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The extent of the widespread damage to health caused by cigarette smoke is almost unbelievable.  Smoking kills 60% of people who don’t quit, and cigarette smoke affects almost every organ system in the human body. People are familiar with the most common problems caused by smoking, like cancers, emphysema, and heart disease.  There is less awareness about the impact of smoking on things like vision, diabetes, cholesterol, wound healing, immune diseases, arthritis, to name just a few.


I thought a discussion about some of the less well known health effects from smoking might be of interest.  As there has been some discussion in the community about smoking and the thyroid, we can start there.


The thyroid is a gland that produces hormones which help regulate general metabolism and blood pressure, heart rate, body temperature, and weight. Thyroid hormones are critical for growth, reproduction, development of nerve cells, and regulation of energy. Underproduction of these hormones (hypothyroidism), or overproduction (hyperthyroidism) are relatively common problems which can cause serious health problems.  You can find an overview of the thyroid and associated problems.


Smoking has multiple effects upon the thyroid.  Some of the reported effects on the thyroid are  strongly supported by research, while the research on other effects is somewhat ambiguous.  Reasons for the ambiguity include the fact that there are many different compounds in cigarette smoke, different studies employ different methods to measure cigarette smoking, and studies on the effect of smoking are conducted with different populations such as those with thyroid disease or general populations without disease.  


There is strong and unambiguous evidence that smoking increases a person’s risk for Graves disease (a condition causing goiter and over activity of the thyroid), and will increase the likelihood and severity of thyroid related eye disease (Graves disease can be a cause for bulging eyes that can become severe enough to threaten vision).  In addition, children who have been exposed to cigarette smoke have a significantly higher risk for Graves disease and eye related conditions, as do women who are pregnant.  Stopping smoking seems to reduce the risk and complications from Graves disease, although former smokers do continue to be at higher risk, but more research with consistent measures of ‘former’ smoker are needed.


The association between smoking and enlarged thyroid is strongly supported by evidence, especially among women.  Smoking is also found to have especially damaging effects on the thyroid among people who are iodine deficient.  A number of studies have found that smoking increases the risk of under-active thyroid among people with Hashimoto’s disease (which is the most common cause of hypothyroidism in the United States).  However other studies have not found this association. 


Unrelated to illness, smokers tend to have lower levels of thyroid specific hormones.  Studies are a bit ambiguous on the effects of stopping smoking on hormone levels, but most of the evidence supports a return to normal after smoking cessation, although the time to return to normality is unclear.


Bottom line, is for some people smoking can cause thyroid damage and dysfunction.  Stopping smoking can help.   People who have thyroid symptoms after stopping smoking, should continue not to smoke and talk with their health care provider.


I would be interested in your comments and feedback, including your thoughts on the level of detail in a blog like this.  Ideally we would like to strike a balance between providing information that is generally accessible and describing varied and sometimes complex research findings.  Let us know your thoughts, and here’s to a tobacco free future!


Michael V. Burke, Ed.D

Program Director and NDC Counselor/ CTTS

Dr. Hays wrote a blog a couple of weeks ago aimed to arm parents to talk with their children about ‘vaping’.  Let’s keep the lectures to a minimum. It’s worth a read.   


I want to add to the resources referenced in that blog by my colleague,  with a new one that is right here on  EX. Helping a Child Quit Vaping | BecomeAnEX. Parents who are interested in helping children stop vaping, or who want to be more informed about vaping, can register on EX, sign up for text messages, explore all the information and support on the platform, and participate in the community. If you've already registered but didn't opt in at registration you can do so now, go to your EX Profile, then expand Personal Information, change your reason To help my child quit vaping and Save. I think that the wisdom and experience available in the community can be invaluable to a parent worrying about their teen and nicotine addiction. 


I also think the topic is important for us all, not only parents. The surge in vaping by teens, the continuing development of new vape devices, and the duplicitous and seductive marketing may well be harbingers of a public health crises. As the Surgeon General recently warned, “E-cigarette use is a cause of great concern about which we must take action to protect the health of our nation’s young people.”


As always, I’ll be interested to hear your comments.


Michael V. Burke, Ed.D

Program Director and NDC Counselor/ CTTS


Real Talk

Posted by NDC.Treatment.Team Jun 26, 2019

We live in a world of comparison. Kids and teens are comparing themselves to their favorite social media icon or pop star, all while developing feelings of inadequacy- “why can’t I be like them”?


Are adults much different?


Stay with me on this. Often as humans we seek approval and reassurance in most things we do. It is built into our society and some will say it is all part of the human condition. We seek approval and acceptance in how we perform at our jobs, relationships, exercise, eating well, and etc. Then we compare…. Is what I am doing on target with my counter parts?

What about the ability to stop using tobacco? What do you think?


The reason I bring this up is so often I hear this “Why can’t I quit?” “What is wrong with me?” “My dad threw his pack out the window and never touched his cigarettes again!”


Nothing is wrong with you, everyone’s journey is different! It’s the curse of the human condition that is driving us to assimilate, compare, and judge ourselves when we set definite expectations.


So I encourage you to cut yourself some slack, this is a lifestyle change, one that does not happen overnight!


The path to recovery is not linear.


To learn more visit quit journeys - here you will find other’s unique experiences


Virginia Fitch-Braun, MS

NDC Counselor/CTTS

As a parent, there is plenty to worry about, as we try to raise our children.  We know that as children grow they become more independent from us and can make decisions that can alter their lives.  Smoking cigarettes, which typically begins in high school, is one of those things that parents hope their children never do.  As the rates of cigarette smoking have fallen dramatically among teenagers, most parents have breathed a sigh of relief.  But now we are faced with a new problem, electronic nicotine delivery devices (often called e-cigarettes) that have become very sophisticated in their ability to deliver high levels of nicotine, while at the same time these devices have become very appealing to teenagers who probably would never have smoked a cigarette.


 How should parents arm themselves so that they can counsel their children wisely about the use of these products? 

Here a few things that might help you as you talk to year children about nicotine vaping devices.


Know the facts and ask your child what they know about vaping, and then educate.

Vaping is “safer” than smoking cigarettes but vaping is not “safe.”  The aerosol that is inhaled from these devices contains a number of chemicals similar to cigarette smoke but in lower concentrations.  Some of these chemicals cause cancer and can cause irritation to the lungs and heart.


E-cigarette aerosol contains nicotine which is a highly addictive substance, especially when introduced to the developing brain.  Dependence can happen quickly with repeated exposure, and lead to persistent use and strong cravings.


Studies also suggest that adolescents who vape are at a 25% greater risk of ultimately using regular cigarettes.


Know the “lingo” and know the products

Juul is the most popular e-cigarette vaping product among youth. Juul looks like a USB drive for computer and is easily disguised from teachers and parents.  The nicotine is contained in disposable pods that contain high levels of nicotine- about as much nicotine as contained in up to 3 packs of cigarettes.


 There are many other types of electronic cigarettes use by teenagers.  Some look like pens and others are simply large containers of various shapes and sizes with a mouthpiece on the end.


To learn more about the emerging products called Electronic Nicotine Delivery Systems (ENDs) visit Truth Initiative


“I don’t want to sound like a hypocrite if I smoke”

If you do currently smoke, be honest and talk to your kids about the struggle and difficulty of quitting or health consequences associated with it.


One thing to remember adolescents appreciate honesty and autonomy, when we approach with lectures and scolding they may come back with resistance and then rebel.


Get support

Truth Initiative provides up to date information on vaping and a text support program to help quit geared for young adults and parents of teens of young adults.


Vaping guide for parents

Reach out to teachers and principals at your schools and see what programs or policies they have in place


Talk to other parents  


Talk to your healthcare provider about what you can do to help your children avoid the use of these products, or how to get help for your children who are using.


    Most importantly, keep the lines of communication open and take action to help your children.



Dr. Hays

Tobacco 21 laws have now been approved in several states (including Arkansas, California, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, New Jersey, Oregon, Utah, Vermont, Virginia, and Washington) as well as some large metropolitan areas.  This law is very important for we know that between the ages of 18 and 21 is the crucial period when those using tobacco experimentally become regular smokers.  Therefore, Tobacco 21 will definitely put a dent in the number of those young adults who become regular smokers.   The facts bear this out as we consider that of 80% of adult smokers became daily users before age 21.


And isn’t this exactly what the tobacco companies don’t want? For they realize that getting these young people addicted earlier will replenish their customer supply as their older customers die from tobacco-related disease – which is good for the bottom line! This is borne out by the fact that tobacco companies spend over $9 billion a year (more than $1 million every hour) marketing to young people.


This law could really be a game changer in that the law not only puts the legal availability, and consequently, the choice of tobacco use in a little older population; but indeed recognizes the tremendous addictive potential of nicotine, and its effect on the developing brain in young people.  Limiting access, as the current aim of the Tobacco 21 law, is indeed a very good step.   Similarly, “the Institute of Medicine … strongly concluded that raising the tobacco age to 21 will have a substantial positive impact on public health and save lives.”


Remember that 1 out of 3 of the 350 young people under age 18 who become regular smokers each day, will die as a result of their tobacco use.  If this doesn’t spur us on to support this type of legislation in more states and localities, I am not sure what will!


Barb Dallavalle, MA, LP

NDC Counselor/CTTS


REF: Raising the Tobacco Age to 21 - Campaign for Tobacco-Free Kids |

Connecticut to Join Growing Number of States Raising Tobacco Age to 21 - Campaign for Tobacco-Free Kids 

Cravings to smoke can hijack your brain, and in that moment the desire to smoke can feel stronger than anything else. Cravings, if given the opportunity can sabotage all your hard work you have put into quitting and leave you feeling powerless.

What is a strategy that might help?


One method could be, “Play the tape through to the end’ or ‘think it through to the end” is a craving crusher mental exercise that can help bring to awareness and facilitate the “choice” of what you can do and what the outcome will be. This is a technique that can be done at any time or place!


Here is how it works:

The next time you have a strong craving to smoke,

  • Think about how you would feel after that cigarette, how would your head, stomach, and tongue feel?
  • Think about how you would feel about yourself? How would your friends or family react?
  • Think about what might happen next: you most likely would not be able to just have one, and it would not be long and you would be back buying a pack.
  • Think about more of the short and long term consequences that you may be facing if you were to smoke again.


If your brain is begging you for a quick fix, play that quick fix out to its longer end. It will remind you that immediate gratification has a downside, which doesn’t align with your new long term goal of being tobacco free.


Therese Shumaker, MA

Supervisor/ NDC Counselor/ CTTS

Many people using tobacco hear this advice from family and friends, but sometimes also hear this advice from a healthcare provider.  It seems very odd that a healthcare provider would ever advise a smoker to continue smoking, but in fact it happens more often than you would think.  For example, most people, including healthcare providers, believe that when someone quits smoking their stress levels increase dramatically.  For health conditions where high stress is viewed as contributing to poor outcomes, think of someone who has just had a heart attack, healthcare providers wrongly believe that they should continue to smoke and quit at a time when their serious health condition is under better control.  Many mental health providers believe the same thing about helping someone quit smoking when they are also dealing with a mental health disorder.  I have personally spoken with cancer specialists who have advised patients not to quit smoking shortly after a lung cancer diagnosis because they felt that this would create too much stress for the individual who had just received such bad news.


All of these people and all of this advice is given for the best of reasons, but it is wrong.  Scientific studies consistently show that smokers compared with nonsmokers have greater feelings of stress, anxiety, depression and lower quality of life.  Although the smoking cessation process can be stressful in itself because of withdrawal symptoms and anxiety about how to deal with urges and cravings, after only a few days stress levels subside substantially.  Virtually every scientific study shows that when someone successfully quits smoking they see a substantial decline in feelings of anxiety, depression, and general psychological distress and note an improved quality of life.  The longer someone stays quit the better quality of life and the lower psychological distress they experience. Studies also suggest depression and anxiety decrease to the same extent as if treated with an anti-depressant medication; and blood pressure decreases, breathing improves, healing after surgery improves, your body receives more oxygen, and the list goes on.


So here is the truth… stopping smoking is the best thing you can do for your physical health and for your mental health.  Well-intentioned people, including healthcare providers, may provide different advice, but now you know the truth.  So, don’t stress out about it, make a plan to quit!


Dr. Hays

Doing the right thing!


Does your health care plan cover smoking cessation?  IF not, it should!  Treatment for tobacco addiction should be included in benefit plans as are other addiction and behavioral health treatments.   Because of the extraordinary benefit to people’s health, the Centers for Disease control recommends that smoking cessation treatment be provided to all health plan beneficiaries without cost or co-pay [1}. 


Providing health insurance coverage for smoking cessation is not only the right thing to do, but it is one of the most sensible decisions an employer or health benefit plan can make.  Smoking cessation can provide extraordinary savings to employers and health plans. According to researchers at the University of Ohio, people who don’t smoke save about $6,000 each year in excess health care costs and lost productivity.[2]


Still, many employers and health care plans don’t cover smoking cessation, even though they do cover treatment for other addictions.  Unfortunately, there is a lot of misunderstanding that people should just stop smoking.  However, as the people in the EX community know, stopping smoking can be one of the most difficult addictions from which to recover.


As Maya Angelou said: “The wisest thing I can do, is be on my own side be an advocate for myself and others like me.”  Check your plan.  Does it cover both counseling and medications for smoking cessation?  If not, take a step.  Let your employer or health insurance plan know about the EX Program. Providing the right support to people who smoke, is a win-win: it’s a smart investment, and a good service.


Michael V. Burke, Ed.D

Program Director and NDC Counselor/ CTTS


  1. CDC. Coverage for Tobacco Use Cessation Treatments. Secondary Coverage for Tobacco Use Cessation Treatments 2014. Coverage for Tobacco Use Cessation Treatments | CDC
  2. Berman M, Crane R, Seiber E, Munur M. Estimating the cost of a smoking employee. Tobacco control 2014;23(5):428-33 doi: 10.1136/tobaccocontrol-2012-050888[published Online First: Epub Date]|.

One of the most poignant “Becoming an Ex” stories I ever heard from a patient was about leaving a loved one out in the rain!


I worked with a 40-year old gentleman, who had smoked all of his adult life, 2 packs a day, for 25 years!  He had a large heart attack, and was reminiscing about what might have “put him in this state of health”, as he described his situation.


Just a few weeks earlier, the patient told me that he was on his way to pick up his 5-year old daughter, from kindergarten.  It was a very stormy day and the rain was coming down heavily. When he was just a short distance from her school, he saw his little girl standing in the rain, with no umbrella and soaking wet.  His heart went out to her!


 At that very same moment, he also realized that he had used his last cigarette just 20 minutes earlier, and he was totally out!  Without missing a beat, the gentleman drove right past his crying daughter, two blocks further to the nearest drug store, and bought, not a pack, but a carton of cigarettes! 


As he got back in his car in the pouring rain, now almost hailing; he headed back to pick up his daughter.  “All of a sudden”, he said “it was like I was hit, alongside of the head with a brick!  What had I just done??   My tobacco addiction, yes addiction, had sent me right past my little girl, on to the nearest drug store, to feed my habit!  At that moment in time, I realized that my priorities needed to change and fast!  I was addicted to tobacco, no matter how I wanted to deny it!


Many times, we make major life changes when our health suffers, when we lose someone close to us, or something important gets our attention!


You are now on the path to “tobacco-free living”! Don’t leave those you love, “out in the rain”!  The BEST thing you can do for anyone you care about is to take care of yourself first, so you are around for them!  You ARE doing that with the support of “Become an Ex”!   Please reach around and pat yourself on the back, each minute/hour/day you are tobacco-free!  It is one of the most important things you will ever do for yourself and those you care about.


Kathy Zarling, MS, APRN


Sometimes the seemingly easy things are actually the hardest to do.  I was talking with a patient today about triggers for smoking, and how the average cravings last 5-7 minutes.  He responded something along the lines of “Well it should be easy to put something in there for THAT amount of time (i.e., rather than smoking).”  “But in reality”, he added,” it is very difficult to do.” 


And YES, it is.  There is NO doubt about that. 


So when you think about making behavioral changes for something like quitting smoking – where do you start?  How do you find something to put in place in your life?


Some find that substituting some form of physical activity– a quick walk around the block, or jumping on a treadmill, is helpful.  Others find that they just need to keep their hands busy with something – a game on their phone, or some craft work. 


Often, what is really helpful is finding something you REALLY LIKE to do, VALUE   doing, and that TIES IN with the reason you wanted to quit smoking in the first place.


Lifestyle changes are nothing short of that – a LIFESTYLE change.  It is not something that happens overnight, or when you simply get that “mindset” to do something.  The motivation will “wax and wane”, but once you have a few reasons or values that are truly meaningful to you, it gets easier – ESPECIALLY when the motivation is not what it could be.  A lifestyle change means that your values are different now.  You are placing THIS over your smoking in what you value in life.


A patient of mine had always wanted to volunteer at the local elementary school; but knew she couldn’t do that and still be smoking.  She was concerned about smelling like smoke around the kids, and she knew that leaving the school to smoke was simply not an option.  So when she did quit, that was the first thing she put in place, and so she now is able to enjoy volunteering at her local school library.


So how can you bring out your values in your behavioral changes when quitting smoking?  Well, how do you like to spend your time?  Maybe making something for a child or grandchild when you get those cravings will help remind you why you are doing this?  Or, perhaps completing that local 5K Run/Walk is a key goal for you, or just completing a walk around the block with a loved one is motivation enough. 


Whatever you find meaning in or priority in your life, make that your reason to quit smoking, and start living the reality you truly value.


Barb Dallavalle, MA, LP

NDC Counselor/CTTS

Wellness-- is a trendy term and, in fact,  has grown on me.  According to Webster, wellness is defined as “the quality or state of being in good health especially as an actively sought goal”.  


What do you think of when you hear this term?

In my experience, many people hear the term wellness and immediately think of exercise or going to the gym routinely, but what we are really talking about is wellness as a whole, which may  mean many different things to each of us! Some of these thoughts and ideas may include:

  • Exercise
  • Meditation
  • Yoga
  • Spending time outdoors
  • Making time for the ones you love
  • Fueling your body with wholesome foods


Overcoming tobacco use may require one to be creative to  find peace elsewhere or determine other ways to get that dopamine fix that is missing.


Research shows physical activity provides a release of dopamine, has been shown to improve mental health, and can be helpful for those overcoming addictions. There is even talk that physical activity should be prescribed just like other medications as it is  crucial for well-being. It has been found, with exercise, one gains confidence through practice and mastery- which in turn can be measurable goals and something to focus on versus using.


Meditation and yoga provide great practice to focus on being in the present moment and being aware/in tune with one’s body. Specifically with addiction, practicing mindfulness (by being aware) one will recognize their signs and symptoms to use and transition them to acceptance and a reduction of impulsivity.


Make the space for those who are important to you. Using tobacco can sometimes place a wedge in close relationships, leaving individuals feeling alone and isolated. Humans are social beings! A quote stumbled upon at Mayo Clinic from William Mayo himself says, “No MAN is BIG enough to be INDEPENDENT of others.


Spending time in nature and fueling your body with wholesome food can be seen as practices of self-care or as a practice of spirituality. Making these positive choices can increase energy levels, allow space for choosing other healthier options for food or activity, and increase overall mood.


The moral of the story is…. When you feel good you can do ANYTHING you set your mind to!


Virginia Fitch-Braun, MS

NDC Counselor/CTTS

Shortly after electronic cigarettes came on the market in 2011 people became interested to know if these devices might help smokers to quit smoking tobacco.  There were a number of early studies and observations that made people believe electronic cigarettes might ultimately be a very helpful product and might be the solution to help people quit long-term tobacco use.  Scientific publications from a number of highly regarded government and non-governmental organizations declared that electronic cigarettes were as much as “95% safer” than standard cigarettes.  Studies also confirmed the vapor from electronic cigarettes contained concentrations of harmful chemicals that were many times lower than the concentrations found in cigarette smoke.  In the early days of electronic cigarettes it was also true that nicotine delivery was unreliable and quite a bit lower than a person could get from a standard cigarette.  All of this information made most people feel electronic cigarettes were safe and unlikely to the cause the kind of addiction we had been used to seeing with standard cigarettes. 


Then, it seemed, everything changed…..


In fact, things did not change suddenly in the electronic cigarette world but they did change dramatically over the course of a few short years.  Electronic cigarettes were changing and the way people use them was also changing.  The newer devices were able to deliver higher and more reliable doses of nicotine and the number of devices and the number of electronic cigarette solutions available to purchase grew into the thousands.  And while this was happening, teenagers were taking up electronic cigarette use in larger and larger numbers, so that between 2011 and 2015 the percent of high school student in the United States using electronic cigarettes had quadrupled.  We were briefly reassured that this was not going to continue when the number of high school students using electronic cigarettes or other tobacco products stabilized and fell slightly in 2017; but then in 2018 there was a dramatic rise again in tobacco product use among high school students.  Most of this rise was due to the increasing use of electronic cigarettes, particularly the ”Juul” device.  Juul raised the stakes a lot by providing a device that was very appealing to teenagers (it looks like a flash drive for a computer, and is easily hidden from naïve adults) and used disposable pods containing flavored nicotine solutions (fruit flavors and candy flavors appealing to kids).  The solution in these pods also contains highly concentrated nicotine and the Juul device delivers high concentrations of nicotine in the vapor which is absorbed quickly into the blood stream when inhaled.  Sounds a lot like a cigarette doesn’t it?


Nicotine addiction from use of electronic cigarettes is now becoming more common both in children and young adults.  In our clinic, where we treat nicotine dependence we are now starting to see more and more people who are addicted to electronic cigarettes after they made the switch to these devices thinking it would help him stop smoking tobacco.  Most adults continue to use tobacco while using electronic cigarettes but many teenagers are using electronic cigarettes exclusively and become heavily addicted.


Our approach to treatment for addiction to nicotine due to electronic cigarettes is very much the same as for the standard cigarette.  Through counseling, we move people toward positive health behavior change and commitment to a plan to quit.  We use medications such as nicotine replacement to reduce withdrawal and craving for electronic cigarettes so that they can have early success and reduced risk of relapse as they put their quit plan in place.  We expect to see more patients like this as electronic cigarettes become better and better at delivering nicotine (“better” meaning more addictive).  As we and others learn more about how to treat people who now are addicted to electronic cigarettes, we are certain we will get better at it. Our mission continues to help people become free of addiction to tobacco as well as electronic cigarettes.


Dr. Hays


Take back control

Posted by NDC.Treatment.Team Apr 3, 2019

Does one have control over smoking? I often hear- smoking is the only thing in their control, it is their right, their freedom, their choice….. But is it?


It sounds mundane, but really thinking about how smoking plays a role in your life and the reasons you want to stop smoking. To some they will say smoking is “the one thing they have,” “their vice,”  “their choice,” “their life,” etc. Then once stopping smoking is brought up, there tends to be this layer of resistance built like someone is taking away their freedom. This became prevalent to me while working with individuals attending our 8-day residential program, that the more one believes the thought “cigarettes are the only saving grace,” the more resistance and struggle one felt.


On the contrary, when these individuals worked to acknowledge and re-frame these thoughts to “I choose to quit” it seemed to lessen the internal battle. Like they were choosing the control knowing they technically could smoke they just are choosing not.  What are your thoughts on this?


I will often encourage people to think about the reasons THEY want to quit. Not why others want them to quit.


What thoughts or motivations tipped the scale for you, to allow you to choose instead of the cigarettes choosing for you?


Virginia Fitch-Braun, MS

NDC Counselor/CTTS

So, we are several months in to the New Year and you find you may be feeling a lag in your drive to stay smoke-free.  In contrast to the excitement you felt on New Year’s day about quitting smoking to have a “fresh new and healthy start in life”, the new “shine” you felt as a new smoker may be giving way to be tarnish from the wear and tear of life and you may sense a dull ache for a cigarette. So, you need a boost to revive your commitment or recharge your motivation to stay quit.  How about using the onset of a new season to add fresh “pep in your step” and recharge the “spring in your vigor” about being smoke-free? If you practice mindfulness about the “new-life” that the spring season brings, you will find ample free things in your environment to motivate you to keep living a healthy, smoke-free life.


Being Spring-filled mindful simply involves opening your senses and plugging into your consciousness the season-specific things you see hear, smell, feel and, yes even taste.  Breathe in a large whiff of fresh spring air

  1. Embrace the newness of animal life (bunnies, lambs, chicks)
  2. Soak up the radiant feel of sun on your skin
  3. Notice the vibrant green of the grass and flower buds
  4. Stretch out in the grass and look up at the clear blue skies
  5. Listen to the serenade of the birds


Now ask yourself, “Do I really want to mess this natural setting and fresh feeling up with cigarette smoke?” Remind yourself, “I don’t need to smoke in order to escape the stress of everyday life.  If I really soak in and stay in-tune with the characteristics of nature, the peaceful calm and sensory stimulation it provides are enough to replace the relaxation and or stimulation I think I am getting from smoking cigarettes.  The characteristics of Spring are reviving, whereas cigarettes are toxic.”


So, remember, a simple, easy, free and natural way to stay on track with smoke-free living is to be mindful of the newness and freshness of nature that “springs” forth and blossoms with the Spring season.


Jennifer Burden, PhD

NDC Counselor/CTTS

If this title resonates with you and you feel that you have tried countless times to quit and/or countless methods to quit and still haven’t found the right approach, don’t worry there may be other options. Also, if this title speaks to you then you are someone that doesn’t give up and you keep on making efforts to quit! Most people are not successful the first time they attempt to quit (actually the last research article I read said 30 or more times before being successful) So keeping that in mind- Don’t give up! Perhaps the next time will be the ONE that WORKS!!

Have you considered the following:

  1. Individual counseling with a TTS (tobacco treatment specialist) – They are all over the country
  2. Combination medications- meaning using at least 1 long acting medication (nicotine_patch, chantix or bupropion ) & using at least 1 short acting medication (nicotine_gum, nicotine_lozenge, nasal_spray or “puffer”) together- I have had patients that use all 7 meds at the same time (most people uses 2, 3 or 4, but whatever it takes to remain tobacco free)
  3. Doing both #1 & #2 simultaneously
  4. Becoming more involved here on the EX Community (having support is key)
  5. Join NicA (Nicotine Anonymous)- Contact your local meeting to see their beliefs on using nicotine products some believe in abstinence some are open to all.
  6. An In-patient treatment program that solely focuses on quitting smoking

If you have ever thought- I just need to be “locked up” to be able to quit, then #6 might be a great option for you. Our in-patient treatment program does not actually lock you up; instead you spend a week in a hotel like setting with other individuals (6-10) that are trying to become tobacco free. Mayo Clinic offers an excellent program in Rochester, MN that I invite you to look into if you have tried EVERYTHING and still struggle with remaining tobacco free.


Laura McConahey

NDC Counselor/CTTS

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