“I’m mad that I can’t smoke anymore! It is so unfair.” This statement was angrily expressed by a clinic participant while introducing himself to the group at the third session of his smoking clinic. He had been totally off smoking for two full days, and was absolutely disgusted about it. I asked him why he was giving up cigarettes if he was so miserable about the prospect of quitting.

His reply was quite incredible. In front of more than 20 people he said, “I have peripheral vascular disease. I have had gangrene on one foot three times and already have lost a couple of toes. I am going to lose that leg in the near future. To tell you the truth, I hope they take it off soon. It hurts so much all of the time. I hope they just take it off and give me an artificial limb that won’t hurt anymore. My other leg is also affected, as well as both of my arms.

Do you know why I have to quit? My family begged and pleaded for me to stop when I was first diagnosed, but they finally gave up. They now say, ‘Keep on smoking, Dad, but be forewarned–once you lose your arms, we are not going to buy or light your cigarettes for you. You can lie and cheat now, but you won’t have a chance of sneaking then.’ I couldn’t believe they were telling me that. I immediately enrolled in the clinic. It is so unfair, but what choice do I have? I hate that I have to quit.”

“Do you realize what you are saying?”, I replied. You are mad that you can’t smoke. But what is it that really is making you mad? The fact that you are going to lose a leg from smoking? No, you have accepted that quite well. In fact, you are looking forward to getting rid of the one quickly because it hurts so much. You are not even upset about losing the other leg, even though it would mean you would probably never walk again. Are you mad that you will lose your arms? No, that is okay with you, too. Sure, with no legs or arms you would be totally dependent on others, a complete cripple. But that still is not the basis of your anger. What are you mad about? You are mad at how unfair your children are because they are not going to let you smoke once you lose limbs.” Without hesitation he replied, “Yeah, how could they do that to me?”

Some of the clinic participants looked on in disbelief at the exchange that just occurred. Some of them thought he was crazy. Others exhibited a sense of shame, for, even though their own conditions may not have been so graphic, they recognized his attitude in their own thinking and they were not very proud of that realization.

Two days later, the participant with peripheral vascular disease who had been so traumatized by the thought of quitting smoking was expressing great relief in being free from cigarettes. Once he beat the initial grip of addiction, he recognized just how irrational he was and the true destructive nature of his cigarettes. He was already feeling some physical improvements in circulation, and, in fact, had starting forming a thin layer of skin underneath a scab that he thought would never improve.

He was still exhibiting anxiety about not smoking, but now from a totally different perspective. He feared smoking and prayed that he would never again get caught in the grip of nicotine dependence. A dependence that he now recognized once controlled his thoughts and behavior to the point of his being willing to give up his limbs, independence, physical abilities, and even his dignity. He was completely justified in maintaining these fears. If given the opportunity, cigarettes would once again regain such control. But now, all he needed to do to insure that cigarettes would never again exert such a grip was to NEVER TAKE ANOTHER PUFF!

Joel