By now, it's almost a cliché to reiterate that smoking is the chief cause of preventable death in the United States. Yet approximately 46 million Americans are still lighting up, according to the latest estimates from the Centers for Disease Control and Prevention. With New Year's resolutions still fresh in people's minds, U.S. News spoke to clinical psychologist Daniel Seidman, director of smoking cessation services at Columbia University Medical Center, about his new book, Smoke-Free in 30 Days: The Pain-Free, Permanent Way to Quit (Fireside Trade Paperback Original). In it, Seidman draws on his 20-plus years of experience with thousands of patients and walks people through the quitting process—including how to prepare for the "quit day" and how to maintain their success. Here are edited excerpts from the chat:
Are you a reformed smoker?
My story is that both my parents were smokers and died very young from it, so I've been very concerned about this issue. My father was 47, and my mother was 59. My mother had lung cancer. She smoked [Kent brand] cigarettes. It was later found that [the brand's specialized filter contained] asbestos. [According to a 1995 article in the journal Cancer Research, the filter contained a form of asbestos for several years during the 1950s.]
What does your monthlong program entail, and what makes it unique?
It outlines what to do each day. What we're saying to people is rather than think about this as just being [about] willpower, focus on things you can do each day that will help you change your behavior, change your attitude, [and] use medicine to the greatest effect. It's sort of like playing the piano. Nobody says, "If you have enough willpower, you'll be a good piano player." They say, "Practice." [Quitting] isn't just about being strong. That's sort of a trap that people believe: "If I'm strong, I can do it. If I'm weak, then there's nothing I can do and I just have to smoke." We're saying [that] if you make these efforts and do these exercises and follow these daily recommendations, you can be successful.
I've found that nicotine replacement therapy, if it's used properly, can be extremely helpful to people and be a really good confidence-builder. A lot of people fail [with NRT] because they don't use it correctly. They don't use it in conjunction with making certain important changes in their attitudes and in their behavior, which could make it more effective. [Seidman says he takes no funding from makers of NRT or other stop-smoking products.]
Can people—even hard-core smokers—really quit in 30 days? That sounds awfully quick to be rid of a deeply ingrained habit.
The adjustment period can go on for a long time because what you're really doing is learning how to be comfortable without the cigarettes. We're really trying to prepare people for the long term, as well as get them off to a good start. But [they] have to continue to live that way. We don't want you to be ambushed by these things. We're going to alert you to the things that could be a problem, but you have to continue to use self-awareness as a tool.
So avoiding cigarettes doesn't magically become easy on Day 30?
It's not like the curtain comes down on the Hollywood movie. We wanted to set up a really structured program [so] people would know what to do each day and to get them to a point where they are really confident. Confidence is really important. I've seen people who could barely walk down the street from emphysema, and they couldn't quit. Once they built up their confidence, they were basically fine, and it's really sad that they waited so long to quit.
With all the evidence that smoking can kill, why do people continue to light up?
We see asthmatics, we see people who have had heart attacks, we see people who have had all kinds of cancer, and they're still smoking. The addiction doesn't live in the rational part of the brain.
Some of it has to do with the health beliefs [people] have. For example, they start to believe that they need [to smoke] to handle stress, as if they're ever going to have a stress-free existence. If people want to wait until their lives are less stressful [to quit], it's just a way of putting off handling the problem. The other really tricky belief is that people develop an insecurity: They don't feel right when they don't smoke and honestly don't believe they can quit, which is a self-fulfilling prophecy.
What are the big obstacles to quitting?
Really, there are three hurdles people have to get past: the physical, the automated behavior (which is the habit), and emotional belief systems.
Most people, when they think about this addiction to smoking, they think of it as a physical problem with some element of habit. But I think people really don't get that for many smokers, making a good emotional adjustment after they quit is the hardest thing. If every time for 20 years you get upset you take a cigarette, that's going to become very much a part of your emotional repertoire, right? Once you can get [people] to think differently about that emotional belief system, it really helps them move beyond smoking and lose interest in it.
Why, in your experience, do people backslide?
Triggers, alcohol, and emotional discomfort or stress: I call these three the "Bermuda Triangle of relapse." It's like a place where people go and then fall off the radar. If you have one of those things, you might be able to figure out how to deal with it. If you have two going on together, you're really looking for trouble. If you have all three, they can really ambush you. So people really need to be aware of those things and figure out how they're going to handle them.
What are triggers?
Triggers are specific kinds of situations that make a person expect to go back to smoking or expect a cigarette. For example, being around other smokers. That's a really powerful trigger. There's something about the smoke that acts on you in a primitive way.
How can people best set themselves up for success?
I think there are four phases of quitting. One is a self-assessment. You have to understand something about your [smoking] pattern. Then, making some kind of a plan that works for you, so that you can build your confidence and prepare yourself. You don't necessarily just jump in and risk failure. It's like if you were going to run a marathon. You wouldn't just wake up one morning and say, "God! I'm going to go the whole way." Prepare yourself with some exercises to build your confidence, and [you'll] start to say, "Hey, wait a second, maybe I can really do this." If you don't believe you can do it, it turns out that you don't do well. The third part is the actual day you're going to stop. Plan that day, so you're going to facilitate your success. Don't go out drinking with a bunch of smokers. The fourth phase is preventing relapse, which is really more of a positive thing: Getting comfortable, finding more creative ways of handling situations where you would have automatically smoked. Let's say that somebody upsets you, and you automatically take [out] a cigarette. Maybe you have to engage more in handling that interpersonal situation in a positive way. People mainly think of the health benefits of quitting smoking, but there are actually tremendous psychological benefits.