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Programme 6. - Smoking
RADIO 4
THURSDAY 28/12/06 1500-1530
PRESENTER:
BARBARA MYERS
CONTRIBUTORS:
ROB MOCKETT
MARIAN CULLWICK
PRODUCER:
ELIANE GLASER
NOT CHECKED AS BROADCAST
MYERS
Hello. So with Christmas over and I hope you had a good one it's roll on the New Year and yet another chance to make that New Year's resolution to quit smoking. Cigarette smoking is the biggest single cause of preventable illness and early death but knowing that doesn't necessarily make it any easier to give up. So what does it take and what help is available? Well to find out I've come to Brighton, to an NHS No Smoking Clinic, to meet a number of smokers, all at different stages in their struggle to kick the habit. Helping them to do so is Marian Cullwick, she's a smoking cessation specialist working here as a member of South Downs NHS Trust. We're also joined by local GP Dr Rob Mockett, himself a former smoker.
So no phone calls and e-mails today but instead a chance for smokers to put their questions to the experts face to face and to share with all of us what works and what doesn't in the battle to become non-smokers. Let's start with Gary. Gary, I know you've tried many a time to give up smoking but there's always a moment when you give in, what's the moment for you?
GARY
Basically when I'm - how can I put it - when I socialise a lot.
MYERS
When you're out having fun?
GARY
Yeah, I meet people and we sit down and then it's mainly drinking and then when I'm having a drink people are smoking ...
MYERS
They encourage you to smoke?
GARY
No it's just the smell - once I've stopped - it's the smell of smoke and I look around and see people smoking and I think oh I've missed that and I really would like to have a cigarette. I kick myself and then eventually I just give in.
MYERS
Marian, I bet you wish you had a pound for every time you've heard that point made.
CULLWICK
You know what I'd be happy with 30p. I think what people can do is they can test out the water without going for a full evening out, and Gary and I have had a conversation or two about this before, that to go and along and try having a drink in different circumstances or with people who don't smoke but maybe not for a full on session. So that you begin to acclimatise yourself to drinking without smoking, socialising without smoking. So that it doesn't become a big black cloud, many people say oh I don't think I'll be going to the pub or I'm not going to see anybody until I've cracked the smoking, well then it'll come back when you're socialising - that's one way to look at it.
MYERS
Rob, do you sympathise with Gary, when you were a smoker was the pub or the club or something a kind of a trigger for you?
MOCKETT
Yeah, well you lose a certain amount of control as well I think. And it is almost like a bereavement process you go through when you stop smoking, so you do keep getting those pangs of wanting to have a cigarette and you just - yes you lose a little bit of self control, you have a beer and it is a pleasurable thing to have a cigarette with a pint of beer or a drink and it's part of unlearning that behaviour I think really.
MYERS
How did you get over that hump then and learn that behaviour?
MOCKETT
I got fed up of being controlled by having to have cigarettes in my pocket or having a sort of sneaky fag when you got home from work in the garage before you went in and saw the family or getting up in the morning - never really an early morning smoker - but at work sneaking up upstairs and having a fag.
MYERS
Of course as a GP ...
MOCKETT
Yeah exactly.
MYERS
... you would know the health risks that you're running every time you lit up.
MOCKETT
Yes I'm in denial.
MYERS
Let's go to Jim next because Jim's concern I think about his health, he's a long term asthmatic, so has good reason to be worried about his chest, his breathing.
JIM
What I'm really worried about is what other damage I'm doing to my lungs and the rest of my body by smoking and I do smoke quite heavily.
MYERS
Do you feel that you are - do you feel that you're doing damage or do you just - you've heard that of course it's damaging?
JIM
Well yeah I get a lot of heavy chesty colds, coughs and stuff like that and I bring up phlegm occasionally. So yeah I have noticed it, especially the last sort of like year or so, even though I've been smoking 38 years.
MYERS
Rob, is he right to be worried?
MOCKETT
Yes he is, I mean there are quite a lot of complex reactions that are going in your body every time you have a cigarette, the nicotine and the tar and all the other things that are in cigarette smoke have an effect on your lung, they're causing the blood vessels to go into constriction, they're causing the lungs themselves to go into constriction which is why he might get wheezing. It's killing the little silia that are lining the lungs themselves, which are there to waft out all the muck at the bottom of your lungs, so if you damage them the muck stays at the bottom of your lungs. If you've got asthma then it will make that worse. And the actual effect of the smoke is to cause the tiny air spaces in the lung to shut down. And they stay there for a while and then they start to open up again but if you're a heavy smoker they're contracting most of the day.
MYERS
Rob, people do worry about lung cancer, which of course can kill and does kill many smokers, unfortunately very early on in some cases, but the kind of constriction and damage that you've spoken about is itself very disabling isn't it?
MOCKETT
Yeah and your quality of life, I mean it's the things like walking up the stairs, it's the things like oh I've got to catch the bus and then you're coughing and wheezing. Just if you don't go to the gym and you go to the gym, you go swimming, you do stuff that you don't normally do you'll notice that you'll feel - oh I can't do that. So yeah it has a big effect and it's not just the big things like lung cancer which are very - they are very, very - they are fairly rare but when you see them you never forget them, people are dead within four to eight weeks, it's very, very rapid. Whereas chronic obstructive airway disease is more of a lifelong thing, that's 30-40 years maybe.
MYERS
Let's go to another of our smokers here today. Barbara, I think, is a smoker and is concerned about giving up and putting on weight, has that been an experience you've had already that when you've tried ...
BARBARA
Yeah, I gave up for 10 months and I gained four stone and I became a compulsive eater.
MYERS
And you put it down to the smoking then or trying to give up?
BARBARA
Yeah, because I was constantly smoking, constantly drinking like tea, coffee, cigarette, I'd go through the day and realise I haven't eaten all day, all I've been doing is drinking and smoking.
MYERS
So that's when people say that smoking helps them keep their weight down and you're saying it's - yes it can do because you don't bother eating when you're busy smoking.
BARBARA
Yeah.
MYERS
And so when you stop you may put on weight because you've got plenty of time to do other things.
BARBARA
Yes, well I've again given up fairly recently but this time I've avoided all the pitfalls from the last time.
MYERS
Well you're certainly not overweight now, so how have you managed?
BARBARA
No I've gained a few pounds over the past so many weeks but I eat a reasonable breakfast, sandwich like lunch, then evening meal and I've been over indulgent, like with a bar of chocolate, something that normally I don't eat, but I'm not going to over indulge.
MYERS
Congratulations and that's rather reassuring what you said that actually you can give it up eventually and not necessarily put on the extra weight.
BARBARA
Just do one day - take one day - today I've still not smoked but also can I just say a lot of it is as well is down to Marian's attitude.
MYERS
Marian, what do you say then to people to get them to give up smoking but not take on other bad habits?
CULLWICK
Well I think it's very common and I think Barbara's absolutely right. I think the difference is that if you're - if you can spend the time, I know many people will have thought right New Year's Eve, that's it I'm going to give up and snatch the opportunity or sometimes when people have come off having a bad cold and they've not smoked for a few days and they think oh now. What they've missed is the opportunity to do what Barbara has now done, which is to thoroughly analyse what she was smoking for and what she was trying to replace that with. If I remember correctly Barbara it was popcorn the first time round, wasn't it, bags and bags of popcorn.
BARBARA
Bags and bags.
CULLWICK
And that is very difficult because it's nibbly type things that people are doing, the hand/mouth action for, and what we would encourage people to do and stop smoking is we're looking at before they give up looking at what am I trying to get out of this cigarette, what else can I replace it with. And the bar of chocolate I'm afraid is my fault - we do encourage people in order to combat the bereavement and the loss of something to treat yourself, to give yourself something but something unusual. And I will say it doesn't have to be chocolate, it could be a book or it could be a bunch of flowers in the house or a scratch card everyday but something so that you're giving yourself something that you don't normally have when you stop smoking but not before.
MYERS
So Rob is that the case that actually a lot of the time smokers don't actually need the nicotine that they might be getting from a cigarette but it's what else they're getting from lighting up?
MOCKETT
Well what they're doing is deep breathing exercises as well by inhaling deeply on a cigarette, holding it in and then letting it out which you can get a certain amount of relaxation just doing that yourself, without cigarettes. It's the simplistic way of looking at it perhaps but I think it's quite a good way of looking at it.
MYERS
Let's go to Tracy. Tracy's giving up smoking, doing quite well.
TRACY
Yeah, now for nearly four weeks, four weeks tomorrow.
MYERS
Well done. So do you have a problem with this?
TRACY
Yeah, I mean my main issue for giving up smoking was my health, I'm partially sighted. I was wondering is there any relation to smoking and sight?
MOCKETT
Yes, it can increase the risks of macular degeneration, which is a degenerative process in the back of the eye, which if you get macular degeneration your ability to see items in detail is reduced. It also increases the risks of cataracts, but that tends to be later in life, not so much ...
TRACY
Well I'm 35.
MOCKETT
So yeah probably not so much at your age but later on.
TRACY
My sight's been getting - I've been smoking since I was seven, I'm now 35, I've just given up four weeks ago.
MOCKETT
What does your optician say?
TRACY
I don't know, I don't go to one hopefully, I try not to.
MOCKETT
You should really get it checked out by an optician.
TRACY
No I know but - well I usually see a guy at the hospital.
MOCKETT
And what has he said to you?
TRACY
Well everyone I've seen ends up telling me to give up smoking.
MOCKETT
Yeah.
TRACY
Which I've now done.
MYERS
Tracy, it's obviously going to be very good for your health to give up smoking, that is the bottom line here. But that said you started at the age of seven and so it must be quite difficult - this is a lifelong habit, even though you're only 35 now.
TRACY
Yes it is. I mean everyone that I was around when I was a child smoked - parents, grandparents, children's home staff, everyone smoked. So yeah and then I've just lived on it since.
MYERS
So Tracey's one of your success stories in that she's managed to stop and there are one or two others here who've also managed to stop Marian, is that a particular feature of your clinic that you have a good success rate because it is helpful to people to come and get help like this?
CULLWICK
Yes and it's been shown in all the statistics and research that's done that whatever treatment one is getting to give up smoking it is the ongoing counselling that makes a significant difference. There isn't a magic pill, there is not magic drug or patch or anything else, all of these things can be helpful in the process but it's coming to that place in your mind where you're ready, it's in your mind where you give up smoking, it's not in your hand that brings the cigarette to your mouth and it's not in the lungs, it's in your mind.
MYERS
Carol, I think you've got a question about the specialist non-smoking clinics and services of the kind that we're here to see today.
CAROL
What kind of service would we get - or what would we expect from the specialists at the stop smoking clinic?
CULLWICK
Our service we would look at either seeing people on a one to one or in a group setting. Now sometimes a group of people giving up together can be very constructive, get help from each other as well as from the specialist. But sometimes seeing people on a one to one basis is useful. Now we'd look at helping people prepare properly in terms of, as I say, what's going on in your mind about where you're coming from with smoking, tips and hints and preparations and looking at what you're doing, what you're wanting when you're having a cigarette. We would help you plan a quit day, we'll help you decide on any medication that's appropriate.
CAROL
The hardest thing is that yes I want to quit but most of the stuff - like the patches and that - I'm unable to wear because I'm allergic to them. Some because they're latex and others I had a bad reaction to the last lot. And now I've got to the stage where I'm frightened to try anymore nicotine patches and that.
MYERS
Can I ask Rob about that, the value of nicotine patches, this is a kind of replacement for the nicotine you're not getting from your cigarettes, is it helpful, is it something that you would recommend?
MOCKETT
I think it's useful that it's there because some people find that it's the actual nicotine withdrawal that they find difficult, so there are lots of different patches, lots of different dosages, it depends on how many a day you smoke. Some people do get a nasty reaction to it, it causes muscle cramps when you put it on and pain or, as you say, an allergic reaction. But it is part of an armoury of treatments I guess, it's not the only one, but it's better that it is available than so many years ago when it was only available really privately.
CAROL
It's just the fact that I feel as if I've let myself down because I so much want to give up because of my health and I've got a sixteen month old granddaughter that I want to enjoy and smoking is stopping me enjoying it because I can hardly breathe.
MYERS
You've got a lot of reasons for wanting to give up and yet it's proving really tough.
CAROL
Yep, very tough. I'm fine for the first 24 hours but it's when someone goes you've been six hours without a cigarette and you just really want to smack them.
MYERS
Is it better to tell friends and family that you're giving up or to just get on with it - what would you say Marian?
CULLWICK
Well it depends on the individual. If people are preparing thoroughly and thinking about what they're going to do then you can sort of talk yourself into it and put yourself in a position where you're committing to that date. Like everything coming up, whether it be the Olympic Games or driving test or giving up smoking you can get your adrenaline going, you can get towards it, get in the best place that you can possibly be and part of it is telling other people.
MYERS
There's of course quite a big date coming up in the summer - 1st July I think is the date - when smoking in public places is going to be banned. Rob, do you think that's going to help some people get their act together in good time, do you think it will stop people smoking?
MOCKETT
I think it will, I think it'll make a massive difference. If you go to New York it's like that now and it's a completely different environment, everywhere you go you can't smoke, people don't even smoke on the street that much over there. And it makes a big difference I think - people go out, they enjoy themselves more, it's giving people a six month countdown, yes.
MYERS
Maybe we can take a show of hands of the people here, who thinks it will be a help when you can no longer smoke in a public place? That's almost everyone. Who thinks it won't help them? This lady here. Chris.
CHRIS
If you want to smoke they will smoke, so I don' t think ...
MYERS
What about you then, what are you going to do?
CHRIS
I packed up - I've packed up.
MYERS
You've packed up?
CHRIS
Yeah, I haven't had one for five weeks nearly.
MYERS
And how's that feeling?
CHRIS
Nice, I'm very short - get very short tempered but otherwise than that I'm okay, it's only my grandchildren that do it, I'm a carer for my grandchildren and in October I saw a lady have a heart attack at a bus stop and it wasn't her that I saw it was me and I had my grandchildren with me, what would have happened to them and that was it - I didn't cut out, I just cut down then, phoned Marian up and told Marian and we stopped then, gave me a date and I packed up five weeks ago.
MYERS
Really important motivation wasn't it. Do you think that that memory is going to keep you going through the hard times?
CHRIS
It does, it does. I haven't forgotten it. I don't know whether she lived or whether she died but as I say it wasn't her I saw it was me. And I think some people need that shock in the system to give up.
MYERS
But if we move to Maggie, who's I think a bit worried about when she's under pressure and under stress and we're all sometimes under pressure, that's the difficulty for you is it?
MAGGIE
I did succeed in getting the nicotine out of my body and I was proud of that and then I had a lot of stress one way or another in the family and I started smoking again. But Marian what are you going to do for me dear?
MYERS
There's a challenge.
CULLWICK
We'll be sorting you out an appointment imminently Maggie, we'll sit down again. I think ...
MAGGIE
It makes it worse because I was diagnosed a few months ago with asthma and I do find I think when you're talking you notice that your own voice is getting deeper and deeper and I find that my throat is not so good. So we've got to do it soon Marian.
CULLWICK
And I think Maggie's point - Maggie's made a very apposite point. The issue about stress, what I can't do for you Maggie, bless you, I can't take all the stress out of your life, I wish I could, there'll be something else coming along.
MAGGIE
The thing is it doesn't make the stress go away.
CULLWICK
It doesn't, you're absolutely right. The trick is learning how to deal with what's coming up and finding different routes, as Rob said - the deep breathing exercises or maybe I'm a great believer in things like Tai Chi or Yoga, learning a different way to relax because a lot of times it's that wound up nature and we use the cigarette to get away from whatever is giving us gyp.
MAGGIE
I think it's just yourself, I mean my husband has got vascular disease and - very badly - and lost a leg and he was years ago - he hasn't smoked now for about 30 years - but he's already lost one leg and we know the other one will go and I feel that I'm putting him in danger still.
MYERS
It is a family issue of course and Karen I think you've got a question about how you can help a member of the family give up.
KAREN
My husband is a smoker and I know he absolutely hates smoking and I'd like to know how my two young boys and I can help him.
MYERS
You're non-smokers of course?
KAREN
Yeah my children are only young, they're 11 and 8 but they hate it and they're always on and on and on and I do try and say to them don't go on too much but you know they hate it and they want him to stop, as I do.
MYERS
Marian, what advice can you give Karen then to try and support her husband to stop?
CULLWICK
Even if you say positive things to somebody who's doing well that'll be the one time that day they've not thought about a cigarette. It's so difficult - I'm so proud of your sweetheart, you're doing really well - and they could just punch your lights out. So I think firstly say nothing and get the boys to say nothing, kids are really good, we use pester power, we've just all experienced that over Christmas - I want this, I want that, want something else - kids are brilliant at saying I want you not to smoke. But the thing they're really good at is once you've done it, you might only have done it for a few days and that's it you're yesterday's chip paper, they're on to another concern. So they won't tend to nag on. But it's a question I think of positive support, without alluding directly to the smoking. So we know the buttons that upset our partners don't we and let's not push those just the week they're giving up smoking.
MYERS
We're coming towards the end of our programme but Tim joins us with a good news story because you've managed to give up, you've been smoke free for what a couple of months now?
TIM
About five months.
MYERS
Five months? Good news. And so what's done it for you Tim?
TIM
It was kind of lack of energy, chronic lack of energy I had every day and I was kind of running a little bit and I couldn't really run at all. So I just needed to quit to get rid of that lack of energy.
MYERS
And where are you up to now?
TIM
Well I've just signed up to run the London Marathon.
MYERS
That's fantastic news and did you find it as hard as you thought you might?
TIM
No, I think - I've tried to quit quite a few times without any support and that was - I kind of find impossible really. But the extra support I got from the kind of Smoking Cessation thing was really, really helpful.
MYERS
That's really good news. I mean there is a bit of a debate about how hard it is to give up smoking and of course if it's going to be really, really hard that's going to put people off trying. What's your own view Marian, is it really, really hard?
MARIAN
It seems really, really, really hard when you're a smoker but a good 95-96% of people that I see on the second or third appointment will say, without prompting, gosh it is hard but it's nowhere near as bad as I thought it was going to be. I think there is a big fear about giving up smoking and a lot of worries about it. And we just aim to do - just use a two word phrase - we want to keep people feeling comfortable while they give up smoking and then they'll manage it.
MYERS
And Rob, what's your view, do you think people perhaps are being put off thinking it's harder than it really is?
MOCKETT
It is perceived as hard but once you do it, once you've got past the - the worst way you're going to feel is the third day, that is when you want to kill everybody and once you've got through that it is amazing it's like a pressure that lifts off you and it's this isn't so hard. But the main thing is never to have another one, it's never to have another one, it's like an alcoholic - you can never have another drink.
MYERS
So just the occasional one just doesn't go?
MOCKETT
No never, you can never have one, you can never have another cigarette and that's what people find the hardest - that little friend, that little pick you up when you're working on your car and you can't get it to work you have a fag and then you can fix it. Or whatever your thing is those are the ones you've got to stop having and that's hard. But once you've got past that it's amazing how free you feel.
MYERS
Thank you very much indeed. That's it. Thanks to our group here at the Smoking Cessation Clinic in Brighton. Thanks in particular to Marian Cullwick and Dr Rob Mockett. I hope we have given you some ideas and some inspiration to help you stop and stay stopped. There's more information on our website and that includes details of the National Stop Smoking Help Line. So you can go to bbc.co.uk/radio4/checkup where you can of course listen to the programme again. You can also phone our free and confidential help line, that's 0800 044 044.
I'll be back in the studio next week taking your calls on indigestion, one of the hazards of the season. But for today, from Brighton, may I wish you a happy and a very healthy New Year.
Ends
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