Smoking Cessation Support Group

 Scott Webb (Host): If there's one thing that every healthcare provider agrees on, is that the best way to improve your health is to quit smoking. But of course, quitting isn't easy. And Eisenhower's Smoking Cessation Program aims to change that. And I'm joined today by Donna Boatman, she's the Smoking Cessation Facilitator at Eisenhower Health. And I'm also joined by Regina Schroeder, she's the manager of the Eisenhower Lung Cancer Screening Program.

This is Living Well with Eisenhower Health. I'm Scott Webb. So, thank you both for joining me today. We're going to talk about Eisenhower's Smoking Cessation Support Group and programs and who it can help and all that good stuff. And Donna, I'm going to address these first couple of questions to you. What is Eisenhower's Smoking Cessation Support Group? Like, explain that to folks.

Donna Boatman: This program is a five week-program and it's designed to help smokers understand the psychological and the physical effects of smoking addiction. It's modeled on the American Cancer Society's Fresh Start Program and it's presented as a group program so that participants can share that quitting experience and support each other.

Host: Yeah. And I know supporting each other is a big part of this, and I want to find out what's your sense, your experiences anyway, in what motivates someone to participate in the program.

Donna Boatman: A good number of the participants have been long-time smokers and they're now experiencing some health concerns related to smoking and it feels like it's time for them to quit. Either their physician maybe have suggested that they quit or another family member or they're just feeling in order to be a healthier person, "I need to quit." Others are wanting to stop the whole habit and they're done with smoking. I've heard people come in and just say, "I'm ready to quit. I don't want to do this anymore. It costs too much." The cost of smoking now has gone way up, and they're just ready to stop, and they want to lead a healthier life.

Host: Yeah, I've heard that before. For some folks, you know, maybe it's financial or otherwise, but some folks just sort of know, right? Like, "It's just time. I'm just done smoking." Can you give listeners a sense of who participates in the program, the sort of demographics, if you will?

Donna Boatman: Right. The ages of the participants ranges from early 20s up into the 80s. Some smoke a few cigarettes a day, and some are two packs a day. So, it's a really wide range of the demographics. And what I love about this program is bringing them all together. So, someone smoking two packs a day will listen to someone who's just smoking two cigarettes a day and they both want to quit. And they can use each other's experiences to try and help them get down to zero cigarettes a day.

Host: Yeah, that's the goal, right? That's the dream, get down to zero. Whether it's two packs or just two, you want to get to zero. For folks wanting to understand how much of a commitment this is, what's the duration of the program, how often do you meet, what's the cost, and so on?

Donna Boatman: This program is run with five scheduled weekly meetings. We meet at 5:30 in the evening because some people are working and we try and make that available to them. And after the five scheduled meetings, I do offer some more casual support group or helping meetings, just coming back together for maybe a half hour just to see how everyone's doing. So, the meetings are at 5:30. They usually last an hour to an hour and a half. There is a cost. The participation cost is $100, and that includes all five meetings and any of the support meetings, the workbook that we use, and any other materials that I hand out for education.

Host: Yeah. And Regina, I want to bring you in and ask you maybe the $64,000 question. Why is quitting cigarettes so difficult?

Regina Schroeder: Quitting cigarettes, from what my patients tell me, is harder than quitting any stronger drug addiction. I think probably the gleaning from what I've learned from patients, from my training is that it's so multifocal. There's a physical dependency, there's a psychological dependency, there's a ritualistic dependency. And so, because it touches on so many areas that it's not just one thing that we're trying to approach and getting them to stop, they have to attack from so many different areas.

Many smokers that are in our lung cancer screening program have been pretty much lifelong smokers. Some have started smoking as young as eight years old and when you look at them and you say, "Well, would you like to stop smoking?" They say, "Yes, very much so." But they say, "I don't know who I am as a non-smoker." They have no personal identity of themselves as a non-smoker. So, that's a really tough situation to overcome, is recreating yourself when you look in the mirror and you've always had a cigarette in your hand or in your mouth, and then trying to imagine what that would be like to look in the mirror without that there.

Host: That is so interesting. I'm just kind of processing that and thinking in my head, you know, that's so right. There's just things that we do that we sort of identify as things, as different types of people or whatever it might be. And so if someone sort of self-identifies, and then they think of themselves as, "I'm a smoker," and then, "What will I be like when I'm a non-smoker," that's a tricky one.

Regina Schroeder: Yeah. And so, to get into the psychology of it is different for each person because we're all so individual. You know, as they say, it's the hardest thing you'll ever do, is quit smoking.

Host: Yeah, that's what I've heard for sure, that it is absolutely the most difficult thing that anyone will ever do, for so many reasons, as you're saying, physical, mental, psychological, and so on. Donna, I want to come back to you. Is there value in offering this in a group setting? Or what is the value in offering in a group setting opposed to individual counseling?

Donna Boatman: Well, I think there absolutely is value to the group. I think the support and just the insight that the participants share with each other is extremely helpful for them. To sit around a table with a group where they can interact with each other and talk about struggles that they're having and they open up more and they share maybe more so than if it was just a one on one with a counselor, I found that these groups are great because I'm there to offer them the tools that they need, but it's their work that they have to do and working almost as a group or as a team. They have to speak to each other. And each week when they come in and we share what difficulties they've had or what, you know, great things that have happened to them for the week, they actually support each other and come up with ideas to be helpful. So, I love doing this as a group as opposed to one on one.

Host: Sure. Yeah, and what are the components of the Quit Plan?

Donna Boatman: Well, our plan, we actually have four steps that we go through. The first step is making the decision to quit. Because like Regina said, it's so psychological of going from a smoker to a non-smoker. So, our first part is just talking about the decision you've made to quit.

The second step is the plan to quit. Because what I tell people is this is a life-changing event. This is something that has been in your life for many people for many, many years. And I correlate it with, if you were going to plan, say, a European vacation, you wouldn't just one day get on an airplane and go. You have to start planning this months ahead of time. You have to think about getting a passport, think about making reservations. You know, it's a whole plan to this. So, that's what we incorporate with this, is the plan to quit. How are you going to do it? How are you going to change up your life to go from smoking to non-smoking. We talk about how you can set up a successful quit day.

And then, the fourth segment is staying quit. Once you do quit, how do you stay quit? So, we cover these four components, which includes, like I say, the physical addiction to nicotine, we give educational information about what you're actually smoking when you light up a cigarette, and the behavioral modifications that quitting requires. So, all those components are part of these five weeks.

Host: Yeah. And you know, Regina, when I think about this, group settings versus individual, I can definitely see the value in the group setting. And definitely, the four steps, if you will, in this Quit Plan, but I'm sure there's some medication options as well. I wanted to have you talk about that, medication options, maybe some other resources or support in smoking cessation.

Regina Schroeder: So, just to stick on the support and smoking cessation topic, we have Donna's group, which is a fabulous group here at Eisenhower, which is an in-person group. There are some Zoom options available through Nicotine Anonymous that people can call in or Zoom into meetings. There are phone-only options for support for patients, 1-800-NO-BUTTS is one of them, and then the Kik It California program is another.

Medication options that you would meet with a physician or a PA to discuss include some of the nicotine replacement tools can be prescribed so that can be paid for under insurance. We can prescribe nicotine replacement in the form of patches in the form of a nicotine inhaler or a nicotine nasal spray. All three of those we can prescribe through the pharmacy where the prescription would be applied towards your prescription coverage and, for many people, it is fully covered. So, that helps decrease the cost, added cost to quitting.

The prescription drugs, we tend to use two of them. There are a couple extra ones that we tend not to prescribe because they have heavy side effect profiles, but the two main ones that are mostly well known and mainly used are Welbutrin, which is an antidepressant drug, it's also called bupropion. And the other one is Chantix, which people are familiar with, and it's also called varenicline. So, the varenicline differs from the bupropion in that it cuts cravings by tricking the body to feel like it's getting nicotine, but it blocks the pleasure of smoking. So if you smoke on it, you actually have kind of an adverse experience. So, that is the way that medication is helpful for patients to quit. The bupropion works mainly on decreasing the cravings. So oftentimes, we strongly encourage the bupropion to be paired with a nicotine replacement product.

For non-prescription nicotine replacement, there are things that you can just easily order off of Amazon or online. So, the nicotine inhaler you can actually order through a Google search online. The nicotine patches you can get. Nicotine lozenges and the nicotine gum are available in most pharmacies. So, there is a lot of nicotine replacement items that are available without prescription. There's even nicotine embedded toothpicks, so some people prefer those because they can get both nicotine and have some kind of, you know, item to hold onto or chew on, so that helps with some of the oral satisfaction that people get from holding an actual cigarette. There are some nicotine pouches that you can purchase through online avenues that are little pouches, you know, that you stick into the corner of your mouth in the buccal area that we call it, and they just sit there and it slowly lets out nicotine into your body so that you don't go through withdrawal.

So, non-medical options, there's an item that you can also search. It's under the brand name Quit Go, Quit G-O. It's a soft-tipped plastic cigarette, which is empty. It has nothing in it. So basically, you can hold it like a cigarette. It looks like a cigarette. You can inhale through it, but all you're getting is oxygen. So, that's a non- medical device that may help. There's hypnosis that some people will go and seek out and try to get hypnotized from a therapist to quit smoking. And then, there's good old-fashioned just quitting cold turkey, just making that decision to quit and not using any aids or supports and just making that decision and enacting it.

Host: Yeah. So Donna, Regina was mentioning there about, sort of quitting cold turkey, just deciding that's it, I'm done smoking. And along those lines, how would you recommend that somebody selects a quit date?

Donna Boatman: Well, we have a target quit date in this program, which would be our fourth meeting. Some people get so stressed by having that quit deadline that they may drop out of the group or they may even smoke more coming up to that date. So, what I've worked out is I've found that some people just can't comply by that specific date. So, I work with everyone to find out what is their personal goal. Like Regina was saying, this is all a different journey for everybody. We're all in different aspects of smoking, different reasons why we're quitting.

So, I feel a person has to work with the tools that they're learning in the class and tailor their quit date to what is realistic and doable for them. Typically, at least half of the participants have quit by the end of the program, and the others have at least reduced their smoking by 50%. So by the end of the five weeks, I will have some people in the group that have actually quit, they've set their quit date, and they're done with smoking. But I also feel that if somebody who's been smoking for 40 years has been able to, at the end of five weeks, drop their smoking by 50% and then keep working towards their quit date, then that's a success. So, having an actual quit date is, I think, best done on a personal basis. We talk a lot about how you choose that. Some people like to make it on their birthday. Because that way, it's something that they can really work towards and it means a lot to them or on some other anniversary that they have. And I think that it's helpful to have that. We have a goal of fourth week, but I don't want people to feel that they've failed if they can't quit by that fourth week. So, we individualize it so that it's going to be meaningful and it's going to really work for them.

Host: Yeah, the word you used that stuck in my head was doable. It's got to be doable, right?

Donna Boatman: Exactly. Exactly.

Host: What are some of the resources for people who've been successful, right? And they made it to the top of the mountain, if you will. How do we help them sort of stay quit?

Donna Boatman: It's interesting because we can do weekly meetings after. Usually we finish on the 5th meeting and then I usually wait two weeks. And I say, "Everybody, let's get back together and just have a support group and just see how everybody's doing." And then, I will continue to meet with people as long as they want to.

My experience with this program is that people have told me, "Look, I've quit. I don't want to have to keep coming back here because it reminds me of smoking" and they don't want that reminder. They're kind of done with it. So typically, we would meet two or three times after the whole program is completed and we just have our little support group meetings. And then people, you know, they kind of get on their own. Like Regina said, there are some great online programs. The Kick It California is great. It's kickitca.org. There's also the CDC, at cdc.gov. They have a program where you can actually meet with a counselor there if you need some extra help. And they have some phone lines as well. The 1-800-QUIT-NOW is a good phone line if you're feeling that you need some extra support. Those are available.

Host: Perfect. And Regina, I just want to give you last word today. We think about helping folks quit, staying quit or resources available for any and all the above. What would be your final thoughts and takeaways?

Regina Schroeder: I think some of the things that I've learned in this process is that people need to replace some of their coping methods. So, like, just having good resources for coping methods on stress. So when they have a stressful event that will occur, because most of us will have stressful events reoccur as we go through life, having kind of a plan and a strategy for how to manage that stress, where they don't go back to cigarettes, which were their comfort for stress in the past. So, having new coping methods, replacing rituals, like identifying and realizing the ritualistic part of the smoking, which is, you know, maybe when driving in the car on long distances or that cigarette after dinner or the one in the bar when you're out with friends, that actually recreating new events in their life, new places to go, new things to do that will avoid the potential for them to relapse is also an important aspect. And getting good family support, getting those around them to hold them accountable and to help them with accountability. So, I would just say, you know, having a really good support system, looking for new coping methods, and some new rituals so that you don't go back to some of the old rituals.

Host: That's perfect. Well, I really appreciate your time today. This is one of those topics that is so meaningful, so important and such a challenge for so many folks, but we've given them some good ideas today about how to get started, the different programs, how to stay quit if they're able to make it to that sort of quit status. So, good stuff today. Thank you both and you both stay well.

Regina Schroeder: Thank you.

Donna Boatman: Thank you.

Host: Once again, that was Donna Boatman, Eisenhower Smoking Cessation Facilitator and Regina Schroeder, Manager of the Eisenhower Lung Cancer Screening Program. And for more information about Eisenhower Smoking Cessation, go to eisenhowerhealth.org and select calendar from the top navigation bar if you'd like information about lung cancer screening, browse all programs and services and scroll down to the lung cancer screening page. And to reach Donna directly, call 760-834-3798. That's 760-834-3798. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for additional topics of interest. I'm Scott Webb, and this has been Living Well with Eisenhower Health. Thanks for listening.