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Section 2
Smoking Relapse

Question 2 | Answer Booklet | Table of Contents

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In the last section, we discussed initiating treatment.  Three steps can affect initiating tobacco dependency treatment.  These three steps are acknowledging addiction, wanting to quit, and identifying the reasons why the client smokes.   We also discussed four keys to success.  These four were female menstrual cycle scheduling, reducing caffeine consumption, inequality in genders, and mental gremlins.

In this section, we will continue to discuss defeating mental gremlins.  We will examine early and late relapse gremlins, or mental filters which tobacco dependent clients may use to justify smoking or minimize the harmful effects of tobacco.  For each gremlin, or thought distortion, we will discuss how your clients, like mine, can think through the gremlins to avoid relapse and increase their chances of successfully breaking smoking patterns. 

As you listen to this section, consider your tobacco dependent client.  Which thought distortions can be associated with your client’s early relapse?  Late relapse?  Would it be helpful to play this section in an individual or group session for client education? 

♦ Defeating the Joseph McCarthy Gremlin
First, let’s look at defeating the Joseph McCarthy gremlin.  If you recall McCarthy made many unfounded accusations of communist infiltration. This thought distortion leads clients to think that everything bad that happens is a result of smoking cessation.  Kara, age 32, experienced the Joseph McCarthy gremlin in relation to withdrawal symptoms.  Kara stated, "These withdrawal symptoms will never go away.  I’m nauseated and my period is late." 

How would you have responded to Kara?  I stated, "I don’t want to minimize your symptoms, but there is a tendency for smokers to become so conscious of withdrawal symptoms that normal discomfort gets attributed to withdrawal."  Do you have a Kara who can and will blame just about anything on stopping smoking?  If so, you might consider explaining to your client how to defeat the Joseph McCarthy gremlin. 

I stated to Kara, "Try not to interpret everything that happens to you as withdrawal symptoms.  Most aches and pains are just normal, everyday aches and pains.  If you start feeling bad, ask yourself if you have felt this way before."  Could your tobacco dependent client benefit from separating and dealing with things that are truly withdrawal related versus those irritants that are a part of everyday life? 

Another technique for defeating the Joseph McCarthy gremlin is expecting withdrawal.  Have you found, like I have, that if a client gets through the first day of smoking cessation with relative ease, he or she may believe they have escaped withdrawal symptoms?  This can lead to unexpected relapse within a couple of days when the client experiences unexpected withdrawal symptoms and is unprepared.  To relate this to Kara, I stated, "There will be good and bad days.  Remember that quitting smoking is like climbing a range of mountains instead of just one mountain.  You’ll eventually get over it, but there will be many ups and downs along the way."

♦ Defeating Other Early Relapse Gremlins
Next, let’s discuss defeating some other early relapse gremlins.  Over the past few years, as nonsmokers have become increasingly assertive regarding the health consequences of secondhand smoke, clients like Kara have used the "I don’t want to become one of those obnoxious ex-smokers" gremlin. 

Many smokers have a story about an arrogant and self-righteous ex-smoker who goes around saying, "It’s easy, just quit!"  As I explained to Kara, to defeat this gremlin the client must think through the gremlin and be smarter than the craving.  I stated, "Chances are that those arrogant ex-smokers were arrogant before they stopped smoking.  A change in your life, like quitting smoking, is not going to change who you are or what is important to you.  If you are a considerate smoker, you’ll probably be a considerate ex-smoker, also." 

Kara presented another type of gremlin when she stated, "Tuesday was awful!  I needed a cigarette so bad so I could just relax."  Kara defeated the "cigarettes help me relax" gremlin by thinking through this gremlin.  Kara stated, "I started thinking about how relaxing a heart attack or emphysema might be.  That helped me decide that relaxing with cigarettes wasn’t even possible.  Smoking just adds more stress." 

Do have a client like Kara who is getting attacked by the "cigarettes help me relax" gremlin?  If so, your client may present differently.  Has he or she stated that smoking helps them solve problems?  A colleague of mine uses humor to defeat this gremlin when she jokingly states, "Boy I’m sure glad I smoke!  Smelling like an ashtray sure helped me solve that problem!  It sure was helpful in there when I started hacking and coughing!"  Would this type of humor be appropriate with your tobacco dependent client?  Why or why not?

♦ Defeating Late Relapse Gremlins
In addition to defeating the Joseph McCarthy gremlin and other early relapse gremlins, let’s examine gremlins associated with late relapse.  One of the most common early relapse gremlins that you may have encountered is the reward gremlin.  Marty, age 47, failed at overcoming tobacco dependency a number of times when he succumbed to the reward gremlin.  Marty stated, "I’ll get about a week in and think, ‘Ah, what the hell!  I deserve a reward.’  Then I buy a pack and I’m stuck on cancer sticks all over again." 

Marty later worked out a system of alternative rewards for himself that focused on increasing value corresponding to the length of his success in quitting.  For example, Marty was formerly an amateur motocross racer in his youth.  When I asked Marty what he would like to do with the money he saved on cigarettes, he stated, "I’d like to get back into offroading."  Therefore, Marty began to reward himself with dirt bike paraphernalia on a monthly basis.  Marty started by buying a pair of racing gloves after his first full smoke-free month. 

At six months Marty had planned to buy a helmet, and at one year Marty was going to buy the actual vehicle.  In addition to setting up an alternative reward plan, Marty also had to think through the reward gremlin.  At a later session Marty stated, "I’ve just got to keep telling myself that failure is not a reward.  And neither is cancer."  Do you have a Marty who is struggling with a reward gremlin?  How could he or she think through the gremlin?

Another mental gremlin associated with late relapse is the "I don’t need to anymore" gremlin.  As you know, clients may prematurely abandon techniques for breaking smoking patterns that they have worked so hard to implement successfully.  The result can be late relapse.  To help clients avoid the "I don’t need to anymore" gremlin, I state, "Try to remain vigilant regarding all of the strategies you learn until you can honestly say you’re 100 percent convinced that you’ll never smoke again." 

Like the other gremlins, clients will need to think through this mental filter.  Are you treating a tobacco dependent client who is using mental gremlins?  How can you respond to help your client think through the gremlin? 

In this section, we discussed defeating mental gremlins.  We examined early and late relapse gremlins, or mental filters which tobacco dependent clients may use to justify smoking or minimize the harmful effects of tobacco.  Do you have a tobacco dependent client that would benefit from listening to this section during your next session?

In the next section, we will discuss preparing to quit.  There are three basic steps that can help a client attempt to successfully overcome tobacco dependence.  These three steps are self-monitoring smoking habits, devising a quitting plan, and committing to a quit date. 

Peer-Reviewed Journal Article References:
Palmer, A. M., & Brandon, T. H. (2018). How do electronic cigarettes affect cravings to smoke or vape? Parsing the influences of nicotine and expectancies using the balanced-placebo design. Journal of Consulting and Clinical Psychology, 86(5), 486–491.

Pedersen, E. R., Tucker, J. S., Davis, J. P., Dunbar, M. S., Seelam, R., Rodriguez, A., & D'Amico, E. J. (2020). Tobacco/nicotine and marijuana co-use motives in young adults: Associations with substance use behaviors one year later. Psychology of Addictive Behaviors.

Robinson, J. D., Li, L., Chen, M., Lerman, C., Tyndale, R. F., Schnoll, R. A., Hawk, L. W., Jr., George, T. P., Benowitz, N. L., & Cinciripini, P. M. (2019). Evaluating the temporal relationships between withdrawal symptoms and smoking relapse. Psychology of Addictive Behaviors, 33(2), 105–116. 

Strong, D. R., Leventhal, A. M., Evatt, D. P., Haber, S., Greenberg, B. D., Abrams, D., & Niaura, R. (2011). Positive reactions to tobacco predict relapse after cessation. Journal of Abnormal Psychology, 120(4), 999–1005. 

Van Zundert, R. M., Ferguson, S. G., Shiffman, S., & Engels, R. (2012). Dynamic effects of craving and negative affect on adolescent smoking relapse. Health Psychology, 31(2), 226–234.

How can tobacco dependent clients defeat mental gremlins to break smoking patterns? To select and enter your answer go to Answer Booklet.

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