Our dueling columnists answer your pressing addiction and recovery questions.
By David Moore & Bill Manville
Help! My father has gone back to smoking!
“One of the things we do in our family,” writes 14-year-old Victoria, “is my Dad and I go out for a walk after church on Sunday. We discuss my schoolwork, Grandma’s health, the state of the world in general. He quit smoking a few years ago, but last Sunday, Dad was in a worried mood. He’d just lost his job. ‘I could really use a cigarette,’ he said, and just like that, went into a store to buy a pack. When I refused to go in with him, we had a fight. Dr. Dave and Bill, smoking seems so dirty and disgusting to me. Now my father is back to a pack a day. What is its appeal to him?”
DR. DAVE: First, let’s put Melissa’s question more fully: What makes it appeal to her father so strongly he will risk lung cancer and death to get it? Given the increased sophistication in our schools around drug prevention, most kids have heard of the standard brain chemicals of addiction such as dopamine and endorphin. But although tobacco often gets twice the educational focus compared to other drugs, most teens I run into have never heard of the brain chemical it effects or what it does to seduce the smoker back into its grasp.
BILL: OK, Dave, I know that one. The neurochemical you are talking about is acetylcholine (pronounced “ah-see-ta-koleen”). Exactly how does it lure people such as Victoria’s dad back into the habit?
DR. DAVE: What doesn’t it do? It’s the only brain chemical that will both make you more alert and more relaxed. Essentially, it will focus you on the world around you and momentarily boost your learning and memory capabilities. If you’re groggy, it makes you alert and focused.
BILL: While if you’re anxious and nervous?
DR. DAVE: It gives you a momentary ability to focus and solve the problem that’s generating your agitation. In that case, it causes relaxation.
BILL: Sounds ideal, Doc. The relaxed and alert confidence that comes from having a handle on your world—even if it’s just momentary. What’s wrong with that kind of drug dependence? For instance, I take an aspirin every day for my heart.
DR. DAVE: As in all things addictive, it’s the balance in your brain chemistry. In this case, like all smokers, Victoria’s dad is throwing the levels of acetylcholine off-kilter 20 times a day as he finishes off his pack-a-day habit. It’s not a brain chemical production process you want to mess around with. In fact, that’s the very brain chemical that is found to be off-balance and depleted in Alzheimer’s patients. Of course, acetylcholine is just the addiction brain chemical in tobacco; as Victoria points out, that craving brings along the carcinogens, tars and other deadly tobacco ingredients.
BILL: Some would argue that tobacco is the deadliest of all the addictions: It kills more people than alcohol, AIDS, car accidents, illegal drugs, murders and suicides combined, with thousands more dying from spit tobacco use. Of all the kids who become new smokers each year, almost a third will ultimately die from it. And yet, Dave, when I went out to buy a new pair of sneakers last week, my shoe store had gone out of business. A new store was opening in its place. It was called Cheap Cigarettes. In these tough times, people who can’t afford to buy shoes, flashlights or hammers nevertheless feel they can afford enough tobacco to kill themselves.
DR. DAVE: Great topic, Bill. Back in January, quitting smoking was No. 4 on the list of Americans’ top 10 New Year’s resolutions.
BILL: As a resolution, I’m not surprised to learn it ran ahead even of quitting drinking. Dave, over the years, I’ve made my own non-scientific survey of people who quit both cigarettes and booze. At least half told me giving up tobacco was the tougher job.
DR. DAVE: Most smokers shuffle between all kinds of little cut back schemes—from “light” cigarettes to alternating between chew and Marlboros, usually ending back up rationing themselves until they give up the self-torture.
BILL: No wonder the pharmaceutical industry wants to “help.” Is there some kind of quit-smoking pill Victoria can buy for her father?
DR. DAVE: Was there ever a pill that could get you to stop drinking? Bill, I suspect you’ve been reading the ads for medications. While advertising themselves as nonnicotine, they claim to target nicotine receptors in the brain.
BILL: The makers of one of these medications claim their studies show 44 percent of their users were able to quit smoking during weeks 9 to 12 of treatment, “compared to 18 percent on sugar pills.”
DR. DAVE: Bill, just look at the disclaimers about possible side effects the pharmaceutical companies quote in their television ads: changes in behavior, hostility, agitation, depressed mood, suicidal thoughts or actions, anxiety, panic, aggression, anger, mania, abnormal sensations, hallucinations, paranoia, confusion, trouble sleeping, vivid, unusual or strange dreams … the list goes on.
BILL: Enough to scare you right back into smoking! I’ve also seen these other ads on TV for non-tobacco smoking machines. Do they work, Doc?
DR. DAVE: I’m no Freudian scholar focused on Marlboros as just an oral fixation, but there is something to be said about transitioning from lethal cigarettes to their nondeadly electric nicotine delivery systems: aka e-cigarettes with warm water vapor replacing burning refuse as a way to get your nicotine fix. It’s a far more rational way of cutting down on smoking while giving your hands, mouth and lungs a soothing placebo for a burning cigarette in your hand. Of course, we are talking about a transition phase to finally achieving abstinence— where your brain chemistry can return to a healthy, non-addicted balance.
BILL: Back when I was still drinking, walk into any bar, you’d see people cruising each other, a drink in one hand, a cigarette in the other. I never smoked. That made me easy to spot. I was the one with a drink in both hands. So although I can glibly preach to others about giving up their smokes, I’m not the one to answer the seriously troubled 14-year-old Victoria. Dave, what she can do to help get her father to stop saying “I’ll quit tomorrow,” and do it today?
DR. DAVE: It’s in the palm of her hand, along with the No. 1 New Year’s resolution— “Spend more time with family and friends.” What Victoria needs to say clearly and repetitively is that she is afraid her father is going to die and not be around to share all the things in her future.
BILL: A genuine tearful plea to be there for her graduation, marriage and the next generation of grandchildren. No chastising him for stinking up his clothes or complaining about whiffs of secondhand smoke—just the honest fear that she is seeing him, day after day, dying from a terminal illness.
DR. DAVE: But, just like any good Alateen or Al-Anon family member knows, Victoria has to genuinely join the battle against her father’s disease. The federal government and all its health resources are funneled into one comprehensive website to help Victoria, her father and anyone who wants to learn about nicotine addiction as well as the approaches to go past motivation to cessation. They can go right from this column to that website: smokefree.gov.
BILL: That’s the heart of intervention: Don’t personalize the addiction to the smoker. If they believed they could quit, they probably would have by now. What I really like about that website is that it has healthcare experts you can call from 8 a.m. to 8 p.m. (EST) at 1-877-448-7848. One of our readers shared with me that every time his wife came up with another reason to say “I’ll quit tomorrow,” he would say “Great point!” Then he would call that number.
DR. DAVE: So did she finally quit just to get him off her back?
BILL: Nope, but she did start to talk to the experts herself and finally found a path to quit. Let me put you on the spot, Dave. Suppose Victoria’s fears move her dad to make a commitment to quit. Where would he start to get the best chance of succeeding in going tobacco-free?
DR. DAVE: Knowing how bad withdrawal is and how a smoker needs to get introduced to a 24/7 lifestyle without cigarettes, I would advise him to head to the Mayo Clinic’s state-of-the-art Eight Day Residential Rehab. Their program’s website is mayoclinic.org/stop-smoking/.
BILL: Or at least promise to go to Mayo if an outpatient program fails to work. That smokefree.gov website you mentioned just above can help Victoria and her dad find one in their neighborhood.
David Moore is a licensed psychologist and chemical dependency professional who is a graduate school faculty member at Argosy University’s Seattle Campus. Bill Manville’s most recent work, Cool, Hip & Sober, is available at all online bookstores. A Book of the Month novelist, too, Manville privately teaches “Writing To Get Published.”