Category: Smoking

Every smoker is different

This case shows the power of the magic smoking question. A young woman came for stop smoking hypnotherapy. She told me that she really wanted to stop because of possible health issues in the future. She had no health issues now. I asked if she had ever stopped. She said that she had stopped once for three months but then started again when she arrived in this country. She liked to use cigarettes to break the ice at social events and meeting people. I couldn't get any real reason for why she wanted to give up. She told me she liked smoking and smoked whenever she could. Nobody was allowed to smoke at work so she smoked on the way to work, and after she got home at night. Even so she was getting through 15 cigarettes a day.

She said that she liked to smoke when she was stressed. Sometimes she would deliberately pick a fight with her boyfriend so that she would feel bad. That meant she could go outside and have a smoke to calm down. She did other things to provoke these feelings that let her light up to relieve the stress. Although she was completely honest and open about it, at the same time she wanted to hide her smoking from her parents back home and the people she worked with. She agreed that smoking was her secret and she got a bit of thrill out of that.

Asking the magic smoking question

I was at a bit of loss as to how to start with this client so I decided to ask her my favorite question 'What do you feel when I say "you will never have another cigarette as long as you live''?

Her answer was 'anger'. She felt angry at the idea that she would not be able to smoke again. She felt that she was being prevented from doing something that special to her.

I had never come across this particular response before. But it was an emotion and whenever an emotion surfaces I always do a metaphor replacement therapy on it. In this case I got her to visualize the anger, she saw it as a black triangle, made of squishy sponge, light and soft. You could squeeze the water out of it, but it would always fill up again.

I got her to imagine making the triangle a little smaller, and then a little smaller still. It stopped being able to hold water, and then she tore it in half and put the bits in the bin.

I asked what she felt about smoking now, and she said 'I think I can stop smoking now'!

I find the power of that simple question quite extraordinary. And just as extraordinary is the fact that smokers have these rather bizarre beliefs that stop them stopping.

I love doing smokers, no two are ever the same.

Cycle of addiction

The cycle of addiction explains why people cannot stop smoking. But it does not explain why smokers who abstained for many years suddenly start again. I had a client today who has got me re-thinking  everything I know about smoking. 

This client smokes 25 to 30 a day now but was able to give up for a year. He started again about twelve months ago after a breakup with his long term girlfriend. He came to see me because a few weeks ago he broke up with the latest girlfriend as well and had started smoking really heavily.

I suppose the simple answer is to learn to keep his relationships going. That is not likely to happen, but it got me thinking about why this would start him smoking again. It is well known that stressful events trigger smoking in current smokers, and often make ex-smokers start again.

Cycle of learned behavior

The basic psychology of learned behaviour is CUE-RESPONSE-REWARD. The person gets stressed, lights up, and then feels better. That is the cycle. The addiction comes when the cycle changes to CUE-ANTICIPATION OF REWARD-RESPONSE. The smoker gets a stress cue, immediately thinks of the reward, wants the reward, and then lights up to get the reward. If the smoker does not get the reward, that is, if the smoker does not immediately light up, then the lack of expected reward turns into a craving aimed at making the person do the response. If the smoker does not get the response the result is either anger or depression.

Most smoking therapies focus on the CUE: teaching the client how to ignore the cue. Some focus on the RESPONSE: change how the smoker behaves, suggesting other things to do instead. Some focus on the REWARD: changing the effect of smoking into a bad taste instead of the reward.

But the smoking problem is really in two parts: stopping smoking, and not starting it again. The time between these two points can vary from five minutes to five years.

Is stopping smoking actually a two step process?

But this analysis got me thinking. If the smoking is the response to cue, then you have to look at the cues. The cues are well known: time of day, finishing a task, having a break, getting away from a stressful situation, eating, drinking, after sex, and so on. These are the cues for the current smoker. They are not the cues for the past smoker. The ex-smoker goes through all of these without smoking. So what is different that makes an ex-smoker into a start-again-smoker?

My clients tell me that it is almost always some sort of stressful life event. Every smoker gives up before having the next one. Most smokers don't want a next one, so they are in effect forced into it in order to deal with their stress (which may be purely internal). The required level of stress for some people is trivial, and for others it is high. For successful ex-smokers the required level is very high, so high that they don't start again ever. For others there is some level of stress they cannot deal with, some level that will trigger the smoking behaviour again.

If that is the case then would it not be better to teach the client how to deal with life event stress as part of the therapy?

I have spent a lot of time talking to people who want to stop smoking. Nothing unusual about that, but I have a deep curiosity about why people keep doing things that they know are bad for them. I really got into psychology because I could not understand my own behaviour. I then widened my interest into examining why other people behave the way they do.

I have read all about addiction, compulsion, attention deficit, and all the other explanations for why people persist in self-destructive behaviour when they clearly do not have to.

Excuses for starting smoking 

So when I meet a smoker, I am always interested in their view of why they smoke. I'm even more interested when I find someone who has succeeded in stopping smoking, and then starts again. I have never come up with a satisfactory answer as to why someone who has stop smoking for a year or two years would then decide to take it up again. They know they don't like it, it was usually really unpleasant to stop, and the reasons they give for starting again are way too trivial to be any kind of rational explanation. I have had people tell me that they started smoking again because "I just wanted to see if I had really stopped". Another person told me, "I just wanted to see what they tasted like", despite having smoked for 20 years and being in absolutely no doubt as to what they tasted like.

Starting smoking after pregnancy

Today I spoke with a young woman who said that she is unable to stop smoking. I asked her if she had ever stop smoking. She replied "yes, when I was pregnant. I stopped smoking for nine months." I said to her "and then you just started smoking again?" "Yes. I wanted to."

I said to her "so why did you start smoking again?". She said, "Because the baby made me stop smoking. I didn't want to stop. I was forced to stop smoking because of the baby. So when I had the baby I went back to smoking again."

I have heard this several times from women who successfully stopped smoking during their pregnancy, but started smoking fairly soon after their baby was born. This behaviour totally disproves theories that smoking is an addiction. These women had given up for eight and nine months so there was nothing there to be addicted to. All the nicotine had left the body long ago. The key to smoking in these cases seems to be all about the individual's view of who they are. It seems that there was a residual resentment towards the baby, that they had been forced to do something they didn't want to do, and were exercising their rights not to have other people tell them what to do.

Identifying the causes of starting smoking after pregnancy

It seems to me that in these cases smoking is tied up with their identity, with ideas of personal choice, refusing to do what other people tell them to do. They are quite happy to give up smoking while they are pregnant. They find it fairly easy to do. It is just something that they have to do at that stage in their life. But as soon as they exit that stage they want to reassert their own personality.

I am guessing that smoking is tied up with their own self-image of independence, possibly rebellion.

The challenge for stop smoking hypnosis is how to change that feeling into something positive.

The war against the smoker

All round the world, public health authorities are moving towards stamping out cigarette smoking. In Britain, and many other European countries, smoking and enclosed spaces is totally banned. Some communities have banned smoking in public places outdoors as well. Smokers are increasingly taxed, vilified, and held up as per examples. There has been relentless pressure to stop teenagers starting, advertising has been banned. In Australia, government regulations decree that all cigarette packets have to be printed in a muddy brown colour, covered in horrific pictures of smoking related diseases, and almost indistinguishable from other brands. All of this has had a definite effect.

The anti-smokers are winning

Recent statistics from Britain have shown that the number of smokers in the population has fallen dramatically. The chart below, from the Office of National Statistics, shows a long-term decline in smoking. This is probably irreversible. Social and cultural attitudes have changed. Smoking will probably be extinct by the end of the century.

On the face of it this might seem like very bad news for hypnotists. However, what the chart shows can be looked at differently. 

Actually, it is the hypnotists who are winning

There is a spectrum of smoking behaviour. Some people find it easy to stop smoking. Other people find it impossible. As more and more smokers stop smoking, the smokers who are left in the population are actually the people who cannot give up without help. Although there are fewer smokers, the smokers who remain are different.

And that is why this is good news for hypnotists. Although there are fewer smokers, these are the ones who most need hypnotherapy to get them off the habit. And as the number goes down, those who are left will be more and more cigarette dependent. Eventually we will be left with only those people who are psychologically dependent.

There will be plenty of business for hypnotists in the years to come.

Plain packaging works

In Australia, there is evidence of smokers getting marginalised into extinction. Australia was the first country in the world to introduce plain packaging. Plain packaging is anything but plain. The front and back of all cigarette packs have sickening photos of tobacco related illnesses. All logos and corporate colour schemes are removed and replaced by a drab brown background. The only indication of the brand is a tiny panel on the front.  Every brand name is laid out in exactly the same size and  typeface. There is almost no way of telling one brand from another.

The result of this is that the percentage of people smoking is plummeting in Australia. The government has pledged to keep increasing the cost of cigarettes each year until they are unaffordable. All of this would be expected to lead to what is being seen, a fairly rapid reduction in people smoking.

Smokers getting marginalised

But the government campaign has had an odd side effect. It is not just targeting smokers. It is also having an effect on non-smokers. Over many years laws and regulations have restricted where smokers can smoke. It started with banning smoking in restaurants. Then smoking was banned in pubs.  Later this was extended to every public indoor area. Smoking was banned in jail. Employers started banning smoking in the workplace. So smokers started congregating outside.

This led to the creation of "smoking hot spots" where smokers congregated. To break up this "public nuisance" many states have extended the bans even further. Smoking is banned within 10 m of any playground and on railway platforms, taxi ranks, and bus stops.

The result is that smokers are now being herded into less and less attractive places. The only place they can smoke are places no one else wants to be. The result is a change in public perception. Smokers are getting associated with the places where they smoke. Dirty unpleasant places equals dirty unpleasant people.

So there is increasing social pressure from non-smokers to clear out these smoking places. In the long run this may be just as effective as putting up the price.