Quitting daily cigars: managing withdrawal and cravings

10 My Behavior Reduction Experience My behavior reduction experience was very challenging for me—but I managed to stay firm in my purpose. My goal was to stop smoking cigars. Typically I would have two every day after work and then some more on the weekends when hanging out with my friends. I used to enjoy a 4 o’clock cigar and 10 o’clock cigar to help me unwind after a stressful day at work. Much of the stress I felt came from the fact that I do not enjoy my job as a teacher. I am working towards a career change, but that is still some ways away. Meanwhile, I must find an alternate way to deal with stress as I am serious about giving up my cigar smoking habit. The first three days were definitely the hardest. Yet, what was odd was that I expected the desire to stop after the first three days. It didn’t. It actually became even more intense. I would wake up in the mornings craving a cigar, or I would spend much of my day thinking about the feel and taste and smell of a good cigar. If I’d have a particularly stressful day, I’d feel even worse knowing that I couldn’t go home and smoke a cigar. Yet, in spite of all these negative feelings, I had some really positive feelings too: particularly the pride I felt knowing that my resolve was absolute and that I was not going to have a cigar no matter how much I tried to talk myself into having one. I felt strong in a way that really made me feel good in spite of my obvious withdrawal symptoms. I wanted to brag to my friends about how well I was doing after a week. Even when they would light up and I would be tempted to join it, I’d resist and feel proud about not giving in. Still, I’d crave a cigar even more when I’d get home and that craving would still be there when I’d wake up. I never wondered whether I would lapse, however; I was determined to not have a cigar—and I began looking for new hobbies to replace my old one. After two weeks, I was still going strong, but the desire for my daily cigars never left me. I still felt it strongly and I wondered if the desire was ever going to go away. My resolve had not weakened. I was still determined to never have another cigar—I just expected the desire to lessen over time. So I was surprised that the craving was still so strong. I attributed this mainly to the fact that I still felt so stressed out by my job. One good help that I did have came from my good friend Berta, who was a strong support for me and offered real encouragement over the same time. I was very grateful for her support as she recognized what I was going through and I was able to confide in her my struggles. What influenced me along the way was Berta’s support, my own desire to kick the habit and turn over a new leaf, and the test of my will power, which I viewed as the most important thing. If I could conquer my habit, I could do anything—and that was what mainly motivated me during this time. However, being around my friends who continued to smoke cigars on the weekends, my stressed out by school and wanting that old release that cigars gave me, and not having any real replacement lined up all contributed to a general feeling of temptation and to the craving that I described. My support system mainly consisted of Berta. My friends listened to my successes but they did not stop smoking cigars around me, so it was mostly Berta to whom I would turn when I needed to vent or when I wanted some encouragement. What I realized, however, was that the seed for my success was really within me—and if I wasn’t determined then no amount of encouragement would ever make a difference. Berta saw that I was serious and she wanted to assist me in the process that I was undergoing. I really appreciated this and was glad to have her support as it did help just to have a friend to listen and recognize my struggles. Two approaches that I feel would work for this behavior reduction are cognitive behavioral therapy (CBT) and interpersonal psychotherapy. Together these two approaches actually make up the core methods of supportive psychotherapy. CBT is helpful because it focuses less on why a person is geared towards doing certain actions and more on what steps the person can do to change one’s behavior. The idea behind CBT is that if one changes one’s behavior, eventually the mind will change too and the problems that plague one will diminish over time. Interpersonal psychotherapy is good at working in tandem with CBT because it focuses more on the why by helping the patient to explore how interpersonal relationships and environment impact one’s decision making and choices and vice versa. CBT can be effective because it takes what is essentially a goal-oriented approach to the problem. In my case, the goal is to quit smoking cigars and so the CBT approach would identify the goal and then work on developing practical, pragmatic steps to help me achieve that goal. By changing patterns in behavior, it follows that patterns in thinking can change and that these changes can in turn help the person to better control one’s feelings. In my case, I can see that my anxiety stems a lot from my work and that I was viewing cigars as a way to comfort myself. I am not a weak-willed person though, so I have been able to quit smoking cold turkey—but what I struggle with is the craving that I continue to have the desire that I continue to feel. By changing my behavior, I would expect to change my thoughts and then change the way my feelings affect me. In my case, having two cigars a day at 4 and 10 is almost like a compulsion. McKay et al. (2015) have shown that CBT can be an effective strategy for treating obsessive compulsive disorder, so it makes sense that I would recognize CBT as a viable approach for treating my problem. CBT can be used to show that controlling the will is essential (Beck, 2011). The ancient Greek philosopher Aristotle defined weak will as a problem for people trying to cultivate good habits. In my case, I allowed a bad habit to develop because I was not working on developing a strong will. I was allowing a weakness in my character to dominate my life and it was like living in a feedback loop where my smoking was reinforcing my bad life decisions (in terms of accepting a job I did not like). Now I could see that quitting smoking correlated with my desire to get out of my job and pursue a new career. I was breaking the feedback loop by cultivating a stronger will, changing my behavior, and ultimately transforming the way I let my feelings overwhelm me. Thus CBT would be a great way for a therapist to treat a person looking to reduce a certain behavior like smoking. As Tsakiris and Haggard (2005) point out, CBT is based on the idea of taking control of the “acting self” (p. 387), which is developed in response to feelings and thoughts that one experiences throughout the day. This idea of taking back the acting self can lead to an improvement in self-esteem and I myself experienced this as I felt more confident after two weeks of resisting the urge to smoke. Though I still felt the craving, I felt that I was growing stronger and really developing my will power and showing that I could do more with myself instead of allowing myself to just drift through life, patching the hole in myself with little comforts like cigars. In reality, what I should have been doing was changing my line of work so that I could feel happier and more fulfilled with what I was doing. The cigar smoking I realized was just a symptom of my overall weakness of will, and I needed to make my will stronger in order to accomplish my life goals. Carroll, Rounsaville and Gawin (1991) showed likewise that interpersonal psychotherapy can be an effective way to treat substance abuse. With me, I felt I was abusing cigars, smoking too many of them a weak in order to compensate for the negative feelings I was having towards my job and my life. Instead of addressing the issues I was having in my interpersonal relationships (especially with my relationships towards my students and other teachers) and examining my environment (my work and my recreational environment) to see how I could improve it, I was simply willing to essentially patch the hole on my tire by cultivating my cigar smoking habit. Interpersonal psychotherapy allows the patient to examine relationships and one’s environment to see how it is affecting one’s actions and how those actions are in turn affecting one’s relationships and environments. For me, it was clear that my environment and relationships were not helping me to address my cigar smoking. I did not have much of a support system in place before Berta came on board. She really helped me to improve my situation and was a positive relationship force in my decision to change my behavior. Just doing that helped me over time to re-orient myself towards my work and my life. I began to see that I was relying too much on smoking as a cure when really the cure I needed was educational and relational. I was just trying to get through my days one by one instead of making the most of each day. I was seeing each day as a problem instead of as an opportunity. By examining my relationship with my students and asking myself how I could make these better and why they were not interested in their school work I could perhaps bridge the gulf between us. I saw that I was not connecting with my students for whatever reason and I wanted to know why. I think that interpersonal psychotherapy can be an effective approach for someone trying to reduce a specific behavior because it does allow the individual to address the why of the matter. Relationships and environments do impact us and make a difference on our lives: after all, having a support system in place is helpful in overcoming a problem because of that very fact (Rogers, 2012)—relationships and environments are meaningful and impactful and if ours are toxic, our behavior, mood, and cognition is likely to reflect that toxicity and vice versa. If our behavior, mood and thoughts are toxic, our relationships and environment are likely to be out of whack too. The two approaches taken together can be used as supportive psychotherapy, which helps a person to live with certain issues instead of trying to force them out of one’s existence. For instance, in my life, it would be helpful towards living with the craving I have for cigars. It would be like saying, “Okay, look, this craving is never going to go away but that doesn’t mean you have to give in to it. Instead, you just can be aware that it will always be there and here are some ways that you can respond to that craving that will help you to maintain your decision to not be a smoker anymore.” So in this sense it is about addressing the issues that we face by learning to live with some of them. CBT is helpful in terms of changing one’s behavior in as far as one is able (Hewitt, 2009), and interpersonal psychotherapy is helpful in terms of accepting certain things—the things that one cannot change in other words and learning how to cope with them. Both address the issues so that is the main key and that is why I feel that both would be effective for this behavior reduction. I think that this experience will impact my work with clients in the future because it allows me to have that experience in my background—an idea of what it is like to quit something that is harmful, to overcome a bad habit and develop a good one in its place. I am glad for this experience also because it has shown me that I can have a strong will and take control of my will power and use it to my advantage instead of acting like a passive recipient of life’s challenges and seeking consolation and escape through actions that do not really help in any way. I can now as a result take this experience and use it to highlight my approach to treating other clients in the future. It helps to shed a light on my clinical understanding. In other words, the evidence-based practice that I will enjoy in school will support my approach to clients because my knowledge will be based on actual experience. I become living proof, in a way, that these approaches do work and that behavior reduction is possible and that it can have a positive impact on one’s life. I can also reflect on my experiences and draw deeper meaning from it over time.