For many smokers, giving up cigarettes is one of the most difficult experiences they could ever go through.
But Robert Shipley, associate professor of psychology and behavioral sciences, thinks he can help. Shipley, the director of the Duke Stop Smoking Clinic has developed a system he calls QuitSmart that targets both the psychological as well as the physical aspects of the addiction. The project's short guidebook has distributed more than 125,000 copies since the program's inception in 1985.
One of the major innovations in Shipley's approach is that he makes a clear distinction between being a nonsmoker and not smoking. "When someone enters my office miserable because they want a cigarette, that's not a nonsmoker," Shipley said. "That's a smoker who is not smoking."
And Shipley's program is designed to turn these patients into nonsmokers.
"Through either group or individual treatment, we basically try to hit all the prongs of a nicotine addiction," Shipley said. "If you've smoked a pack per day for 20 years, that's over a million puffs," Shipley said. "It just doesn't feel right for a smoker to get up in the morning and not have a cigarette."
Many smokers have also developed an emotional dependency on cigarettes-whereas a nonsmoker may call a friend when they're feeling down, a smoker will light a cigarette.
Ann Poore, a journalist from Salt Lake City who quit smoking two weeks ago, was one of Shipley's patients. Poore smoked a pack and a half each day for more than 25 years. She had quit smoking once before and stayed free of cigarettes for more than a year before she finally succumbed to the craving.
This time, however, her experience is proving different.
"I have no cravings now," she said. "I used to want a cigarette all the time. Everyone was telling me to start smoking again because I was very moody."
To combat the nicotine addiction, the QuitSmart program uses a "warm chicken" method, as opposed to the "cold turkey" approach. Patients begin by switching from their favorite brand of cigarettes to a label that has a lower level of nicotine. A week later, they switch to a cigarette with even less nicotine. By the time the quit date arrives and the patients switch to medication like a nicotine patch, they have already lowered their nicotine intake levels significantly.
A key ingredient in this step-down process is choice-a smoker who prefers nonfilter Camels can choose to switch to one of more than 30 different lower-nicotine brands.
To help smokers break their habit, Shipley uses the Better Quit cigarette, a plastic tube that looks like a cigarette but contains no nicotine. Since smokers' brains have come to associate the cigarette as an object with a hit of nicotine, Shipley encourages smokers to take puffs of fresh air from the Better Quit. Its lack of nicotine will eventually sever the association.
"That really worked for me," Poore said. "I wondered how I'd drive without smoking, but I found that the fake cigarette helped."
Shipley addresses the emotional dependency of cigarettes by having patients listen to a hypnosis tape that helps them relax and focus on the more pleasurable aspects of life.
"The unconscious mind works only in positives," Shipley said. "The tape suggests things like clean air and deep breathing."
Patients also use the money they save by not smoking to buy themselves an instantly gratifying gift. Poore, for example, buys fresh-cut flowers with the money she used to spend on cigarettes.
As a former smoker, Shipley realizes fully how difficult it is to stop smoking. Even the most complete programs designed to help people quit have only a 25 percent one-year quit rate. That means that within one year of the quit date, three-fourths of the patients will take up smoking once again. Additional studies have shown that 95 percent of smokers who take a single puff after their quit date quickly pick up the habit again.
"The addiction is that powerful," Shipley said.
The problem with smoking, he added, is that unlike alcoholism or other drug addictions, cigarettes are a time-bomb-their real effect may not be felt for decades. Alcohol and heroin, on the other hand, have an immediate impact on someone's life; these substances destroy families and cause people to lose their jobs. Therefore, Shipley explained, it is difficult for many smokers to take their addiction seriously and put in the energy to stop.
His program, though, has lessened this burden enough that thousands have quit smoking "warm chicken."
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