Dr. Robert Sokolove knows that it’s difficult to stop smoking cigarettes. But he also knows that with a little help, it’s certainly possible.
“The whole issue … is to help you endure the discomfort of the longing and the symptoms you get when you stop an addiction,” says Sokolove, an associate clinical professor of psychiatry and medicine at Boston University School of Medicine and the director of smoking cessation programs at Boston Medical Center (BMC). “And no addiction that you have, whether it’s to heroin or to nicotine or to gambling, is going to kill you [through withdrawal].”
But stopping is uncomfortable, Sokolove acknowledges — which is why taking advantage of the support available through groups like the smoking cessation program at BMC, which he has overseen for most of the last decade, is of paramount importance.
As Sokolove explains, there are two versions of the eight-week program, each of which meet once per week — one for the medical center’s employees, and one open to patients referred either by BMC physicians or a doctor at a community health center affiliated with BMC.
Both programs consist of five components that participants must experience, learn and perform before they are ready to stop smoking. Those components, Sokolove says, are based on keys recommended by the U.S. Centers for Disease Control and Prevention: “Get ready, get support, learn new skills and behaviors, get medication, and be prepared for a relapse or for difficult situations.”
First up, Sokolove says, is stress reduction, an element on which not all programs really focus.
“One of the main reasons that people smoke as adults is for the anxiolytic quality of nicotine,” or the anxiety-relieving impact of the drug, Sokolove explains. “So even if we can get you to stop smoking, the minute that things get tough — you lose your job, someone gets sick, a problem happens, your girlfriend dumps you — you might start smoking again as a way of dealing with the feeling. The relaxation training we practice gives people another way to handle life’s problems.”
With the foundation for the program’s approach laid through the practice of stress reduction, Sokolove says, the next step is pharmacotherapy, or the prescribing of medicines that can help patients deal with the symptoms of nicotine withdrawal by reducing the frequency and intensity of cravings and other side effects of putting a sudden stop to smoking.
After that comes perhaps the most difficult step: Teaching people to change their thinking, a process Sokolove calls “cognitive restructuring.”
“One of the things that happens when people try to stop is that they have what [Alcoholics Anonymous] calls ‘stinking thinking,’” Sokolove says. “Thoughts like, ‘One won’t hurt me,’ or, ‘I’m going to have to die of something — I might as well die with a smile on my face and a cigarette on my lips.’
“So we go over all the stinking thinking that people have used in the past to get them to start smoking again, and help them replace those thoughts with much more realistic thoughts about what will happen if they start smoking again.”
With participants’ mindsets changed, behavioral modifications need to follow, Sokolove says.
“If you usually pick up your cigarettes at the local bodega or grocery store or variety store, once your quit date comes, you can’t go to that store again for a full year,” he explains. “If you usually smoked when you had a cup of coffee in the morning, you have to switch to tea for a certain period of time … [These are] small little things that change the habits of your day-to-day living, so that it reminds you that you can’t smoke.”
The final step in Sokolove’s program is promoting support from participants’ social circles.
“We have kin or friends or both make five signs,” he says. “Your fiancée might make a sign that would say, ‘I am so proud of you for stopping smoking. You smell so good and you look terrific. Keep up the good work. I love you.’
“Then,” he continues, “if you’re the kind of person that smokes right when you wake up in the morning, she’d put up one on the mirror in your bathroom. If you’ve got to have a cigarette with a cup of coffee, she’d put one above the coffee maker. If you smoke while you’re watching football, she might hang one over the TV set, and we’d have her put one inside your car and one in your cubicle that you can look at when you’re at work.”
The support also comes from within the cessation group, Sokolove adds.
“Everybody stops at the same time, in a group” in a unified quit date on the day of the fifth session, says Sokolove. “Then, the sessions after that are spent talking about how you’ve done and … if you haven’t stopped, we talk about why you haven’t been able to stop and what you can do about it.”
Sokolove notes that some people who come through the program just aren’t ready to quit. Though 40 to 50 people might sign up for the classes, less than one-fourth typically show up to the first session, he says, and of those, only about six or eight usually stay with the program beyond the initial meeting.
“The people who make it all the way to the end? That’s usually about 4 or 5,” he says. “… As you can see, there’s an attrition rate.”
But those who tough it out and make it through often stay quit for long periods of time, Sokolove says — due in part to the support of loved ones and cessation classmates, which he says can provide the same anxiety-reducing feeling that many smokers associate with nicotine.
“The more you feel loved and connected to someone — the more you know that you are attached to and loved by somebody — the more you can endure the uncomfortable experience,” he says.
Patients at Boston Medical Center or BMC-affiliated community health centers who are interested in participating in the BMC smoking cessation program can have their physicians call 617-638-8670 for a referral. For more information, visit www.bmc.org.