Careers in the field of smoking cessations
Below I am going to attach a response I composed several years ago to people who wrote me inquiring about pursuing careers in smoking cessation and also about getting trained by me to be able to do these programs. Since I wrote the original response here I retired from doing live programs, not having done any financially compensated work since 2009.
I basically moved my program into free video lessons at www.whyquit.com/joel. These lessons along with the articles I have written for clinics over the years are allowing me to reach more people with more information in every month than I was able to reach in over 30 years of doing live programs.
I think if you go through the day by day video lessons and read the materials you will have a thorough understanding of what can be done to help people to quit. You will in fact know more than most smoking cessation experts in the world who are in some way accredited for running smoking clinics. The problem is, if you list your knowledge or experience as being based on my lessons, you will most likely be summarily dismissed by most people in the public health community.
The Clinical Practice Guidelines that almost any credible organization are going to abide by are going to follow state of the art advice on smoking cessation and if you are ever going to try to work with such an organization or even have them as a referral source you are going to likely have to work within these guidelines. Almost everything I advocate though will fly in the face of the advice given in these quitting guidelines. A cornerstone of the guidelines is how almost all people should be provided quit smoking medication and aids. Here is my standard response page that have most of my articles and videos that address why I do not believe these guidelines are the best mechanisms for helping people to quit:
I occasionally get emails from people inquiring why I have such a critical view on the use of nicotine replacement products. Being that it takes time to personally answer all of these emails, I have assembled a series of articles that address different issues involving the use of nicotine replacement products for smoking cessation.
Here is a link to my page addressing these issues: http://www.joelspitzer.org/limitations-of-nrt.html
Here is a general response I wrote in 2006 about working in this field. In a way I feel that prospects are even more dismal now for anyone wanting to provide programs that would really best help others wanting to quit:
“I occasionally get requests from people wanting advice on pursuing a career in smoking cessation. I am probably not the best person to offer advice on how to turn this work into a money making proposition. If I told you what I make annually from my work in the field you would likely find yourself writing me a check as a donation. Just for the record, I don’t take any donations-I was just using the example to illustrate a case in point.
I left my 20 year full time job in a hospital based health promotion program over six years ago to just do my smoking cessation work independently. I basically went into this in a state of being semi-retired. Since I left the hospital I have just hit the six-figure mark of income for my smoking cessation work. That is if you combine all the money I was paid for all the work I did since I left the hospital six years ago. If you do the math I think you will see that I was never in it for the money.
I have never actually met anyone else who was really employed for any great length of time in true full time smoking cessation work. The only people who I have worked with in the past who did this as a full time job worked for the voluntary health agencies like the American Cancer Society or the American Lung Association. I am not sure that they even have these kinds of positions any more and if they did they are usually low paying organizations.
I would often get college students who would come interview me for ideas of working in the field of smoking cessation. I couldn’t in all good conscience steer them to this work if they actually needed a steady income. There are times when money becomes available, like when the first state settlement monies were released and I had contact with a few people who took jobs in the field. I think all of them were phased out within two years as the money was slowly diverted to other areas. Also, when some of this money is made available it will almost never fund a cold turkey approach to cessation. Funders only seem to back programs that work with pharmaceutical interventions.
With this being said, I would like to say that the work is one of the most rewarding things you may ever do if you get involved with it. Just be sure to get and keep another paying day job or win a lottery.”
My work in the field of smoking prevention and cessation
Why I no longer conduct stop smoking clinics
“I liked my other support group more”
How I started running quit smoking clinics
Helping others quit
Showing others that there is life without smoking
Can you help a person who doesn’t really want to quit smoking?
Are people doomed to fail if they don’t get professional help to quit smoking?
Can you help a person who doesn’t really want to quit smoking?
Over the years I have seen numerous members thrust into my program, totally against their wills who still manage to succeed in quitting smoking. I had two in the last clinic who clearly stated they did not want to quit but were forced in by parents. Other people are forced in by doctors, some people have even been tricked into coming to my seminars by family and friends who told them they were going somewhere else and literally brought them to the room under some form of false pretense. While I won’t say this tactic works in the majority of cases, it works a lot more often than most people would think.
To say that these people had no prior motivation or desire to quit would probably not be true. I suspect most smokers have some level of motivation to quit, but motivation without understanding isn’t enough to succeed. That is what I try to do in the first session of a clinic or in the single session seminars. I try to cram in four areas of understanding, all of which I think are crucial for the smoker to understand if they are going to have a good shot at success.
The areas I try to cover are why they smoke, why they should stop, how to quit and then how to stay off. I think these four areas are crucial points of understanding, without having a firm grasp of each component, the smoker is handicapped in his or her efforts.
Understanding why he or she smokes help the smoker see that all the magical qualities associated with smoking are false feelings. While most smokers think they smoke because they want to, the real reason they smoke is because they have to. Their bodies demand it. They are drug addicts, plain and simple and understanding this premise is the crucial first step. As with any other addiction or 12 step program, the premise of being powerless over the drug is the first step in recovery.
I want them to recognize that while they thought smoking was keeping them calm, it was actually increasing their stress levels, or more accurately, their reactions to stress. While they thought smoking made the energetic, it in fact robbed them of endurance and energy. That it made keeping their life style fun and active, it was actually robbing them if ability to do many things and was in fact putting every activity and relationship at risk. That it was at their core of their ability to be an active member of society, it was in fact causing them to resort to many antisocial behaviors, leading them to smoke in lieu of human contact or even leaving gatherings because smoking was not permitted.
Why they should stop smoking is probably the least surprising to most people, they already know smoking is bad for them, but most people don’t recognize how bad it is. Many people are blown away when they realize the full magnitude of the dangers from smoking. While I don’t spend a great quantity of time on the issue, maybe only an hour and a half of 10 hours of presentation time, it is still one of the areas that many people refer back to years later as a major motivating factor to stay off. The recognition that quitting smoking is in fact a fight for very survival is often of paramount importance in long term success, dealing with the occasional thoughts that are still triggered by circumstances and situations faced throughout the ex-smoker’s life.
How to quit, now there is a shock to most people, especially after the more reading and research they have done prior to coming to my programs. If they are medical professionals, bombarded by the influence of the state of the art of smoking cessation techniques, what I am proposing is so radical that it takes them a few minutes to overcome the idea that I am out of my mind. After being bombard by study after study and expert after expert, to come out and accept that the way to quit smoking is simply to quit smoking seems ludicrous. It is only when I have them think real hard of all the long-term (one year plus) ex-smokers they know, of how these people initially quit, that they start to realize that the vast majority of these people, and in many cases all of them, quit by cold turkey. It is often like a light bulb goes off in their head for the first time seeing the obvious, even though it flies in the face of conventional wisdom.
Finally, how to stay off, here is another kicker. Almost every piece of professional literature on smoking cessation produced over the last 30 years will bury one line in the text, or sometimes make it really obvious that will undercut the most truly motivated and educated smoker. The line is “don’t let a slip put you back to smoking.” That makes as much sense as don’t let a drink put you back to drinking to an alcoholic, or a heroin addict given the message of don’t let a little injection put you back to using. The message needs to be stronger than that, not don’t let a slip put you back to using, the message had better be–DON’T SLIP!
There is no such thing as a slip, or an accident, or a mistake, or a puff, or just one, they are all a RELAPSE! This point, more than anything else is what is going to make a quit last. Forgetting this concept, or worse, never knowing it all but assures failure.
I have seen the education of the smoking problem work thousands of times in getting people to be properly prepared to quit. Again, that problem is more than just the physical dangers of smoking. It entails the smoker developing a full appreciation of the physical, mental, social, economic, and aesthetic implications of smoking. I have also witnessed the understanding of these issues to be the tools utilized by thousands of ex-smokers in keeping their quits going as long as they keep the understanding of all these issues at the forefront of consciousness.
So can we motivate a smoker to want to quit? I think most smokers of any appreciable time period is already motivated. If not most smokers in general, any smoker who shows up here for even a glimpse at Freedom is motivated or they would not even have typed in the word smoking into a search engine or followed a link sent by a friend. If they took a peak, there is an interest. Now it is a matter of tapping into that interest and helping them realize that there really is a way out. You have all found it here. Those just starting, listen to those who are here for months and years already. Listen to how they sound about not smoking, the overall improvement of life experienced by most.
Those who are here for months and years now, listen to those who are just joining. Hear the fear and doubt expressed and realize that was you so long ago and how you never want to be back at that stage of your life again. You don’t know you will have the strength or sufficient desire or opportunity to quit again if there were another need to do so. For everyone, recognize to quit smoking and stay smoke free, always remember to never take another puff!
How can I get my family and friends to quit smoking?”
That is the question I am often asked by successful graduates wishing to help those closest to them achieve freedom from their deadly addiction to cigarettes. Unfortunately, there is no simple solution. Smokers are going to smoke until they are ready to quit. Pestering, threatening, insulting, destroying or hiding cigarettes all cause the smoker to feel resentful and usually result in higher consumption of cigarettes for spite. These are not the methods of choice.
One method which I do suggest is understanding. Smokers do not smoke because they are stupid. They don’t smoke because they are mean or obnoxious and wish to hurt their families and friends. They smoke because they are human, and as humans they make mistakes. One that all smokers are guilty of is experimentation with a highly addictive and dangerous drug-nicotine. Many of them took up smoking long before any dangers were known. When they realized the dangers, they may have attempted to quit, but for some it is not easy. They are hooked on a drug, and it will take strong resolve and a support system to overcome the initial difficulties encountered during the quitting process.
The best support which can be provided by significant others is to offer love, patience and understanding, and to try to make the smoker’s life as easy as possible over the first few days. The smoker giving up cigarettes may have severe emotional outbursts and be irritable, depressed, and even irrational. These are all the effects of nicotine withdrawal. Many family members and friends will encourage them to smoke rather than act like that. If they were recovering alcoholics, they would not be offered drinks by these people. If they were reacting to chemotherapy they would not be begged to give it up and sacrifice their lives for the family’s momentary comfort. Unfortunately, many friends and family members often do not take smoking cessation seriously enough. We are not talking about giving up a simple little annoyance such as biting of nails. We are talking about a powerful and deadly addiction. They are dealing with a real physiological need as well as a strongly ingrained psychological dependence. Offer the most encouragement you can. Be tolerant of their temporary emotional outbursts. They will soon return to normal, and you will have the personal satisfaction of knowing you helped them over one of the greatest challenges of their lives-giving up cigarettes.
While non-smokers may offer their love, patience and understanding, you, as an ex-smoker, have the unique ability to be a highly supportive and credible source to the individual attempting to quit smoking. You knew what it was like to smoke. You know how much nicer it is to go through life as an ex-smoker. Share this knowledge. Be honest-if you still have thoughts for a cigarette, tell them. But clarify what the thoughts are like. If you are a typical ex-smoker, the thoughts occur quite infrequently, and even when they do occur they last only seconds and are just a passing desire rather than a real painful episode such as those encountered during initial cessation.
People giving up cigarettes need to know this natural evolutionary process of smoker to ex-smoker. When they encounter urges after the first two weeks, they are no longer experiencing physical withdrawal, rather they are responding to a psychological trigger. They are experiencing a new situation for the first time without a cigarette. The urge will pass and they will have learned how to face all future similar experiences as an ex-smoker, with no discomfort.
Share with them the information we shared with you during the clinic. Give them the same support that the others in your clinic gave to you. Most important, once smokers give up their cigarettes, offer periodic support to them letting them know you care about them, and always reinforce one concept to guarantee success in their continued non-smoking status-NEVER TAKE ANOTHER PUFF!
Individual Approaches Used to Motivate Smokers to Quit
Every now and then, someone informs me of an original technique they devised or heard of to help motivate family and friends to quit smoking or to at least consider getting outside assistance to break free from this deadly addiction. I feel that since the majority of people who have given up smoking have done so on their own without any professional intervention, these approaches are often viable alternatives for smokers who wish to quit or for you as ex-smokers to use to help significant others stop smoking.
Most recently, a clinic participant told us of a friend who wanted to convince her husband to give up smoking. She considered his habit not only to be deadly but also wasteful and expensive. To illustrate her point to the husband, every time he purchased a new carton of cigarettes she promptly went to the nearest sewer and deposited an equivalent amount of money. This was making the poor husband sick. He usually retorted, “Why don’t you at least donate it to a worthy cause?” She would reply, “At least my way of wasting money isn’t hurting anyone.” This activity went on for a little over a month, at which time the husband, realizing the real waste of his habit, decided it was time to stop. He made it. Not only was he saving money, but, more important, he was saving his life. I give the wife a lot of credit for having the guts and perseverance to continue this unconventional practice to motivate her husband to help himself.
At all my clinics, I always tell the story of the lady who eight years ago had a circulatory condition, Buerger’s disease, and had to have her right leg amputated. As you may recall, she quit smoking and had no further circulatory complications for three years.
Then one night at a party, a friend offered her a cigarette. She figured that since she had been off cigarettes for so long, she now had control over her habit. If she liked the cigarette, she would smoke one or two a day. If she didn’t like the cigarette, she just wouldn’t smoke anymore.
Well, she took the cigarette. She didn’t particularly like the cigarette, but the next day she was up to her old level of consumption. Four days later she lost circulation in her other leg. She knew the reason. After three years with no problem and only four days after going back to smoking her circulation was affected. Her doctor told her that if she did not quit immediately, she would probably lose her other leg.
She enrolled in a smoking clinic that week and quit smoking. Almost immediately her circulation improved. The doctor took her off anti-coagulant drugs. She no longer needed them. Soon, things were back to normal.
Nine months later, I called to ask her to serve on a panel. At that time, she replied, “I can’t come. I have been in the hospital the last two months.” When I asked what had happened, she replied, “I had my toes amputated.” She had gone back to smoking. She tried one because she just couldn’t believe she would get hooked again. She was wrong. She lost circulation, had her toes removed and eventually had her leg amputated.
I have had other clinic participants with similar experiences. The reason I talk about this story is I again ran into her about 3 years ago, at which time she told me she had finally quit smoking. I told her I was surprised, I thought she had permanently lost control. After all, she had her leg removed, the toes from her other foot, and eventually her second leg. When I confronted her with that information she replied, “The doctor finally convinced me. He said, ‘You might as well keep on smoking, I’ll just take your arms off next.” That scared her into quitting smoking. Her next comment to me was unbelievable. She looked me straight in the face, dead seriously, and said “I didn’t need a house to fall on me to tell me to quit smoking!”
I still have periodic contact with her, and whenever I bring up that conversation, we both find ourselves amazed that she could ever have made such an irrational statement. She happens to be a very rational, bright and inspirational individual. She gets around on wooden legs, socializes, and even occasionally sings and dances on stage. Once she had broken free of the drug’s effects and the smoker’s psyche, she knew she could do anything.
Frequently, I encounter people who quit smoking on their own. When I ask how they did it, they tell me of this marvelous lady they met who told of how she used to be hooked on smoking. Hooked so bad, in fact, that she had her legs amputated from a smoking related illness. It usually turns out to be the same person. By spreading her story, she offers inspiration and hope to countless smokers to break the habit before the habit breaks them.
You, too, probably have stories you can share with your smoking friends of your past experiences smoking, or of people you met in your clinic. Maybe you know of ways to help motivate family and friends to quit. Try to help those people most important to you. If they try to stop but can’t on their own, remember, we are always out here to help them. You can really make a difference in their lives. Share your knowledge. For friends who have already quit, as well as for yourself, don’t forget to reinforce the one principle – NEVER TAKE ANOTHER PUFF!