Sunday, May 29, 2016

I think I've finally quit for real - here's how I did it, and why

I've probably had 4-5 attempts at quitting smoking between my last post (2013) and now (2016), but I think this last attempt might have been the final one - I haven't smoked in over 4 months now.

Let's start with the most important thing when it comes to quitting smoking, or perhaps, any kind of addiction: Why.

Some of my old readers (those of you who are still around, that is) would know the first time I tried to quit smoking was back when I was 17 - when my mother also tried to emotionally blackmail me by threatening to start smoking. Yes, it is unfortunate that I started smoking so early in life, and even more unfortunate that I was such an addict by age 17 that I had already realised I needed to quit. Needless to say, I tried and failed miserably.

Each time I tried to quit, I failed, and each time, I became more hesitant to quit. Somehow I still managed to gather the strength, energy and willpower to try again, and for the past 15 years, the top item on my new year's resolution was to quit smoking.

I tried everything. Chewing gum and mint candies in my teens; cessation clinics, cessation programs, nicotine replacement therapies like gum, lozenges, and patches; and even tried quitting together with friends and/or siblings who smoked. We all failed. Each time. Numerous times.

At some point I moved from Singapore to Pakistan, which was supposed to be a short-term thing, so I decided to get into smoking wholeheartedly because it was dirt cheap to get good-quality cigarettes (SGD 1 or PKR 55 for a pack of Marlboro reds). Bad decision, I know. But it would've been impossible to quit smoking in a city (Karachi) where each and every male and female friend of mine smoked. I harnessed a large circle of friends, yet somehow they were ALL SMOKERS. In this supposedly short-term period, I even got married, and my partner joined me in Karachi as well. Poor thing was so in love with me, she was happy becoming a passive smoker.

We had a 'no smoking in the bedroom' rule that I was often allowed to violate. Needless to say, I had become quite comfortable as a smoker.

Yes, of course there was an attempt made at quitting smoking before I got married. I remember, on the day of my wedding, I had to be seated for a very long period in public, but one of my uncles, out of regard for my addiction, managed to brisk me out with a reasonable excuse just so I could smoke. He was an ex-smoker so he understood the pain. (Can't expect that level of compassion from a non-smoker, EVER.)

I look back at my life in Karachi sometimes - it was all hunky dory - except that some nights I would open my pack of cigarettes before going to bed to only see 1-2 cigarettes in there, and I would panic. Even if it was 3 am (when all the nearby stalls were closed), I'd grab the car keys and make a dash for the nearby pump to get a refill. I couldn't imagine the horror of not having enough cigarettes to get through the morning.

I had a ridiculously problematic car so I remember several times when I walked to the nearby Caltex in the middle of the night, even. I can't describe the paranoia that comes with addiction - like something that could never be risked.

Through these years, I've begged and borrowed if necessary, just to get my daily dose of nicotine. In a country like Pakistan, the hawkers understand the addiction and they're largely comfortable with starting tabs if need be, just so they can make their sales, and you can get your fix. Anyway.

What started out as, 'oh it's so unhealthy to smoke' and 'I don't want my loved ones to smoke passively' soon became 'I don't want my addiction to control me'. It did.

It affected my job, because I took more smoke breaks than non-smokers. It affected my diet, because I'd avoid food if I didn't also have time to smoke a couple afterwards. It affected my relationships, because I avoided people and situations where I couldn't smoke. At night, it affected my sex life, because I wanted to smoke before and after. It affected my sleep, because I just couldn't get enough nicotine in me, and when I had enough I couldn't sleep.

I'm sorry for the long-winded history lesson to tell you why I wanted to quit, but I thought context was important - everyone's context is different. Mine was this: my addiction was out of control.

As someone with atopic asthma, I used to smoke slowly - taking about 10-12 minutes per cigarette. I probably only averaged around 15-18 cigarettes a day, but there were party nights and beach days when I'd get through two packs of cigarettes in a single day. That's more than 40 cigarettes.

Sometimes I'd have unexplained headaches, which were horrible, and it would take me a while to realize I was smoking for far too long on an empty stomach. I was blissfully miserable.

I knew quitting smoking meant I needed the support of ex-smokers and smokers alike. Ex-smokers because they knew exactly what it would take, and smokers, because they had to become tolerant of the hatred all quitters try to embrace towards cigarettes and smoking. The latter often proved to be an impossibility within my wonderful group of friends. And non-smokers are just unbearable - they have absolutely no regard, compassion or empathy for quitters. They just can not relate to us.

So I decided to embark on creating a program called War On Smoking - named after this blog - to help people like me in similar situations. I got the wireframes ready for the app and website, and wrote some materials that I would also follow with the first group of recruits when we launched. The startup even got selected by an Acumen-PASHA fund, pending final selections. I took my wife in as a partner because she's a doctor who could not only explain the dangers of smoking and the effects of chronic obsessive pulmonary disorder (COPD) but also perhaps give her seal of approval on the program as well as prescription of nicotine replacement therapies. It was a good plan.

We stayed up all night preparing for the presentation, but we had a major argument in the morning. She didn't want to give her seal of approval, or even suggest that she might do it later, because this program was 'fake'. The creator of it, myself, was still a smoker, so I shouldn't be selling this program, she opined. My argument was: I need this program for me - as the primary user I will ensure its success and learn from its failure. Whatever the case, we ditched the selections and that was that.

By this time it was clear in my mind what exactly I needed to quit smoking successfully. I needed:
1. Some medicine or nicotine supplement to help me get through the initial withdrawal.
2. An environment where cigarettes weren't easily available.
3. A shift in my primary social group to one where most people did not smoke.
4. Plenty of things in my schedule to keep me occupied.

I hadn't anticipated our relocation to London last year (2015), but I welcomed the move, and noted how I might be able to fulfill the ideal conditions I needed to quit smoking soon. However, I remained patient.

I arrived in London with just 2 cartons of cigarettes, hoping to get through the homelessness and joblessness at a fast pace. But these things take time. Took us a month to figure out the house (which you need to be able to see a doctor who can prescribe nicotine replacement pills). It took another month for me to sort out my job. And then another month for the end-of-year holidays to finish and my job to begin.

At some time in January when I had begun working full-time I went to see my GP, who referred me to a nurse who got Champix prescribed to me. What a wonderfully horrifying medicine, this Champix. You experience all the horrible side-effects mentioned in the leaflet - there wasn't one that I didn't experience. On some days I was in a worse state than my pregnant wife! (Her words, not mine!) But boy, does this medicine work!

The nurse told me to continue smoking as per usual as I started taking Champix. She more than encouraged me to smoke, because this medicine blocks the receptors in our brains that receive pleasure from nicotine. So every time I smoked, it wasn't as pleasurable, resulting in me only smoking when it was truly essential.

But then the dose went up! By the 8th day of me taking the medicine, I was more than ready to completely stop smoking cigarettes altogether. I had already decided that 9 being my lucky number, my quit day would be day 9, and so it was.

The nurse urged to see me or speak to me every week as the medicine can have some horrible side-effects, as does quitting smoking, so it requires a lot of support and coaching. She was worried I was taking on too much too soon, but I was adamant on quitting smoking successfully.

The way Champix works is that you have to take it for 4 months. The quit date is set in the 2nd week, and then, to counter slips, because they do occur, you have to continue taking the drug to ensure that you don't get any pleasure from smoking, even if you do slip and find yourself lighting up. It's kind of like your own will against your own will, I know. But it worked for me.

I could, of course, simply stop taking the medicine, but it would have to be a conscious choice for me to set myself up to get pleasure from smoking, whereas smoking a cigarette for an addict would often be, in some way, an unconscious or semi-conscious choice - one that we'd regret later. Whatever the case, the drug really helped, I feel, despite its horrible side-effects. I don't think I could've done it without it.

I slipped several times. Once I bought a 10-cigarette pack, and I think I smoked at least 8 of them in a week. A few times when I met smoker friends, I'd ask for a puff or two. But smoking just was not the same any more. And I would always try to remind myself of all the horrible lucid dreams, the nausea and headaches, and so many other things (flatulence, ahem!) that I endured. When I'd take the puff and it wouldn't deliver the satisfaction I'd expected, I reminded myself of these things and resolved to persevere. Even those 8 cigarettes I smoked I didn't get through each one of them. Most of them were chucked less than halfway through. So yes, I'd recommend Champix.

I kept at it for a month, but then I just couldn't take the medicine any more. It was affecting my (new) job, and taking its toll on me in a time when I needed to be there for my pregnant wife. I also felt quite confident by the end of my first month as a non-smoker because I knew my physical addiction had gone. It was the habitual addiction that I had to watch out for, but it was unlikely to become a problem since none of my friends who smoked were around, and none of my colleagues smoked.

And psychological addiction can trigger in at any time of your life. I learnt this the hard way in my previous 'successful' quit attempt when I quit for almost 8 months. This time I will watch out for that one.

Another reason why I didn't take Champix for the full 4 months was because I had a daughter on her way - I was about to become a dad - so I did have that extra reserve of willpower to count on, if needed. But it didn't come to that. My reasons for quitting smoking were clear to me - I didn't want to be an addict any more.

I have now been clean since 4 months, and I have yet to break my previous quit smoking record of 8 months, but I am feeling much more confident now. As for the four conditions to quit smoking, they are also being met:

1. Some medicine or nicotine supplement to help me get through the initial withdrawal.
>>> I took Champix for the first month and it worked like a charm, and didn't keep my hooked to nicotine like other nicotine replacement therapies.
2. An environment where cigarettes weren't easily available.
>>> Cigarettes aren't cheap in the UK. Plus they don't sell loose cigarettes here.
3. A shift in my primary social group to one where most people did not smoke.
>>> My friends who smoke live far away so I don't see them on a day to day basis. None of my colleagues smoke. In fact three of them are ex-smokers so that really helped.
4. Plenty of things in my schedule to keep me occupied.
>>> I have this new demanding job, a lovely baby at home who keeps us occupied, and when I get some free time, I am pursuing an educational program, so I am super duper busy.

I suppose when I find some time I can look into putting this program in place for smokers around the world who wish to quit. In the mean time, I hope this piece helps you, and if you have any questions, feel free to drop me a line. I still run the War On Smoking Facebook page and I also have a little Facebook Group called The United Federation of Ex-Smokers with some of my ex-smoker friends. Support groups do help! Just drop me a line and I will be happy to add you in

Good luck to you in quitting smoking. And if you're reading this to help someone else quit smoking, bless you for making the extra effort to understand their addiction - this is just the right way to build empathy towards nicotine addiction.