A co-worker referred her husband to our tobacco dependence treatment program. After many months and with much reluctance, “Dave” decided to start individual tobacco treatment with me. His smoking history had been somewhat typical – he had tried to quit many times on his own with various forms of medication. Dave always felt like there was no other option but to return to smoking – because that’s what felt normal.
It wasn’t that he was not interested in quitting because he was, but rather the belief that quitting was even remotely possible was hard for him to imagine. However, once we started treatment, he really did try to come to the sessions with an open mind. Working as a pastor for many years provided Dave with some insight that having hope is so much a part of one’s success.
Dave took in as much information as I could give him and would then go home and research more. He wanted to understand the addicted brain. After a few sessions, he started to feel more relaxed and less fearful about making a quit attempt. Together we decided that he would try combination nicotine replacement therapy. He liked the idea that there was an “emergency relief” medication that he could grab. We incorporated strategies and behavior change tactics to deal with the expected cravings and triggers. We talked often about gaining control over one’s life instead of the cigarette having all the control.
When quit day came, although he expected it to be difficult, he felt somewhat prepared and motivated. What he wasn’t prepared for was the overwhelming feeling of doom and gloom that came so quickly. It wasn’t obvious at first, but in just a few days into quitting it became very apparent that not smoking was making him feel very depressed. The days became terribly long and Dave found it very hard to cope. He consulted with his primary care physician who added bupropion to his treatment. Dave kept plugging away. But by weeks end, he felt discouraged and disappointed because he kept reaching for a few smokes to get through each day.
On week three his depression started to lift, yet he still found himself unable to deal with all the pressures of his job. Being a “ patient pastor” for so many others when he couldn’t be patient with himself proved to be exhausting. As the weeks progressed, Dave began to question, “is this really worth it”. By the end of a typical day, he finds himself so tired of fighting the fight. On the outside, he manages to keep it all together yet on the inside he just can’t find any comfort. He asks, “why do these damn cigarettes have such an affect on me?” We adjust the medication and try different ways to address his struggles, yet as the weeks go on it feels harder and harder to attain what he set out to do.
Unfortunately, Dave’s situation is not unique. He has family support and appears to have good coping skills. But quitting smoking is hard for him. What can I do? I ask myself that everyday. He really wants to quit smoking!
Dave and I continue to meet week after week and I tell him, “we can’t quit quitting!” We continue to battle together, waiting for science and medicine to catch up with the complexity of this problem. We both keep faith that, eventually, we will win this war.
– Norristown, PA. August 2012