Relapse - the Lesson Learned

[Thomas3.20.2010]

One of two things happens following relapse. Either the user will think they have gotten away with using and, as a result, with the passage of time a "false sense of confidence" will have them using again, or they'll quickly find themselves back using nicotine at their old level of daily intake, or higher.

Although it sounds strange, as Joel notes, the lucky ones are those who quickly find themselves once again fully hooked.

Why? Because this group stands a far better chance of associating that first puff, dip or chew of nicotine with full and complete relapse. Instead of learning the Law of Addiction from some book such as this, they stand a chance of self-discovering the law through experience and the school of hard-knocks. 

It's a lesson that's become increasingly difficult to self-discover since 1984, when the FDA approved the first of a now vast array of nicotine replacement products (NRT), the nicotine gum. 

Today, the lesson that just one hit of nicotine spells relapse gets muddied and buried by promotion and marketing associated with ineffective nicotine weaning schemes. Those standing to profit from the sale of NRT have re-labeled a natural poison medicine. They teach that instead of ending nicotine's use that you need to replace it, and describe doing so as "therapy." 

Its why teaching and sharing the "Law of Addiction" with those still in bondage is the most important gift we can give. Pre-NRT generations enjoyed clean mental chalkboards upon which to record prior relapse experiences. Today the chalkboards of millions are so filled with conflicting messages that identifying truth has become nearly impossible. 

This generation needs us. They need our insights. 

 No Legitimate Justification for Relapse

Over the years we've heard nearly every relapse justification imaginable. Some relate extremely horrific and brutal life situations and then put their back against the wall as if daring you to tell them that their nicotine use and relapse wasn't justified.

Guess what? Again, there's absolutely no legitimate justification for relapse. None, zilch! 

As Joel puts it, we understand why the person failed. They "violated the Law of Addiction, used nicotine and are paying the mandatory penalty - relapse. We also know that any excuse that the person is attempting to give for having re-awakened an active chemical dependency is total nonsense. There is no justification for relapse."

Don't expect any serious support group or competent nicotine dependency recovery counselor to allow relapse excuses to stand unchallenged. They can't, as silence is a teacher too. Here, a deadly one. 

It's "like someone standing on a ledge of a building," writes Joel. "Do you want the people standing on the ground giving the person on the ledge reasons not to jump, or after listening to all the woes in the individual's life saying, 'Gosh, I understand what you are saying? ?’ 'I feel that way too.' 'I guess if I were in your shoes I would jump too.' 'Don't feel guilty, though, we understand.'" 

"I don't want this statement to be read like a mockery of those attempting to offer help," says Joel. "I am trying to illustrate an important point. Obviously, if the person on the ledge jumps he or she will die. But understand, that if a person relapses and doesn't quit, he or she is likely to face the same fate, just time delayed."

"Yes, if you saw a person on a ledge you would try to use empathy to coax him or her back. 

But, empathy would be in the form of explaining that you understand his or her plight but totally disapprove of his or her current tactic for dealing with it. There are better ways to resolve these problems than committing suicide." 

"You may understand the feelings the person had. You may have even felt them at some point yourself. But you don't give into the feeling," writes Joel. We are nicotine addicts: real, live honest to goodness drug addicts. If we were all heroin addicts sticking needles into our arms, when one of us relapsed and started again injecting heroin into their veins, would the rest of us pat them on the back and tell them that "it's ok"?

Would we tell them "don't worry about it," "it's just a little slip, nothing big" "you just keep slipping and we'll just keep hugging you each time you come back." "Hey, we all slip everyone in a while; it's just part of life," that "it's no big deal"?

No big deal? Surrendering control of life to an external chemical is a big, big deal. The smoker waiting for the sky to fall while committing slow motion suicide is massive. 

Continuing Use Rationalizations

While the relapsed addict may feel that their reason for relapse was sufficient, it will not be sufficient to explain the fact that they find themselves still using. They now need a new rationalization to explain why their relapse justification has passed, yet they haven't stopped using.

"I'm just too weak to stop."

This excuse dismisses or ignores having been successful up to the point of relapse. 

Obviously, they were not too weak then. 

This user would benefit by focusing upon and breathing renewed life into freedom's neglected dreams and desires. 

During their next recovery they need to master putting and keeping those dreams in the driver's seat of their mind, especially during challenge. They'd be wise to review the crave coping techniques shared in Chapter 11 and prepare for battle by arming themselves with additional coping skills. They need to appreciate that the growing pride they felt before they relapsed can take root anew in just a few hours, as they navigate withdrawal again, just one challenge at a time. 

"Well, at least I tried."

As Joel notes, chalking the attempt up to "experience" will mean absolutely nothing unless the user "objectively evaluates what caused his relapses." "Instead of recognizing his past attempts as failures, he rationalizes a positive feeling of accomplishment about them.

 This type of rationalization all but assures failures in all future attempts." He needs to understand that claimed use justifications never cause relapse. Administering another dose of nicotine is what causes relapse, not the circumstances surrounding it.

"I know I will stop again."

This addict justifies continued use today by promising to navigate withdrawal in the future. But what if their now shattered dreams and desires never again become sufficient to motivate them to stop? What if there just isn't time? What if continuing use causes the fats and plaque building and gathering within an artery delivering oxygen to their brain to become fully blocked before arrival of the courage to again say "no." 

Once sufficiently re-motivated, why should they expect a different result if they still have little or no understanding as to why the last relapse occurred? 

If their motivations are sufficient now and they understand why they relapsed, what are they waiting for? 

They are likely waiting because they've invented some new silly drug use rationalization as to why now just isn't the right time. 

"I've tried everything to stop and nothing works."

Joel tells the story of a clinic participant named Barbara. She "told me that she had once attended another clinic and liked it more than ours. I asked her how long she had stopped after that program and she said, 'Oh, I didn't stop at all.'"

"I then asked her how many of the other people succeeded. She replied, 'I don't know if anybody stopped.' I then asked, if nobody stopped then why did she like the program more?

She answered, 'When I completed the program, I didn't feel bad about smoking!'"

I often hear, "I've already tried cold turkey plenty of times!" What this person doesn't yet appreciate is that education is a recovery method. In contrast to uneducated abrupt nicotine cessation it's like turning on the lights. Products and procedures clearly can fail to produce as advertised. But it's a little hard to blame knowledge and understanding when our actions are contrary to them.

 Like any tool, knowledge cannot take credit for being used, or blame for being ignored. Unlike products, this book can never claim credit for having endured a single challenge for any reader. Credit for their ongoing victory will always be 100 percent theirs. Likewise, responsibility for allowing nicotine back into their bloodstream and brain is totally theirs too. 

"Maybe I'm different."

"Maybe I can't quit."

It isn't that this person is different. In fact, they're the same as us. Relapse after relapse, with at least a dozen serious failed attempts of my own, I eventually came to believe that it was impossible for me to stop. 

After one last failed attempt in early 1999, I surrendered to the fact that I was a drug addict, hopeless and would die an addict's death. What I didn't then realize was that each of those battles was fought in ignorance and darkness. I was swinging blindly at an unseen opponent. What I didn't realize was that I'd never once brought my greatest weapon to the battlefield, my intelligence. 

I'd made recovery vastly more challenging than need be. I skipped meals, added hunger anxieties, mind fog, experienced caffeine doubling associated with at least a pot of coffee daily, and leaned heavily upon others for support. 

Insanely, more than once I celebrated and rewarded myself with just one cigarette after three days, once the early anxieties began easing off a bit. I knew nothing of the body's ability to rid itself of nicotine within 72 hours. And having inter-spaced cold turkey with at least four NRT attempts, I was totally lost. Was nicotine medicine or was it what was keeping me hooked? 

How could I possibly self discover the Law of Addiction via one puff and relapse when now being taught that nicotine was medicine? Was I weaker than the hundreds of millions who had successfully stopped? Was I different? 

Certainly not with respect to what happens once nicotine enters the brain. As Joel notes, it Is impossible to locate any person who relapsed who didn't introduce nicotine back into their bloodstream.

More Excuses Coming

As far as relapse excuses are concerned, life will provide an abundant supply for anyone looking for them. We will have friends or loved ones who will get sick, diseased and die. Dying is a normal part of life. If the death of someone close to us is an acceptable reason for relapse then the freedom and healing of nearly a billion now comfortable ex-users is at risk. 

Expect imperfect humans to do the unthinkable. We change, disagree, sometimes break promises, argue, and start and end relationships. Expect financial distress as food, medicine, fuel and living costs continue to rise. The loss of a job or inability to work may be an injury, disease or pink slip away.

Floods, droughts, fires, tornadoes, earthquakes and hurricanes will happen. People die, vehicles collide, sports teams lose, and terrorists attack and wars will be waged, won and lost. 

Life promises loads of excuses to relapse. But freedom's promise is absolute. It is impossible to relapse so long as all nicotine remains on the outside. We each have a 100 percent guarantee of staying free today so long as no nicotine gets inside. 

Harm Reduction

What if we do relapse? What then? Hopefully, relapse will instill a deep and profound respect for the power of one hit of nicotine to again take the mind's priorities teacher hostage. 

Hopefully, belief in the Law of Addiction will thereafter forever remain beyond question. 

Hopefully, we'll immediately work toward reviving and strengthening our dreams and soon start home again. But if not, what then?

And what if our relapse was to the dirtiest, most destructive and deadliest form of nicotine delivery ever devised the cigarette? 

We're told it accounts for 20% of all deaths in developed nations. According to the World 

Health Organization, smoking is expected to claim more than one billion nicotine addicts by the end of the 21st century.

Respected nicotine toxicologist Heinz Ginzel, MD writes, "burning tobacco ... generates more than 150 billion tar particles per cubic inch, constituting the visible portion of cigarette smoke. But this visible portion amounts to little more than 5 to 8 percent of what a lit cigarette discharges and what you inhale during puffing. The remaining 90% of the total output from a burning cigarette is in gaseous form and cannot be seen.

Many health officials wish they could immediately transfer all smokers to less destructive forms of nicotine delivery. And some are now strongly advocating it. 

"If NRT were ever able to replace smoking, which is highly unlikely," writes Dr. Ginzel, "morbidity and mortality caused by nicotine itself would manifest over time and replace that of cigarette smoking. It would probably be lower for the adult, but nicotine exposure during fetal development and infancy could have alarming consequences for affected populations." 

How many fewer deaths would occur? We don't really know. Although most harm reduction advocates are extremely optimistic and expect massive reductions, their suppositions ignore the fact that most smokers have already logged years of tobacco toxin and carcinogen exposure. 

How does their continuing use of the super-toxin nicotine factor into the damage already done? 

What are the long-term risks associated oral tobacco, electronic cigarettes, and replacement nicotine in long-term ex-smokers? It may take decades before science can untangle relative risks and draw reasonably reliable conclusions. 

As for any traditional combustion-type cigarette claiming to be less harmful than other burning cigarette, don't buy it. Inhaling gases and particles from a burning mini toxic waste dump is inherently dangerous and extremely destructive. 

A recent study examined the effects of smoke from three brands claiming harm reduction upon normal embryonic stem cell development. It found that smoke from these so-called harm-reduction cigarettes inhibited normal cell development as much "or more" than traditional brands.

Some public health advocates are alarmed that harm reduction campaigns may actually backfire, keeping millions who would have successfully arrested their chemical dependency hooked and cycling back and forth between cigarettes and other forms of nicotine delivery. 

They are also concerned that harm reduction campaigns tossing about terms such as "safe," "safer," or "safety" may actually entice ex-smokers to relapse.

I hold in my hand sample packets containing two 2mg pieces of "Fresh Fruit" and "Ice 

Mint" Nicorette gum with tooth whiteners. I was told that these sample packs were being sold at self-service checkout counter displays in Canadian beer stores for one penny.

How many ex-smokers will be tempted to give it a try while drinking alcohol? How many will relapse? How much of this sample gum will end up in the hands of youth?

The second sentence on the back of each Canadian sample pack tells smokers that Nicorette gum isn't just for stopping smoking. "Nicorette gum can also be used in cases in which you temporarily refrain from smoking, for example in smoke-free areas or in other situations which you wish to avoid smoking." 

Imagine pharmaceutical companies dove-tailing their marketing with that of tobacco companies in order to make continued smoking easier or more convenient. Have you ever wondered why you have never once heard any pharmaceutical industry stop smoking product commercial suggest that, "Smoking causes lung cancer, emphysema and circulatory disease, that you need to buy and use our product because smoking can kill you"? 

You haven't and likely never will. But why?

 As hard as this may be to believe, the pharmaceutical and tobacco industries have operated under a nicotine marketing partnership agreement since about 1984. The once secret documents evidencing the agreement are many, and suggest that neither side may directly attack the other side's products.

The primary purpose of their partnership is to ensure the purchase and use of each side's dopamine pathway stimulation products. They want you to pay them to satisfy your dependency's wanting. This book's purpose is to aid you in arresting it. 

Back to harm reduction where both sides in the debate appear to be overstating their case. 

Some opposed to harm reduction have argued that the risks associated with a smoker transferring to oral tobacco is like getting hit by a small car instead of a large truck, like shooting yourself in the foot instead of the head, or like jumping from a three-story building rather than one ten stories tall. 

Lacking accurate relative risk data themselves, the harm reductionist counters by asserting that, "Based on the available literature on mortality from falls, we estimate that smoking presents a mortality risk similar to a fall of about 4 stories, while mortality risk from smokeless tobacco is no worse than that from an almost certainly non-fatal fall from less than 2 stories."

"We estimate"? It's disturbing to see us stoop to educated-guessing when it comes to life or death.

It is also disturbing that no serious harm reduction advocate has yet been willing to provide an accurate accounting of known and suspected harms associated with chronic nicotine use. They know that the amount of nicotine needed to kill a human is 166 times smaller than the amount of caffeine needed to do so (40-60 milligrams versus 10 grams). Yet, in order to sell smokers on "safer" delivery many have resorted to falsely portraying nicotine as being as harmless as caffeine.

Harm reduction advocates have also done little to quiet concerns about the impact of marketing upon youth, messages already bombarding them with a wide array of tempting flavors being portrayed as vastly safer than smoking. 

They seem unconcerned by an increasing number of adolescent nicotine harm studies showing nicotine's horrific toll on the developing adolescent brain.

Let me give just one example among many. Ever wonder why those who started using nicotine as children or early teens tend to have greater difficulty learning through listening?

Research shows that adolescent nicotine disrupts normal development of auditory brain fibers. This damage may interfere with the ability of these fibers to pass sound, resulting in greater noise and diminished sound processing efficiency.

Harm reduction advocates not only ignore the harms inflicted by nicotine, they ignore nicotine's greatest cost of all, living every hour of your life as an actively feeding drug addict. They must, otherwise they couldn't sell it. They focus on dying not living. Some have resorted to accusing cessation educators and counselors unwilling to incorporate harm reduction lessons into their recovery programs as having a "stop or die" mentality. 

It is as if they have no appreciation for the fact that bargaining is a normal phase of recovery, and there may be no more inviting bargain for a drug addict than one which invites them to keep their drug.

It's why it pains me to include this harm reduction section here at the tail end of this book.

I worry that some new struggling ex-user reading this book, who would have succeeded if this section had not been included, will instead seize upon the words that follow as license to relapse.

But the alternative, the potential for relapse and then smoking yourself to death because relative risk had never been discussed or explained, is totally unacceptable. 

Still, as Dr. Ginzel notes, it would be nice if we knew the actual relative risks in contrasting oral tobacco to NRT but we don't. What is the relative risk when comparing cigarettes to oral tobacco or to electronic cigarettes or replacement nicotine?

We know that cigarettes currently contribute to nearly five million deaths this year, and that cigarettes release more than 4,000 chemicals while oral tobacco releases 2,550 chemicals. We also know that 81 potential cancer-causing chemicals have been identified in cigarette smoke versus 28 in oral tobacco.

The only as yet known harmful agent in both the new electronic or e-cigarettes (which uses an atomizer to create a nicotine mist) and replacement nicotine (NRT) is nicotine, and trace amounts of tobacco-specific nitrosamines (TSNA's), which should be correctable via quality control.

Still, additional research is needed as we have little long-term data for pure nicotine, as nearly every user has years of cigarette or oral tobacco exposure, which makes it nearly impossible to determine direct and proximate cause.

Clearly, smokers face serious risk of many different types of cancers, a host of breathing disorders including emphysema, and serious circulatory disease as carbon monoxide combines with nicotine to destroy vessel walls and facilitate plaque buildup. 

Smoking's risks and roughly 50% adult kill rate are well known. What wasn't being studied until recently were the health concerns being expressed by long-term NRT users. Although we still don't know whether or not NRT user health concerns are in fact directly related to chronic nicotine use, online complaints among those who have used nicotine gum for one year or longer include: 

Addiction with intense gum cravings, anxiety, irritability, dizziness, headaches, nervousness, hiccups, ringing in the ears, chronic depression, headaches, heart burn, elevated blood pressure, a rapid or irregular heartbeat, sleep disruption, tiredness, a lack of motivation, a heavy feeling, recessed, bleeding and diseased gums, diminished sense of taste, tooth enamel damage, tooth loss, jaw-joint pain and damage (TMJ), canker sores with white patches on the tongue or mouth, bad breath, dry mouth, sore or irritated throat, difficulty swallowing, swollen glands, bronchitis, stomach problems and pain, gastritis, severe bloating, belching, achy muscles and joints, pins and needles in arms and hands, uncontrollable foul smelling gas that lingers, a lack of energy, loss of sex drive, acid reflux, stomach ulcers, fecal impaction from dehydration, scalp tingling, hair loss, acne, facial reddening, chronic skin rashes and concerns about immune system suppression.

While smoking's harms are clearly vastly greater and far more life threatening than nicotine's, how do we weigh and balance pure nicotine's ongoing use harms against smoking's? 

How many millions of additional air sacs would these lungs have today if I'd permanently transferred my dependency to nicotine gum the first time I used it in 1985 or 86? 

If my goal had been long-term gum use instead of 8 to 12 weeks during cessation, would I have been more willing to accept gum's slower, less precise and less controllable delivery?

If I'd permanently transferred my dependency to cleaner delivery in 1986, would I be able to run for more than a few hundred feet today? Would I have more teeth?

If I had allowed myself to become hooked on the cure, as an estimated 37% of U.S. nicotine gum users were as of 2003,451 would I have had the motivation to eventually break free from all nicotine, as I did on May 15, 1999 when I stopped smoking? 

Would I have created WhyQuit two months later in July? Would I have met Joel in January 2000? Would this book have been written?

I don't know. Maybe, Maybe not. Hopefully you understand a bit better my reluctance to suggest that if you relapse to smoking nicotine, that if a non-pregnant adult, that you consider attempting to adapt to a cleaner form of nicotine delivery.

There, I've done it. But my dream isn't about seeing you develop the patience to allow yourself time to adapt to and remain slave to a cleaner less destructive form of delivery.

It's that you develop the "one day at a time" patience needed to go the distance and allow yourself to sample and taste the freedom and healing beyond. 

Once free, I pray you never forget the most important lesson of all. As Joel says, the true measure of nicotine's power isn't in how hard it is to stop, but in how easy it is to relapse.

Thousands of words but still just one guiding principle determining the outcome for all ... 

no nicotine today! Yes we can!

Breathe deep, hug hard, and live long,