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title: Keep Quit! : A Motivational Guide to a Life Without
Smoking
author: Rustin, Terry A.
publisher: Hazelden Publishing
isbn10 | asin: 1568381042
print isbn13: 9781568381046
ebook isbn13: 9780585317342
language: English
subject Tobacco habit--Relapse--Prevention.
publication date: 1996
lcc: RC567.R88 1996eb
ddc: 613.85
subject: Tobacco habit--Relapse--Prevention.
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Page iii
Keep Quit!
A Motivational Guide to a Life Without Smoking
Terry A. Rustin, M.D.
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Page iv
Hazelden
Center City, Minnesota 55012-0176
© 1996 by Terry A. Rustin, M.D.
All rights reserved. Published 1996
Printed in the United States of America. No portion of this publication may be reproduced in any manner without
the written permission of the publisher
01 00 98765
Library of Congress Cataloging-in-Publication Data
Rustin, Terry A.
Keep quit: a motivational guide to a life without smoking/
Terry A. Rustin.
p. cm.
Includes bibliographical references and index.
ISBN 1-56838-104-2
1. Tobacco habitRelapsePrevention. I. Title.
RC567.R88 1996
613.85dc20 95-52662
CIP
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Page v
Dedicated to the memory of my mother,
Jean Moss Rustin,
who taught kindness by her example.
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Page vi
HAZELDEN INFORMATION AND EDUCATIONAL SERVICES is a division of the Hazelden Foundation, a
not-for-profit organization. Since 1949, Hazelden has been a leader in promoting the dignity and treatment of
people afflicted with the disease of chemical dependency.
The mission of the foundation is to improve the quality of life for individuals, families, and communities by
providing a national continuum of information, education, and recovery services that are widely accessible; to
advance the field through research and training; and to improve our quality and effectiveness through continuous
improvement and innovation.
Stemming from that, the mission of this division is to provide quality information and support to people wherever
they may be in their personal journeyfrom education and early intervention, through treatment and recovery, to
personal and spiritual growth.
Although our treatment programs do not necessarily use everything Hazelden publishes, our bibliotherapeutic
materials support our mission and the Twelve Step philosophy upon which it is based. We encourage your
comments and feedback.
The headquarters of the Hazelden Foundation are in Center City, Minnesota. Additional treatment facilities are
located in Chicago, Illinois; New York, New York; Plymouth, Minnesota; St. Paul, Minnesota; and West Palm
Beach, Florida. At these sites, we provide a continuum of care for men and women of all ages. Our Plymouth
facility is designed specifically for youth and families.
For more information on Hazelden, please call 1-800-257-7800. Or you may access our World Wide Web site on
the Internet at http://www.hazelden.org.
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Acknowledgments
During the twenty-four years I have worked in the addictions field, I have benefited from the knowledge and
experience of hundreds of colleagues. Those with a special interest in nicotine and tobacco dependence have been
by far the most eager and dedicated of all. For their support over the years, I especially want to thank Richard Hurt,
John Slade, Andrea Barthwell, John Hughes, Paul Earley, Abby Hoffman, Jeff Goldsmith, Lucy Barry Robe, Ken
Roy, and the staff of the American Society of Addiction Medicine in Washington and New York.
The inspiration for my approach to relapse prevention derives in large part from the work of James Prochaska and
Carlo DiClemente, who developed the Stages of Change model, and William Miller, who developed the
motivational counseling approach to therapy. I am also indebted to the work done on the prevention of relapse in
addictions other than nicotine and tobacco by Terence Gorski, Arnold Washton, and many others. Without the
support and encouragement of the staff of the Addiction Treatment Unit of the Harris County Psychiatric Center in
Houston, Texas, this work would never have been completed. Our unit has pioneered the integration of nicotine
and tobacco dependence treatment with the treatment of other addictions, and many of the strategies in this book
were developed there. No one gave up, in spite of the difficulties. I am proud of the work of this staff and grateful
for their efforts.
This book didn't just happen, of course. It arrived after four long, painful, and exhilarating years of growth and
maturation, constantly nurtured by my editor, Tim McIndoo. On days when I thought I would never complete it, I
lived for Tim's comments in the margins of the early draftsYes, he liked it! Three asterisks
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meant I was really onto something. Every author should have an editor who cares as deeply for the work as does
Tim.
While I was working on Keep Quit! I know I was often hard to live with (and at most other times, too, to be
completely candid). I would often disappear for many hours, losing track of time entirely. I am grateful for my
wife, Laura, and my daughter, Rachel, for tolerating my bizarre schedule. Laura, an indexer by profession, agreed
to index the text, even though the two of us hardly ever agree about anything. She probably regretted that decision
the moment she made it, but she saw the project through. Fortunately for you, she hardly ever took my advice in
preparing the index. As you will see, it is clear and precise, and will guide you quickly to the topics you seek.
Many thanks, Laura.
Finally, I want to acknowledge the contributions made to this book by the many clients and patients I have had the
honor to work with over the years. They have taught me what works; my goal has been to put those successful
strategies into this book.
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Page 1
Introduction
The goal of Keep Quit! is to help you stay clean and freeto never smoke a cigarette again.
For many years, I have been working on bringing an effective, inexpensive method of recovery from nicotine and
tobacco dependence directly to the people who need it; this program is the result. Research has shown that people
do better when they move at their own pace, when they set their own goals, and when they take personal
responsibility for their recovery. I designed this program with those facts in mind.
Most likely, you have tried to quit smoking before; nearly half of all smokers have, and most of them have tried
many times. Why do smokers try to quit, but fail? Every smoker knows someone who says, "Sure, I used to smoke.
One day, I decided to quit; tossed those coffin nails away and never smoked again. No problem at all." Makes you
want to strangle him. (Or herbut more likely him. Women smokers have more difficulty quitting than men smokers
do.) Smokers who could quit easily and without help have already done so. There are smokers who can quit by just
using the nicotine patch or nicotine gum, or by attending half a dozen classes, or by being hypnotizedbut they have
already quit. You are still smoking because your dependence is much stronger.
I am using the word "dependence" in the same way we use it when describing an alcoholic as "alcohol dependent"
and a cocaine addict as "cocaine dependent." I am a medical doctor, a psychotherapist, and an addictions specialist;
I have worked in the addictions treatment field for more than twenty-three years. I discovered long ago that most
people who smoke daily meet the criteria for dependence on nicotine (the addicting drug in
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cigarettes) in the same way that heroin addicts are dependent on heroin and amphetamine addicts are dependent on
amphetamines. But there is more:
Smokers are dependent on the pleasures of smokingthe fire, the smoke, the inhaling, and the exhaling.
Smokers are dependent on the image of being a smoker (created by cigarette advertising).
Smokers are dependent on the rituals associated with smoking (the special ways smokers hold, handle, and
manipulate their cigarettes).
Smokers are dependent on the act of smoking, with its smoke, fire, and oral satisfaction.
Smokers are controlled by the many activities they associate with smoking (eating, drinking alcohol, drinking
coffee, having sex, driving a car, and talking on the phone, to name just a few).
Smokers use nicotine to help them deal with uncomfortable feelings (like anger, embarrassment, fear, depression,
loneliness, and boredom, to name a few).
When smokers try to quit, they experience significant nicotine withdrawal symptoms (such as anxiety, irritability,
difficulty concentrating, trouble sleeping, and intense craving for a cigarette).
No wonder it's so hard to quit! Smoking is rewarding, satisfying, and a good deal cheaper than most other
addictions. Most of the problems from smoking don't occur until people are past age sixty, and smoking rarely
causes any serious social problems. In fact, most smokers find many more reasons to keep smoking than to quit
smoking.
Over the years, I have tried all sorts of ways to help smokers
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quit smoking. Most of them didn't work at all. Lectures and advice didn't work; pleading and scolding didn't work;
showing pictures of diseased lungs didn't work. So far, I have found only three things that work, each to some
degree. They are
Having a serious heart attack
Wearing the nicotine patch
Helping people develop their own plan for quitting smoking
The heart attack method works about 30 percent of the time. You would think that any smoker who has had such a
serious medical complication from smoking would quit, but most are not able toeven if they really want to.
Breaking free of nicotine and tobacco dependence can be extremely difficult.
Treatment with the nicotine patch doubles the effectiveness of whatever other measures a person is using. Many
smokers hesitate to use the patch because of the costa full course of patch treatment usually costs between $30 and
$300. Each patch costs about $3about the same as the average smoker spends on cigarettes each day. If you think
the patch could help you, consider the expense as an investment in your future.
The very best treatment for dependence on nicotine and tobacco is helping smokers develop their own plan for
quitting smoking. You are a unique person; your history, your goals, and your strengths and weaknesses are not the
same as any other persons. Personalizing your recovery program will give you the best chance of staying clean and
free.
Here are some tools you can use:
Quit and Stay Quit: If you are just thinking about quitting smoking but have not yet made up your mind, you aren't
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