Setting Quit Dates

Setting Quit Dates

Joel
Joined: 18 Dec 2008, 23:57

08 Mar 2006, 20:19 #1

Joel's Reinforcement Library
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Setting Quit Dates

Conventional wisdom in smoking cessation circles says that people should make plans and preparations for some unspecified future time to quit. Most people think that when others quit smoking that they must have put a lot of time into preparations and planning, setting quit dates and following stringent protocols until the magic day arrives.
When it comes down to it, this kind of action plan is rarely seen in real world quitters. I emphasize the term real world quitters as opposed to people quitting in the virtual world of the Internet. People who seek out and participate in Internet sites do at times spend an inordinate amount of time reading and planning about their quits before taking the plunge. Even at our site we see people say they were reading here for weeks or months before finally quitting and joining up. Although I suspect there are a fair number of people who had already decided to quit right away and searched us out after their quit had begun, and some people who may not have actually decided to quit but who when finding WhyQuit.com and seeing cigarettes for what they are decided then and there to start their quits.
Getting back to real world experience though, the best people to talk to when it comes to quitting smoking are those who have successfully quit and have successfully stayed off for a significant period of time. These are people who have proven that their technique in quitting was viable considering they have quit and they are still smoke free. Talk to everyone you know who is off all nicotine for a year or longer and find out how they initially quit smoking. You will be amazed at the consistency of the answer you get if you perform that little survey.
People are going to pretty much fall into one of three categories of stories. They are:
  • People who awoke one day and were suddenly sick and tired of smoking. They tossed them that day and never looked back.
 
  • People who get sick. Not smoking sick, meaning some kind of catastrophic smoking induced illness. Just people who get a cold or a flu and feel miserable. They feel too sick to smoke, they may feel too sick to eat. They are down with the infection for two or three days, start to get better and then realize that they have a few days down without smoking and decide to try to keep it going. Again, they never look back and stuck with their new commitment.
 
  • People who leave a doctors office who have been given an ultimatum. Quit smoking or drop dead--it's your choice. These are people for whom some sort of problem has been identified by their doctors, who lay out in no uncertain terms that the person's life is at risk now if they do not quit smoking.
 
All of these stories share one thing in common--the technique that people use to quit. They simply quit smoking one day. The reasons they quit varied but the technique they used was basically the same. If you examine each of the three scenarios you will also see that none of them lend themselves to long-term planning--they are spur of the moment decisions elicited by some external circumstance.
I really do encourage all people to do this survey, talking to long- term ex-smokers in their real world, people who they knew when they were smokers, who they knew when they quit and who they still know as ex- smokers. The more people do this the more obvious it will become how people quit smoking and how people stay off of smoking. Again, people quit smoking by simply quitting smoking and people stay off of smoking by simply knowing that to stay smoke free that they must never take another puff!
Joel
© Joel Spitzer 2006
Page created February 19, 2006 and last updated by Joel Spitzer on February 19, 2006

The British Medical Journal reported an interesting study that tied into this article very well. Here is a link to the abstract of that study:
I wrote a reply to the journal that got posted on their response website. Here is a link to that reply:
2015-11-05 Note added: I see that the link above no longer exists. Here is a link to a web archive that shows the whole discussion referred to above: https://web.archive.org/web/20060214215 ... 73866.AEv1
Because of the broken link I am going to attach my full response here:
Below is a short commentary  I wrote in February of 2004 at an online quit smoking forum I was co-managing.  I wrote it for both members of the online support group and visitors reading at the site. I was trying to pass along an observation that I realized decades ago when I first started talking to people who were quitting smoking. I was trying to encourage them to survey people who had stopped and were now long-term ex-smokers. I have worked with and talked extensively with over forty five hundred smokers since conducting my first clinics in the mid 1970's. I have also encouraged all of those people to talk to all of the ex-smokers they ever knew. In all that time I have never heard any of them come back saying that the results they came up with varied differently with what I had observed. 

Here again is the piece I wrote in 2004 for an online quitting support group.  I feel that this survey and the ensuing discussion ties very well in with this piece: 

Setting quit dates 

Conventional wisdom in smoking cessation circles says that people should make plans and preparations for some unspecified future time to quit. Most people think that when others quit smoking that they must have put a lot of time into preparations and planning, setting quit dates and following stringent protocols until the magic day arrives. 

When it comes down to it, this kind of action plan is rarely seen in real world quitters. I emphasize the term real world quitters as opposed to people quitting in the virtual world of the Internet. People who seek out and participate in Internet sites do at times spend an inordinate amount of time reading and planning about their quits before taking the plunge. Even at our site we see people say they were reading here for weeks or months before finally quitting and joining up. Although I suspect there are a fair number of people who had already decided to quit right away and searched us out after their quit had begun, and some people who may not have actually decided to quit but who when finding WhyQuit.com and seeing cigarettes for what they are decided then and there to start their quits. 

Getting back to real world experience though, the best people to talk to when it comes to quitting smoking are those who have successfully quit and have successfully stayed off for a significant period of time. These are people who have proven that their technique in quitting was viable considering they have quit and they are still smoke free. Talk to everyone you know who is off all nicotine for a year or longer and find out how they initially quit smoking. You will be amazed at the consistency of the answer you get if you perform that little survey. 

People are going to pretty much fall into one of three categories of stories. They are: 

People who awoke one day and were suddenly sick and tired of smoking. They tossed them that day and never looked back. 

People who get sick. Not smoking sick, meaning some kind of catastrophic smoking induced illness. Just people who get a cold or a flu and feel miserable. They feel too sick to smoke, they may feel too sick to eat. They are down with the infection for two or three days, start to get better and then realize that they have a few days down without smoking and decide to try to keep it going. Again, they never look back and stuck with their new commitment. 

People who leave a doctors office who have been given an ultimatum. Quit smoking or drop dead--it's your choice. These are people for whom some sort of problem has been identified by their doctors, who lay out in no uncertain terms that the person's life is at risk now if they do not quit smoking. 

All of these stories share one thing in common--the technique that people use to quit. They simply quit smoking one day. The reasons they quit varied but the technique they used was basically the same. If you examine each of the three scenarios you will also see that none of them lend themselves to long-term planning--they are spur of the moment decisions elicited by some external circumstance. 

I really do encourage all people to do this survey, talking to long- term ex-smokers in their real world, people who they knew when they were smokers, who they knew when they quit and who they still know as ex- smokers. The more people do this the more obvious it will become how people quit smoking and how people stay off of smoking. Again, people quit smoking by simply quitting smoking and people stay off of smoking by simply knowing that to stay smoke free that they must never take another puff! 

Joel 

I really do encourage all medical professionals to conduct this survey, talking to your long term ex-smoking patients, colleagues, family  members and friends. People who you knew when they were smokers, who you knew when they were quitting and who you still know as being successful long-term ex-smokers. The more people that medical professionals talk to, the more obvious it will become to them how people quit smoking and how people stay off of smoking. Again, people quit smoking by simply quitting smoking. 

I don't believe that there is a single professional smoking cessation "plan your quit" advocate who will suggest other medical professionals should take a similar survey. For if they did their study results would almost certainly be called into question when the health care professional starts seeing the results of his or her real life survey. The experts will end up having to spend quite a bit of time trying to explain away the discrepancy, using rationalizations like the people who planned their quit "didn't do it right" or didn't "plan" long enough or were "just more addicted smokers."  

I see that one of the authors of this study and a few other commentators who clearly have ties to pharmaceutical interests have tried to link this survey results to the need to recommend pharmaceutical interventions. As long as I am asking all health care professionals to survey their own patients and others who they associate with as to the kind of planning they had done to quit, I suggest that all health care professionals go the extra step and find out how many of the successful long-term ex-users* of nicotine actually used pharmaceutical products to quit. They will likely find that most of the long-term successful ex- users* that they survey will not have used any of these products in the quit that actually succeeded. Tying pharmaceutical intervention recommendations to the results of surveys showing that spontaneously quitters as being more successful seems totally unwarranted and I suspect that all health care professionals who conduct their own surveys will also come to this very obvious conclusion. 

*Long-term ex-user being defined as an individual who has not used any nicotine from any source for at least a year or longer. 

Joel Spitzer has over 30 years of experience in the development and implementation of smoking cessation programs for adults and smoking prevention programs for children in the Chicagoland area. While with the American Cancer Society (Chicago Unit, Illinois Division)and the Rush North Shore Medical Center and now for the Evanston and Skokie Illinois Health Departments he has conducted over 350 stop smoking clinics with over 4,500 participants. He has also presented over 570 educational seminars to over 90,000 children and adults on smoking prevention.
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Competing interests: Educational Director of WhyQuit.com, the Internet's leading abrupt nicotine cessation resource.[/size]
________________
That commentary elicited a reply from another person, who was basically trying to give the impression that serious scientists shouldn't put too much emphasis on real world experiences. I wrote a reply to this editorial but it somehow did not seem to get past the editorial review board at the British Medical Journal. I think the reply is still valid so I am attaching it below:

Re: Flawed reasoning
Joel Spitzer,
Health Educator
Conduct Stop Smoking Clinics for the Evanston and the Skokie Illinois Health Departments 60201,60076[/size]
Send response to journal:
Re: Re: Flawed reasoning
[/size]





"...because something commonly happens in a particular way 'in the real world' then this should be considered the best way."[/size] Smoking cessation experts often seem to have to be telling people to dismiss real world experiences. Usually I see a little different variation of the comment above. Common statements I have seen are something to the effects that while it is likely that a person may at times encounter real world quitters who succeeded by using non-recommended techniques, usually meaning no pharmaceutical intervention or in what this study is showing, people who used no set quitting date, that these people are just the exceptional cases. What the experts are trying to do in effect is discredit observations made by people, making them think that the occurrence of such experiences are really rare.[/size]

The author above was at least accurate enough to say, "While it is true that most smokers who quit do so without any specific behavioral support or pharmacological treatment..." The rest of the comment was going on to try to give the impression that there would have been even more successful quitters if people would just do what smoking cessation experts say should work as opposed to doing what actual quitters continually say has worked for them.[/size]

The tactic being employed here is to leave the impression that we could just have a whole lot more successful quitters if people would just utilize the miraculous effective products out there that actually help people to quit. There is also the perception being portrayed that there really are very few ex-smokers out there because most who have tried to quit have done so unaided and everyone just knows how improbable it is for people to be able to quit in an unaided attempt.[/size]

Medical professionals and the general public are being misled to believe that quitting smoking is just too plain difficult for people to do on their own and that the odds of a person actually quitting on their own is really pretty dismal.[/size]

This would all make perfect sense if not for the fact that we have so many successful ex-smokers in the real world. In America, we have more former smokers than current smokers. Over half of the people who used to smoke have now quit smoking. From the comment made above it should be clear to all that most of the people who have quit either did not know of professional recommendations for quitting or chose to ignore professional intervention techniques. Yet these people successfully quit anyway. I think that this is an important point to hit home with all medical professionals. The medical profession has got to start to help people to realize the real potential of success that individuals do have to quit smoking instead of perpetuating the idea that quitting is just too hard for an individual smoker to expect to actually succeed without help.[/size]

While this article should have been about planning techniques, the original author and a few experts weighing in on the discussion have tried to turn it into a referendum on selling pharmaceutical interventions. Nicotine replacement products have been around for over two decades now-- and a significant percentage of smokers have used them to try to quit smoking. If a product has been around for decades, used by millions of people worldwide, AND, has been truly effective, it should be easy for most health care practitioners to come up with lots and lots of successful patients, colleagues, family members and friends who have quit with these products.[/size]

As I said in my original commentary above:[/size]

" I don't believe that there is a single professional smoking cessation "plan your quit" advocate who will suggest other medical professionals should take a similar survey. For if they did their study results would almost certainly be called into question when the health care professional starts seeing the results of his or her real life survey. The experts will end up having to spend quite a bit of time trying to explain away the discrepancy, using rationalizations like the people who planned their quit "didn't do it right" or didn't "plan" long enough or were "just more addicted smokers."[/size]

In all honesty, I don't expect my encouraging of real world observations by health care professionals to have much impact with smoking cessation experts. They are going to profess to believe whatever other experts keep telling them to believe or, what the funders of their studies believe.[/size]

I do however believe that health care workers who are on the front line and actually deal with patients who smoke are going to be a bit more critical and analytical about this. If they spend any time talking with patients they are going to see through the rhetoric and the rationalizations of the experts.[/size]

I have always tried to disseminate the message that just because something works in the lab or in study conditions doesn't necessarily translate to the fact that the process will work in the real world. The smoking cessation experts seem to have to work on the basis that just because something works in the real world doesn't mean that it is a good approach if it doesn't seem to work in a lab.[/size]

I have high hopes that medical professionals really wanting to help their patients are going to be more influenced by what they see is successful than by being told by the experts what should be successful, but somehow not replicable in their own practices.[/size]


Last edited by Joel on 05 Nov 2015, 22:19, edited 4 times in total.
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Joel
Joined: 18 Dec 2008, 23:57

08 Mar 2006, 20:31 #2

Edited August 30, 2012 to add in following new video:






There are likely a few people here today who may in fact have set today to be a quit date because it is "No Smoking Day" in the UK. I don't want to discourage any of them from quitting now because of the comments written in this article. If you really spend time now reading and learning all that we have to offer here at Freedom and at www.whyquit.com and implementing our advice you will be able to start this quit and sustain it over the long-term. People's long-term success at quitting does not occur because of the planning they do before they quit, but more so because of the work and effort that they put in reinforcing their resolve after they quit.

I do suspect that there may be more people finding our resources today for the first time because of the heavy media attention that is being paid to smoking and quitting. In the UK because of "No Smoking Day," and in the U.S. because of the media attention surrounding lung cancer because of a celebrity death from the disease.

There are likely people reading here today who have not put any forethought into quitting. Don't let that fact discourage you. You are fully able of starting and sustaining a successful quit today by making a commitment now that you stick to over the long-term to never take another puff.

Joel
Last edited by Joel on 30 Aug 2012, 15:14, edited 1 time in total.
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Joel
Joined: 18 Dec 2008, 23:57

10 Mar 2006, 20:05 #3

Below another issue I thought would be important to attach to this string. Setting a future quit date--especially and extended future date, carries the risks of something going wrong before the date actually arrives:

Many years ago I had a man in my clinic named John. John was a pretty high profile public figure, in his early 40's who had many great accomplishments in his life. He came to my clinic, lasted a few days and lost the quit. He was in the middle of a high profile media situation and just decided he needed his focus and the stakes of what he was involved with at the time were just too high to deal with withdrawal. John explained this to me, and promised he would return again one day when things would be better. Well, I have heard this hundreds of times before, and while occasionally people do return, it is not the majority and probably not even a significantly high percentage. Being that I was having 50 or more people at a time in these clinics, I couldn't spend much time dealing with those who were not quitting.

Three year later John does return to the clinic and does quit smoking. He did great his second time around. Not only did he quit, but he became a regular volunteer for me, coming to many clinics as a panelist to help people first quitting. He also sent in lots of people, probably 15 to 20 over the next couple of years.

About three years after John's quit, he was going in for a physical and to his surprise there was a small spot on his chest x-ray. When it was biopsied they found out John had cancer. He was about 48 at the time, in the peak of his career, still had children of school age and now was facing this terrible diagnosis. It was a horrible shock to many people. As is often the case with lung cancer, it was a fast deterioration. Within a year and a half John had succumbed to the disease.

I went to John's funeral--it was huge. There were hundreds and hundreds of people there. Many I knew, some because of their high public profile, but more because John had sent in so many people to the clinic in the time period that he was off smoking. Even after the diagnosis he was still sending people in.

One of the men there was from one of the recent clinics and had told me how tragic this was that John had lost his life and how his lost quit was probably the reason. To be realistic I told him that it is possible that if John had quit the first time in the clinic it may not have made a difference. He basically found out he had lung cancer three years after he quit, and that lung cancer could be present for 5 years or even 10 years without presenting symptoms or even showing up on the x-ray. Being that the day I met him was about 6 years before the diagnosis, it was not totally improbable that at that time the cancer had already been initiated and was silently growing.

The man then proceeded to tell me that my clinic was not the first clinic John had tried. That in fact, 10 years before joining that first group with me, he and John had gone to another local clinic together to quit and both in a matter of days wrote it off as a bad time to quit--but knew they would both quit again one day.

Well John was right, he did eventually quit again one day. But it turned out to be over 16 years later. Now the odds were quite different--if he had quit that first time around he probably would never had developed the disease that ultimately cost him his life.

The lesson here needs to be once you have a quit going, do everything in your power to make it last. While you are seeing people come back who just seem to be quitting again, if you relapse you just don't know you will ever get the strength or desire to quit again, and that even if you do, you don't know whether something won't go wrong in the interim period before the next quit.

John is not the only person I know who fits this profile--I know lots of them--people who could have had extra years and extra decades who lost them by minimizing the implications of not quitting or of relapsing. Once you have a quit smoking, understand your very life is contingent on understanding the importance of knowing to never take another puff!

Joel
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Joel
Joined: 18 Dec 2008, 23:57

30 Sep 2006, 01:00 #4


Last edited by Joel on 01 Mar 2011, 14:48, edited 1 time in total.
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freedom6 4
Joined: 19 Dec 2008, 00:32

03 Sep 2007, 04:43 #5

From reading other sites. The site explained to another quitter about going cold turkey. This is my first quit, after 30 years of smoking.

The coach explained to the quitter, that if they use patches, gum, pills, their chances of quitting doubles. Is that correct?
Last edited by freedom6 4 on 30 Apr 2013, 16:42, edited 1 time in total.
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John (Gold)
Joined: 18 Dec 2008, 23:57

03 Sep 2007, 05:13 #6

"...if they use patches, gum, pills,
their chances of quitting doubles.
Is that correct? "

The quick answer is, inside clinical studies, when competing against those who wanted phamaceutical nicotine but were assigned to the placebo group and didn't get it "yes," but in real world use, when competing against those going cold turkey "absolutely not." This is a link to an article I wrote that better answers your question.
It is false to suggest that any of the more than 100 NRT clinical trials had anything at all do with quitting cold turkey. Expecting to endure withdrawal is a totally different mindset from changing forms of nicotine delivery from smoke to some slower form of nicotine delivery. Also, quitters with a prior history of attempting to quit know what full blown withdrawal feels like. Most could tell within a few minutes whether or not their nicotine gum was the real deal or an inert placebo. If you'd joined the study hoping to get three full months of free nicotine gum but instead realized that you'd been assigned to the placebo group, would you have stayed around for three months to be toyed with? Neither did they. The result was victory by default for NRT.
I am now of the opinion that it;s probably impossible to use a double-blind randomized study format when evaluating any chemical that claims to diminish symptoms of drug withdrawal. The reason being is that it is the only medical study area where those assigned to the placebo group are actually punished by being forced to add full blown withdrawal to their then existing condition. For example, when testing a new medicine that claims to relieve headaches, we don't force those assigned to receive the placebo device to also endure full blown chemical withdrawal. Using the double blind randomized study format in drug addiction studies truly is a license to steal.
Still just one rule .... no nicotine today!
John (Gold x8)
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Joel
Joined: 18 Dec 2008, 23:57

03 Sep 2007, 06:08 #7

Other articles related to the topic of quitting in real world setting as opposed to what happens in experimental settings:
Pharmacological Aids to Smoking Cessation
Pharmacological Aids Part II
40 Years of Progress?
Quitting Methods: Who Should You Believe?
So How Did Most Successful Ex-Smokers Actually Quit?
Most expert say "Don't quit cold turkey"
Hooked on the Cure
Is Cold Turkey the Only Way to Quit?
Wall Street Journal article explores pharmaceutical industry "Nicotine Fix"
Related videos:
Last edited by Joel on 16 Jun 2013, 19:42, edited 2 times in total.
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Just Hannes
Joined: 18 Dec 2008, 23:57

03 Sep 2007, 06:10 #8

Hi Freedom6-4,

You are almost 3 months of nicotine. That's huge. Congratulations.

Important for everybody is to keep on reading and educating yourself at http://whyquit.com/joel/

Joel wrote about cold turkey here: http://whyquit.com/joel/Joel_03_31_is_c ... ly_way.htm

My personal experience is that quitting while chewing nicotine gum or using the patch or whatever nicotine delivery device is impossible.

Keep on the good work!

Frits (8 months+)
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Krissy
Joined: 04 Mar 2010, 14:55

26 Mar 2010, 16:43 #9

The lesson here needs to be once you have a quit going, do everything in your power to make it last. While you are seeing people come back who just seem to be quitting again, if you relapse you just don't know you will ever get the strength or desire to quit again, and that even if you do, you don't know whether something won't go wrong in the interim period before the next quit.

This is such an awesome truth, thanks Joel.

When you are addicted to nicotine, it is easy to rationalize and make any excuse to keep the addiction going.  Smokers always say "I'll quit tomorrow" or "I'll quit after such and such is over."  It's also incredibly tempting for a recently turned ex smoker to blow a quit and say "I can quit again later."  But the vital truth remains that when it comes to quitting, NOW is better than later, and we must sustain NOW, because later could easily turn into never...or cancer.    

Krissy - Free and Healing for Twenty Five Days, 12 Hours and 18 Minutes by avoiding the use of 510 nicotine delivery devices that would have cost me $153.24.
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hwc
Joined: 18 Jan 2009, 16:17

26 Mar 2010, 19:26 #10

Krissy:

Indeed! The thing about a cold turkey quit is that once you past the first few days, the hardest part is always behind you. There are, of course, small ups and downs along the way, but the path gets relentlessly easier the longer you stay off nicotine. 2 weeks is easier than 1 week. 2 months is easier than 1 month. 4 months is easier than 2 months. 12 months is easier than 6 months. And, so on and so forth. So, if you think about it rationally, you never want to have to give up the easier part only to have to repeat the hardest part.  I think this is why it's so important to say, "no, it's not OK to slip." You want to avoid a relapse to smoking at all costs because staying quit is easier than starting over!.
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