Social change work is hard and frustrating and wonderful and terrible; it is also, at times, funny, quirky and just plain fascinating. With this blog we hope to capture all that goes into what we do at Capital Good Fund, and we invite you to join the conversation!

Thursday, November 21, 2013

Guest Post, Part 2: Muna Idriss, Coaching Fellow

This is part two of Muna's post.  You can read part 1 here.

Why Not Quit?
Now we’ve arrived at the $64,000 question: why doesn’t everyone just quit? There are certainly plenty of aids to help a person stop if they want to. Nicorette gum satisfies the oral fixation while also dosing the chewer with the nicotine equivalent of 1-2 cigarettes. NicoDerm uses a patch and a multi-week cessation program to wean smokers off the drug. Chantix and Wellbutrin act as agonists and antagonists to nicotine: they bind to nicotine receptors in the brain and are able to block nicotine from fully activating those receptors while also releasing small amounts of dopamine during the bind, similar to the effect nicotine has on the brain.

Regardless of the route, quitting smoking is an intense and personal experience. I, myself, thought the gum tasted foul and the patch was far too strong relative to the amount I smoked, causing dizziness, headaches and nausea. My ultimate issue with the Nico-product line most definitely was (and still is) the price. A week’s worth of patches costs around $40 and a 100-ct pack of Nicorette gum can cost upwards of $60. Considering the fact that NicoDerm advocates a cessation program that can take up to six weeks to complete and gum has a short “life span” in general, the immediate cost of these products far outweighed the cost of smoking. Ultimately, I was put on Wellbutrin (never tried Chantix), which worked out perfectly for me: I was able to quit after two or three cigarettes because smoking just didn’t feel the same.

There are caveats, however: Wellbutrin, like any antidepressant, has very serious and very real possible side effects; some of the ones I dealt with were heightened anxiety, suicidal ideation, and accelerated heart rate. Also, I am not technically prescribed Wellbutrin as a smoking cessation tool, and it is unlikely my provider would pay for it if I was (as most don’t), which would bump up the monthly cost from about $15 to as high as $250. Now, consider the 32.3% of smokers living below the poverty level and what their options are if they want to quit smoking: spend a month’s worth of groceries on smoking cessation tools or white-knuckle their way through quitting cold turkey.

Quitting cold turkey is an extremely unpleasant undertaking: there is a reason why only 3-10% of smokers are able to stop without help. As is often the case with any kind of substance withdrawal, the first 48 hours are the most harrowing. I was both fidgety and listless, as nicotine is chemically a stimulant but I had paradoxically conditioned myself to use cigarettes as a way to calm down. Now I was never calm, unless I was half-comatose. My every moment was either a mental fog or a splitting headache. I could barely be around people: I hated everything, snapped at everyone I came in contact with and the slightest whiff of cigarette smoke on my friends could incite a tidal wave of cravings. All the while, I knew that one cigarette would make it all go away. Just one. One can’t be that bad right? Only one, and then the rest of the pack will be for “emergencies”. Then, the “emergencies” started becoming more and more frequent, until I was back to my old routine. I don’t know if that’s how everyone backslides, but that’s how it generally happened for me.

Life After Smoking?
See, life is forever changed once you become a smoker. Putting down the pack is the easy part: the awfulness of withdrawal comes on with a vengeance but ebbs away eventually. It’s the challenge of living a life full of triggers that’s the hard part. The idyllic experience of watching a sunrise with a friend is accompanied by the wistful thought that, wow, a cigarette would make this experience all the more perfect. The soothing feeling of smoking is practically the stuff of daydreams during a hectic and stressful finals season. The awkwardness of being in a room full of smokers who are casually taking drags and gesturing with their smoking hands, all the while being more social than you, and thus making you feel all the more uncomfortable and left out.

The unfortunate truth about cigarette smoking is that the cigarettes are not the problem. The feelings of dissatisfaction, loneliness, and anxiety are. The reasons why smokers start are the same reasons why they can’t seem to quit. Of course it is unhealthy, but the human mind is myopic and melodramatic, prone to demanding satisfaction and comfort, no matter the cost. Smokers not only have to deal with this cognitive dissonance of the brain demanding something that ails the body, but also with an intense alienation from society. Smokers have to go outside and, in some places, designated areas a certain distance from doorways or buildings to smoke. People specify they do not want to date people who smoke. Even when I quit, I was a man without a country, so to speak: I could barely be around the group of people I related to and I still feel fundamentally misunderstood by the group that once ostracized me. When I talk to my parents about quitting, we might as well be having two different conversations: non-smokers do not understand the difference between being a non-smoker and being a smoker who stopped smoking.

My client and I were able to bond over this; our discussion about smoking cessation was not so much about the direct health or financial benefits, but rather about the psychic rewards of breaking a bad habit and shaking off a dependence which happened to be both expensive and unhealthy.  So rather than demonize smokers for behavior they are well aware is detrimental, let’s try to be compassionate and to understand that there must be deeper issues at play if a person is willfully paying hard-earned money to poison themselves. Tackling those deeper issues, examining what ails the human spirit rather than judging the behavior symptomatic of that ailment, is what will empower people to throw that pack in the trash and leave smoking in the past. 

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