I’m not sure if it’s the policy of the hospital I work for, a New York State campaign, or if it’s because I’m overseen by OMH (the Office of Mental Health) but as a LMHC (Licensed Mental Health Counselor) at a community clinic, I am required to ask about my clients’ cigarette smoking status the first time we meet. If they do identify as smokers, my job entails assessing how much they smoke and if they want to quit. I’m required to check-in about this topic every three months. It’s not that I want to HOUND my clients about their tobacco use, but rather that there exists a direct link between cigarette smoking, preventable diseases (cancer, emphysema, Chronic Obstructive Pulmonary Disease, heart disease, etc) and client misery down the road.
By encouraging clients to quit smoking, I am aiming to support them in living longer, healthier and happier lives. My approach is to try to utilize the principles of MI (Motivational Interviewing) in order to help assess where clients are in the “Stages of Change.” James Prochaska and Carlo DiClemente created the “Stages of Change” in the late 1970s within their theory, the Transtheoretical Model of Behavior Change.
The “Pre-Contemplative Stage” can be the start of the journey and indicates that the client doesn’t think their substance use is a problem. They don’t have a desire to quit at this point. Best to build rapport and trust with folks presenting in this stage. For other clients that I sit down are already in the “Contemplative Stage.” This means that a part of them consciously knows that smoking equals health problems and a part of them would like to quit, although it might be very challenging to actually do so. A At this point, it’s helpful for therapists to gently explore the mix of feelings and thoughts that exist here. A good therapist will honor their client’s experience, while also working to dig deeper into any contradictions that arise at this stage.
With time, patience and support, it is my hope that my clients will chose to move into the “Determination/Preparation Stage.” This indicates that the client has a true desire to quit. They are ready to crunch up those last cigarettes in their fist like in the picture at the top of this article! It becomes my job, and is always my honor, to assist them in collaborating on the creation of new plans of action. We must look at potential triggers (other people they usually smoke with, routine/danger times of day, thoughts/feelings that they NEED a cigarette just to get a break from work, etc) in order to plan around possible pitfalls. The “Action Stage” is where folks start their major life change. Giving up those pesky cigarettes! I strive to be their biggest cheerleader during this and to, hopefully, get them to reach the “Maintenance Stage.” This is where their new, healthier mode of living has been sustained for a number of days, weeks and months. It becomes the client’s deep hope and dream that this will be a lifelong change.
It’s important to realize, however, that there is a “Relapse Stage.” While it doesn’t happen to everyone, it is actually quite common. If the client picks up smoking again, this not a reason to beat oneself up, neither as the client nor as the clinician. Better to re-frame a relapse as a trip or slip-up and use the opportunity to learn from the experience. What was the trigger/reason behind returning to smoking? What were the thoughts and feelings before smoking again? And now? How would it feel to get back up on the no-smoking horse and to try again?
So, I’m writing this particular post for New Year’s. Picking a *specific* Quit Date has been found to increase people’s chances of successfully giving up a substance they no longer want to use. Besides New Year’s Day, other ideal Quit Dates could be: your birthday, your child’s birthday, beloved grandparents’ anniversary, etc. There is even a world-wide, official No Smoking Day held on the second Wednesday of March. It can be inspiring to know that others will be quitting on the same day! Psyche yourself up. I had one person tell me that her Quit Date would be a few weeks before her wedding. She shared that imagining herself in her beautiful, white wedding dress, with a cigarette hanging out of her mouth, felt tacky to her and caused her to feel disgust. She wanted to make a healthier, more attractive, choice.
Helping clients to thoroughly explore WHY they want to quit smoking is powerful in therapy. Is it to be able to breathe more easily? To save money? To have a better chance of seeing grandchildren grow up? Or maybe to set a positive example for others? I like to ask clients how much money they are spending on cigarettes per week, then figure out how much the total is per month. What would they rather do with that small fortune if they weren’t burning it up? Get a professional massage? Take a weekend trip? Go shopping for new clothes?
For clinicians, it is crucial to approach smoking cessation with a non-judgmental attitude. In a neutral, client-centered manner, explore what cigarette smoking is actually doing FOR the client. Many people explain to me that it relaxes them, decreases their anxiety or prevents them from losing their temper. On one hand, if going outside for a cigarette is stopping a client from punching their co-worker, I am going to support that as a Harm Reduction lifestyle choice. Or, if smoking a cigarette prevents my client from relapsing on heroin, I’m also going to look at that behavior through a Harm Reduction lens.
Upon hearing that smoking helps with a client’s relaxation or anger management, I conceptualize this as more information for me as a therapist. I gain an understanding of their behavior and will strive to incorporate additional Distress Tolerance coping skills into our work together. I am a big proponent of mindfulness, Deep Breathing practices, Progressive Muscle Relation, distraction techniques and other Grounding philosophies.
Beating the drums to encourage smoking cessation, I’m into it! But it does need to be done carefully, skillfully and with respect. If you or a loved one is interested in receiving more tips about quitting smoking, or would like free resources to assist in these endeavors, the NY State Smoker’s Quit hotline can be reached at 1-866-NY-QUITS (1-866-697-8487). Good luck and have a happy, healthy New Year!!
