Addendum
Dr. Jennings’s Smoking-Cessation Strategy

If you or someone you know is struggling to stop smoking, following are some simple steps that can help you or them break free from nicotine’s grasp.

1. Stop caffeine. In the brain caffeine causes a neurobiologically increased craving for nicotine. Therefore, drinking caffeinated beverages increases the craving for cigarettes and makes it more difficult to quit smoking. If you have been drinking more than six caffeinated beverages per day, taper down by two drinks per day until off the caffeine. This taper will minimize caffeine-withdrawal headaches and fatigue. Plan to stop smoking after the caffeine has been eliminated. (Once you are cigarette free for a month, you can cautiously reintroduce one to two caffeinated beverages per day if you desire. However, be prepared to experience sudden nicotine cravings.)
2. Avoid alcohol. Alcohol causes a neurobiologically increased craving for nicotine, just as caffeine does, but alcohol also interferes with the functioning of the prefrontal cortex. This means it undermines judgment, resolve, and willpower, and the combined effects of increased cravings and diminished willpower typically lead to relapse of smoking. (If you are a social drinker you can reintroduce an occasional alcoholic beverage once you are tobacco free for one month, but be prepared for the potential onset of nicotine cravings.)
3. Set a date. Set a date for your last cigarette and stick to it. When the date comes, get rid of all your cigarettes, ashtrays, and smoking paraphernalia.
4. Identify triggers and replace. Smoking is not only a physical addiction; it is also a psychological one—a conditioned response. Smokers have certain habits or times in which they routinely smoke. These habits will trigger a craving for a cigarette. For instance, a smoker who has the habit of smoking when he gets into the car will experience a desire to smoke whenever he gets into the car. If the habit is smoking after a meal, then anticipate a craving for a cigarette after each meal, or after a shower, and so on. Sometimes triggers can be emotional such as smoking when angry or frustrated. Take an inventory of your habit patterns and recognize your triggers, and then either avoid them (if possible) or plan a replacement, such as popping a Tic Tac or chewing gum instead of smoking.
5. Join forces. If your spouse smokes and is willing to stop, then team up together and implement a smoking-cessation plan jointly. Encourage each other during this process. If your partner doesn’t smoke, solicit their involvement as your coach and partner to encourage, praise, and support you during this time.
6. Exercise. Exercise not only improves cardiovascular health, resulting in improved lung function, but also results in the production of brain chemicals (endorphins and enkephalins) that reduce cravings. If you haven’t been exercising, start with easy exercises and go slowly to avoid injuries. Also, check with your primary care physician if you have any health problems that could preclude exercise.
7. Take charge of your imagination. Within a few hours of the last cigarette, a smoker will typically experience cravings. This is often the turning point in the battle to be free of smoking. If you are not prepared when the cravings hit, the desire will grab hold of you and you may begin to imagine things, such as the familiar sound of opening a pack, the feel of the flick of the lighter, the smell of the smoke, and the taste of the tobacco. Such imaginary events fuel greater cravings, undermine resolve, and typically result in a relapse into smoking. One way to avoid this is to be prepared to take purposeful charge of the imagination. When the cravings come, imagine pulling a flip-top box of cigarettes out, opening the top, and seeing cockroaches come crawling out on your hand, or imagine it is filled with maggots wiggling around. Use an imagery that will cause an emotion of revulsion and disgust.
        Genuine victory over an addiction is not achieved by gaining more facts about the harm of the habit. Smokers don’t need more education on cancer risks or heart disease risks. In order to be genuinely free, a smoker (or any addict) must experience a change in the way they feel about their addiction. When a smoker thinks of smoking, they usually experience some positive emotion, “yeah,” “that’s nice,” or “oh that’s good,” what is commonly called a warm fuzzy. Warm fuzzies need to be replaced with emotions of revulsion. What emotion would you experience if someone offered you a fresh bowl of dog feces with a spoon? As the smell wafted up toward you, would you experience revulsion? If you had the same emotional response toward smoking, what would be the chances you would put one in your mouth? You have the power to imagine cigarettes in some way that engenders revulsion rather than a warm fuzzy. Do it!
8. Drink plenty of water and fresh juices. For the first week (at least), be sure to flush your system with plenty of water and fresh fruit juice as this will help remove toxins, free radicals, and other damaging products caused by smoking.
9. Buddy up. Solicit a close friend to be your buddy during the first week of the cessation process. If during this time a craving comes that seems more than you can handle, call your buddy to talk you through it. Tell your buddy why you need them and what their role is, and get their permission to call anytime day or night for that week. Cravings come in waves—if you resist, the craving will pass. The craving will return later but if resisted will pass again. Over the course of the first week cravings will get weaker and weaker until they remit for good. The physical withdrawal from nicotine lasts only a week; if you can make it past seven days, the physical portion will be over. It will then be a matter of changing habit patterns, thought processes, and feelings about the addiction.
10. Pray. Don’t forget the power of prayer. Ask God into your heart and mind and obtain his strength each day. Be thoughtful toward him and call on him anytime throughout the day or night. Ask God to change your desires, strengthen your willpower, diminish the cravings, and enhance your mind’s ability to think clearly. Ask friends and family to lift you up in prayer, especially during the first week, soliciting special intervention to help during this time. But remember, God will not send an angel from heaven to snatch the cigarette from your mouth. You must willfully choose to say no in order to receive God’s power to succeed.
11. Clean everything. Clean car, rugs, clothes, curtains, windows—get the smell of tobacco out of your life and bring in a clean freshness to start your new healthy living.
12. Avoid mental games. Don’t tell yourself, “I am going to quit—unless I have a really bad day” or “This is my last cigarette—unless I feel overwhelmed.” Such thinking leaves an escape clause from total cessation, and most people will unconsciously create the necessary circumstances in which to exercise their secret escape clause. Be real with yourself. When you decide to quit tell yourself that it doesn’t matter how bad it gets, you are not smoking again. No escape clauses!
13. Remind yourself the reasons for quitting. Make a list of all the benefits for quitting. This would include health, monetary savings, and no more hassles finding a place to smoke. But even more important, remind yourself of all the loved ones whom you will be benefiting. You will increase the likelihood of being there when your daughter graduates, your son gets married, your first grandchild is born, as well as no longer exposing your loved ones to secondhand smoke. Remind yourself of all the additional joy you will have in life. Write this list down, put it in your wallet, and when discouraged pull it out and look at it. Maybe put it near a picture of your spouse or child. They will be proud of you!
14. Consider nicotine gum or patches. Nicotine gum or patches should not be used if still smoking as both together could cause lethal doses of nicotine. Nicotine gum and patches continue to supply the brain with nicotine so the physical addiction will not be resolved until all sources of nicotine are removed. However, for some individuals the nicotine gum or patch allows them time to break the psychological triggers and smoking habit pattern, clean their house, and then taper off the gum or patch, finally quitting all of it. This is not necessary for everyone but does help many.
15. Consider medications. There are a variety of prescription medications available to assist with smoking cessation. Consult with your doctor to see if any of these might be helpful during this time. However, medications are not a substitute for all the steps above, and medications do not magically remove a smoking addiction. Medications can, for some persons, reduce the intensity of the physical cravings—that is all. They do not break habits, they do not change the imagination, they do not remove toxins from the body, and they do not instill a revulsion for tobacco. If medicine is used as an additional aid to stop smoking, the smoker will still be required to actively choose to put the cigarettes down, change habits, and implement all the steps above.