Quitting

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This section will give you a broad overview of some of the issues you need to think about when you talk to people about quitting and is based on information contained in our Talkin’ Up Good Air: Indigenous Tobacco Control Resource kit. This section also has further information which you may find useful and is available for download by clicking on the link below. We have also included lots of links to quitting resources and websites as well as links to other information on this website.


Download Section 3: Helping people quit the smokes	Go to Talkin' Up Good Air download page

On this page:

Getting started
Nicotine: A hard habit to break
Breaking the cycle of addiction
The 5 Stages of change in tobacco smoking
Triggers for lighting up
Triggers for quitting
Withdrawal and cravings
Ways to quit
Talking to people about quitting

Getting started

Getting people to think about their smoking is the first step to change. Let them know what’s in the smokes if they don’t know already, what they are in for when they give up – both the good things AND the not so good things. Concentrate on the good things but don’t leave out the not-so-good things.

To find out more on this website about Tobacco and its effects go to:

Smoking and health section:

Indigenous smoking facts and figures:

Nicotine: A hard habit to break

Cigarettes and other forms of tobacco are addictive because they contain nicotine. Nicotine is found naturally in tobacco plants and when tobacco is chewed or smoked, the nicotine sets of chemical or biological changes in the brain, altering the mood of the smoker. Nicotine makes smokers want to keep smoking.

When a smoker first starts to smoke they do so at social gatherings or when they feel angry or down. In relaxed situations, smoking can perk up a person’s mood, while in stressful times smoking can have a calming effect. Before long, smokers find their day is organised around smoking. They feel anxious when they feel like a smoke and can’t have one. After a while the body gets used to nicotine, so that the smoker starts smoking more.

See also: Quit Victoria's fact sheet on Addiction

Many smokers go through nicotine withdrawal symptoms when they stop smoking. Smokers who are addicted to nicotine have a few tell-tale signs:

smoke within 30 minutes of waking up;
smoke mote than 10 cigarettes a day; and
experience withdrawal symptoms when trying to quit.

Knowing a smokers level of nicotine dependence will help you work out the best way to help your client quit. Most people who attempt to quit take several attempts before they are quit for good, so it is important to help them to keep on trying. Focus on the positives and what they have learned form quitting in the past and how to use it next time.

For a list of questions to help you work out a smoker’s level of nicotine dependence see the Fagerstrom Test for Nicotine Dependence.

Breaking the cycle of addiction

Most smokers have been told many times that they should quit smoking but it is up to them as to whether or not they continue to smoke. They will often know many of the bad things about smoking but believe the good things outweigh the bad or it is just ‘too hard’ to quit. It is therefore important to get them to really think long and hard about the good things versus the bad things about smoking so that they can really decide how they feel.

If we understand what people are thinking and feeling about their smoking we have a much better chance of helping them to quit. So, when talking to your clients, it might be helpful to work out which stage in the quitting process they fit into. We call this the 5 stages of change in tobacco smoking.

The 5 Stages of change in tobacco smoking

1. Not ready to quit

“I love smoking.’ ‘I’m not interested in quitting.’ ‘I get a lot out of it!’

They could be:

not concerned about smoking;
not wanting information;
not saying anything at all;
talking about something else or looking uncomfortable;
not aware of the health effects of smoking;
filtering out anti-smoking information; and
in denial.

2. Unsure about changing

‘I’m not sure I’m ready.’ ‘I’m thinking about it.’ ‘Yes, but…’

They will:

have some concerns
be more aware of pros and cons;
want more information;
seem interested and ask questions;
be thinking about how they need to give up;
not be ready to give up yet;
be more personally vulnerable; and
be unsure.

3. Ready for change

‘I want to stop now!’ ‘ I need some help.’

They will be:

making decisions;
making some changes now and intend to give up in the near future; and
wanting solutions.

3. Action

‘I’m trying to quit.’

They will be:

showing concern;
happy to have more information;
happy to talk about choices and support;
wanting to plan how to give up;
making active attempts to stop smoking;
making a commitment of time and energy;
finding it hard to make new routines or finding things to replace cigarettes; and
in two minds, or unsure, as to whether they can stay off the smokes.

4. Staying stopped

‘I want to prevent relapsing.’ ?‘I may need a boost to help keep to the changes I’ve made.’

They will:

have given up smoking tobacco;
want to stick to their decision;
be happy to talk about how much better things are;
want to think about how to keep of the smokes through hared times;
be smoke free for over six months;
continue with the change;
maintain gains and work to prevent relapse; and
have established new patterns as a non-smoker.

Slip-up and relapse

‘I’m smoking again.’ ‘I’ve failed.’ ‘I’ll try again.’

They can:

go back to an earlier stage-retreat to comfort zone; and
learn from past for next attempt.

At the end of the day, your aim is to help the smoker quit for good. You can help the smoker change their smoking behaviour by travelling the smoker through these 5 stages of change.

Source: Adapted from information supplied by Quit Victoria for the Talkin’ Up Good Air kit

Triggers for lighting up

Every smoker knows that there are ‘triggers’ or situations that will make them want to light up a cigarette. Getting smokers to think about the situations they are in and the emotions they are feeling when they light up a smoke can help them quit successfully.

Situations:

having a cup of coffee or and alcoholic drink
talking on the phone;
driving a car;
at the end of a meal;
relaxing in front of the TV;
when taking a break from work or a task;
when other people smoke; and
having a yarn with friends, and so on.

Emotions, when people are feeling:

sad;
bored;
relaxed;
tired;
angry;
lonely;
stressed; or
happy (making good times better).

Triggers for quitting

Some people give up the smokes because of:

a life-changing experience, such as pregnancy;
a serious health problem, like heart attack or stroke;
seeing a friend or family member with a serious tobacco related illness.
wanting to make a better life for themselves and their community, like not wanting to smoke in front of kids; and
changes to workplace policies

Withdrawal and cravings

Giving up smoking is different for every smoker. Some will find it easy to quit, while others will find it far more difficult and show signs of nicotine withdrawal. Most people only have mild symptoms. People also talk about feeling happy about giving up.

Withdrawal symptoms:

the urge to smoke;
feeling depressed;
difficulty sleeping or interrupted sleep;
irritability, frustration or anger;
anxiety;
difficulty concentrating; and
restlessness.

Withdrawal symptoms usually start within 24 hours and are at their worst in the first week. Most symptoms fade and are gone after one month, although some people’s symptoms stay with them for longer. After six months, people feel better or at least the same as when they were smoking.

Cravings

These are the urge or desire to smoke and usually happen in the first few weeks of quitting, as you adjust to living without nicotine. Cravings can also happen in situations where people are used to smoking and can happen out of the blue, months after quitting.

Coping with withdrawal symptoms

Generally withdrawal symptoms only last for a few minutes at a time so it is important to give people strategies to cope with them. The four Ds – Delay, Drink water, Deep breaths and Do something else – are a way of coping and to avoid smoking.

The 4 Ds guide to beat the craving...

Delay

Delay acting on the urge to smoke. Don’t open a pack or light a cigarette. After a few minutes, the urge to smoke will weaken.

Drink water

Sip some water slowly, holding it in the mouth a little longer to savour the taste.

Deep breaths

Take deep slow breaths in and out and repeat three times. Deep breathing will take the focus off the cravings.

Do something else

To take your mind off smoking, do something else: listen to music; go for a walk or exercise; or talk to a friend.

See also: Quit Victoria's fact sheet on Withdrawal

Ways to quit

Different people quit successfully in different ways. It is important for a smoker who is thinking about quitting to choose a way that is safe and suits them best.

Before quitting – Chemicals in cigarettes can change the way some medications work. Quitting can also be stressful. A smoker who is ready to quit should see a doctor before hand if they take medications or suffer from (or have suffered) a mental illness. Also see Quit Victoria's fact sheet on Smoking and Mental Illness
Cold Turkey – Stopping suddenly and completely. This is a good way to start.
One-on-one advice with a doctor, health worker, health educator or other health professional
Courses an support groups run at community centres and health services
Cutting down on, changing where or when or delaying smoking – for those people who are not ready to quit this can be a useful on the way to quitting for good.
Nicotine replacement therapy (NRT) – patches, gum, lozenges, inhaler and tablets – are all sold at pharmacies (patches are available for free or on the pharmaceutical benefits scheme (PBS) although conditions apply).
Prescription medicines such as Bupropion and Varenicline which work by cutting down on some of the nicotine withdrawal symptoms are also available on the PBS.
Acupuncture and hypnosis has been found helpful by some although there is no real evidence to support its effectiveness.

See also: Strategies to tackling smoking on this website

Talking to people about quitting

People make their own choices about tobacco. However what you say to them, how you say it and how you listen will play an important part in influencing their decision and hopefully will lead to them quitting smoking for good. Be respectful, sensitive and flexible when you talk and avoid lecturing them.

Sharing positive information and stories in an informal way will hopefully get people thinking and bring them around to being quit. Look for success stories within your community to show that quitting is possible. Ask the smoker about people they know who have managed to quit and get them to retell their story.

Features of good communication skills include:

The interaction between you and your client is private.
Talking often involves the client telling their personal story, in their own words.
Talking includes sharing knowledge and talking about options.
The health worker's role is to be non-judgemental, not forceful, not confrontational
The client's decision to change, or not to change, is up to them.

Some techniques to encourage and motivate smokers to quit are:

Ask open-ended questions. That is ones that don't have a yes or no answer.
Get the person to tell you in their own words how they feel.
Actively listen, This means repeating back in your own words what the example is 'So you're saying you think gum might be better for you than patches?'
Encourage doubts. Help the person to see that it doesn't make sense for them to do something they feel is harmful.
Be personal. Provide feedback on the person's particular situation.
Motivate change. Get the person to tell you why they should change. Match the type of action you advise to the client's stage of change. This is important because mismatched interventions can be frustrating and disappointing for both you and your client.
Record on the client's file their stage of change and what you advise them. Next time you see them, talk up the positive changes.

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