I have a number of clients who continue to smoke. Over the years, I have seen patients give up smoking over and over again. I certainly believe the research that says nicotine is an extremely addictive drug in the category with such drugs as cocaine. A number of my clients have given up smoking in response to developing medical conditions related to their “habit.” One client, however, that I have worked with for many years who has a chronic mental illness has, in the last few years, developed chronic obstructive pulmonary disease and has had a number of hospitalizations. He has been told by me and by his physicians that the next time he develops pneumonia and enters the hospital, he may not leave.
But does such a “scare ‘em” approach really raise their awareness of the need for change since, if you believe in the stages of change, consciousness raising is one of the processes that you need to use to move people from precontemplation, not thinking about making a change into contemplation, actually thinking about and weighing the pros and the cons of changing.
This effort on my part and the part of other medical providers seems to have made my client more fearful regarding the possibility of dying and more willing to “cut down” and to at least consider stopping.
But he is not the third stage of change. He has not made a decision to stop, although he is more concerned and there is more dissonance which he is aware of between engaging in behavior (smoking) that may end his life and wanting to live. It would therefore seem that “working” the dissonance is a process of change that myself and the other medical providers seeing him should continue to emphasize. Until he makes the decision to stop, we will continue to provide empathy, offer support and point out that once he makes the decision, there are a number of things that can be provided for him to help him implement the decision, such as “the patch,” medications, group support, etc. We will also continue helping organize his life better and make only commitments that he can follow through with. But we cannot make the commitment for him. Unfortunately, for this person, like for many chronic smokers, smoking may be one of the few really pleasurable activities that they engage in on a daily basis. Helping him to find other activities that give him pleasure may help him to finally make the commitment that he needs to stop. As of this date, unfortunately, he continues to smoke.