Quit It - Part Three

Part Three of dispatches from the front line after ONE YEAR without smoking

(Part One, Part Two)

Have I smoked in the last year? No. Not one. Do I still want to? Yes. Will I give in? The hell I will.

The addict part of my brain will always be there but it’s become a puny, mewling thing.

One of the strongest triggers now is leaving a cinema; my first thought is still to light up. Last week I dreamed I was smoking and really enjoying it; for the next couple of days I really wanted one. An ex-smoker I know said this still happens to her occasionally, even after years.

People keep saying that I must feel so much better. In theory, my immune system should now have recalibrated, the cilia and cells in my airways regrown. My risk of coronary heart disease, heart attack and stroke has dropped to less than half that of a smoker. But it’s only in the last couple of weeks that I’ve actually started feeling well after being almost constantly ill for more than eight months - not just with post-smoking coughs and colds but with non-respiratory viruses.  The GP tells me this is normal. Bloody marvellous.

I’ve just got back to my pre-quitting weight. Maintaining it is hard and means not even looking at lovely, lovely sugar more than once a week. I’m eating less overall than I was too, which is a real challenge.

My knees have adjusted to the extra cardio and my bum muscles are a bit firmer than they were.

I’ve saved myself a couple of thousand pounds (my brand, Silk Cut Silver, now sells for £10.45 in my local supermarket, of which £5.19 is tax). Am I saving the NHS money? I may not need it for smoking-related diseases but if I live longer, I will need it for other things.

Since I quit, standardized cigarette packaging has been introduced and the ten pack is no longer available. The idea is that the drab boxes with big ugly health warnings will make more people quit and put children off starting. The evidence for quitting is very slim but there is some evidence that the boxes are less attractive to teenagers. 

Most of the legislation, constant price increases and public health strategies are aimed at preventing young people from starting. They won’t put off the addicts – and certainly wouldn’t have made me stop.

You can see why vaping is becoming more popular with its pretty colours and no health warnings or gruesome images. So far. Evidence is growing of the dangers of vaping if it is not used as a short-term quitting aid. 

Some tobacco companies have started selling tins to avoid the new packaging rules and keep their branding visible. One expert said “The fact that these tins appeared almost immediately prior to the branding and size restrictions coming into force is suspicious.” It’s not suspicious, it’s predictable. They are not going to go down without a fight for a global industry currently worth $770 billion a year.

I’ve learnt a lot about quitting in the last year, some of it scientific, some of it personal. The main messages are:

• Quitting is bloody awful but if it was easy everyone would do it. I am super special sparkly
• There is no good time to stop. This last year has been a bugger for many reasons
• It’s different for everyone
• Think before you open your mouth around a quitter
• There will be consequences. Quitting is damage limitation, not resetting to zero
• There are both genetic and cultural components to addiction
• Public health information and support is very inadequate
• It’s really important to get support from anyone who will listen to you constantly whining
• Punching people won’t make you want to smoke any less

So that’s my year of quitting. Now give me that damn cake.


UPDATE APRIL 2018

Nearly two years in and I am now a much greater drain on the public purse than when I smoked. Sorry about that.

UPDATE MAY 2018

I keep dreaming I'm smoking again, possibly because it's coming up to two years since I quit and it's on my mind. Sometimes you just have to wake up and say Fuck off, brain.

We had an interesting talk at London Skeptics (which I run) about harmful behaviour. The speaker, Dr James Erskine, has done research that shows not thinking about something isn't the answer. That just increases the cravings and the likelihood of giving in. And when you do give in, you'll do way more than you used to as a kind of rebound effect (the return of the repressed). The trick is to acknowledge and observe the thought, which helps 'decouple it' (his words) from acting on it.

Quit it

There’s a lot of advice about how to give up smoking but, as with many public health initiatives, much of it is one-size-fits-all and so not very helpful to anyone who isn’t a mythical average.

This is my experience after 23 days of not smoking. None of what follows is setting myself up to fail, it’s being realistic about the task ahead and preparing myself for it. As the Boy Scouts say: Be Prepared. As far as I can see, thinking it will be easy is the best way to fail. Forewarned is forearmed.

What they don’t tell you
It will be fucking awful. No one tells you quite how awful it will be because all the health advice givers want you to stop.

Mood swings. I expected to be a bit grumpy. I didn’t expect to want to punch people, to burst into tears and to be bouncing around like Tigger all in the same day. Things and people that would normally mildly irritate you will make you go postal. It’s a bit like the worst PMS - for weeks on end.

If you live in a city and/or use public transport getting your sense of smell back is not a bonus. London and Londoners do not smell good.

You may never stop wanting to smoke. People have told me that even 30 years on they would go back to it if it was safe.

Cravings feel like a monster has taken over your body. Advice says that they get weaker and less frequent after about 14 days. They should last just a few minutes and then pass. Not so far. I still want to smoke just as much and just as often. My cravings can last up to half an hour.

Most people fail. Some research shows that around a third of smokers try to quit each year and that ‘fewer than one in eight former smokers who had abstained for a month or less at baseline were continuously abstinent over the next 2 years’. Other research has varying percentages for cold turkey and assisted quitting but in all cases, the percentage who succeed is very small.

What not to say
Do not say ‘I decided to give up and just did it. It was easy’. I will slap you. Hard.

Do not say ‘It doesn’t matter if you put on a bit of weight’. It clearly does matter or it wouldn’t have been mentioned. Stick to making sympathetic noises.

Do not say ‘Think of all the money you’re saving’. If that was a reason for giving up, no one would smoke. See also comments about not smelling like an ash-tray, not dying etc etc. I gave up because I just wasn’t enjoying it any more. I didn’t want to smoke. As simple as that. This doesn’t mean I don’t want a cigarette. Because I’m an addict.

ETA: Do not say 'Try to avoid triggers'. For me these are: waking up, going to the gym, eating, drinking and, it turns out, being with one of my closest friends (a non-smoker).

Do not talk about being a chocoholic or being really grumpy before you have your morning coffee. If you haven’t been a smoker, you won’t get it.

This may sound harsh and ungrateful but I reserve the right to be Oscar the Grouch verging on She Hulk for the next few months.

Nicotine Replacement Therapy
NRT covers products like patches, nicotine gum, inhalators and e-cigarettes. In theory it helps break the habit of smoking (as opposed to the addiction) while still getting some nicotine to lessen the cravings, and it doubles the chances of success.

The problem is that it’s aimed at a theoretical average smoker of 20 full-strength cigarettes a day who would get about 15mg of nicotine. I was smoking 10-12 of what used to be called ultra-low cigarettes which meant that I was getting about 1mg of nicotine a day. So I would have to use about 6% of a nicotine patch – not exactly practical. There are products with less nicotine for phased quitting but even these would give me a lot more than I was previously getting.

You’d think this would mean quitting was easier, but no. I know this because I tried to give up about 20 years ago when I was smoking 20 full-strength a day.

I opted for an inhalator and worked out from the information given that about 15 seconds of sucking on it would give me about the same nicotine as a cigarette. But there is no precise information about how nicotine absorption from cessation products compares with smoking other than the fact that it’s slower and less effective. Advice tells you to suck until you feel satisfied but as it takes longer to feel the effect you can end up getting a lot more nicotine than you actually want or need. So I’m very probably getting more than I was - although in a safer form.
ETA Day 32: I've done a bit more research and concluded that I was possibly under-dosing with the inhalator, which is why the first few weeks were so rough. I wasn't quite going cold turkey but certainly lukewarm turkey.

Some people I know used vaping and e-cigs as a way to give up and it worked for them. But if you go into vaping shops and talk to staff (as I did), it’s clear that vaping is becoming a hobby in itself with accessories, flavourings and associated products. I did consider it but I didn’t want to look like Puff the Magic Dragon billowing out clouds of vapour. Most of the flavourings smell disgusting to me. Many places don’t allow it indoors now so I’d have to go outside to do it and I want to break that association. It’s a lot more involved than lighting a cigarette (flavoured liquids, replacing coils at regular intervals, charging batteries and so on) and I just wanted to get the nicotine into me in the simplest and least twattish way.

Weight gain
This is a big one for me. When I gave up about 20 years ago I put on about 30lbs/13.5kg. I couldn’t lose it after a year and got so miserable that I went back to smoking. At the moment, my weight is about 4.5lb/2kg above where it should be and it’s a battle royal to stop it going any higher. Nicotine is an appetite suppressant and metabolism stimulant, which is why you gain weight when you stop smoking. If you’re using NRT this shouldn’t happen. But it has.

Your digestion will get messed up and your metabolism may well slow down so even if you resist the urge to snack you’ll gain weight. It also kicked off my Irritable Bowel Syndrome. Oh joy.

The advice web sites say to exercise more. I already go to the gym four times a week and walk a lot. I’m trying to walk more but it’s killing my knees. Being atypical sucks.

Getting help
One big difference between giving up now and my failed attempt 20+ years ago is social media. It didn’t exist then. Telling everyone on Twitter and Facebook that I’d given up meant that backing down was a lot harder but, more importantly for me, it means that I can get support and encouragement, especially if I'm having a bad day.

The downside is that giving up takes months and months and people will lose interest in daily updates. I don’t blame them, I would too. So I’ve picked a couple of close friends for long-term support, people who won’t get sympathy fatigue. Lucky them.

The next step
The advice is to use NRT for at least 12 weeks as in theory this is how long it takes to break the habit or at least the psychological addiction. Again, this is a one-size-fits-all guestimate. Some people take a lot longer. I’m not expecting to get over 30 years of smoking in a couple of months. And I am not a patient person. This is the long, slow, tedious bloody haul.

Nicotine itself isn’t that bad for you so getting off the NRT isn’t such a pressure. It’s generally considered no worse than caffeine – not totally without negative effects but way safer than smoking. So I may still be using it this time next year. We’ll see.

I haven’t fallen off the wagon yet. The important thing is to take responsibility for quitting. I’ve decided that if I do have a smoke, I won’t blame anyone or anything else. I am not a victim, I have had a lapse of willpower. It happens. Get back on the wagon.

After smoking for so long I accept that there may be some damage that will never be reversed.

Someone asked me if I now see myself as a non-smoker. I see myself as someone who is not smoking right now. That’s not giving myself an escape route, that’s focussing on the present because it’s in the present that I want to smoke.

So that’s where I am now. It’s early days. Watch this space.

PART TWO IS HERE

PART THREE IS HERE