WEBVTT 00:00:00.666 --> 00:00:03.546 >> Hi, I'm Dr. Mike Evans and I think quitting smoking is a journey. 00:00:04.106 --> 00:00:06.736 For some, it's a short journey full of resilience. 00:00:06.736 --> 00:00:11.116 But I think for most it's a long journey, a long affair, if you will, of quitting and relapse. 00:00:11.636 --> 00:00:14.856 A complicated relationship that can have as much to do with a person's relationship 00:00:14.856 --> 00:00:16.476 with themselves, as with the cigarettes. 00:00:17.386 --> 00:00:21.276 What starts as a pleasant sensation, an opportunity to rebel or even to belong, 00:00:21.966 --> 00:00:24.266 is replaced by less pleasure and a feeling of being trapped. 00:00:24.876 --> 00:00:29.016 A daily or hourly ride of nicotine withdrawal and then another cigarette, which brings relief. 00:00:29.806 --> 00:00:33.356 Most teens who smoke, think they will in their twenties and actually don't until their forties. 00:00:34.266 --> 00:00:38.516 Stopping smoking is about making a change and that is something we're not too good at. 00:00:38.516 --> 00:00:40.506 When I think of change, I think of two concepts. 00:00:40.626 --> 00:00:43.706 Where you are at and the mechanics of how we change. 00:00:44.296 --> 00:00:46.106 So, we should start where you are at. 00:00:46.306 --> 00:00:49.656 When I started medical school, I thought I could take somebody who smoked and convert them 00:00:49.656 --> 00:00:51.386 into a non-smoker in one fell swoop. 00:00:51.836 --> 00:00:52.886 Now I see it differently. 00:00:53.096 --> 00:00:55.226 I focus on where the person is at. 00:00:55.346 --> 00:00:57.246 You may be in what we call pre-contemplation, 00:00:57.846 --> 00:01:00.366 where you're not really even thinking about change. 00:01:00.876 --> 00:01:03.166 Approximately 75% of smokers want to quit. 00:01:03.586 --> 00:01:05.346 But 25% are not interested. 00:01:06.126 --> 00:01:09.336 Maybe you're at the contemplation stage, thinking about it, but not quite ready to act. 00:01:10.096 --> 00:01:11.216 Next is preparation. 00:01:11.686 --> 00:01:16.006 This is critical with smoking, especially in the likely event that you've tried to quit before. 00:01:16.146 --> 00:01:17.866 What has worked in the past and what hasn't? 00:01:17.976 --> 00:01:19.116 What caused the relapse? 00:01:19.746 --> 00:01:21.146 Maybe you're at the action stage. 00:01:21.686 --> 00:01:23.416 This is when you're ready to make your move. 00:01:24.346 --> 00:01:25.626 There's never a perfect time to quit. 00:01:25.626 --> 00:01:27.086 And at one point you just have to jump. 00:01:27.316 --> 00:01:29.906 I'll tell my patients, "Hey, it's going to be a challenge now 00:01:29.906 --> 00:01:31.336 and it's going to be a challenge in five years. 00:01:31.336 --> 00:01:32.326 So, why not do it now?" 00:01:32.566 --> 00:01:34.736 And then finally, there's the maintenance stage, 00:01:34.736 --> 00:01:37.176 where you become a non-smoker and are trying to stay that way. 00:01:38.526 --> 00:01:41.016 [cheers]. When we make changes it's critical to stop and think, 00:01:41.126 --> 00:01:42.716 how important is this change to me? 00:01:42.716 --> 00:01:45.216 And how confident am I in making this change? 00:01:45.596 --> 00:01:47.186 What we call your self-efficacy. 00:01:47.606 --> 00:01:48.716 Your job is to be honest. 00:01:48.716 --> 00:01:51.236 My job is to see if I can move your score towards ten. 00:01:53.876 --> 00:01:56.466 The second concept is about the different parts of change. 00:01:56.466 --> 00:01:58.076 So, there's the what. 00:01:58.576 --> 00:01:59.306 What are we changing? 00:01:59.506 --> 00:02:01.846 With smoking, I suppose it is straight forward, stopping. 00:02:02.586 --> 00:02:04.866 But if you think about it, you might be changing lots of things. 00:02:04.866 --> 00:02:06.896 And I think it is like a relationship breakup. 00:02:06.896 --> 00:02:09.196 You start by just keeping things simple and low risk. 00:02:09.196 --> 00:02:11.086 You might breakup your routine a little bit. 00:02:11.396 --> 00:02:12.766 Avoid certain places. 00:02:13.276 --> 00:02:15.616 Maybe use that juicer every morning to distract yourself. 00:02:15.866 --> 00:02:19.156 But you will need to change more than your smoking, to stop your smoking. 00:02:21.306 --> 00:02:22.336 The next is the why. 00:02:22.766 --> 00:02:23.426 Why change? 00:02:23.936 --> 00:02:26.376 I feel like I could do a ten-minute video just 00:02:26.376 --> 00:02:28.816 on all the medical reasons why not to smoke and they are legion. 00:02:28.816 --> 00:02:29.826 But I'm going to spare you. 00:02:30.056 --> 00:02:31.516 Partly because you already know. 00:02:31.706 --> 00:02:33.246 Partly because you don't need anymore guilt. 00:02:33.246 --> 00:02:36.776 And partly because in clinic, I actually spend more time asking people what they 00:02:36.776 --> 00:02:37.836 like about smoking. 00:02:38.096 --> 00:02:39.636 Which sounds funny, but I think we have 00:02:39.636 --> 00:02:42.476 to recognize there are positives or at least perceived positives. 00:02:42.476 --> 00:02:46.046 And I think it's important to reframe these perceptions, if we are to make a change. 00:02:46.046 --> 00:02:47.966 So, let's run through a few of the common ones. 00:02:48.746 --> 00:02:49.946 Cigarettes are my friend. 00:02:50.156 --> 00:02:51.086 They destress me. 00:02:51.306 --> 00:02:52.116 They relax me. 00:02:52.116 --> 00:02:55.576 Hmm, I'm not going to deny that you may feel a sense of relief 00:02:55.576 --> 00:02:57.316 and satisfaction, when you have a cigarette. 00:02:57.736 --> 00:02:58.896 But I see it a bit differently. 00:02:59.086 --> 00:03:00.326 You have a nicotine addiction. 00:03:00.716 --> 00:03:02.776 The nicotine in tobacco is highly addictive. 00:03:02.936 --> 00:03:06.946 Within a few seconds of inhaling, it travels to your brain causing you to have a temporary high. 00:03:07.756 --> 00:03:12.786 Over time, your brain changes, causing you to smoke more to get the same effect. 00:03:12.816 --> 00:03:15.486 We rate your addiction to nicotine with a few simple questions. 00:03:15.516 --> 00:03:17.436 Do you smoke more than 15 cigarettes a day? 00:03:17.576 --> 00:03:20.166 Or smoke within 30 minutes of getting up in the morning? 00:03:20.296 --> 00:03:23.576 Do you find it difficult to go more than four hours without a smoke? 00:03:24.346 --> 00:03:28.226 The power of nicotine comes from the repeated small doses you give yourself when you smoke. 00:03:28.896 --> 00:03:33.576 It may seem innocent at first, but if you take 15 puffs from a cigarette and smoke, say, 00:03:33.576 --> 00:03:36.376 20 cigarettes a day, that's 300 drug doses a day. 00:03:37.126 --> 00:03:39.436 You think smoking relieves your stress or is satisfying. 00:03:39.436 --> 00:03:40.376 But it actually isn't. 00:03:40.376 --> 00:03:43.056 The cigarette is just making your nicotine addiction go away. 00:03:43.666 --> 00:03:45.616 Smoking doesn't make your concentration better. 00:03:46.106 --> 00:03:48.576 It just calms your nicotine receptors cry for more. 00:03:49.616 --> 00:03:51.356 Smoking makes your heart beat faster. 00:03:51.456 --> 00:03:53.636 Increases blood pressure and breathing. 00:03:53.856 --> 00:03:56.446 These are all symptoms of stress, not stress reduction. 00:03:56.916 --> 00:03:57.766 Let me repeat that. 00:03:58.416 --> 00:04:00.946 The cigarette just reduces your nicotine stress, not your real stress. 00:04:05.926 --> 00:04:07.396 I've got a lot of trigger times. 00:04:07.936 --> 00:04:10.886 Coffee, sex, meals, certain people. 00:04:11.006 --> 00:04:13.476 Break times, telephone calls, the car. 00:04:13.726 --> 00:04:16.086 There are a lot of triggers you're going to have to prepare for. 00:04:17.016 --> 00:04:18.875 You got to change your coffee routine. 00:04:18.875 --> 00:04:21.005 Plan something to do right after meals. 00:04:21.076 --> 00:04:22.446 Throw out your car ashtray. 00:04:23.106 --> 00:04:25.976 I have no advice on sex, but make a plan for breaks 00:04:26.026 --> 00:04:28.136 or the telephone, with lots of distractions. 00:04:29.336 --> 00:04:32.586 Know that when you have a hunger or caffeine or other types of pangs, 00:04:32.586 --> 00:04:35.146 you also have a nicotine pang that needs to be satisfied. 00:04:35.506 --> 00:04:37.776 You have associated these, but they're actually separate. 00:04:38.526 --> 00:04:42.506 Alcohol and parties double the risk, as you have the association. 00:04:42.506 --> 00:04:45.086 Plus, you're imbibing something that intends to lower your resolve. 00:04:46.756 --> 00:04:47.996 I want something in my hand. 00:04:49.146 --> 00:04:52.126 Yes, you are making maybe 300 hand motions a day. 00:04:52.586 --> 00:04:57.006 You may need to replace this by chewing gum or chewing on a straw or a cinnamon stick. 00:04:57.006 --> 00:05:01.116 Or playing on your cellphone, to keep your hands busy, to replace this daily habit. 00:05:02.596 --> 00:05:03.376 I will gain weight. 00:05:04.946 --> 00:05:05.616 Yes, you might. 00:05:05.686 --> 00:05:08.106 But I think this is actually more marketing than reality. 00:05:08.106 --> 00:05:09.876 What I call the Virginia Slims effect. 00:05:10.496 --> 00:05:14.156 On average, people who quit, gain about 2.5 kilograms or five pounds. 00:05:14.696 --> 00:05:15.866 So, two thoughts on this. 00:05:16.266 --> 00:05:19.616 Firstly, if this is a concern for you, you might want to focus on strategies 00:05:19.616 --> 00:05:21.416 that affect calories in and calories out. 00:05:21.416 --> 00:05:24.006 Such as your new daily routines might focus on walking. 00:05:24.486 --> 00:05:27.126 A special emphasis on being mindful of emotional eating. 00:05:27.666 --> 00:05:30.546 Or that your hand mouth routine includes carrots or celery sticks. 00:05:31.096 --> 00:05:32.676 My second point is about perspective. 00:05:32.836 --> 00:05:35.906 A possible five pounds may be important from a vanity perspective. 00:05:36.336 --> 00:05:37.866 But from my doctor perspective, 00:05:38.076 --> 00:05:41.186 the health return is spectacularly higher, when you stop smoking. 00:05:41.986 --> 00:05:43.946 Remember, we said smoking was a relationship. 00:05:44.146 --> 00:05:46.646 Part of the healing of stopping a damaging relationship, 00:05:46.646 --> 00:05:48.216 is start a new healthy relationship. 00:05:48.766 --> 00:05:52.706 So, now it's the time to start a deeper relationship with your bicycle or salads 00:05:52.706 --> 00:05:55.586 or walking or gardening or your support of friends. 00:05:56.956 --> 00:05:58.026 Next is the how. 00:05:58.276 --> 00:06:00.206 What do the skills require to change? 00:06:00.206 --> 00:06:02.286 How do I change, with the emphasis on I? 00:06:03.306 --> 00:06:04.086 So, what works? 00:06:04.086 --> 00:06:05.596 Well, let's start with willpower. 00:06:05.906 --> 00:06:06.896 It's a strange word. 00:06:06.896 --> 00:06:11.016 On the one hand, it permeates behavior change and all of the interventions we talked about. 00:06:11.516 --> 00:06:14.026 It's also a word I don't love, as people see it as black and white. 00:06:14.026 --> 00:06:17.506 If a person succeeds, they have willpower and if they fail, they have no willpower. 00:06:18.076 --> 00:06:20.566 The science of willpower and smoking gives a mixed message. 00:06:20.566 --> 00:06:23.486 Approximately 5% of smokers who try to quit cold turkey, 00:06:23.486 --> 00:06:26.026 achieve prolonged abstinence for six to 12 months. 00:06:26.696 --> 00:06:29.486 With most relapsing in the first eight days of attempting to quit. 00:06:29.486 --> 00:06:32.706 And the other hand, most people who quit, do so unassisted. 00:06:32.736 --> 00:06:35.946 Maybe 2/3 to 3/4 of people do so by themselves. 00:06:36.786 --> 00:06:41.276 Reconciling these two stats reveal the natural history of smoking cessation, that quote, 00:06:41.526 --> 00:06:43.986 "failures" are part of this process. 00:06:43.986 --> 00:06:46.916 And can be seen as dress rehearsals for the eventual success. 00:06:48.686 --> 00:06:51.536 Another key pearl here is the data which tells us that a perception 00:06:51.536 --> 00:06:54.706 of the quitting smoking experience is often much darker than reality. 00:06:55.666 --> 00:06:58.696 In a British study of people who were surveyed about their quit experience, 00:06:59.046 --> 00:07:02.386 53% said that it was not at all difficult to stop. 00:07:02.996 --> 00:07:05.286 Twenty seven percent said it was fairly difficult. 00:07:05.286 --> 00:07:07.316 And the remainder found it very difficult. 00:07:07.606 --> 00:07:10.236 So, to summarize, you can do it by yourself. 00:07:10.236 --> 00:07:12.016 And it may be less difficult than you think. 00:07:12.356 --> 00:07:16.316 On the other hand, it looks like your chances are better if you layer on some other tactics. 00:07:16.316 --> 00:07:17.556 So, if you fail, try again. 00:07:17.556 --> 00:07:19.226 And think about adding another strategy. 00:07:20.476 --> 00:07:22.276 Some say there are two types of cigarettes. 00:07:22.276 --> 00:07:24.746 Those that are dealing with your nicotine addiction and those 00:07:24.746 --> 00:07:26.076 that have become part of a routine. 00:07:26.736 --> 00:07:28.996 So, let's see what works for both these types of cigarettes. 00:07:30.756 --> 00:07:33.226 Let's start with treatments that have not been proven affective. 00:07:33.676 --> 00:07:35.276 And where you may be wasting your money. 00:07:35.466 --> 00:07:37.736 Now, some of my patients have found they help. 00:07:37.736 --> 00:07:41.206 And to be honest, if they stop your smoking, I suppose I don't really care. 00:07:41.646 --> 00:07:45.156 But under this category I put laser therapy, acupuncture and hypnosis. 00:07:45.616 --> 00:07:49.276 When we compare these treatments to a placebo or just compare them to the quit rates 00:07:49.276 --> 00:07:51.536 on waiting lists, the rates don't appear to be improved. 00:07:52.266 --> 00:07:54.396 Next is medications to help stop smoking. 00:07:55.156 --> 00:07:58.666 The data shows that medications, especially when combined with behavioral support, 00:07:58.666 --> 00:08:00.306 can double your chance of success. 00:08:01.206 --> 00:08:03.246 Many patients are resistant, which I get. 00:08:03.666 --> 00:08:05.776 But I also see an irony in the fact that people are willing 00:08:05.776 --> 00:08:07.876 to inhale chemicals much, much worse for them. 00:08:08.276 --> 00:08:10.706 But they won't take a medication for a few weeks or months 00:08:10.706 --> 00:08:12.446 to stop smoking for the rest of their life. 00:08:13.406 --> 00:08:16.796 If we use nicotine replacement therapy as an example, it allows people to deal 00:08:16.846 --> 00:08:18.506 with the addiction of nicotine, without having 00:08:18.506 --> 00:08:22.366 to inhale the other 7,537 chemicals in cigarettes. 00:08:22.906 --> 00:08:24.106 And that's what I worry about. 00:08:24.266 --> 00:08:29.566 People die, two full 747's of people a week in Canada, from smoking, not nicotine. 00:08:30.906 --> 00:08:33.126 Nicotine replacement therapy comes in multiple forms. 00:08:33.126 --> 00:08:35.645 And there is usually less nicotine then what you get in a cigarette. 00:08:36.296 --> 00:08:38.306 You can put on a patch, which is easy and discreet. 00:08:38.306 --> 00:08:41.126 You can chew gum, although in a different way than you usually chew gum. 00:08:41.666 --> 00:08:43.866 You can suck on a lozenge or you can use an inhaler. 00:08:44.285 --> 00:08:47.396 The patch gives you a nice baseline nicotine level to lower your cravings. 00:08:47.676 --> 00:08:50.146 The latter three, offer the advantage of flexible dosing, 00:08:50.146 --> 00:08:51.426 when you have a nicotine craving. 00:08:51.826 --> 00:08:55.036 And a familiar routine of opening packages and putting something in your mouth. 00:08:55.546 --> 00:08:59.736 The important thing people need to know about nicotine replacement therapy are, firstly, 00:08:59.736 --> 00:09:01.436 you can design your own nicotine program. 00:09:01.786 --> 00:09:03.016 You do not need a prescription. 00:09:03.476 --> 00:09:07.166 Prefer the patch and then the gum or lozenge or inhaler for breakthrough cravings? 00:09:07.166 --> 00:09:09.706 Great. Maybe you smoke under ten cigarettes a day 00:09:09.706 --> 00:09:11.256 and just want to use the gum when you need it. 00:09:11.846 --> 00:09:13.606 Your pharmacist can really help here. 00:09:14.286 --> 00:09:16.036 People get a bit confused with the cost. 00:09:16.036 --> 00:09:19.686 NRT is generally cheaper than smoking, but you might be buying a month at once. 00:09:20.526 --> 00:09:22.226 Moneywise, of course, it's a no brainer. 00:09:22.226 --> 00:09:24.706 A pack a day is maybe $3,600 a year. 00:09:25.366 --> 00:09:26.886 imagine what you would do with that money. 00:09:26.886 --> 00:09:29.526 Imagine what you would do with ten years of that savings. 00:09:30.396 --> 00:09:34.056 Secondly, with nicotine replacement, you can stop cold turkey 00:09:34.056 --> 00:09:35.766 or you can wean down your smoking. 00:09:36.326 --> 00:09:37.876 Taking nicotine and smoking together, 00:09:37.876 --> 00:09:40.736 does not increase your risk of heart attacks, smoking does. 00:09:40.736 --> 00:09:43.216 You probably started smoking gradually. 00:09:43.216 --> 00:09:45.176 And I guess the same can be true of stopping. 00:09:45.616 --> 00:09:48.126 If you feel you need another month of NRT, then that's fine. 00:09:48.126 --> 00:09:51.376 I'm not going to go into details of pills for smoking cessation. 00:09:51.376 --> 00:09:53.906 But I will give you a quick overview of the two most known ones. 00:09:54.296 --> 00:09:56.126 The first is Zyban or bupropion. 00:09:56.796 --> 00:09:58.436 This started just as an antidepressant. 00:09:58.436 --> 00:10:01.896 And then users found their desire for smoking dropped and they were able to quit more easily. 00:10:02.486 --> 00:10:06.046 Champix or Chantix, in the U.S., is varenicline. 00:10:06.046 --> 00:10:10.296 It is a newer option that may be even more effective, but also has some side effects 00:10:10.296 --> 00:10:11.866 that may make it not for everyone. 00:10:12.566 --> 00:10:15.386 You can discuss these options with your doctor or other healthcare providers. 00:10:15.386 --> 00:10:17.076 The counseling needs to be individualized. 00:10:17.926 --> 00:10:20.066 The final approach is the behavioral interventions. 00:10:20.066 --> 00:10:24.856 I covered some of this ground, but I don't think people realize how many fantastic resources are 00:10:24.856 --> 00:10:25.536 out there for them. 00:10:26.186 --> 00:10:28.566 Governments make a lot of money from people who smoke. 00:10:28.566 --> 00:10:30.356 And they fell into superb programs. 00:10:30.596 --> 00:10:32.616 You want a text message, a supportive e-mail? 00:10:32.956 --> 00:10:35.486 You want expert counseling, want to be connected with other people going 00:10:35.486 --> 00:10:37.756 through the same thing or who have just been there? 00:10:38.496 --> 00:10:39.916 Or maybe you just want to talk to someone? 00:10:40.266 --> 00:10:40.926 Go online. 00:10:41.086 --> 00:10:41.936 Call the help line. 00:10:42.036 --> 00:10:42.606 Buy the book. 00:10:42.646 --> 00:10:43.456 Get the message. 00:10:44.016 --> 00:10:46.676 In the first months following quitting, I want you to prepare 00:10:46.676 --> 00:10:48.546 for the roadblocks of risk and stress. 00:10:49.206 --> 00:10:51.056 So, avoid high-risk situations. 00:10:51.206 --> 00:10:51.956 You know what they are. 00:10:52.276 --> 00:10:54.596 You might want to tell the people involved in advance. 00:10:54.976 --> 00:10:57.026 And then I want you to focus on stress reduction. 00:10:57.626 --> 00:11:00.456 Stressful things are going to happen to you, but you create the stress. 00:11:01.076 --> 00:11:03.546 Tell people, "Hey, I'm quitting smoking this month." 00:11:03.546 --> 00:11:05.726 So, what's the least stressful strategy that works. 00:11:06.106 --> 00:11:08.416 I also get people to think about the three A's. 00:11:08.986 --> 00:11:11.136 Avoid situations you know are stressful for you. 00:11:12.136 --> 00:11:13.476 Alter expectations. 00:11:13.586 --> 00:11:15.716 So, when you look at your to do list, be realistic. 00:11:15.986 --> 00:11:18.416 Manage the expectations up front before it's stressful. 00:11:18.716 --> 00:11:20.506 And the final A is acceptance. 00:11:21.386 --> 00:11:26.316 If we use driving as an example, traffic jams, bad drivers and flat tires happen. 00:11:26.316 --> 00:11:26.946 Take a deep breath. 00:11:27.466 --> 00:11:28.796 Focus on what you can control. 00:11:28.796 --> 00:11:30.806 And accept what you can't. 00:11:31.216 --> 00:11:33.886 Now, let's say you quit smoking, that's excellent. 00:11:34.256 --> 00:11:34.886 You've broken up. 00:11:34.886 --> 00:11:36.246 So, what now? 00:11:36.706 --> 00:11:38.086 Well, first of all, you're great. 00:11:38.656 --> 00:11:41.296 Secondly, there's going to be some ups and downs. 00:11:41.296 --> 00:11:43.446 More ups, especially after you get through the first month. 00:11:43.516 --> 00:11:46.716 But some of the things to expect with nicotine withdrawal are cravings. 00:11:46.716 --> 00:11:48.626 And these don't follow a perfect line. 00:11:49.336 --> 00:11:52.246 Headaches, nervousness, irritability, trouble sleeping. 00:11:52.246 --> 00:11:53.546 And you may want to eat more. 00:11:53.546 --> 00:11:54.916 So, have some healthy foods ready. 00:11:54.916 --> 00:11:58.686 And then also people tend to have more of a cough, as their lungs self-clean. 00:11:59.566 --> 00:12:03.576 Finally, the Japanese have a proverb that success is falling 00:12:03.576 --> 00:12:05.496 down seven times and getting up eight times. 00:12:06.186 --> 00:12:07.826 If you get derailed, don't feel guilty. 00:12:08.396 --> 00:12:10.436 As I said in the beginning, this is a journey. 00:12:10.656 --> 00:12:11.666 Come back and see us. 00:12:11.816 --> 00:12:13.466 This is the best thing I can do for you. 00:12:13.996 --> 00:12:15.016 Don't learn helplessness. 00:12:15.016 --> 00:12:17.006 Learn about yourself and get ready for the next round. 00:12:17.976 --> 00:12:18.816 And thanks for listening.