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BMC smoking cessation program offers five-step plan to kicking butts

Banner Staff | 1/21/2009, 4:44 a.m.

Dr. Robert Sokolove knows that it’s difficult to stop smoking cigarettes. But he also knows that with a little help, it’s certainly possible.

“The whole issue … is to help you endure the discomfort of the longing and the symptoms you get when you stop an addiction,” says Sokolove, an associate clinical professor of psychiatry and medicine at Boston University School of Medicine and the director of smoking cessation programs at Boston Medical Center (BMC). “And no addiction that you have, whether it’s to heroin or to nicotine or to gambling, is going to kill you [through withdrawal].”

But stopping is uncomfortable, Sokolove acknowledges — which is why taking advantage of the support available through groups like the smoking cessation program at BMC, which he has overseen for most of the last decade, is of paramount importance.

As Sokolove explains, there are two versions of the eight-week program, each of which meet once per week — one for the medical center’s employees, and one open to patients referred either by BMC physicians or a doctor at a community health center affiliated with BMC.

Both programs consist of five components that participants must experience, learn and perform before they are ready to stop smoking. Those components, Sokolove says, are based on keys recommended by the U.S. Centers for Disease Control and Prevention: “Get ready, get support, learn new skills and behaviors, get medication, and be prepared for a relapse or for difficult situations.”

First up, Sokolove says, is stress reduction, an element on which not all programs really focus.

“One of the main reasons that people smoke as adults is for the anxiolytic quality of nicotine,” or the anxiety-relieving impact of the drug, Sokolove explains. “So even if we can get you to stop smoking, the minute that things get tough — you lose your job, someone gets sick, a problem happens, your girlfriend dumps you — you might start smoking again as a way of dealing with the feeling. The relaxation training we practice gives people another way to handle life’s problems.”

With the foundation for the program’s approach laid through the practice of stress reduction, Sokolove says, the next step is pharmacotherapy, or the prescribing of medicines that can help patients deal with the symptoms of nicotine withdrawal by reducing the frequency and intensity of cravings and other side effects of putting a sudden stop to smoking.

After that comes perhaps the most difficult step: Teaching people to change their thinking, a process Sokolove calls “cognitive restructuring.”

“One of the things that happens when people try to stop is that they have what [Alcoholics Anonymous] calls ‘stinking thinking,’” Sokolove says. “Thoughts like, ‘One won’t hurt me,’ or, ‘I’m going to have to die of something — I might as well die with a smile on my face and a cigarette on my lips.’

“So we go over all the stinking thinking that people have used in the past to get them to start smoking again, and help them replace those thoughts with much more realistic thoughts about what will happen if they start smoking again.”