We are all aware of the dangers of smoking. Yet the
reports that in the United States over 46 million people (20.6%) over
the age of eighteen and 2.7 million (17%) of all high school students
are current smokers. Out of the 46 million adult smokers, the CDC
reports that over 40% of them tried to quit in the past year. The
implication here is that to some degree they wanted to quit, but were
unable to to actually stop smoking. It is hard, very hard, to separate
oneself from the addictive nature of nicotine.
exposure is not the only danger.
and the newly implicated
smoke exposure endangers a much higher number of individuals; putting
even the innocent at risk for many acute and chronic health conditions. The
knowledge of these hazards is not new. We have been well aware of them
for years yet about 21% of our adult population continues to puff away.
no doubt that everything we do, we do for a reason. Therapeutically as a
Behavioral Health Consultant in a primary care office I see behavior as
less of an issue regarding right or wrong but more so does it or does
it not work. So with the known risks of smoking there must be a pretty
good reason why people continue to smoke, right? Nicotine has
psychoactive properties that are very addictive; most likely related to
how it effects the brain’s pleasure/reward center---the mesolimbic
smoke because it works! Some say it "relieves stress”, even though it
is a stimulant. Some admit they smoke for "something to do” when they
are "bored”, Others report that they smoke when they are "feeling down”
and depressed and even when they are "feeling great”--a reward system
for feeling both crappy and wonderful. People smoke when they drive,
they smoke when they sit at the computer, they smoke when they are
having coffee, tea or a beer with a friend. Some even smoke because "as
sad as it is, smoking is really the only thing in my life I enjoy
many years assisting patients in the smoking cessation process, I have
becoming more convinced that most individuals, even though they are not
consciously aware of it, relate to cigarettes as a friend—an
unconditional friend that is always there when they need them. What I
find most interesting is the one sided, almost masochistic nature of
this obliging yet very pernicious friendship.
use is the single largest cause of morbidity and mortality in the
United States; as touted by the CDC "the only legal product that when
used as directed will kill one-third of users”. Each year smoking
cigarettes accounts for 1 in 5 deaths--that is about 438,000 people.
Just to give you a relative benchmark, deaths related to alcohol and
illicit drug-use combined total 44,000 per year. This is surely a
dubious friendship but it is one that comes with minimal conditions. It
is a relationship that for most has no perceived incentive to change.
Below is a letter written by a client:
been friends and co-dependents for a very long time, 46 years to be
exact. I remember the first time we met...I was five and boy did you
get me in a lot of trouble. First I climbed high to reach you and then I
gave you a try. I got yelled at and spanked because your partner burned
my mummy's rug.
mom knew you first and I wanted you to be my friend too. You seemed to
be liked by my mom and almost all of her friends, but I was forbidden to
associate with you...until 5 years later when I was 10, I snuck you
away from my mom and we bonded in the basement. We lived in the
projects. It made me cool with the other kids to be your buddy. You
hung around until I couldn't get rid of you...but I didn't want to
because you felt good, you calmed me and you made me look cool. Little
did I know you were the controlling one in our sick relationship.
It took me years to realize that we were unhealthy together but I seemedto
overlook it. Even when my mother cut her ties with you; when she begged
me to do the same, I refused. I tried but you were stronger than me.
I want to tell you that..."you're killing me" and I don't want to have
anything to do with you anymore. Very soon you can rest assure that I
won't let you send me to my grave. I can't take the pain I've seen you
cause so many other people.
nut shell I want to say "watch out" because you'll soon lose out in
this friendship. I can't wait for the day I say...NICOTINE-I QUIT!!!
Your soon to be ex-friend.
Fifield is an integrated Behavioral Health
Consultant at Families First Health and Support Center; an FQHC in
Portsmouth NH. In his off time he is the Managing Editor of CFHA Blog and makes all attempts to keep up with his wife and two sons.|