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>> Hi, I'm Dr. Mike Evans and I
think quitting smoking is a journey.

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For some, it's a short journey
full of resilience.

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But I think for most it's a long journey, a long
affair, if you will, of quitting and relapse.

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A complicated relationship that can have
as much to do with a person's relationship

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with themselves, as with the cigarettes.

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What starts as a pleasant sensation, an
opportunity to rebel or even to belong,

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is replaced by less pleasure
and a feeling of being trapped.

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A daily or hourly ride of nicotine withdrawal
and then another cigarette, which brings relief.

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Most teens who smoke, think they will in their
twenties and actually don't until their forties.

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Stopping smoking is about making a change
and that is something we're not too good at.

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When I think of change, I think of two concepts.

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Where you are at and the
mechanics of how we change.

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So, we should start where you are at.

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When I started medical school, I thought I
could take somebody who smoked and convert them

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into a non-smoker in one fell swoop.

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Now I see it differently.

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I focus on where the person is at.

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You may be in what we call pre-contemplation,

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where you're not really even
thinking about change.

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Approximately 75% of smokers want to quit.

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But 25% are not interested.

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Maybe you're at the contemplation stage,
thinking about it, but not quite ready to act.

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Next is preparation.

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This is critical with smoking, especially in the
likely event that you've tried to quit before.

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What has worked in the past and what hasn't?

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What caused the relapse?

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Maybe you're at the action stage.

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This is when you're ready to make your move.

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There's never a perfect time to quit.

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And at one point you just have to jump.

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I'll tell my patients, "Hey,
it's going to be a challenge now

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and it's going to be a challenge in five years.

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So, why not do it now?"

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And then finally, there's the maintenance stage,

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where you become a non-smoker
and are trying to stay that way.

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[cheers]. When we make changes
it's critical to stop and think,

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how important is this change to me?

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And how confident am I in making this change?

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What we call your self-efficacy.

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Your job is to be honest.

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My job is to see if I can
move your score towards ten.

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The second concept is about
the different parts of change.

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So, there's the what.

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What are we changing?

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With smoking, I suppose it is
straight forward, stopping.

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But if you think about it, you
might be changing lots of things.

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And I think it is like a relationship breakup.

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You start by just keeping
things simple and low risk.

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You might breakup your routine a little bit.

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Avoid certain places.

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Maybe use that juicer every
morning to distract yourself.

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But you will need to change more than
your smoking, to stop your smoking.

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The next is the why.

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Why change?

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I feel like I could do a ten-minute video just

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on all the medical reasons why
not to smoke and they are legion.

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But I'm going to spare you.

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Partly because you already know.

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Partly because you don't need anymore guilt.

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And partly because in clinic, I actually
spend more time asking people what they

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like about smoking.

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Which sounds funny, but I think we have

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to recognize there are positives
or at least perceived positives.

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And I think it's important to reframe these
perceptions, if we are to make a change.

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So, let's run through a few of the common ones.

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Cigarettes are my friend.

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They destress me.

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They relax me.

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Hmm, I'm not going to deny that
you may feel a sense of relief

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and satisfaction, when you have a cigarette.

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But I see it a bit differently.

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You have a nicotine addiction.

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The nicotine in tobacco is highly addictive.

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Within a few seconds of inhaling, it travels to
your brain causing you to have a temporary high.

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Over time, your brain changes, causing
you to smoke more to get the same effect.

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We rate your addiction to nicotine
with a few simple questions.

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Do you smoke more than 15 cigarettes a day?

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Or smoke within 30 minutes
of getting up in the morning?

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Do you find it difficult to go more
than four hours without a smoke?

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The power of nicotine comes from the repeated
small doses you give yourself when you smoke.

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It may seem innocent at first, but if you
take 15 puffs from a cigarette and smoke, say,

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20 cigarettes a day, that's
300 drug doses a day.

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You think smoking relieves
your stress or is satisfying.

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But it actually isn't.

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The cigarette is just making
your nicotine addiction go away.

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Smoking doesn't make your concentration better.

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It just calms your nicotine
receptors cry for more.

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Smoking makes your heart beat faster.

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Increases blood pressure and breathing.

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These are all symptoms of
stress, not stress reduction.

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Let me repeat that.

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The cigarette just reduces your
nicotine stress, not your real stress.

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I've got a lot of trigger times.

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Coffee, sex, meals, certain people.

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Break times, telephone calls, the car.

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There are a lot of triggers you're
going to have to prepare for.

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You got to change your coffee routine.

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Plan something to do right after meals.

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Throw out your car ashtray.

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I have no advice on sex,
but make a plan for breaks

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or the telephone, with lots of distractions.

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Know that when you have a hunger or
caffeine or other types of pangs,

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you also have a nicotine pang
that needs to be satisfied.

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You have associated these,
but they're actually separate.

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Alcohol and parties double the
risk, as you have the association.

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Plus, you're imbibing something
that intends to lower your resolve.

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I want something in my hand.

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Yes, you are making maybe
300 hand motions a day.

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You may need to replace this by chewing gum
or chewing on a straw or a cinnamon stick.

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Or playing on your cellphone, to keep your
hands busy, to replace this daily habit.

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I will gain weight.

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Yes, you might.

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But I think this is actually
more marketing than reality.

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What I call the Virginia Slims effect.

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On average, people who quit, gain
about 2.5 kilograms or five pounds.

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So, two thoughts on this.

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Firstly, if this is a concern for you,
you might want to focus on strategies

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that affect calories in and calories out.

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Such as your new daily routines
might focus on walking.

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A special emphasis on being
mindful of emotional eating.

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Or that your hand mouth routine
includes carrots or celery sticks.

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My second point is about perspective.

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A possible five pounds may be
important from a vanity perspective.

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But from my doctor perspective,

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the health return is spectacularly
higher, when you stop smoking.

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Remember, we said smoking was a relationship.

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Part of the healing of stopping
a damaging relationship,

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is start a new healthy relationship.

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So, now it's the time to start a deeper
relationship with your bicycle or salads

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or walking or gardening or
your support of friends.

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Next is the how.

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What do the skills require to change?

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How do I change, with the emphasis on I?

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So, what works?

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Well, let's start with willpower.

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It's a strange word.

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On the one hand, it permeates behavior change
and all of the interventions we talked about.

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It's also a word I don't love, as
people see it as black and white.

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If a person succeeds, they have willpower
and if they fail, they have no willpower.

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The science of willpower and
smoking gives a mixed message.

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Approximately 5% of smokers
who try to quit cold turkey,

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achieve prolonged abstinence
for six to 12 months.

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With most relapsing in the first
eight days of attempting to quit.

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And the other hand, most people
who quit, do so unassisted.

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Maybe 2/3 to 3/4 of people do so by themselves.

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Reconciling these two stats reveal the natural
history of smoking cessation, that quote,

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"failures" are part of this process.

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And can be seen as dress
rehearsals for the eventual success.

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Another key pearl here is the data
which tells us that a perception

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of the quitting smoking experience
is often much darker than reality.

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In a British study of people who were
surveyed about their quit experience,

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53% said that it was not
at all difficult to stop.

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Twenty seven percent said
it was fairly difficult.

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And the remainder found it very difficult.

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So, to summarize, you can do it by yourself.

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And it may be less difficult than you think.

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On the other hand, it looks like your chances
are better if you layer on some other tactics.

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So, if you fail, try again.

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And think about adding another strategy.

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Some say there are two types of cigarettes.

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Those that are dealing with your
nicotine addiction and those

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that have become part of a routine.

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So, let's see what works for
both these types of cigarettes.

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Let's start with treatments that
have not been proven affective.

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And where you may be wasting your money.

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Now, some of my patients have found they help.

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And to be honest, if they stop your
smoking, I suppose I don't really care.

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But under this category I put laser
therapy, acupuncture and hypnosis.

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When we compare these treatments to a placebo
or just compare them to the quit rates

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on waiting lists, the rates
don't appear to be improved.

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Next is medications to help stop smoking.

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The data shows that medications, especially
when combined with behavioral support,

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can double your chance of success.

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Many patients are resistant, which I get.

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But I also see an irony in the
fact that people are willing

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to inhale chemicals much, much worse for them.

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But they won't take a medication
for a few weeks or months

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to stop smoking for the rest of their life.

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If we use nicotine replacement therapy
as an example, it allows people to deal

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with the addiction of nicotine, without having

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to inhale the other 7,537
chemicals in cigarettes.

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And that's what I worry about.

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People die, two full 747's of people a
week in Canada, from smoking, not nicotine.

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Nicotine replacement therapy
comes in multiple forms.

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And there is usually less nicotine
then what you get in a cigarette.

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You can put on a patch, which
is easy and discreet.

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You can chew gum, although in a
different way than you usually chew gum.

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You can suck on a lozenge
or you can use an inhaler.

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The patch gives you a nice baseline
nicotine level to lower your cravings.

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The latter three, offer the
advantage of flexible dosing,

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when you have a nicotine craving.

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And a familiar routine of opening packages
and putting something in your mouth.

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The important thing people need to know about
nicotine replacement therapy are, firstly,

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you can design your own nicotine program.

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You do not need a prescription.

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Prefer the patch and then the gum or lozenge
or inhaler for breakthrough cravings?

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Great. Maybe you smoke under
ten cigarettes a day

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and just want to use the gum when you need it.

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Your pharmacist can really help here.

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People get a bit confused with the cost.

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NRT is generally cheaper than smoking,
but you might be buying a month at once.

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Moneywise, of course, it's a no brainer.

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A pack a day is maybe $3,600 a year.

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imagine what you would do with that money.

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Imagine what you would do with
ten years of that savings.

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Secondly, with nicotine replacement,
you can stop cold turkey

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or you can wean down your smoking.

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Taking nicotine and smoking together,

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does not increase your risk of
heart attacks, smoking does.

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You probably started smoking gradually.

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And I guess the same can be true of stopping.

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If you feel you need another
month of NRT, then that's fine.

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I'm not going to go into details
of pills for smoking cessation.

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But I will give you a quick
overview of the two most known ones.

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The first is Zyban or bupropion.

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This started just as an antidepressant.

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And then users found their desire for smoking
dropped and they were able to quit more easily.

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Champix or Chantix, in the U.S., is varenicline.

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It is a newer option that may be even more
effective, but also has some side effects

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that may make it not for everyone.

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You can discuss these options with your
doctor or other healthcare providers.

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The counseling needs to be individualized.

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The final approach is the
behavioral interventions.

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I covered some of this ground, but I don't think
people realize how many fantastic resources are

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out there for them.

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Governments make a lot of
money from people who smoke.

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And they fell into superb programs.

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You want a text message, a supportive e-mail?

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You want expert counseling, want to
be connected with other people going

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through the same thing or
who have just been there?

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Or maybe you just want to talk to someone?

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Go online.

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Call the help line.

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Buy the book.

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Get the message.

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In the first months following
quitting, I want you to prepare

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for the roadblocks of risk and stress.

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So, avoid high-risk situations.

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You know what they are.

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You might want to tell the
people involved in advance.

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And then I want you to focus
on stress reduction.

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Stressful things are going to happen
to you, but you create the stress.

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Tell people, "Hey, I'm quitting
smoking this month."

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So, what's the least stressful
strategy that works.

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I also get people to think about the three A's.

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Avoid situations you know are stressful for you.

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Alter expectations.

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So, when you look at your
to do list, be realistic.

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Manage the expectations up
front before it's stressful.

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And the final A is acceptance.

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If we use driving as an example, traffic
jams, bad drivers and flat tires happen.

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Take a deep breath.

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Focus on what you can control.

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And accept what you can't.

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Now, let's say you quit smoking,
that's excellent.

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You've broken up.

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So, what now?

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Well, first of all, you're great.

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Secondly, there's going to
be some ups and downs.

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More ups, especially after you
get through the first month.

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But some of the things to expect with
nicotine withdrawal are cravings.

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And these don't follow a perfect line.

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Headaches, nervousness, irritability,
trouble sleeping.

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And you may want to eat more.

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So, have some healthy foods ready.

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And then also people tend to have more
of a cough, as their lungs self-clean.

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Finally, the Japanese have a
proverb that success is falling

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down seven times and getting up eight times.

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If you get derailed, don't feel guilty.

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As I said in the beginning, this is a journey.

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Come back and see us.

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This is the best thing I can do for you.

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Don't learn helplessness.

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Learn about yourself and get
ready for the next round.

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And thanks for listening.