Skip navigation
All Places > Mayo Clinic Blog > Blog
1 2 3 Previous Next

Mayo Clinic Blog

370 posts

As the weather gets warmer, we can all enjoy getting back outdoors and being active. You see, when you are physically active, endorphins in the brain are released, thus improving your mood.  So those pleasurable feelings that you previously associated with smoking, you can still have while obtaining them in a healthy new way.


And, while being more active in the summer is certainly a plus when quitting, often your normal routine is somewhat upset; or at the very least, different in the summer (i.e., kids are out of school, family vacations, home projects, etc.)  When people find that their normal routine is interrupted, this is also a good time to quit; as they don’t have those typical triggers in their day that have become so much a part of their everyday life.


Some steps you may want to consider as you prepare to quit:

  1. Begin by tracking when you are smoking.  This technique, often referred to as “journaling” or “logging” about your smoking is one way that you can make some steps toward quitting, without actually quitting right now. 

   Put a small notecard in your cigarette pack, and record:           

  1. The time of day you are smoking,  a rating of your current urge to smoke ( L-light, M-medium, or S-strong)
  2. Your current mood in one word (angry, stressed, happy, etc.), and
  3. What you are doing at this time (having coffee, working on a project, watching TV, etc.)

This is one way that you can begin the process of quitting smoking.  By considering what times of the day are going to be the most difficult for you when you quit, you can begin to plan those lifestyle changes that will be helpful to you when you quit (i.e., the times when a little physical activity, or merely a distraction or some kind, will be the most helpful such as a few minutes of meditation, calling a friend, or throwing a ball around). 

  1. Make an appointment with a tobacco treatment specialist, or your family care physician, to discuss medication options.  Plan on using at least two of the 7 approved smoking cessation medications (nicotine patch, nicotine inhaler, nicotine nasal spray, nicotine gum, nicotine lozenge, Bupropion, or Varenicline), and find a plan that is right for you.   
  2. Set a stop date.  When picking a stop day,  you may want to choose a day that may be less stressful – such as a day that you are not working;  or perhaps you would rather be working on your quit day, as you feel keeping busy would be helpful to you.  Again, this is your plan, and you know yourself the best.

When quitting smoking, with whatever medication plan you choose, plan on using it for at least 3 months.  It will take that long to get your new, smoke-free lifestyle into place.   After all, you have those 3 glorious months of summer to fine tune these changes, and make this quit attempt the one that really sticks!


Barb Dallavalle, MA, LP

NDC Counselor/CTTS



The 10 Year Anniversary

Posted by Dr.Hays May 16, 2018

In 2008, the Truth Initiative and the Mayo Clinic Nicotine Dependence Center began a strategic partnership to support people in their efforts to become ‘tobacco free’. Since then, the EX program has helped many thousands of people to recover. The counseling staff at the Nicotine Dependence Center (NDC) is very happy to commemorate this milestone, and to continue to serve in our role as clinical partner to Truth and the EX Community.


The mission of the NDC is to inspire hope and empower change for healthier living and a future free from tobacco. During the past 30 years, in pursuit of this mission, we have provided counseling and treatment to 10’s of thousands of patients, trained thousands of health care providers to help their patients stop smoking, and have participated in hundreds of research studies to improve treatment of tobacco use disorder. But, none of our work is more germane to our mission than our relationship with EX and Truth.


As a society, we have made significant progress in addressing the tobacco epidemic. During the past 10 years smoking rates have declined from about 20% to about 16% today. But, almost 40 million Americans continue to smoke. The large majority of these people wish they never would have started, and if they don’t quit, more than half will die from a tobacco caused illness.

We still have important work ahead. We look forward to continuing to work with the community and the Truth team to develop new ways to connect with all those who want to stop and support them in becoming an ‘EX’.


Congrats and thanks for being part of this successful 10 year journey. We look forward to many more!


Dr. Hays and the NDC Treatment Team

So you’ve decided to quit tobacco and sure could use some support from your friends, family, loved ones, and of course the BecomeAnEX Community to make becoming tobacco free happen.  After all, as the trendy saying goes, “Team work makes the Dream Work!”.   You may feel you don’t need or want to ask for anyone’s support because this is “your thing, your battle, your fight”.  Let’s face it: you will not go through withdrawal and recovery in isolation if you live in modern society.  No matter how you may try to “bare it alone”, certain people will be in your presence during your “quit time”.  So, whether you like it or not you will be the beneficiary of people’s words and actions that will either encourage you or trigger your desire to use.  The bottom line, every social interaction affects you and has the potential to be helpful or harmful to your success.  Therefore, it is to your benefit to do what you can to increase the probability that those closest to you will interact with you in a way that is supportive of you quitting.


Alright, if you buy that argument, you are now thinking, o.k., well expert, what words and actions from others will be helpful for me in my quit journey? That, my friendly reader, is yours to determine.  You know yourself best, so dig deep and consider past challenges to identify what you benefit from.  Because you will undoubtedly be the recipient of their input it is in your best interest to figure out what you need and want.  Also, this is your quit journey, so it is your responsibility to share your findings with them.


To achieve these, take some time to be introspective, and reflective.


Ex. Introspective and reflective:  What would help me stay on the quit track?


Helpful is a very ambiguous term; what it is and how it “looks” is unique to the individual recipient.  

  1. Figure out what you need in the way of support and encouragement.
  2. Figure out what you do not need or like.
  3. Do not let SHAME, anxiety or fear keep you from expressing what you need.


Finally, to actually get this help, you need to make sure you best communicate your wants and needs to your loved ones. 

  1. Figure out and practice how you can best convey that message Specific:  Choose and practice wording that clearly communicates what you intend to say, i.e., gets your message across to them.
  2. Be careful of your approach and tone: Tell those who are closest to you exactly what you need in a loving way – Speak the truth in love.
  3. Be prepared to answer their questions without getting defensive.
  4. Find a comfortable space and time to communicate that message.
  5. Choose a setting where there are no distractions (noise, other people “butting in”.)
  6. Show gratitude for their willingness to support you.

Jennifer Burden, PhD

NDC Counselor/CTTS

Often times popular media headlines cloud our ability to weigh actual risks.  Just yesterday I had a group of patients who are interested in stopping smoking say “Well isn’t everything causing cancer? What about coffee?”  This allowed for a great discussion on weighing the risk and knowing the source of the media.

Take Coffee vs. Cigarettes for example:

A preliminary ruling by a Superior Court judge in California has created quite a buzz in the headlines about coffee causing cancer.  The decision may eventually require shops to put a warning label on coffee that contains acrylamide, a chemical formed when some coffee is roasted.   Acrylamide has been classified as a Class 2A carcinogen, meaning that it has been shown to cause cancer in animal studies, but studies done in humans have not found a clear association with cancer in the quantity of exposure typical in diet.  Acrylamide can also be found in breads, cookies, breakfast cereals, French-fried potatoes and some canned goods.

The health risks from coffee have been evaluated and debated for many years.   People who drink coffee tend to live longer, and may lower their risk from many cancers.  On the other hand, there may be health risks.   A helpful discussion among experts at the American Cancer Society concludes that there may be health benefits to drinking coffee, but further research is needed.  If you are concerned about acrylamide, it might be worthwhile to limit coffee intake, and eat fewer chips, cookies, and French fries.

If you truly want to reduce your risk for cancer, by far the most important thing you can do is stop smoking and stay stopped. 

The risk from smoking outweighs the risk from any other product made for regular human consumption.  Cigarettes are the only product that kills 60% of the people who use it as the manufacturer intends.  Tobacco is responsible for almost 1 in 5 deaths in the United States; it is known to cause 14 different types of cancer, including 90% of all lung cancers, the leading cause of cancer death for both men and women.  In addition it more than doubles the risk for coronary heart disease, stroke, and causes most cases of emphysema. 

So, don’t let the headlines cloud your vision.   Who knows what will come of the coffee labeling, or how much coffee you would need to drink to cause harm, but what we do know is tobacco products are are proven to harm, and the best single thing you can do for your health is to stop and stay stop.  BecomeanEX!


Michael V. Burke, Ed.D

Program Director and NDC Counselor/ CTTS

As way of introduction, we are a group of Master’s/PhD level counselors and Certified Tobacco Treatment Specialist who provide tobacco treatment to individuals at the Mayo Clinic Nicotine Dependence Center. We are happy to announce we will be joining the BecomeAnEX community to continue writing blogs to support tobacco-free living. To learn more about our team visit our NDC Treatment Team profile page.


It has been an honor joining with the BecomeAnEX community and reading all the empowering stories you present. If you are thinking of quitting, have quit, or have many years of being quit under your belt, BecomeAnEX Community provides support near and far. We cannot wait to learn more about you, and let you get to know us, through participating in the community.


Keep working towards your goals!



NDC Treatment Team

The NDC Treatment Team


Channeling self-care?

Posted by Dr.Hays Apr 25, 2018

I wanted to give a shout out to psychick, who wrote a blog a while back on self-care and what it means to her in a very honest and very real tone.

We all have good days and bad days and practicing self-care can improve how you plan to quit tobacco and manage the stress of it all. Practice self-care for the best interest of you, this is YOUR quit attempt! Own your quit and make it something you want or are looking forward to. Think of all the reason you want to do this for YOU not for your doctor, spouse, friend, co-worker… YOU!

Make a plan:

One thing we practice at Mayo is HALT, making sure you are never too Hunger, Angry, Lonely, or Tired.  It is situations like these where we are spread thin and impulsively respond to stress in a way we later may disapprove of such as relapsing on tobacco, indulging in fatty food, drinking too much, or etc. Do a body scan- “what is it that I need in this moment to feel content?”

Before these moments of desperation occur; think of things you enjoy and can easily be distracted by…. Add that to your self-care plan. The more you plan the easier it will be to recall in times of need, so don’t wait, start thinking today!  

One of my patient’s would write down their favorite self-care strategies then when they had a craving they would pull from the jar. Example: hiking, biking, spa day, attend church, spend time with family, laugh, play with your dog, go for a run, the list goes on.

Send us what a good day looks like for you when you are keeping up with your self-care

Stay positive 
Dr. Hays


Spring: A time for growth

Posted by Dr.Hays Apr 18, 2018

Spring is a time for growth as the flowers start to show, the grass turns bright green, and we start to come out of our winter hibernation. This can be an exciting and hopeful prospect, especially when trying to quit tobacco. Keeping busy and distracted with pleasurable activities can be a great strategy as part of a plan to quit, and springtime affords many opportunities: walking, gardening, bike riding, or sitting outside and enjoying the fresh air.


Spring can be a time for optimism, with sunshine and warmer weather bringing positive thoughts and motivation for making a change. When people quit tobacco, it sometimes inspires a host of other healthy lifestyle changes.  Incorporating physical activity into your day may boost your quit plan by reducing nicotine withdrawal and cravings, and by helping to manage weight gain. It may also spark further motivation to stay quit when you start to notice that you can walk farther, stay out in the garden longer, or have more money in your pocket for new summer toys!


Plan to take advantage of the spring season this year and all of the opportunities it affords as you quit tobacco. Even better, quit with a friend and take up a new healthy hobby together – and share your ideas on The EX Community!


Dr. Hays


Weighing the Pros and Cons

Posted by Dr.Hays Apr 11, 2018

While giving up smoking is a hard thing to do, sometimes you have to consider the alternative.


What else are you really “giving up” by continuing to smoke?  Perhaps running after your 2 year-old granddaughter, blowing out candles on a birthday cake, singing the national anthem at a football game, helping your son move into his new home, dancing with your spouse at your high school homecoming, or even, walking your daughter down the aisle.


Life takes breath.  Breath is what gives life. 


People with severe chronic obstructive pulmonary disease (COPD), which includes conditions such as emphysema or chronic bronchitis, often have difficulty with many of the routine tasks of everyday life such as pushing a cart at the grocery store, walking to your car in a parking lot, or mowing the lawn. Not only does COPD affect your physical health, it can also affect your mental health as well, leading to anxiety, fear, and depression. Many who have been there know how scary it is for them when they have difficulty catching a breath.


So the next time you think about picking up a cigarette, think about this: 

Would you rather fight the urge to smoke every 10 minutes,  or fight to breath every 10 seconds?


Sleep time

Posted by Dr.Hays Apr 5, 2018

Twice in the past two weeks we wrote about sleep and stopping smoking, and strategies for getting a good sleep. Sleep is important.  Not only is sleep an issue in stopping smoking, but good sleep is linked to decreasing risk of heart disease, kidney disease, diabetes and immune system.  Because good sleep is so important, we wanted to share the results of a recent large study on sleep and stopping smoking, before putting the topic to bed.


More than 1000 people who were participating in a stop smoking study were asked to rate sleep problems, abnormal dreams, and insomnia prior to stopping smoking and one week after their targeted quit date.[1]  The study found that reported sleep disturbance was higher whether the person was taking nicotine patch, Chantix, or no medication, but sleep disturbance was rated higher if the person had stopped smoking and was taking a medication.  On the other hand, withdrawal symptoms were rated highest among those who were not taking any medication.  The implication is that sleep disturbances when stopping smoking may not be caused by withdrawal.


The take home message is that sleep is important but can be disturbed when you are stopping smoking.  Good sleep habits can help.   When you are stopping smoking include in your planning a regular sleep routine, physical activity, and stress reduction, all of which can help to improve your sleep.



[1] Ashare RL, Lerman C, Tyndale RF, et al. Sleep Disturbance During Smoking Cessation: Withdrawal or Side Effect of Treatment? Journal of smoking cessation. 2017;12(2):63-70.


What is Sleep Hygiene?

Posted by Dr.Hays Mar 28, 2018

Sleep hygiene is defined as healthy sleeping habits that are conducive to regular quality sleep. Sleep is very important for improved physical and mental wellbeing. Sleep may improve your quit abilities and leave you more energized to be in the right frame of mind to take on each day.

6 Tips from Mayo Clinic to improve sleep:

  1. Stick to a sleep schedule: This may look like going to bed and waking up at or around the same time daily. Set aside no more than 8 hours for sleep. The recommended amount of sleep is about 7 hours for adults.
    If you cannot fall asleep after 20 minutes, get up, leave the room, and do something relaxing. It is this idea that you should only utilize your bed to engage in sleep or intimacy, to avoid associating your bed with other activities making it hard to sleep.
  2. Pay attention to what you eat and drink: Don’t go to bed hungry or stuffed. Provide caution around caffeinated beverages and if you are using nicotine and have had noted sleep disruptions, you may benefit from avoiding it 1-2 hours before bed.
  3. Create a restful environment: Create a room that is ideal for sleeping. Avoid light from screens or TVs as it may disrupt your ability to fall asleep. Practicing calming activities such as relaxation techniques before bed can promote better sleep.  Visit Dr. Amit Sood’s website for ideas
  4. Limit daytime naps: this can interfere with nighttime sleep. If you find you must take a nap during the day, try to limit it to 30 minutes.
  5. Include Physical Activity in your daily routine: Physical activity and spending time outdoors can contribute to better sleep.
  6. Manage worries: Bedtime is a time when our worries tend to take over since we do not have the daytime distractions. One tip try to resolve worries before bed or write them down to concur tomorrow. Practicing stress management techniques may be beneficial. More information on stress and resiliency on


Don't forget to check out last week's blog: Not sleeping? 


Not sleeping?

Posted by Dr.Hays Mar 21, 2018

Because there are many different factors, and different ways to measure this, there is not yet a clear answer to the question, ‘how quitting smoking impacts sleep?’


Nicotine is a stimulant, and can lead to insomnia, but insomnia can also be a symptom of withdrawal from nicotine.  Nicotine does appear to suppress dreaming, and this can ‘rebound’ when nicotine leaves the system.  Nicotine has a half-life of 2 hours, so when thinking about your typical night sleep (8 hours or so), it could be marked as periods of withdrawal that may be interfering with the quality of sleep and your sleep wake cycle. 


Impairments in sleep can cause a number of issues some being ability to: make reasonable decisions, think clearly, and be more productive. With chronic sleep deprivation it can impact heart heath, risk of diabetes, and put you at a greater risk for depression.  


So for members of the EX community, it is important to get enough quality sleep to avoid making snap decisions when you may not be in the right head space. What are some of your favorite practices to make sure you are getting quality sleep?


Stay tuned for next week’s blog on Sleep Hygiene!


Perspective on Nicotine

Posted by Dr.Hays Mar 14, 2018

There is a lot of misunderstanding about Nicotine Replacement Therapy (NRT). What is NRT- It is a medication containing nicotine approved by the Food and Drug Administration and in the United States sold in the forms of patch, gum, lozenge, inhaler, and nasal spray.  A great deal of research, including research conducted here at Mayo Clinic, has found that people using these products are more likely to be successful in stopping smoking than people who don’t use these products. NRT helps to ease withdrawal symptoms by giving you a slow release of nicotine. Yes slow release--- Nicotine in a cigarette releases “feel good” chemicals in your brain in 7-10 seconds (no comparison to nicotine replacements). This makes the cigarette comparatively highly addictive.

Nicotine replacement medications provide a safe amount of nicotine that does not cause heart disease, cancer, strokes, or other serious conditions that are linked to tobacco. However, being that nicotine in a cigarette is the FASTEST delivery, it causes addiction, while delivering other harmful chemicals and carcinogens in the tobacco smoke.

People tend to take their own path while they quit and maybe NRT’s are something you plan to try. If so, be assured that it can be helpful and add to the likelihood of success.

Shame is distressful feeling related to negative thoughts or perceived evaluations of ourselves – a sense that ‘I am bad’.  It is distinguished from guilt, which is a remorse focused upon an action – a sense that I did something wrong.  When it comes to making changes like stopping smoking, that may require multiple tries, and learning from past efforts that were not fully successful, shameful thoughts like ‘what’s wrong with me’, can be an obstacle to success rather than an effective motivation for change.  

Shame about tobacco use has increased over the past 20 years as smokers feel more ‘stigmatized’.   This feeling is understandable.  Rules about smoke free indoor environments, tax increases intended to promote quitting, and public health messages about the tragic health consequences from tobacco can evoke the feeling among smokers of ‘being singled out’.    People can understandably become defensive, defiant, and isolated in response to feeling ‘stigmatized’, and this can decrease the desire and intention to stop smoking.

An additional complication related to shame and smoking has to do with the nature of tobacco addiction.  Tobacco addiction can be seen in part as the hijacking of the unconscious, habitual, automatic part of the brain.  When a person is in a usual smoking situation, like the car, with other smokers, a break between jobs, or a stressful situation, the urge and physical response of reaching for a cigarette can be triggered automatically.   Planning to manage these situations with forethought based upon self-knowledge and past experience of trial and error is much more likely to lead to success, rather than a shame based reaction such as ‘what’s wrong with me’ or ‘why do I keep doing this’.

Stopping smoking can be very difficult.  How we evaluate that challenge, can add or lessen distress and discouragement.   Looking at past attempts as educational, rather than as ‘failures’, and perceiving yourself with self-compassion rather than blame can pave the way for success.


Can Counseling Help?

Posted by Dr.Hays Feb 28, 2018

Counseling can help in many ways. In fact, the more times or number of sessions a person spends in counseling for quitting tobacco, the more likely a tobacco user will become and stay tobacco free.


 A counselor can review past experiences and help discover strengths and new strategies for success from prior attempts to quit. A counselor can encourage a person to elaborate on their reasons for stopping, which can help strengthen confidence to quit.  Counselors can help develop a plan to recognize and manage dangerous situations that could lead to a lapse or relapse. Counseling can help tobacco users to understand why it is so hard to stop. They can help with the proper use of medications, and can refer a smoker to a healthcare provider to prescribe medication. Tobacco dependence impacts many areas in a person’s life; therefore working together with a trained professional can help to cope with what arises and take proper action to reach your goals.


Counseling with a tobacco treatment specialist (TTS) may be available in your area through your State Quit-line or through one of the local hospitals or clinics. If a TTS is not available, you can ask local mental health and substance abuse counselors if they can help to support your efforts to quit


When you decide to quit, use all the tools at your disposal, and don’t forget that counseling could be the key.


What about Chew?

Posted by Dr.Hays Feb 21, 2018

We often talk on this site about the dangers of smoking, but what about smokeless tobacco? Smokeless tobacco is any product that is held in the mouth.  Nicotine, the addicting substance in tobacco, is absorbed through the lining of the mouth. Smokeless tobacco products may be perceived safer than cigarettes because it is not associated with lung cancer, but the truth is these products can cause serious harm. Smokeless tobacco increases a person’s risk for nicotine addiction, as well as oral diseases.  These products are associated with an increased risk for oral cancer, pharyngeal cancer, laryngeal cancer, esophageal cancer, and pancreatic cancer (Ebbert, Elrashidi, & Stead, 2015).


Consider trying to quit if you are chewing tobacco or using other forms of smokeless tobacco.  Create your own quit plan by tracking your triggers and developing support with the EX-community. The nicotine patch, gum, or lozenge are all effective options to help you quit smokeless, as well as smoked tobacco.  In addition, hard candy, sunflower seeds, mints and gum are helpful when having urges to chew.  You can also contact a tobacco treatment specialist if you are struggling to quit.


Ebbert,  J.O., Elrashidi M.Y., & Stead L.F. (2015). Interventions for smokeless tobacco use cessation.  Cochrane       Database System Review Oct.26 (10). doi: 10.1002/14651858. CD004306.pub5

Filter Blog

By date: By tag: