Chapter 14

Assessing Your Readiness and Motivation to Quit

IN THIS CHAPTER

Bullet Looking at stages of change

Bullet Knowing the stage you’re in

Bullet Moving through the stages

You’ve made the decision that it’s time to quit smoking, using smokeless tobacco, or vaping. Or you’re at least curious and considering the possibility, or you wouldn’t be reading this book. It’s possible you’re reading this book to help someone you care about — if so, that’s great, too. This material can help you help your loved one.

In this chapter, we tell you about the stages of change. These stages have been identified and researched over a few decades. They help people understand where they are in the process of quitting and recovery from addictions. Next, we help you figure out where you stand and how to move through the stages. Finally, if you’re ready, we move you to the step before quitting — declaring your intention, firmly — to yourself and most likely other people in your life.

Knowing How the Stages of Change Work

Sometimes ideas in psychology make such common sense or are so practical that they become a part of the popular narrative. The Stages of Change model is one of those theories that are currently applied to many aspects of behavior change, including smoking, weight control, drug abuse, and emotional problems ranging from anxiety to anger.

When people are faced with a challenging behavior or habit, such as smoking or vaping, they face a series of decisions about what to do. The Stages of Change model reflects the current thoughts, feelings and behaviors of a person’s readiness to engage in changing behavior. The following sections describe the characteristics of people at each level in the Stages of Change model as it relates to smoking.

Initially proposed by Drs. James O. Prochaska and Carlo C. DiClemente, the model for Stages of Change has been updated and changed based on new research. For example, an addition of relapse has been proposed and the last stage, termination (the sixth stage), is often left off. For our purpose, we describe a six-stage model that includes termination, but not relapse — which we talk about in great detail in Chapter 19. This basic stage model has been rigorously studied and has remained robustly consistent.

Take as much time as you need in each stage of change. There’s no need to rush moving ahead before you’re ready.

People do not necessarily start at the precontemplation stage and move smoothly up to the maintenance stage. It’s perfectly normal to bounce around going up or down over time. That’s especially true of smokers who normally have multiple quit attempts before succeeding.

Stage 1: Precontemplation

Smokers in the precontemplation stage are not even thinking about quitting smoking. They usually don’t consider their behavior a problem. They have no intention of quitting in the near future. Smokers in this stage are pretty much not concerned about health risks, costs, secondhand smoke, or lost time from smoking. They’re smokers, and that’s the way they like it. Someone in the precontemplation stage would be likely to say or think things like the following:

I know someone who smoked for over 50 years and lived to be 92 — why can’t that work for me?
I plan to smoke until the day I die.
Life without smoking isn’t worth it.
I know my smoking is a problem, but I don’t want to do anything about it.
I don’t worry about my smoking — it’s just not an issue.

Stage 2: Contemplation

Many smokers are in the contemplation stage. They haven’t had their heads buried in ashtrays; they know that smoking is unhealthy. They see what they pay for cigarettes every week and how much time they waste on their habits. They have a sense that is growing over time that something may need to be done about their smoking but have no plan to accomplish it.

Contemplators feel ambivalent or unsure about quitting smoking. They know they should quit, but they don’t really want to go through the discomfort. Quitting is hard; they may have tried and failed in the past. Smokers in this stage can definitely see themselves quitting in the future, and actually hope to quit, but the future is, well, down the road. They may plan on quitting in the next six months or so, but six months may just be a rolling timeline. Someone in the contemplation stage would be likely to say or think things like the following:

I often think about stopping smoking, but I haven’t done much about it lately.
I enjoy smoking, but I do worry about what it will do to me.
Sometimes I think I really do have to stop smoking, but I don’t know if I can.
I’ve come to realize my smoking hurts or at least bothers others.

Stage 3: Preparation

We imagine that quite a few readers of this book are in the preparation stage, starting to prepare for change — in other words, planning how to quit. You see that smoking is bad for your health and bad for your pocketbook, and the pain of quitting seems almost manageable. You’re ready to take some steps to move forward with your own quit plan. You may even have cut back a few cigarettes or contemplated substituting something less dangerous (see Chapter 12).

You’re getting ready to set a quit date (see Chapter 16). You may be giving thought to making an appointment with your primary care provider to talk about nicotine replacement therapy (NRT) or medication to help manage your cravings. You may be lining up people in your social sphere who could join with you to provide a support system. And perhaps you’ve been wondering what triggers will be most difficult for you to deal with — possibly even planning for how you’ll manage them successfully.

In the preparation stage, you may be worried about taking a chance on changing and not being successful. What will others think? Don’t worry, that’s a typical part of this Stage of Change. It’s good that you’re a bit worried! It will help push you to make a complete plan before moving ahead to the next stage. Someone in the preparation stage would be likely to say or think things like the following:

Tomorrow I have an appointment with my doctor to review my options on quitting smoking.
I’m starting to read about how people manage to quit smoking.
I’m making a list of all my triggers for smoking.
I’ve decided that my quit date is going to be in two weeks — scary!

Stage 4: Action

The quit date is here. Now, the hard work begins. The action stage incorporates all the strategies necessary to get through the first day, month, and year of quitting. NRT or medication is already onboard to help with urges if it’s part of the quit plan.

People in the action stage may have stopped or reduced smoking. They’re learning to deal with smoking triggers by avoiding, changing, or handling them with new healthier strategies. They may have new concerns about gaining weight, irritability, or difficulty sleeping. These issues are additional problems that may need to be addressed.

During the action stage, there is considerable emotional energy spent handing the many urges and cravings that come with quitting. Vigilance is required because the worst urges are those that come by surprise. Temptations are still difficult, and the possibility of relapse always looms over the horizon.

The early weeks of the action stage are the most difficult. That’s evidenced by data indicating that most quitters relapse within a week of quitting.

Someone in the action stage would be likely to say or think things like the following:

I stopped drinking coffee at home in the morning because it’s a trigger for me to smoke.
I cleaned my house with a fine-toothed comb and worked to get rid of the smoke smell.
I review my coping with triggers plan every single day.
I quit two weeks ago, but I think it’s going to be really hard to hang out with my friends this weekend without smoking.
I made it through my first week of not smoking — yeah!

Although most people who relapse do so early, the risk of relapse continues for weeks, months, and sometimes years for many smokers. It’s doable, but constant attention is needed. In almost all cases, a single cigarette conveys a surprising degree of risk for relapse.

Step 5: Maintenance

Some people trying to quit don’t make it to this stage and will need to try again. However, after about six months of nonsmoking, most of those who have succeeded in quitting enter the maintenance stage of change. These individuals have learned to adapt to a new, nonsmoking life. Urges and cravings have faded and occur relatively few and far between. New, healthier ways of dealing with what used to be smoking triggers have emerged as new, better habits. Someone in the maintenance stage would be likely to say or think things like the following:

Occasionally, I get tempted to smoke, but it’s way better than it was.
I feel so much healthier since I stopped smoking.
It feels great to save the money I used to throw away on cigarettes.
I know I can’t go back to smoking, although I get a few urges here and there.
Now that I don’t smoke, I have lots of time to do other things I’ve wanted to do, like go to the gym.

The good news? Risk of relapse has decreased significantly in this stage of change. The bad news? The risk of relapse remains lurking for some time to come. More good news: Many people in the maintenance stage cope with a relapse by taking new actions to quit. That’s because they have more confidence, knowing they’ve done it before and can do it again. But don’t take that bit of information as permission to have only a few. If you do have a lapse, slam the brakes on as soon as you can.

Amir was a smoker for 20 years. He quit almost one year ago and firmly believed he was in the maintenance stage of change. However, one evening changed that. See the nearby sidebar for his story.

A FEW CIGARETTES DOESN’T MEAN IT’S OVER

Amir gets a text while waiting for his train home. It’s from his sister-in-law, who rarely texts him. He reads the following about his wife: “Meet at ER. Aliya in car accident. Don’t worry. Think she’ll be okay.”

Frightened, he texts back, “What do you mean you think she’ll be okay? What happened?”

She replies, “Doc said possible concussion. Unconscious now. Needs CT scan.”

Forty-five minutes later, Amir jumps from a cab racing into the ER waiting room. His sister-in-law greets him with a hug. “We’re still waiting for the results,” she says.

“Where is she? I want to see her now,” he demands. The nurse at the desk explains that Aliya needs an MRI and that he can’t go back yet. He paces around the room for 20 minutes and notices someone going outside for a cigarette. Amir follows him out and bums his first cigarette in almost a year.

Times of extreme stress, as seen in Amir’s story, often lead to lapses. That’s pretty understandable. Amir buys a pack of cigarettes at a corner drugstore and continues to smoke for the rest of the day. Then he realizes what he’s doing and that Aliya won’t be happy to hear he’s smoking again. He recommits to his quit plan and throws the rest of the cigarettes in the trash.

Amir was lucky to see where he was headed. He was also lucky because his wife was fine. He went from the maintenance stage to the precontemplation stage in a short time (only a few hours). For those few hours, he had no desire to stop and wasn’t thinking about pros or cons of smoking. However, he caught himself and flipped back into the action phase of quitting and soon moved back into the maintenance stage.

Stage 6: Termination

Stages of change models usually include a termination phase, but because relatively few people get there, it’s sometimes dropped from the model. This stage refers to those fortunate people who’ve maintained their nonsmoking status for so long that they experience virtually no temptations any longer.

They feel confident that they’ll never relapse, even under extreme stress. They no longer have any conscious desire to smoke. They don’t pay much attention to cigarette ads or smoking triggers, both of which cause no trouble for these people. Someone in the termination stage would be likely to say or think things like the following:

Smoking feels like ancient history to me.
I would never consider smoking again and haven’t thought about it for a year or more.
I can’t imagine I ever used to smoke — I can barely remember what it felt like.
It doesn’t bother me to be around smokers anymore, although I really kind of hate the smell.

Relatively few smokers reach the termination stage of change. But that’s okay, because they find life in the maintenance stage just fine. Yes, they still have some urges and cravings, but they know they can manage them. Yet they remain a bit vigilant for years. In other words, they’re optimistic and hopeful, tempered with a bit of realism at the same time.

KNOWING HOW THE STAGES INTERACT

People don’t always go through the stages in a straight-line manner from precontemplation to preparation to action, to maintenance, and finally, termination.

For example, someone could be in the precontemplation stage, not even thinking about quitting. Then, boom, a longtime friend is diagnosed with lung cancer. The smoker immediately jumps into the action stage and quits. The quit decision lasts for three days; then, boom, the person goes back to the precontemplation stage. The plan didn’t work because there were no contemplation and preparation phases to smooth the path.

In another example, imagine someone who smoothly moves from precontemplation to contemplation to preparation and then to action, getting to the maintenance phase. Then the attempted quitter loses focus and decides she’s done with smoking forever. She thinks she doesn’t need to worry about triggers. But she falls off the wagon and goes back to square one, precontemplation. That’s because she ignored a previous serious trigger and went back to a bar to meet some friends. She had a few drinks, her friends lit up, and she had no plan for dealing with that major set of triggers. So, she started smoking again. See Chapter 19 for more information about lapses and relapses.

Other relapsers go from the action stage to preparation when they relapse for a while. Other people who relapse go from action to contemplation, intending to take a break from quitting for a while.

Remember: There’s no precise right way to go through the stages of change. But it’s usually a good idea to spend enough time in each stage to properly prepare for the next.

Identifying What Stage of Change You’re in Right Now

You can probably guess that it wouldn’t hurt to know what stage you’re in currently. You’re right! You may already know. If not, read over our descriptions of each stage (earlier in this chapter) and ask yourself which one fits you the best at this time. Realize, your status could change, and you may even feel a bit of two stages at once.

After you’ve decided which stage you’re in, you can concentrate on moving up one level at a time to combat your smoking or vaping addiction. Each stage can be thought of as a springboard to progress onto your next step. Start at the stage you’re currently in and answer the questions listed for that particular stage. Be thoughtful and thorough. Take your time:

Precontemplation: How do you feel about smoking? Have you ever wondered about your health and smoking? What do you think other people around you think about smoking and health? Was there ever a time in your life when you didn’t smoke? If so, what was that like for you? What could get you to think about quitting smoking?
Contemplation: What do you think is getting in your way of quitting smoking? Are there things you could do to make it easier for you to stop? If so, what? Have you ever experimented with cutting back or stopping for a short time? If so, what did you do? If you were a smoker a year from now, what would that look like?
Preparation: Do you feel you know enough about the best ways to quit smoking? If not, where can you get that information? When (if) you’ve quit in the past, what got in your way? What plans have you made to manage triggers and cravings? Who could support you in your quit effort? What are your most problematic triggers for smoking?
Action: How have you gotten through your first day? Week? Month? What are the best things you’ve done to manage your cravings? How much money have you saved so far? Do you know that after a day of not smoking, you’re already getting health benefits? Do you know what those benefits are? What’s working for you and what’s been more difficult?
Maintenance: Congratulations! How are you feeling about smoking and not smoking today? How are you handling occasional triggers? Are you adding up the health benefits as the months go by? What are they? What helped you get where you are today?
Termination: What advice would you give to other smokers who are struggling with addiction? Do you think you’re in a better place without cigarettes? Do you feel that your cravings have become almost nonexistent? What’s the best thing about being a nonsmoker?

Spend some time reflecting on the answers to the questions in the stage that you’re in currently. Now, how do you feel about moving on to the next stage? Do you feel there’s light at the end of the tunnel?

Millions of people move successfully through the Stages of Change to become nonsmokers. You can also use the model to help you meet other life challenges.

DECIDING WHAT TO DO IF YOU’RE JUST NOT READY

What happens if you’ve read through the Stages of Change and you decide that you’re not ready to give up smoking, using smokeless tobacco, or vaping? Maybe you’re reading this material because someone who cares about you suggested it (or nagged you until you agreed to give it a try). And now that you’re reading it, you still don’t want to change.

Well, guess what? That’s okay. Because we’d like all our friends and readers to be healthy, we’re a bit sad. But somewhere along the road, we’ve learned that you can lead a horse to water … you know the rest.

If you aren’t ready, give yourself a big pat on the back for getting this far. You obviously feel that, for right now, the positives you get from smoking outweigh the negatives. But that may change. You probably wouldn’t be reading this unless you had at least a little doubt, a small feeling somewhere in the back of your head that you’re going to have to face this battle one way or another.

So, when and if that time comes — that the negatives of smoking are beginning to outweigh the positives for you — remember that there are resources, like this book. And all the tools we present here can make your challenge just a bit easier. Good luck, and don’t forget that you can always change your mind!

Oh, and one more thing: Just for fun, try going back and skimming through Chapter 8. Or, review the next section — you’ve got nothing to lose by taking a glance. And it won’t take too long. Something there just may catch your attention. Really, it’s totally up to you.

Deciding Your Intent

Perhaps you’re still not sure what stage you’re in. Or maybe you know, but you’re not sure you’re ready for the next stage. We have an exercise to help clarify your own intentions. After completing it, you may find yourself closer to a decision about what comes next for you. We mostly recommend this exercise for those who think they’re in the precontemplation or contemplation stages of change. Here’s how you can illuminate what your current stand on your smoking decision is with the Smoking/Quitting Clarifier:

Take a piece of paper and divide it into a box with four quadrants.
Label the upper-left quadrant “Why I Like to Smoke.”
In the upper-left quadrant, list every idea you can come up with.

When you’re done, leave it for a while and go back again — see if you can come up with more reasons you like to smoke.
Label the upper-right quadrant “Why I Really Don’t Want to Smoke.”
In the upper-right quadrant, list every idea you can come up with, no matter how small.

When you’re done, leave it for a while and go back again — see if you can come up with more reasons you don’t want to smoke.
Label the lower-left quadrant “Things That Make Quitting Hard.”
In the lower-left quadrant, list every idea you can come up with.

When you’re done, leave it for a while and go back again — see if you can come up with more things that make quitting hard.
Label the lower-right quadrant “Reasons I’d Like to Quit.”
In the lower-right quadrant, list every idea you can come up with.

When you’re done, leave it for a while and go back again — see if you can come up with more reasons you’d like to quit.
When you finish, read what you’ve written.

Consider reading it out loud with some emotion — as though you’re talking to someone else. Read it out loud again while checking in on how you feel when arguing each side. Your feelings will inform you about where you’re headed for now.

You may find this exercise a bit redundant. That’s okay. We want you to come up with all the reasons on both sides of the argument. There’s a subtle difference between wanting to smoke and not wanting to quit. Don’t worry if many of your responses overlap.

GETTING CLEAR ON YOUR FEELINGS

Nicholas had mixed feelings about quitting his smoking habit. Several years ago, he’d decreased his smoking from two and a half packs per day to one pack per day. He felt good about that but wasn’t sure he was ready to quit completely. He now knows he’s at the contemplation stage of change. Now he uses the Smoking/Quitting Clarifier to figure out what’s next. Here’s what he came up with:

Nicholas carefully ponders his Smoking/Quitting Clarifier. Later, he even goes back and adds more items. He tries reading the Smoking/Quitting Clarifier out loud to his wife. She’s thrilled!

Nicholas decides that he’s ready to start making plans for his quit day after reading his responses. He’s always known logically that he should quit, but now he senses that his feelings are in line with his logic. He concludes that he’s ready to move from the contemplation stage of change to the preparation phase.

It’s not just about the number of reasons in each quadrant, but the actual importance of these reasons to you. Highlight the most important items.

Writing down what’s been rattling around in your head may feel a bit silly or unnecessary. But our decades of practice have informed us that getting thoughts and perspectives on paper increases the power of commitment. It really works. Try it! What have you got to lose?

The decision about quitting or continuing with smoking, vaping, or smokeless tobacco is yours and yours alone. The information in this chapter is designed to help you know what you want at this moment, and to show you that what you want may change over time.