Driving along last September 11, enjoying some Waylon Jennings, I passed the church where I first got sober. As always when I pass the site, it triggers a sense of gratitude and accomplishment: a subtle confluence of positive thoughts that reaffirms my newly found state of integration. My automatic brain takes a glance at the parking lot to see if any of my old cohorts were at the meeting that particular night.
As it happened, it was break-time and as usual there was a phalanx of “friends of Bill” smoking their customary cigarettes. If ever there’s a place to enjoy a smoke in a society that treats smokers like lepers, it’s outside of a 12-step meeting. Believe me, I enjoyed those stogies right along with everyone else when I was active in AA.
What did 9/11 have to do with a bunch of AA people having their constitutional cigarette break in the parking lot?
Having given up cigarettes three years prior, I had a further sense of gratitude that I was living “the clean life.” But, it was disheartening to think about all those wonderful warriors who had battled the baffling disease of alcohol with great success, but would probably die from a tobacco-based illness. What is it about addicts that almost universally cigarettes are the last bad habit they put down? Why doesn’t their high addiction IQ trickle down to extinguish this killer addiction?
That day something deeper was bothering me— maybe it was residual despair from watching 9/11 footage on the six o’clock news and re-living that horror. I had a nagging feeling that something more profound was festering in my brain. I pulled over to the side of the road. Ever since I reached the age of 50, I would occasionally have a senior moment where my convoluted thoughts would freeze. Fortunately, I play enough Luminosity games that it is usually short-lived and this time was no different.
It was now clear that indeed my focus on the smokers was activated by watching the evening news showing the two planes knocking down the Twin Towers, thirteen years earlier. What did 9/11 have to do with a bunch of AA people having their constitutional cigarette break in the parking lot? The answer came to me suddenly: several years earlier I indelibly processed a public service commercial that stated: "America loses the equivalent of three World Trade Centers a week to tobacco-related diseases." That equates to 9,000 people a week dying from cigarette-related deaths such as heart disease, lung cancer, bladder cancer, throat cancer and emphysema.
While this statistic shouldn’t shock me, I found the juxtaposition sadly ironic: here were a bunch of people fighting for their lives, battling alcoholism or drugs, who were most likely to be taken down by one of these wretched tobacco-borne diseases. As I drove away, I realized the same passive suicide dance could be said of NA and GA (two other groups I had frequented). Even though my nicotine habit had been arrested for “many a 24 hours” (as they say) I knew from my parents’ tragic demise from smoking that I already had plenty of nails in my coffin.
My dad died in 1993 from lung cancer after quitting in 1978 at 49. His cold turkey conquest came on the heels of my mother’s lobectomy to remove a grapefruit-sized tumor that, although it was the result of smoking, was, thankfully, benign. Having nerves of steel and great love for my mom, my dad quit so it would be easier on my mom. Tragically, though my mother relentlessly tried a myriad of tools to quit (smoke enders, Seventh-day Adventist Retreats, acupuncture, hypnosis, psychotherapy and even psychotropics) she could not stop her addiction.
My mother passed away at the age of 80 from emphysema, spending her last two years on life support. In all fairness, my mother suffered from depression and my father had the cancer gene. Of course, it didn’t help that our government gave GIs in WW2 as much tobacco as they wanted. I always thought about how ironically tragic it was that my mother lived 16 more years than my father even though he gave up smoking and she didn’t. It was also eye-opening that smoking can still kill you many years after you put out your last butt. Without trying to be too technical, it appears that it doesn’t take much for our excitatory glia (our immune neurons) to turn on a mutant gene that creates friendly fire and unlocks inflammatory Cytokines that incite tumor growth from the location of the resultant scar tissue from smoking. My father’s oncologist put it much more succinctly saying, “It looks like the horse has left the barn.”
While lung cancer isn’t the only killer disease smokers face, it is responsible for more than half the deaths from smoking and is by far the most insidious and most stigmatized disease. Not to underestimate other fatal diseases such as heart disease and emphysema, but they do not carry the shame that the big “C” does in way of disenfranchised guilt (see my other full article in The Fix devoted to this phenomena).
Why does lung cancer (LC) come with such toxic shame and guilt? Well, the answer is several fold. One major ingredient is from the influence of public service commercials, which are ghastly and macabre to put it mildly. They show unsightly LC patients in the last throes of the disease, and repeat ad nauseum that this is the reason people get lung cancer: “They choose to smoke.” What genius is it to further scare addicts, who unconsciously know they are killing themselves and would do almost anything to quit? Any freshman taking Psychology 101 knows that this is paramount to putting fuel on a fire: it further accentuates anxiety,which is the major reason people smoke in the first place. Furthermore, most addicts are sensitive people who already suffer twice as much depression as the non-smoker. Do we need to increase that?
Here in the 21st century counselors, like myself, know that the best behavioral modality to get people to stop is through positivity and using humanitarian constructs such as Rollins and Miller’s Motivational Interviewing whereby compassion, empathy and positive reinforcement are promoted by way of isolating and mirroring back the clients concerns in a non-threatening and ego-building process. To effect change people need to be built up, not torn down.
Of course, this is a tough job for the clinicians when the general public’s overwhelming feeling is that smokers are losers. Is this why, even though lung cancer is the most formidable cancer, resulting in more deaths than breast, colon and prostate combined, it gets less funding than any major cancer, and compared to breast cancer, it gets one-tenth the funding, per death? This becomes a vicious cycle because when smokers where asked what emotion they would feel if diagnosed with LC, 70% of 4 them used words such as shame, stigma, and hopelessness. What a great mindset to have when fighting for your life!
If this wasn’t enough of a travesty, this mindset has slowed corporate and government funding causing many researchers to change careers since they were basically stripped of funding at a time when a new, exciting therapy was emerging. Who can blame scientists, whose work can save lives but become frustrated by the lack of resources and the stigmatization?
Making this negative value stream even more combustible is the “therapeutic nihilism” that exists amongst the lung cancer health practitioners; an ingrained feeling that the modalities available for LC are marginally effective and are so toxic that there is little passion or optimism for success. Fortunately, hope emerged when Dana Reeves (who never smoked) initiated publicity, and finally funding, for these exciting new therapies that magically appeared because it was apparent LC could happen to non-smokers as well. While it is disappointing that the impetus for change was not a concerted effort to change the moral prejudices of lung cancer, smokers will take any result that mitigates their step-child status. Now with a little momentum, hopefully LC research can bring back the world-class researchers and practitioners who left the field because of the despair and impairment they felt from having their “hands tied.”
Furthermore, the new Affordable Care Act is seriously looking at making insurance companies pay for annual CT scans for people over 50 who either have smoked more than a pack a day or ex-smokers who smoked a pack a day for over 30 years. This is a huge initiative because often early cancers (which are treatable) aren’t picked up by conventional X-rays.
Too bad this policy wasn’t around when my dad was alive or the many people who lost their lives to this “silent disease.” I don’t want to be an ax grinder, but if a similar diagnostic tool was available for detecting breast cancer, it would have been fully-reimbursable 20 years ago. I purposely chose breast cancer because even though it is quite clear that moderate drinking or heaving drinking dramatically increase a women’s chance of breast cancer, the moral disenfranchisement is not evident because of the huge charitable base of funding-- even the White House goes pink in October. Apparently, alcohol abuse is a socially acceptable contributing factor and even the elephant in the room gets painted pink.
The sad reality of smoking in this country is that it is perpetuated and exacerbated by our government and big tobacco lobbyists that are infatuated with the huge tax revenue that help politicians balance the budget and allocate monies for projects that will help them get re-elected.
And when discussions for funding tobacco research or helping rehabilitate smoking come along they are usually outgunned by more organized groups like the breast cancer and pancreatic cancer coalitions. Funding groups with a lower mortality sort of sanitizes the criteria for who gets funded. It is not unlike a military going to war and accepting collateral risks in favor of what they feel is the greater good.
Longitudinal studies clearly show that the net result of putting a chunk of that tax money into research would leave much smaller medical bills than the exorbitant end-of-life costs we now pay. Consequently, it wouldn’t be far-fetched to say our government plays God by deciding who lives or dies. Is this logic wrong? Or do we live in a dystopia like the “killing fields,” only the fields are full of lethal tobacco?
As for my 12 step friends, we know all too well that even though it seems like everybody is out to get us, ultimately, it is our own friendly fire that lights up our cigarettes and the responsibility lies with us to find a way to quit. There is, however, a pervasive, implicit knowledge among 12 steppers that cigarettes are the last hurdle in the addiction carousel-after all, the dopamine rush from inhaling is efficient, legal, and accessible.
And its allure masquerades as a friendly hug when conceived danger lurks on every bog of the recovery wheel. I certainly needed my cigarettes in those early days of recovery even though I was aware of the conscious shame (disenfranchised-see my other article) I felt from continuing something that the whole world and I knew was slowly killing me. I needed something to smoke away what were mostly unjustified fears. But my rationalization was sound when that ubiquitous “Bud Light” neon light was staring me in the face: sure enough, a light and a puff suppressed that craving with remarkable efficiency-bringing me back to default mode.
I reasoned, like my fellow smokers, that lighting up was the lesser of two evils and I would trade some shortness of breath for destroying my liver and brain with ethyl alcohol. Besides, no one gets pulled over by the police for DWS (driving while smoking).
But the time came when I no longer wanted to be in that default mode anymore- I wanted to free that monkey from my back. What did I do? I wish I could tell you I had some brilliant didactic modality I followed and it was painless, but that was not the case. The best I can say is I used a kind of Rorschach approach where I tried every available suggestion or piece of information I had heard over the years. With no semblance of a crystalized plan (other than nicotine gum) I “quit” 5 minutes at a time, then an hour at a time. When I woke up and did not reach for that morning cigarette (a 20-year habit-I was that kind of a smoker) I gained enough confidence to magically get through the day. Getting through the third day was the toughest, but thankfully I was able to close my eyes tobacco-free. I must say I probably drank 20 gallons of water that first week and ate enough pumpkin and sunflower seeds that when I see them in 7/11 now I almost go into PTSD mode. I also have to admit I had the luxury of having a very light work schedule the first couple of weeks where I did not have to think too hard. This was a good thing because my neural networks were not firing.
In fact, as embarrassed as I am to be saying it now: twice that week I paid for gas for my car and pulled away without pumping it-what a great feeling for a mental health counselor who fixes people’s problems for a living-I could have described myself as “a box of rocks” and that was an understatement. The one good thing I did every day was walk and that gave me a feeling that I was slowly reversing the ill effects of my 20 years of a pack a day. In short, I wanted it bad enough and got lucky that things fell into place. I am not going to say that I don’t from time to time wish I could get that dopamine rush that would give me an almost symbiotic feeling that I was back in my mother’s womb, but I know from my 12-step meetings that the first cigarette is the highway to hell. One other thing: I was lucky to be picked as part of a study for the efficacy of CT scanning for LC (that I will talk more about later) and had a free scan which found my lungs to be clear. To anyone trying to quit, I think it is important to pick an individual plan that suits you and you don’t forget to use all those good tools you've learned in your 12-step meeting. Finally, I would be remiss not to mention the program Nicotine Anonymous and I think they let you smoke outside in the parking lot!
Kenneth Gaughran is a recovering cross-addicted addict who is also a drug counselor and freelance writer.