An innovative tobacco cessation program helps people break the habit for good.
Jacob Richman of Bedford, Texas, smoked his first cigarette when he was 11 years old. By the time he was 16, he smoked regularly, and as an adult he was “easily” smoking a pack a day.
Over the years, Mr. Richman, 42, has repeatedly tried to quit. “I’ve tried gutting it out, but the longest I’ve made it was 12 days,” he says.
While he worries about the health risks of smoking, his main motivation for trying to quit is financial. A pack of cigarettes costs $6.69 on average in Texas, adding up to more than $200 per month. “I was so fed up with smoking and tired of being broke,” he says.
Mr. Richman works for UT Southwestern, installing telephone lines and computers, and some colleagues told him about Simmons Comprehensive Cancer Center’s tobacco cessation program. “They said, ‘When you’re ready to stop, this program will help,’” he says.
In November, he contacted the program and said he was ready to quit. At 10 p.m. on Dec. 4, 2018, he smoked his last cigarette.
“The program opens your eyes and offers solutions. I had no idea there was help like this available.”
How It Works
The program includes eight weeks of group sessions and unlimited individual counseling. Each patient meets regularly with David Balis, M.D., an internal medicine physician who is the program’s medical director.
“I get really excited about going to see Dr. Balis the day before and the day of my appointment,” Mr. Richman says. “I know for the next four or five days it will be easy not to smoke, because of his energy.”
Three certified tobacco-trained counselors – Maria Grabowski, M.S.N., RN, OCN, Karla Jerkins, and Michele Yates – also meet one-on-one with each patient. Those sessions can be in person or on the phone, whichever works best for people. “We do anything we can to help people quit,” Dr. Balis says.
The clinic is free. “That’s very important. We need to remove barriers. If it was easy to quit, people would have already done it,” Dr. Balis says. Any medications are processed through insurance, but there’s no cost to see Dr. Balis or the counselors.
Breaking the Habit
Dr. Balis points out that there are two main factors in smoking – nicotine addiction and habit. “We have tips and tools to help with the habits, and medication to help with the addiction,” he says.
As part of the program, people receive a booklet they can use to record their smoking. For Mr. Richman, this tracking was huge. “I could see all kinds of patterns. Every time I drove, the first thing I would do was light up,” he says. He also smoked when he had his first cup of coffee, and after eating.
Substitutions help break those patterns. “The tobacco and nicotine are out of your system in a few days, but you still have those habits you built over 20 or 25 years of smoking,” Mr. Richman says. Those habits can be mentally harder to break. “When I get in the car now, I pop in a piece of gum. That takes the place of lighting up a cigarette. With my coffee I eat a banana, so now I’ve added a fruit to my diet. These are the little things they show you and teach you,” he says.
When Mr. Richman really wants to smoke, he tries the exercises he has learned in the program. “They say to take three deep breaths, but I take five. They say to count to 20, but I count to 50. The next thing you know, three to five minutes have gone by and you didn’t smoke,” he says.
He also limits the time he spends with people who smoke. “Since I quit I have only been around people who smoke a couple of times. Both times those people were encouraging me to stay off cigarettes. And I have a big group of friends who don’t smoke,” he says.
Mr. Richman also worried about gaining weight as a side effect of giving up cigarettes. He had family members who quit smoking and saw their weight balloon. “Dr. Balis said there’s help for that, too,” he says, and so far he hasn’t had trouble managing his weight.
He had a couple of weeks when he felt like he might overeat, but he learned ways to keep his hands busy, like exercises and spinners, to avoid turning to food.
Medication Can Help
Three medication options can help people quit smoking:
- Nicotine replacements, such as patches and gum
“Because it’s so hard to quit and so important, I stress using medication. It can make a big difference,” Dr. Balis says.
He presents these three options to patients. Most people have tried to quit in the past, so they review what worked, what hasn’t, and what side effects they experienced. “If they’ve never tried anything, we pick something together,” Dr. Balis says.
He is especially bullish on Chantix. “It’s targeted therapy for smoking. It blocks the nicotine receptors in the brain. It’s the most effective medication we have,” he says. “I encourage Chantix, but it’s the patient’s choice.”
Mr. Richman believes that Chantix helped him quit. “I don’t want to say it was easy the first month, but it was not as bad as when I tried to quit in the past with nothing. I’m still on it now, and it definitely helps with the immediate cravings.
Dr. Balis individualizes his medication recommendations, since everyone is different. “People might respond to one medication but not another, or have side effects from one but not another,” he says. “There are all kinds of combinations.” Getting the medications right can eliminate cravings and make it easier to quit, he notes.
E-cigarettes might also be an option for some adults trying to quit smoking, since people can use them to taper down the nicotine they are using. And there’s a lot of new technology people can turn to for support – apps like My QuitBuddy, quitlines like Texas’ 1-877-YES-QUIT, texting support, and websites like smokefree.gov. Along with counseling and medication, these reminder tools can help people quit.
Quitting for Good
Because relapse is a huge problem among people who stop smoking, Dr. Balis thinks that people should stick with medication and the cessation program for a long time.
“Treating people with medication has been shown to reduce the risk of relapse, but I see smoking as a chronic disease. It’s great if you quit, but you’re not done in a day or a week. You need long-term treatment to prevent relapse,” he says.
The tobacco cessation program has been in place at UT Southwestern since September 2018, but Dr. Balis has been running a similar clinic at Parkland Health & Hospital System for many years. “So far it’s been really successful. I’m really excited,” Dr. Balis says.
While some people, like Mr. Richman, join the program because they have decided to stop smoking, others need to quit before surgery or hospitalization.
“That’s a good opportunity to quit,” Dr. Balis says. Treatment outcomes are better in people who don’t smoke, from fewer complications to better wound healing to better odds of remission from cancer. “Everything is affected by smoking, and everything is worse if you don’t quit,” Dr. Balis says.
“The program opens your eyes and offers solutions,” Mr. Richman says, “I had no idea there was help like this available.”
Ready to Quit?
Sign up for UT Southwestern’s tobacco cessation program, which includes free group and individual counseling sessions, in addition to one-on-one visits with a doctor who can provide medication as needed to help you quit. Call 214-761-3139 or email firstname.lastname@example.org to enroll.