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Can Social Science Help You Quit Smoking For Good?

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Can Social Science Help You Quit Smoking For Good?

Can Social Science Help You Quit Smoking For Good?

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SHANKAR VEDANTAM, HOST:

Hey, listeners. We're putting together a podcast episode about vacations. Do you have a funny story about a vacation that went terribly wrong? Call and tell us about it at 661-772-7246. That's 661-77BRAIN. Enjoy the show.

This is HIDDEN BRAIN. I'm Shankar Vedantam. Several months ago, I noticed one of my colleagues taking breaks from work during the day. At first, I thought Max Nesterak was trying to build some exercise into his schedule. Good for him, I thought. But when I asked him about it, he confessed that he was stepping outside to smoke. We did a podcast episode about New Year's resolutions and Max's resolution to quit smoking at the start of the year.

MAX NESTERAK, BYLINE: It's 2016, and I have not spoke for two minutes.

VEDANTAM: Lots of you have written and phoned and emailed to ask how Max is doing and whether he's managed to stick to his resolution.

NESTERAK: Ah, I really want a cigarette.

VEDANTAM: Yeah, about that - we'll get to it in a few minutes. Today we're going to talk about Max's story and three interventions I suggested to help him quit smoking. You can apply these ideas in your own life, whether that's giving up smoking or that three-latte-a-day Starbucks habit. When Max decided to quit, he and I sat down to chat. I asked him how he became a smoker and what cigarettes meant to him.

So you told me that you started smoking when you were 14 or 15 years old.

NESTERAK: Yeah.

VEDANTAM: That seems shockingly young to me.

NESTERAK: It seems shockingly young to me, too. I should say the first cigarette I actually smoked, I was 10 years old. It was Christmas. And my aunt smoked, so they would be on the back patio, you know, shivering outside. And, you know, I'm like - I wonder what it's like to smoke a cigarette. And my dad was like - sure, go ahead. Join Aunt Doe (ph) and, you know, Cousin Jenny and have a cigarette. And so I went outside, and I had a cigarette.

And I think his hope was that, you know, I would just vomit or just get so sick that I would never do it again because he never - you know, he never touched cigarettes. But, you know, I never did. And I - you know, it didn't really have an effect. I was a little buzzed.

VEDANTAM: Did you like it?

NESTERAK: I did like it. I thought I liked it. I mean, I liked, you know, being there, like, with my family outside smoking. I felt kind of cool. And all the other cousins who were my age were kind of, like, peering out of the patio behind the glass door, the safety of the nonsmoking kitchen nook. And just like - what is Max doing? And there I was in my coat huddling with the other ostracized family member smokers.

VEDANTAM: What did your mom say about this? My mom, I think, rolled her eyes. And she was like I can't believe your dad said this was OK. But I hope you vomit, too.

VEDANTAM: But, as Max said, he did vomit. In fact, he liked smoking. A few years later, when he was a freshman in high school, he asked an older friend to buy him a pack of cigarettes. He began smoking regularly.

NESTERAK: I used to take the dog on walks. And that was, like, my smoke break. And so I think, you know, starting around age, you know, 14, that dog got so many walks a day. Or like...

(LAUGHTER)

NESTERAK: It got increasingly more exercise as the years went on.

VEDANTAM: So a scientist would say there was an inverse relationship between the dog's health and your health.

NESTERAK: Correct. Yes, I think that's an apt description.

VEDANTAM: As he's gotten older, Max says he's become aware of the stigma around smoking. It didn't stop him, but it did make him think twice about telling friends and co-workers about his habit.

NESTERAK: I don't think it makes me cooler or more interesting. And generally, I think when I first meet people, I'm not afraid of being judged. But it's just something that's, like - yeah, it's not something I just want to share right off the bat.

VEDANTAM: But if there's a social stigma to smoking, there are also social benefits. One thing Max and I discussed was the smokers club that forms outside of offices and libraries. You see the same people congregating every day, chatting as they smoke. I mean, that's very profound, psychologically speaking, if you're constantly meeting people only at the times that you're doing something that you enjoy. Those are people you're going to associate, in a Pavlovian fashion, with the thing that you enjoy. You're going to be forming friendships with them. And other friendships keep you in that world.

NESTERAK: Yeah. I think it's same with activities. I mean, the more you smoke, the better life gets in a way (laughter). I mean, smoking and television, smoking and eating breakfast, smoking and eating ice cream. But I think that's true with people - that there is, like, this shared bond where you're out on the break. And right, the pleasure center is being activated and - while you're talking. So you probably think, you know, the conversation is better. I think it's the same as when people go out to the bar to happy hour together, and they have drinks. There's this bond that's formed that's - that just wouldn't be formed at work around the water cooler in a way.

VEDANTAM: There are other clubs you get to join when you're a smoker. But of course, smokers like Max tend not to think of those clubs when they're smoking.

NESTERAK: With smoking, I associate myself with the film noir, the cigarette after dinner, the social smoking, but not the emphysema or lung cancer or oxygen mask part of the game, if you will.

VEDANTAM: So that's the interesting thing, of course. And you know all the social science literature on this, which is that the pleasure and the social camaraderie and the friendships are real and immediate, and the potential costs are delayed and distant. And there's just six warehouses filled with psych studies that basically show that when you set up the incentives this way so that the short-term incentives are positive and gratifying and the long-term incentives are horrible, people will ignore the long-term and focus on the short-term.

NESTERAK: Yeah, I think there's never a good day to quit smoking, right? You know, there's the part of yourself that wants to wake up at 6 o'clock in the morning, and so you set the alarm clock. The you at 6 o'clock in the morning presses the snooze button 20 times until it's 8 o'clock, and then you're rushing into work, and you're late. And, you know, there's the part myself at night who says, OK, tomorrow I'm going to stop smoking. And then, you wake up and you have one. And then, you're like, well, if I had one, I'm not going to go the rest of the day without - without smoking. So it's easy to weigh the long-term benefits of smoking when you're not craving a cigarette.

VEDANTAM: An old smokers' joke says, quitting is easy; I've done it lots of times. Knowing that most people who quit go back to smoking, I suggested that Max do three things to help him stick to his resolution. All were ideas drawn from social science research. First, I asked him to put the money he was spending on smoking - about 6 bucks a day - into a savings account. If he succeeding in quitting at the end of the year, he would be able to go on a nice vacation. But if he started smoking, he would have to donate the money to an organization he detests. Now, I'm not going to identify it, but let's just say max picked an organization that does a lot of lobbying in Washington. Second, I asked him to reach out to a bunch of friends and ask them to be there for him when he needed support. And finally, I asked him to record a public service announcement about why young people should never start smoking. The idea is that when you publicly declare you're against smoking, it makes it hard to start smoking again. It produces cognitive dissonance, makes you feel like a hypocrite. We aired Max's public service announcement in January. Here's an excerpt.

(SOUNDBITE OF ARCHIVED RECORDING)

NESTERAK: If you don't smoke, here's what you should know. When you're a smoker, life is lived around cigarettes. You'll be laughing with friends at dinner or totally engrossed in a good book, and something will tug at you. And as much as you want to stay in this moment, you'll be thinking about a cigarette. So you'll get up, walk outside and light up. And it will feel really good, but you'll wish you were back inside, and you'll be so tired of trading off these moments for a smoke. If you don't smoke, you should know that smoking makes a prison out of perfectly normal situations - long flights, concerts, class, anything that lasts longer than a couple of hours. These are your enemy as a smoker. And any time you go on a date or to a job interview or to your grandparents' house, it will be accompanied by a pang of worry. You'll wash your hands and pull your shirt to your nose and hope they can't smell smoke.

VEDANTAM: We also asked something from all of you. We asked that you call in with your own stories about how you managed to quit smoking. We were absolutely overwhelmed and moved by your responses. So many of you wrote and called with words of wisdom and encouragement.

UNIDENTIFIED WOMAN #1: Hi, this message is for Max. I was just on my way home listening to the resolutions podcast. And I was actually on the way home from my dad having surgery on his lungs for lung cancer. So I just wanted to wish Max good luck. And hopefully he's able to quit, and this isn't him in 50 years. My dad is 74, so...

UNIDENTIFIED MAN #1: There's no need to badmouth your old self, but best to nurture the new direction with as many creative ways as you can come up with. I have no doubt you will succeed. It's been 28 years since the day I quit.

UNIDENTIFIED MAN #2: The thing that really helped me was not to focus on the whole project, but only on steps. For instance, I kept repeating to me every time I had the urge of going out to smoke a cigarette, well, this one - you're not going to smoke it. So, I mean, I just concentrate my attention and my power on the single cigarette that I was craving. And that way, cigarette by cigarette, I successfully quit it.

UNIDENTIFIED WOMAN #2: I threw out my cigarettes. And in that moment, I decided that not only was I going to quit smoking, but that I would become a non-smoker right then. And from then on, every time I would want a cigarette, I would ask myself why in the world a nonsmoker would want a cigarette.

UNIDENTIFIED WOMAN #3: Go to the places where you usually buy cigarettes and introduce yourself to the person behind the counter. And just let them know that you're trying to stop smoking. You don't have to tell them not to sell you cigarettes or anything like that, but just say to them that you're trying to stop smoking. It's going to be really hard for you to then go back there and buy cigarettes.

(SOUNDBITE OF MUSIC)

VEDANTAM: We're going to take a break now. When we come back, we're going to hear from Max. He kept an audio diary as he went along to document his triumphs and setbacks.

NESTERAK: It's, like, this mental obsession. So you're kind of like, oh, should I have a granola No, I want to have a cigarette. Should I go for a walk? No, I want to have a cigarette.

VEDANTAM: Stay with us.

(SOUNDBITE OF MUSIC)

NESTERAK: Quitting smoking is kind of like a really bad break up. At first, I'm OK. I feel relieved, happy even that I finally did it. This isn't so bad. I go to bed that night looking forward to waking up the next day as a new person. Tomorrow is January 1, 2016. It's going to be the first day of the rest of my so-much-better life. Of course, the first thing I think about when I wake up is a cigarette. I plan to go downstairs and poor myself a cup of coffee, bundle up in my winter coat and have the first cigarette of the day, which is, as any smoker will tell you, the best cigarette of the day. Then I remember what I had done - said I would quit smoking. And I do not stop remembering it. I started keeping an audio diary. Here's a clip.

(SOUNDBITE OF AUDIO DIARY)

NESTERAK: It's just - it's, like, this mental obsession. So you're kind of like, oh, should I have a granola bar? No, I want to have a cigarette. Should I go for a walk? No, I want to have a cigarette? Should I watch a movie? No, I want to have a cigarette. So (laughter) that's - it's just, like, this obsession is all you want, and it's all you can think about.

I think back to the early days of the romance, when I would get lightheaded, tingly in my fingers and just feel giddy. I started smoking around the time I realized I was gay. I went to high school in suburban Colorado with a champion football team. And, well, by the time I started smoking at 14, I needed it. Sometimes I would inhale as much as I could, close my eyes and just let my head buzz while I held in the smoke. The withdraw feels like just the opposite. I'm sad and frustrated. My head aches. My muscles tighten up. My thoughts are foggy. I'm acutely aware that there's suffering in the world. When you're having a craving, you just - you don't think that you're ever going to feel differently or have felt differently.

I try to embrace it. A craving comes, and I just lean into it.

You have to love the burn almost, you know what I mean? Like, you - it sucks. It hurts. And you just kind of lean into it and you're like, yeah, like, this is what quitting feels like. And, yeah, so I'm loving the burn right now - loving, hating the burn right now.

I'm chewing sugar-free gum and drinking seltzer water.

NESTERAK: These are my sad romance song and cinnamon bun equivalents. I bask in the pain and let my mind do what it wants to do - think about how much it sucks to not have a cigarette. Then I think about something I heard about buffalo - that when Buffalo see a storm coming, they walk towards it rather than away from it because they know they'll get through it faster. I am the buffalo.

It's, like, three minutes away from being 48 hours, so it's at the end of day two. Oh, there were some dark moments today. I don't know if I can take another day of this. I think about the money I've said on cigarettes that I'd have to donate to that horrible organization if I smoked. It's actually only $13. I think, if I'm going to relapse, I should do it now while there's so little at stake. Then I think about having to say I failed on this podcast. I google quitting smoking timeline. After 20 minutes, your blood pressure and heart rate will return to normal. After 12 hours, blood-oxygen level has increased to normal. Forty-eight hours - damaged nerve endings start to regrow and anger and irritability have peaked. Seventy-two hours - entire body is free of nicotine, number of cravings have peaked, lung function is improving.

I make it to day 3. I go for a run, and I'm surprised at how much my lungs have already recovered. The cravings come less frequently, just like the quitting-smoking websites promise they will.

I'm nearly three weeks into quitting smoking now. It's day 20, and the most amazing thing happens.

I woke up, and I drank a glass of orange juice. I took a shower. I got dressed. I packed my bag for work. And, you know, as I'm about to head out, I realized that I hadn't thought about a cigarette the entire morning. I had literally gone through my entire routine without once thinking about a cigarette. And, of course, then I was thinking about a cigarette, but it was incredible because, for me, by that time, I would have already had a cigarette and would have been planning to have my next one right as I walked out the door.

I've made it this far before. I quit for about six months when I was 18. And last year, I quit for 10 months. So this isn't even the longest I've gone without smoking. I google how many people successfully quit smoking. It says 90 percent of smokers who try to quit relapse in the first year. The last time I quit, I relapsed on a Black & Mild - one of those 60-cent cigars they sell at gas stations. I think I've only smoked one other Black & Mild in my life, when I was 16 at a house party. I bought it because they're strong, and you can buy one at a time. I thought if I could just have one really strong cigarette, it'd be enough to last me the rest of my life. The next day, I bought a pack of Camel Lights. This time, I know to stay away from Black & Milds. It's been about a month since I quit smoking, and I'm walking home from work. It's cold, but sunny. I'm happy. I see a guy about my age step out of his office and start walking in front of me. He reaches into his coat pocket and puts a cigarette to his mouth. Then he reaches into his other pocket, and I see him do that familiar pause to light up before he starts walking again. The smoke drifts back to me, and I'm just jealous that he's not doing a radio story about quitting smoking. He reminds me of how much I miss the ritual of the after-work cigarette.

I've had a bunch of cravings like this, so I've had to call my friend Larry Hanson (ph) in Minneapolis. He's a former smoker and one of the support people Shankar suggested I line up before quitting.

It's like - I don't know. It's like I wish I could smoke without any of the, like, consequences, you know?

LARRY HANSON: But that's magical thinking, Max. Don't even go that - don't even go there. Yeah, don't even go there. I mean, that's foolish. We can't do it, you know? It's not in the stars for us. I couldn't, you know, light up a cigarette and just say, oh, I'll have a cigarette, and I won't have another one for six months or something like that. It wouldn't work that way for me. You know, I'm sure. And I don't want to even experiment and, you know, say, oh, would that really happen? You know, no, I don't care. I'm not going to try.

NESTERAK: I asked Larry if it was hard for him to quit.

HANSON: You know, I told you how I had tried to quit, and I would go buy cigarettes and then smoke one and - and then flush them down the toilet. And then, I - you know, I tried the various things. I tried tapering off, and then I tried going to smoke low - whatever those - you know, they were supposed to be, like - I don't know - diet cigarettes or something like that.

NESTERAK: Then I ask him what I've been most scared to ask him. Does he still miss it?

HANSON: Well in - you know, I mean, I feel - I feel great now. I mean, I'm, you know, 72 years old. I haven't smoked for more than 30 years, you know? And I know if I were still smoking now, it - it would - it - well, I just - I can't imagine it. But to answer your question, did - do I miss it? I don't really, you know? And, you know, when I was in Vienna back in November, I - they still allow smoking in in some cafes there. As soon as you walked in the door of the place, it reeked of smoke. And it's just not a pleasant kind of experience. And maybe that was a line that I crossed when - when I used to get a whiff of cigarette smoke and there would be this pang of remorse, you know, or, oh, that smells good. I wish I could have a cigarette right now. And then - I've passed that point now. And I - you know, I just go, oh, what's that smell? It stinks, you know. Yeah.

NESTERAK: I have not reached that point yet. When I smell a cigarette, it still smells pretty good to me. But I'm so grateful I don't have to smoke anymore. Everytime I run, I'm grateful I don't smoke. I'm grateful I don't have to get up and leave my desk all the time. I'm grateful I don't need a cigarette when I feel stressed or sad or happy. I used to smoke every couple hours - every hour on the weekends. Last week, I looked up at the clock and couldn't believe how late it was. That rarely happened to me as a smoker, but it happens to me all the time now. It wasn't anything unusual. I cooked dinner with my roommate. We played a few games of Cribbage. And we were laughing about something or other as I ate my nightly bowl of cereal. Before, each of these moments were bookended by a cigarette. Now, I'm just here - present.

(SOUNDBITE OF MUSIC)

NESTERAK: It's been 186 days without a cigarette, but I'm by no means out of the woods. I thought I'd be able to say I quit smoking, but I realize it's not something I get to say yet. I just get to say I'm not smoking today. But I think, one day, I'll get to the point where I can go to a beautiful place like Vienna, full of outdoor cafes with strong espresso and ashtrays at every table, and think those cigarettes, they just stink.

VEDANTAM: As I listened to Max, I realized one really hard thing about giving up smoking is that you don't get to declare victory. You don't get to say, OK, I'm done. The victory is always provisional. But recently, I was speaking with Tom Frieden, who heads the Centers for Disease Control and Prevention, the CDC. I told him about Max. Tom told me that getting to six months is huge. Turns out, every day you stay off smoking makes it less likely you'll ever go back. The longer you quit, the longer you quit. Max had one big source of inspiration these last six months that he isn't going to have going forward. That's you. Max knew we were going to put together this podcast six months after he stopped smoking, and he knew lots of you were waiting for it. He didn't want to tell you he'd failed. On the plus side, he's now put away more than a thousand dollars in that savings account, and he's going to donate all that money to that evil organization if he goes back to smoking. They're going to do terrible things with the money, Max - awful things. Don't let them do it. If you want to help Max, follow him on Twitter - @maxnesterak. He's agreed that if he ever goes back to smoking, he'll announce it the same day publicly on Twitter. I know you'll have his back. This episode of HIDDEN BRAIN was produced by Maggie Penman and Max Nesterak. It was edited by Michael May and Jenny Schmidt. Our staff also includes Kara McGuirk-Alison and Chris Benderev. You can find us on Facebook, Twitter and Instagram and listen to my stories on your local public radio station. If you liked this episode, please consider giving us a review on iTunes or any other podcast platform. It will help other people find the show. I'm Shankar Vedantam, and this is NPR. Thanks for listening to HIDDEN BRAIN.

You should check out NPR's music-discovery podcast, Alt.Latino. Hosts Felix Contreras and Jasmine Garsd are your guides into the world of Latino arts and culture. Alternative approaches to traditional music, interviews with cultural icons like Rita Moreno and Carlos Santana, as well as contemporary vanguards like Calle Trece and Junot Diaz. Find Alt.Latino on the NPR One app and at npr.org/podcasts.

MAGGIE PENMAN, BYLINE: Hi, listeners. This is Maggie Penman. I'm one of the producers of HIDDEN BRAIN. And I'm here, as usual, to encourage you to try out the NPR One app, if you haven't already. You can check out Invisibilia. Their new season is underway, and it is so good. The second episode, about the myth of personality, will have you questioning everything, so check it out. Have an existential crisis. Ask your loved ones who they are anyway. And use NPR One.

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