22902_000_013Understanding the struggles of those addicted to tobacco helps us be more loving and less judgmental in supporting their efforts to escape its grasp.
One December night several years ago, I went Christmas caroling with several members of our ward. Among those we visited were several Latter-day Saints who smoked. The bishop, who was with us, had become friends with them over the years. He knew their challenges with tobacco, and they knew he loved them. They also knew that he hoped they would quit smoking.
Spiritual motivation is often high for members or potential converts to quit using tobacco, since being tobacco-free is a requirement for baptism and temple attendance. The physical challenges of quitting tobacco use are daunting. Most smokers, such as those we visited on that cold December evening, find themselves caught up in the all-too-familiar trap of dependence on tobacco.
People I meet who learn that I study tobacco use sometimes ask me: Is there hope for tobacco users? Can a smoker overcome the physical addiction and habitual behaviors of tobacco use? The answer is a resounding yes. Not only is quitting possible, but it is also highly beneficial. It is never too late to stop using tobacco. Quitting at any age and in any state of health improves one’s health. 1 Nonsmoking Latter-day Saints need to understand the physical and spiritual struggles intrinsic to quitting tobacco in order to provide love and nonjudgmental support for others in their efforts to put tobacco aside.
Following the Pattern of Addiction
Tobacco contains an addictive substance called nicotine. Most people who use tobacco regularly become addicted to it. 2 Nicotine delivered through cigarettes is comparable to illegal drugs such as heroin and cocaine in its power to addict. 3 In addition to physical addiction, smoking cigarettes or cigars or using smokeless forms of tobacco provides sensations many users perceive as pleasurable. 4 Tobacco users often rely on tobacco as a way to cope with the stresses and demands of life. 5
Only half of all smokers eventually quit permanently, and most who do succeed in quitting try several times before they finally become completely tobacco-free. 6 However, tobacco dependence is a condition that medical authorities identify as a treatable medical problem, 7 even though some of the effects of nicotine on the brain are believed to be permanent. 8
As a result of continued exposure to nicotine, the body needs nicotine on a regular basis to stave off a distinct constellation of unpleasant symptoms called withdrawal. When as little as even one cigarette (or one “dose” of nicotine) is missed, a smoker typically craves tobacco. As abstinence continues, the smoker is likely to become irritable, have difficulty concentrating and sleeping, or experience digestive problems, intense hunger, cravings for sweets, and powerful cravings for tobacco. As the user continues to miss doses of nicotine, the symptoms will peak for a few difficult days and then will gradually subside during the next two weeks. Within a month of quitting, most people can be relatively free of these symptoms, although withdrawal symptoms are different for every smoker. 9
However, one symptom can recur suddenly and without warning throughout an ex-smoker’s lifetime: an intense craving for tobacco. A sudden, stressful event often prompts this craving. Sometimes being in a social setting or experiencing a familiar emotion can also trigger a craving. Whatever prompts it, the sensation of craving is the single greatest factor leading to the return to tobacco use, also called a relapse. 10
Obviously, the best and healthiest choice is to avoid the use of tobacco throughout life. However, millions of people do not know of the health risks associated with tobacco, while others choose to ignore the risks. Tobacco use for many is an unfortunate and regrettable choice made with serious consequences.
The Lord’s instructions in Doctrine and Covenants 89 [D&C 89] cautioning against the use of tobacco are a blessing for those who follow them. This revelation was given through the Prophet Joseph Smith at Kirtland, Ohio, on 27 February 1833. As a consequence of the early brethren using tobacco in their meeting, the Prophet was led to ponder upon the matter and soon inquired of the Lord concerning it. This revelation, known as the Word of Wisdom, warns of “evils and designs which do and will exist in the hearts of conspiring men” and specifically cautions against the use of tobacco. It states, “Tobacco is not for the body, neither for the belly, and is not good for man” (D&C 89:4, 8).
Armed with this knowledge, those who adhere to the Word of Wisdom can avoid the harmful physical and spiritual effects of addiction to tobacco, and they can provide loving support to others who want to stop using tobacco, particularly those who are striving to participate fully in the Church.
Staying tobacco-free is not just a one-time process of quitting. It also involves avoiding relapse throughout one’s life. The ongoing process of overcoming an addiction to tobacco can enhance confidence, self-assurance, and spiritual strength. In this, as in all of our righteous endeavors, God stands ready to help in ways that are best for each of us. Seeking spiritual strength from Deity through prayer and fasting can help in overcoming the challenge. Toward this end, a priesthood blessing, with promises bestowed through the prompting of the Holy Spirit, can also be valuable.
How Does a Smoker Stop?
Because no single condition leads to tobacco dependence, no single solution cures smokers of their dependence on cigarettes. Some people are able to quit smoking easily, while some find quitting so difficult that they do not quit even when facing tobacco’s serious health problems. Smokers who believe that quitting smoking will be easy or that God will make it easy for them may become disillusioned if they experience the normal withdrawal symptoms or if they relapse back to smoking. Therefore, it is wise for smokers to take time to plan this important change carefully and prayerfully.
Successful treatment can include at least three components: (1) counseling and advice from a skilled, knowledgeable professional, with a focus on developing problem-solving skills, overcoming barriers to quitting, and preventing relapse; (2) support from friends and family members; and (3) the possible correct, careful use of legal stop-smoking medications, including nicotine replacement and other drugs tested for safety and effectiveness.
A local hospital or clinic may offer a stop-smoking group, and a health professional may be able to provide expert advice about medications that can help ease the physical and emotional discomfort of withdrawal symptoms. A nicotine replacement medication helps control withdrawal symptoms over a period of weeks or months while the ex-smoker gradually becomes accustomed to living without tobacco. 11 Nicotine replacement products are not designed to replace nicotine permanently; rather, the ex-smoker tapers off the nicotine replacement medication over a period of weeks.
The least successful way to stop smoking is to try to quit all at once, or “cold turkey,” without any kind of help. Quitting this way may seem like a good idea at the time, but statistics show that only a very small percentage of those who attempt to quit this way will still be smoke-free a year later. The work of quitting smoking involves not only the initial actions of becoming tobacco-free, but also the lifetime task of remaining tobacco-free.
What Can Family, Friends, and Ward Leaders Do to Help?
Providing spiritual and social support for those who struggle with tobacco dependence is a role that ward leaders and other ward members can fulfill well. Home teachers and visiting teachers may be able to offer encouragement as smokers undertake this life-changing process. Ward leaders can also provide an excellent service by directing a tobacco user toward stop-smoking treatment available through hospital clinics, community centers, and organizations such as the American Lung Association and the American Cancer Society.
Remember that no one, not even someone as close as a spouse or a parent, can force another to quit. The love and acceptance of others and the awareness that others need us can be among the strongest motivations for quitting. Other strong motivations are the desire to obey the Lord’s counsel in the Word of Wisdom and the goal of receiving the blessings of faithfulness in the Church. Even so, motivation to quit develops over time. Motivation can be seen as a series of stages rather than as an all-or-nothing condition. Any movement through these stages, even a small change in attitude, is a step forward.
How Can a Parent Keep Children from Using Tobacco?
For some young people, using tobacco—either smoking it or chewing it—is little more than a statement of rebellion. In their naïveté, they rarely intend to become dependent on it. To help them, parents can work on opening communication and being supportive.
The more a child knows about tobacco and its addictive nature, the better he or she is prepared to avoid it. This education can be accomplished through guided discussions with peers in church and school settings. Many schools and health settings also have reliable pamphlets and books about tobacco. Experience shows that prevention is not accomplished through one program at school, one lesson in family home evening, or one lesson at church. Efforts toward prevention need to be ongoing. Parents, teachers, family, and friends who do not use tobacco serve as important models.
Parents sometimes blame themselves for not doing more to keep their children from using tobacco. They may feel that they have failed to set a good example or failed to insulate their children from bad influences. Parents cannot make decisions for their children, but they can teach them correct principles, love them, and help them.
Avoiding Permanent Relapse
Smokers who have difficulty quitting may feel discouraged after numerous unsuccessful attempts to quit. In fact, many tobacco users relapse several times before they quit for good. Fortunately, a return to smoking need not be permanent. An ex-tobacco user who relapses can use the experience as a way to learn more about the process of quitting. For example, perhaps ex-smokers relapse when they get together with friends who still smoke or chew tobacco. Rather than considering this as a failure, they can learn to manage situations that prompt them to relapse. They may need to ask friends and family to avoid using tobacco in their presence, and they may avoid situations where tobacco is being used. Church can be a useful setting in this regard, particularly since someone who has quit using tobacco will be surrounded largely by others who do not use tobacco.
Curbing Secondhand Smoke
Exposure to environmental tobacco smoke, commonly called secondhand smoke, can result in serious health problems for nonsmokers living or working with smokers. This danger is especially serious for children and can be life-threatening to infants. 12
A parent who smokes may not be aware that his or her smoking serves as a model for children and can also result in serious health and behavioral consequences. Children should not be exposed to tobacco smoke, particularly in enclosed spaces such as automobiles or rooms of a house. In keeping a child’s environment smoke-free, a family member is likely to find that nagging and criticizing those who smoke are not effective. A better strategy is to negotiate the need for physical distance between the cigarette smoke and the nonsmoking family members, while maintaining an attitude of love, support, and companionship.
Similarly, children should not be allowed to play with cigarettes or cigarette butts; thousands of children are poisoned each year from ingesting tobacco products. Further, a pregnant woman should make certain she does not use tobacco and is not exposed to others’ tobacco smoke. These are not merely guidelines to be followed at one’s convenience; these are matters of health and well-being for all nonsmokers, particularly children.
A smoker who has support from friends and family, who seeks help and advice from a health professional, and who uses stop-smoking medications appropriately has the best chances for quitting permanently. In addition, through the process of quitting tobacco use, as with any other process of improving life, all persons can benefit from the spiritual strength and guidance available from divine sources.
People addicted to tobacco may feel alone and hopelessly mired in their condition. They may assume all the blame for harming themselves and their loved ones. In reaching out to them, Latter-day Saints should adopt the attitude of the Lord: “I will seek that which was lost, and bring again that which was driven away, and will bind up that which was broken, and will strengthen that which was sick” (Ezek. 34:16).
Widespread Use, Deadly Consequences
About one-third of adults in the world use tobacco, most of them starting as children or adolescents. Tobacco use reaches into all economic, educational, and social levels, and in some way touches the life of nearly every person on earth. Consider the following: *
In the United States, about one-fourth of the adult population uses cigarettes. In Asian and Pacific countries, smoking rates among men rose from 50 percent in 1994 to 60 percent in 1997. In Mumbai (Bombay), India, 69 percent of men use tobacco, and 57 percent of women use smokeless tobacco. In Russia, the smoking rate among young men is 73 percent.
Worldwide some 700 million children are exposed to secondhand tobacco smoke.
Women are using tobacco in increasing numbers even in cultures where they traditionally have not smoked. In the United States, the average age at which girls experiment with tobacco is 12 years.
As few as four cigarettes may be enough to set someone who experiments with tobacco on a path to becoming a regular smoker.
The consequences of tobacco use are fatal for about four million people worldwide who die every year of tobacco-related disease, including heart and circulatory disease and cancer.
You Must Not Smoke
“Observe the Word of Wisdom. You cannot smoke; you must not smoke. You must not chew tobacco. … You must rise above these things which beckon with a seductive call. Be prayerful. Call on the Lord in faith, and He will hear your prayers. He loves you. He wishes to bless you.” President Gordon B. Hinckley, “Converts and Young Men,” Ensign, May 1997, 47.
Breaking the Chains of Tobacco Use
“God help us to shake off and break the chains with which we are bound. With God’s help they can be shaken off by faith, works, prayer, constant commitment, and self-discipline. May we have the will and strength to shake off the chains that would control and destroy our progress.” Elder Marvin J. Ashton (1915–94) of the Quorum of the Twelve, “Shake Off the Chains with Which Ye Are Bound,” Ensign, Nov. 1986, 13.
Recommended Web Sites
1. www.surgeongeneral.gov/tobacco This Web site includes a downloadable brochure, “You Can Quit Smoking,” developed by the U.S. Public Health Service. This brochure offers the best evidence-based advice currently available for smokers and other tobacco users. Copies are available by calling 1-800-358-9295 or writing to Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907-8547.
2. www.cdc.gov/tobacco/how2quit.htm The U.S. Centers for Disease Control and Prevention provide stop-smoking advice.
3. www.stop-tabac.ch This site, designed by Swiss university researchers, offers a well-designed questionnaire that is linked to personalized advice that can help a smoker plan to stop and avoid relapse. It is available in French, English, German, Danish, and Italian.
4. www.surgeongeneral.gov/library/womenandtobacco/ This report from the U.S. Surgeon General presents information about women and tobacco. Note the links on the page to additional helpful information to help women and girls quit using tobacco.
5. www.nida.nih.gov/researchreports/nicotine/nicotine.html This report provides scientifically sound information about nicotine and tobacco. To obtain printed copies of this report, call or write the National Clearinghouse on Alcohol and Drug Information, P.O. Box 2345, Rockville, MD 20852, 1-800-729-6686. Ask for NIDA Research Report-Nicotine Addiction: NIH Publication No. 01-4342.
Sources available upon request to the Ensign.
U.S. Department of Health and Human Services, The Health Benefits of Smoking Cessation: A Report of the Surgeon General (Washington, D.C.: GPO, 1990).
W. A. Corrigall, “Nicotine Self-Administration in Animals as a Dependence Model,” Nicotine & Tobacco Research 1 (1999): 11–20.
J. R. Hughes and others, “Nicotine Withdrawal versus Other Drug Withdrawal Syndromes: Similarities and Dissimilarities,” Addiction 89 (1994): 1461–70.
U.S. Department of Health and Human Services (1998). The Health Consequences of Smoking: Nicotine Addiction (Washington, D.C.: GPO, 1998).
D. M. Warburton and others, “Smokers of the Future,” British Journal of Addiction 86 (1991): 621–25.
U.S. Food and Drug Administration, Nicotine in Cigarettes and Smokeless Tobacco Products Is a Drug and These Products Are Nicotine Delivery Devices under the Federal Food, Drug, and Cosmetic Act, Appendices, Department of Health and Human Services, Aug. 1995, A1–A99.
World Health Organization, Addressing the Worldwide Tobacco Epidemic through Effective, Evidence-Based Treatment (1999). www.who.int/inf-fs/en/fact222.html
D. C. Perry and others, “Increased Nicotinic Receptors in Brains from Smokers: Membrane Binding and Autoradiography Studies,” Journal of Pharmacology and Experimental Therapeutics 289 (1999): 1545–52.
J. R. Hughes and D. Hatsukami, “Signs and Symptoms of Tobacco Withdrawal,” Archives of General Psychiatry 43 (1986): 289–94.
J. D. Killen and S. P. Fortmann, “Craving Is Associated with Smoking Relapse: Findings from Three Prospective Studies,” Experimental and Clinical Psychopharmacology 5 (1997): 37–42.
E. C. Westman and J. E. Rose, “Nicotine Replacement Therapies and Beyond,” in Nicotine in Psychiatry: Psychopathology and Emerging Therapeutics, ed. M. Piasecki and P. A. Newhouse (Washington, D.C.: American Psychiatric Press, 2000).
Committee on Substance Abuse, “Tobacco’s Toll: Implications for the Pediatrician,” Pediatrics 108 (2001): 502.
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