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Understanding the Addiction

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I had a patient who had come in to my clinic to quit smoking. He was smoking 30 cigarettes a day and had tried to quit before but to no avail. On the first night of our smoking cessation class, I taught him a simple practice -- to simply notice what habits he had formed through smoking. He came back two days later almost too excited to sit still as the class started. He had cut down by 20 cigarettes in two days! How? He noticed that he smoked most of his cigarettes, not out of any intense craving, but simply out of habit. For example, he noticed that he didn't like the bitter taste of coffee, so he smoked after drinking his morning coffee to cover up the taste. When he noticed this, he realized that he could simply go and brush his teeth instead of smoking. One cigarette down, 19 to go.

Cigarette by cigarette, just by paying attention he was able to change his behavior.

I'm an addiction psychiatrist at Yale University School of Medicine where I treat patients with a wide range of addictions and also do research to try to improve our understanding and treatments of these disorders. Over the years I've seen a lot and learned even more from working with my patients. I've learned what evidence-based treatments are out there and what actually happens when these are applied in the real world with real people who are struggling everyday with their afflictions. Recently, I've homed in on smoking.

There's something about smoking that fascinates me. Maybe it's because it's the hardest addiction to quit and I like challenges. (It's more difficult to quit smoking than to quit heroin, alcohol or crack cocaine and I'll talk about why in subsequent blog posts). Maybe because cigarettes are the only known carcinogenic and addictive products that are legally sold in the U.S., and this just seems messed up to me. Maybe because of the consequences I see everyday: a patient on oxygen due to advanced emphysema after many years of smoking, a mother at the grocery store privileging a pack of cigarettes over nutritious food for her young children. Likely it's a combination of these.

In this blog, I will focus on some of the things I have learned from the research side about smoking and the addictive process and from helping people quit smoking. My aim is to highlight some key points such that if you or someone you know smokes, you can get a bit of insight into this process, and if you are looking to quit, you learn a few tips that might be helpful along the way. As I have learned the most from working with folks who are "in the trenches" working with their addictions, I welcome your comments along the way such that together we can make this world a healthier place.

Stay tuned...

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