’t back down!"  Could letting others know about the quit date help your client enforce his or her commitment? 
-- In addition to focusing on quitting and informing others about his quit date, the third simple technique Eric used to commit to a quit date was to devise alternatives to smoking that he could begin to implement ahead of time.  Eric stated, "I think I’ll start using toothpicks to help fight off cravings as long as I can."  By finding alternatives to smoking ahead of time, Eric had an opportunity to find out how best to fight urges to break smoking patterns before his quit date. 

Think of your Eric.  Could preparing to quit well ahead of time help your client successfully overcome tobacco dependency?

In this section, we have discussed preparing to quit.  There are three basic steps that can help a client attempt to successfully overcome tobacco dependence.  These three steps are self-monitoring smoking habits, devising a quitting plan, and committing to a quit date.   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 the SALES approach to overcoming tobacco dependency.  The SALES approach is a technique that attempts to maximize the effectiveness of a client’s quitting partner.  Clearly, SALES is an acronym for speak, abstain, link, empathize and solve.  We will examine each of the five elements of the SALES approach through a clinical vignette.  We will also take a look at a three step problem solving process regarding smoking cessation.

Peer-Reviewed Journal Article References:
Berg, C. J., Schauer, G. L., Buchanan, T. S., Sterling, K., DeSisto, C., Pinsker, E. A., & Ahluwalia, J. S. (2013). Perceptions of addiction, attempts to quit, and successful quitting in nondaily and daily smokers. Psychology of Addictive Behaviors, 27(4), 1059–1067.

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.

Kurti, A. N. (2020). Reducing tobacco use among women of childbearing age: Contributions of tobacco regulatory science and tobacco control. Experimental and Clinical Psychopharmacology, 28(5), 501–516.

McCarthy, D. E., Ebssa, L., Witkiewitz, K., & Shiffman, S. (2015). Paths to tobacco abstinence: A repeated-measures latent class analysis. Journal of Consulting and Clinical Psychology, 83(4), 696–708.

Streck, J. M., Heil, S. H., Higgins, S. T., Bunn, J. Y., & Sigmon, S. C. (2018). Tobacco withdrawal among opioid-dependent smokers. Experimental and Clinical Psychopharmacology, 26(2), 119–124.

What are three basic steps to preparing to quit that can help a client attempt to successfully overcome tobacco dependence? To select and enter your answer go to Answer Booklet.

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