Slave to the Stick...No More
Having smoked up to a pack of cigarettes a day for 45 years, Karen Kuhl felt she tried everything under the sun to quit the habit. It wasn’t until she sought out resources from the Tobacco Dependence Program, supported by Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School and Rutgers School of Public Health, that she began a successful journey and is now one-year tobacco free.
Kuhl’s story may seem typical. But smoking was not something that made her feel good or took the edge off of a stressful day in a good way. If anything, she was repulsed by the smell and felt smoking repressed her emotions, not allowing her to express her true feelings and handle relationships with loved ones in a clear manner. And with many of her five children and six grandchildren having asthma, she always felt compelled to stop. She felt she had a true addiction to nicotine. So, when a cousin tried the Tobacco Dependence Program a year and a half earlier with great success after smoking up to three packs a day, Kuhl didn’t think it would hurt to give a call. She was finally emotionally and mentally ready.
Kuhl is definitely not alone. According to the Centers for Disease Control and Prevention, nearly 17 percent of New Jerseyans 18 and older smoke. A significant proportion of them have challenges including financial difficulties, behavioral or mental health conditions, other substance use, and other health issues.
The Tobacco Dependence Program provides evidence-based treatment services that have been proven to be most effective for tobacco cessation. While telephone quit lines and Internet-based programs also play an important role in this process, there are very few programs across the state and region like the Tobacco Dependence Program that offer a combination of one-on-one counseling, group support, physician consultation and prescriptions for quit aids. All services are free, and some cessation medications may be free to those who qualify.
A short time prior to making that first contact with the Tobacco Dependence Program, Kuhl had just moved from Sayreville, New Jersey to Staten Island, New York. She was incredibly surprised that she could not find a one-stop shopping resource in her area to help meet her needs. Some programs offered free nicotine patches, but only for a brief trial period. A group program close to her new home turned out not to meet regularly. So despite a hefty toll to pay in crossing into New Jersey each week, Kuhl found value in the program. Like all new clients who come to the program, she underwent a one-hour, one-on-one assessment, discussing her history of tobacco use, as well as triggers and withdrawal symptoms. It was determined that Kuhl would benefit from a combination of medication and behavioral support.
The first time she ever tried varenicline (brand name Chantix®— a drug that blocks the effect of nicotine on the brain) seven years ago, she felt nauseated, thus discontinued its use. In between she tried patches, gums, acupuncture, and even a laser treatment touted to her as “breaking up the nicotine” built up in her body. None of it worked. After understanding the comprehensive nature of the Tobacco Dependence Program, she worked with its director Michael Steinberg, MD, MPH, to find the right quit aids for her. She started with the patch again, coupled with lozenges, nasal spray and gum to start. She also added a nicotine inhaler and started to see success. But the one thing Kuhl says really helped make a difference was the weekly support group offered. Ironically, the day she first came to the program and was placed on the patch, there happened to be a support group meeting that night…and she made sure she attended. She knew if she didn’t, she would regret it.
Donna Richardson, MSW, LCSW, LCADC, CTTS, facilitates the weekly group that meets at the Cancer Institute of New Jersey and is the clinical coordinator of the program. Attendees share how their week was—how they fought urges to light up. Sometimes they share their failures—how they slipped and had a smoke because of stress at work, a family problem, or other event. No matter what the circumstance, Richardson is there to provide support—to help those on their journey figure it out. Was it an emotional trigger? A stress trigger? Something else? Sharing the latest research and evidence available on the subject, Richardson helps participants recognize what prompted them to light up and what might help them better manage their daily stressors. In developing a personal plan for the coming week, group members may commit to coming to the next group session, getting back on one of the many quit aids, or working on staying away from smokers at the office. Richardson also helps to debunk myths such as difficulty in quitting is not simply due to a “lack of willpower.”
"Every day I planned to quit smoking…until I had that first cup of coffee. It was some of the habits that are associated with smoking that are tough to break. Through the group, I learned about such things so that I could make this work,” notes Kuhl. One reason she says she failed in the past is that she gained weight when she tried to stop smoking. But thanks to the group setting, Kuhl says she was prepared to combat any extra pounds. Through tips from other group members, she learned about making better food choices and the benefits of exercise. She joined a gym and began walking outdoors…enjoying the fresh air.
Other habits were tough to break too. “I didn’t know what to do with my hands,” Kuhl said. Through the program, she was prescribed a nicotine inhaler that includes a plastic cigar-like filter tip. She calls it the ‘puff puff.’ After a few tries Kuhl didn’t like the nicotine, but from time to time would just pull out the plastic tip to place in her mouth. Having a supportive family, she notes that on one occasion, her young granddaughters threw the ‘puff puff’ in the fish tank, saying “Grandma doesn’t need this anymore.”
Richardson notes the habits associated with lighting up are half the battle for many. And some who are trying to quit smoking are afraid to ask others for support. In Kuhl’s case, she took charge. When she decided she smoked her last cigarette, she threw out all of her ashtrays and got new air filters for her air conditioner for her home and car. And she asked co-workers, family and friends not to smoke around her anymore, noting it was both a feeling of pleasure and empowerment in making each improvement.
But some of that empowerment and success may not have come if it weren’t for Dr. Steinberg, Richardson, and the group, Kuhl says. Kuhl’s son, a four-tour Iraq war veteran, lost his home, car, medals and other possessions during Superstorm Sandy in October 2012 and had to move in with her. Shortly after, around the holidays, Kuhl wanted to reduce the level of the nicotine patch. Despite Kuhl’s progress up to that point, Richardson urged against the change. Her 30-plus years experience in addiction treatment, with the last 13 focused on tobacco dependence, told her that the holidays and life events like a child moving back home add extra stress and can easily trigger a relapse. Group members shared with Kuhl other warning signs. Kuhl decided to wait before reducing the dosage. She is glad she did.
Do the Math
Evidence shows the benefits of “staying quit” are enormous. One day after quitting, carbon monoxide levels and blood pressure drops. Within two weeks, one’s risk of pulmonary infection decreases. Improvement in lung function is seen after one month, and a chance of suffering a heart attack is cut in half one year after stopping. Five to ten years after, the risk of heart attack and stroke is the same as one who never smoked. Ten years after stopping, one’s risk of developing lung cancer is cut in half. So, as Steinberg and Richardson encourage, “it’s never too early or too late to quit.” Kuhl was more than happy to heed that advice, admitting it was unnerving to wait for results from x-rays and other scans to see if she would “escape lung cancer one more time.”
By not smoking, Kuhl is saving roughly $288 a month. As a smoke-free reward after her first month, she treated herself to a new winter coat and by six months bought new summer clothes, ridding herself of the nicotine odor that lived within those garments and freeing herself of some of those last bonds to lighting up.
“To see the transformation is fantastic,” Kuhl says. “My family has been so supportive and they’re so proud of what I have accomplished. It is a relief not to be a slave to the stick any more. It is definitely a tremendous feeling of freedom.” Now that she’s reached her one-year milestone of not smoking, Kuhl will start to attend the group meeting every other week, relying on all she has learned during the last 52. ■