This is the first of several articles directed to smokers. In order to better understand the psychology of nicotine addiction, I need to have input from smokers, and get inside your head. I look forward to your input and replies on my stop smoking discussion boardIn my practice as a pulmonologist as well as in my Quit Doc Clinic, I have finally acknowledged that I can not MAKE anyone quit smoking. I can not scare anyone into quitting smoking. Half of lung cancer patients go back to smoking!!! The drive to stop smoking has to come from within. Statistics tell us that over 80% of smokers want to quit smoking. My "on the street" interviews suggest that it is significantly less than this. Why the difference? When someone fills out an anonymous survey they can be more open. In the interview process I get the "yeah, I know I should quit but…" When I get to the one on one level, I find out that there are only a few reasons. Most of the time the failure to think about quitting is driven by either fear or immaturity. It is further fueled by denial ("oh that will never happen to me"). The top fear is not of the health consequences (stroke, heart attack, cancer) but the FEAR OF FAILURE. Most of my patients that I treat are afraid of failing their smoking cessation attempt. The second most common fear is that of gaining weight. I hear the rationalization of "I'll probably gain so much weight that I will make myself more unhealthy than if I smoked!" Well, let's look at this. It is estimated that you would have to gain 150 pounds to have the cardiovascular effects of smoking. And still you would not have the cancer risks! The third most common fear is FEAR OF CHANGE. Yep, most of us do not want to change our lifestyle. I get the comment "I've done it this way for the last 30 years no need to change now!" My response is usually, "The way that you have been doing it has gotten you into the mess you are in. Look at your lifeless skin? What about your breathlessness? What about the silent plaque that is building up inside of your arteries or the slow dissolution of lung tissue with each puff of that poisonous crap! What about immaturity. Well you are full of it! There is the rebellious punk side of you that says "no one is going to make me do anything!" To this I say "Well Einstein, don't you think that the big tobacco companies are responsible for getting you hooked in the first place? Don't you think that addiction is controlling your life? Can you go over to a friend's house and have a wonderful dinner and conversation without crawling out of your skin for your nicotine fix? This addiction has total control over you and can make you grovel at its whim." In my Quit Doc Clinic, I usually do not treat patients younger than 30. The reason is that they generally lack the maturity to stay quit. They are invincible and have not suffered from health problems or faced their own mortality. I often tell my patients whom are children of the 60's,70's or 80's that the mind set that they need to quit smoking is the same as they had when they quit all that other childhood stuff. They must be able to say "I'm done" and walk away. If they are still doing the late nights, alcohol, drugs etc. chances are that they have not matured to the point of being a successful nonsmoker. I turn them away and tell them to come back when they grow up."Denial? I don't have denial!" This denial accounts for why many people go without even trying to quit. "It will never happen to me." Or "you gotta die of something?" Smokers know they are playing Russian roulette. They believe there is one bullet and one thousand empty chambers. In reality, there is one bullet and only one empty chamber. Yes, that is right! Out of every two smokers, one will die prematurely of a smoking related death. The good news is that for every 2 people that we can get to stop smoking, we will save one life!! So what is the point of this article? Well you have to start somewhere. Before you decide to attempt quitting, you must look at your own reasons for not quitting thus far. You surely don't enjoy making the tobacco companies rich by giving them $1000/year for each pack per day that you smoke. You really don't enjoy the odor that reeks off of your body or breath (oh yeah, I forgot, you can't smell it until you quit). You may think it is your right to kill yourself by whatever means that you choose but what about the cancers, heart attacks and other illnesses that you are causing in those around you? That brings me to my next article on second hand smoke.Kirk G. Voelker MD FCCP - Quit Doc Smoking Treatment Network