Butt Out: Quit Smoking

Each year, 34 percent of America's 50 million smokers try to kick the habit. But only about 5 percent of those attempts are successful, according to the American Lung Association. Luckily, Timothy Baker, Ph.D., a psychology professor at the University of Wisconsin and consultant to the U.S. Department of Health and Human Services, is discovering means of breaking our nation's tobacco dependence. Here, Baker explains why the human psyche may never allow us to become completely smoke-free.

Susan Fiske: What are the most effective ways to quit smoking?

Timothy Baker: There is a strong dose-response relationship between the amount of psychological treatment and rate of success in quitting. The best possible outcome requires both medication—nicotine patches, Zyban and so forth—as well as psychosocial intervention. Each doubles a person's chance of quitting successfully.

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Do smokers need therapy?

What we know is that about 70 percent of smokers want to quit, but smokers also have a much higher rate of depression and anxiety than those who don't smoke. There is also growing evidence that the longer you smoke, the more likely you are to develop some of these negative emotional states.

Why might a person quit, then start again?

The most characteristic way people relapse is that they encounter an upsetting stressor—an argument, anger or anxiety. Negative mood inflates the incentive value of drug use: Expectations that smoking will soothe that negative mood increase.

Is that because of the contrast between feeling lousy from withdrawal and feeling good from the cigarette?

Smokers are in withdrawal virtually all the time. As soon as the body's nicotine level starts to drop, they start to go through withdrawal. So smokers are always getting some reward from smoking.

Does that mean they're used to the link between smoking a cigarette and feeling better?

Addiction is a vicious cycle. The best predictor of success is how much negative mood a person experiences in the first few days of quitting. Another interesting part of this equation is that many smokers don't experience a decline in withdrawal symptoms after they quit, but rather, their withdrawal symptoms can be higher one or two months later.

So many people just continue to feel rotten?

Right. And when people have long-term withdrawal syndromes, they are much more likely to fail.

But with psychotherapy and medication you can perhaps get through it?

On your own, the success rate is around 5 percent. But with intensive treatment, it can be five times higher. When you quit smoking, in some sense it's like mourning. Nicotine stimulates some of the same brain regions stimulated by interaction with a loved one. So when smokers say, "I feel like I lost my best friend," neurologically, they have.

What advice would you offer?

Don't be too optimistic about what quitting is going to be like; that will make you better prepared. As opposed to mourning a loved one who is gone forever, here the loved one is available at the nearest convenience store. Once a person has a single puff, the odds are 80 to 85 percent they will go back to full-time smoking.

So should they keep trying?

Smokers are most likely to quit in their third, fourth or fifth attempt. Nothing predicts success like failure.

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