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

Mayo Clinic Blog

413 posts

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


Lung Cancer Screening

Posted by Dr.Hays Mar 13, 2019

Early in the 20th century lung cancer was described as one of the rarest forms of cancer, but what could not be predicted in the early 1900’s was the impact cigarette smoking would have in the United States. Since 1986 lung cancer is the leading cause of cancer death for both men and women.  The dramatic increase in lung cancer caused death, estimated to reach over 150,000 deaths in 2018, can be directly attributed to the manufacture, sale and consumption of the modern cigarette.


For people who smoke, stopping smoking and staying stopped is the single best thing you can do to extend your life and to reduce your risk for many health problems, including lung cancer.  If you have a significant smoking history, another important step you can take is to talk with your health care provider about receiving a Low Dose Computed Tomography (LDCT) screening x-ray for lung cancer.


Previously lung cancer was usually diagnosed only after it was advanced enough to cause symptoms, like chronic coughing, coughing up blood, chest pain or weight loss. However, in the past 5-10 years research studies have shown that annual LDCT screens for people at risk can save lives by identifying lung cancer before symptoms arise and early enough for more effective treatment.  Those who can benefit from screening are people between the ages of 55 and 80, have smoked a pack per day for 30 years or the equivalent (smoking one package per day for 1 year would be “1 pack-year”, so smoking 1 pack per day on average for 30 years or 2 packs per day for 15 years would both be equal to “30 pack-years”), and are currently smoking or quit within the past 15 years. 


Annual lung cancer LDCT screening is now covered by most major health plans including Medicare.  If you are at risk, we recommend that you talk with your health care provider to decide if it is right for you. And while you are thinking about the decision to have LDCT lung cancer screening, give some thought to the benefits of quitting cigarette smoking. That will be the most important decision you make for your health. 


Dr. Hays

As the number of children using e-cigarettes remains at epidemic levels, the FDA has announced new actions that are currently being taken focusing on both retailers and manufacturers, as part of our commitment to combat youth access to e-cigarettes.


 On March 4th, 2019 a letter was sent to Walgreens corporate management requesting a meeting to discuss whether there is a corporate-wide issue related to their stores’ track record of violating the law by illegally selling tobacco products to kids. Last month alone, the company’s stores have racked up almost 1,800 violations across the country. Walgreens is currently the top violator among pharmacies that sell tobacco products, with 22 percent of the more than 6,350 stores inspected having illegally sold tobacco products to minors.  As the leaders of the FDA note, this is disturbing, particularly since the company positions itself as a health-and-wellness-minded business.


Walgreens is not the only corporate owned chain and franchise stores with very high rates of violations for illegal sales of tobacco products to minors.


The FDA plans to hold these companies accountable as well!  Ignoring the law and then paying associated fines and penalties can no longer be the cost of ‘doing business.’


 The stakes are too high for our young people and our country’s decades-long fight to reduce the morbidity and mortality that accompanies tobacco product use.


What are your thoughts about this?




Therese Shumaker, MA

Supervisor/ NDC Counselor/ CTTS


Lately, I have been encountering many individuals that are “closet smokers.”  This made me wonder how many of you on the EX Community were hiding your smoking from loved ones?  What types of lies did you tell yourself? How big of a canyon did you create in your relationships with the people you love?


When people smoke in secret it creates loneliness, pain, and isolation for the smoker.   It often times makes the person feel ashamed, guilty, and trapped. In addition, most have gone to great lengths to cover up their addiction to avoid being discovered.  Using mints, air fresheners, perfume, changing clothes, reasons to get up and leave, not go somewhere, and hiding in unusual places are all methods and excuses for the closet smoker to hide their addiction.  I once had a patient tell me that she hid under a school bus to smoke.


If this is you, how do you go about quitting? The first step is being honest with yourself and others to help end your relationship with cigarettes. Many times, covert smokers quit in secret, which eliminates support when it is needed the most. Your loved ones may already know of your addiction, but have chosen to avoid confrontation.  Being honest opens up a bigger circle of support bringing you out of isolation. Set your stop date and plan your quit approach whether it be reducing to quit, “cold turkey,” or nicotine replacement medications.  Even if your road to quitting tobacco has a few detours, STAY OUT of the CLOSET and keep reaching out for support.


Heather Kraling-Coons

NDC Counselor/CTTS

There is SO much information/MISinformation out there about how nicotine replacements are harmful for our hearts!  But, is it?  Literature has been plentiful, since the 90’s on how nicotine replacement therapy (NRT) is much safer for our heart health and blood vessels, than smoking!


Yes, nicotine can cause constriction of blood vessels. Although when smokers use NRT, this doesn’t seem to happen, probably because they are used to using the high doses delivered from cigarettes. Not to mention, nicotine alone does not have 7000 chemicals released when burned, like tobacco, which include cancer-causing agents, heart disease, and stroke-causing agents. Therefore, when looking at harm reduction, nicotine replacement therapy is a viable option. 


What about heart attacks?  Individuals, with heart disease who are able to stop all tobacco use, can have a rapid drop in the recurrence of acute heart events and slowed or stopped “hardening of their arteries”.   Nicotine patches have shown to be of benefit in aiding smoking cessation and is a prominent feature of Clinical Practice Guidelines for smoking cessation by major healthcare institutions and organizations.


Does it affect blood pressure? We know that nicotine has effects on blood vessels that can lead to increase in heart rate and blood pressure and cause constriction of the blood vessels.  But at the same time, wearing a nicotine patch can lead to lower nicotine levels in the blood than cigarette smoking and will lead to many fewer bad effects on the heart, than smoking.   Tobacco and its components cause blood vessel constriction; they cause a roughness in the vessels where normal cholesterol needed for body building and body repair collects, as it flows through the body; and, we know that tobacco products “latch” on to the oxygen in our blood stream, leaving carbon monoxide (a waste product from the blood), for our heart and blood vessels to work on, rather than rich oxygen.


Not everyone will choose to use nicotine replacement therapy but get to know the facts and talk with your doctor  to make the choice that will lead to a healthier you! There are SO many misconceptions regarding tobacco cessation aids, for more information ask your healthcare team and visit!  Good luck, YOU are well on your way!


Kathy Zarling, MS, APRN


Recently when working with a group of patients quitting tobacco, we were talking about coping skills for urges and cravings.   While we have traditionally looked at the 4 D’s (Delay, Distract, Deep breathing, and Drink water), this group added 2 more to the list: Discuss, and a surprise fun one - Dance!!


So, consider trying these cognitive strategies for your cravings or urges to smoke:

Delay:  Delaying acting on your urges - say 5 minutes  - and most likely the urge will lessen or even completely go away.

Distract:  Find something to occupy yourself with for a few minutes while the urge or cravings dissipate.

Deep breathing:  Breathe in through the nose, and out through the mouth.  This can be very calming and relaxing.

Drink water:  That’s right!  Drinking water does help with cravings; and while most of us don’t drink enough of this life giving fluid anyway, it is a good reason to drink up!


And finally, the 2 new ones:

Discuss:  Ask for help from, and utilize, the support people in your life to help you work through cravings and urges.

Dance:  Quitting smoking is hard work – make sure you celebrate your efforts !!


Barb Dallavalle, MA, LP

NDC Counselor/CTTS

I wanted to express my gratitude to all of the members of the EX community for our partnership.  Mayo Clinic’s blogs on the EX Community started more than 10 years ago! Through the years we have appreciated being part of your community.  We have learned immensely from the real life experience and expertise shared on the site by community members. It is wonderful to read how each and everyone one of you have generously shared your vulnerability, determination, and courage in support of each other. I appreciate being able to confidently refer my clients/patients to BecomeAnEX.


The mission of the Nicotine Dependence Center is to inspire hope and empower change for healthier living and a future free from tobacco. This mission continues to grow in the partnership of Truth Initiative and the members of the EX Community.


A warm thank you from yours truly,

Dr. Hays

Mindfulness is a term one hears frequently these days.  It is associated with an almost unbelievably wide array of self-improvement and relaxation strategies, as one look in the ‘self-help’ section of a bookstore, or a web search can confirm.   While I can’t vouch for the many claimed good effects of mindfulness, it does seem to help to reduce both the intensity and frequency of tobacco cravings.  So what is it, and why would it work?


Mindfulness is the process of directing your awareness to the present moment with an attitude of curiosity, openness, and acceptance.  The mind has a tendency to almost constantly jump around from sensations, to past experiences, to future plans, to emotions, to hurts or joys or thoughts, or imaginings.  Mindfulness is taking a step back to observe the constant bouncing of one’s attention, rather than being unconsciously bounced from thought to thought.


Craving can be understood as a strong desire, usually to consume a specific food or drug that intrudes into awareness.  Cravings develop when rewards from food or a drug are associated to cues, either internal or external.  The craving serves to induce an action/behavior to obtain the associated reward.


There are a number of theories as to why and how cravings are affected by mindfulness.  One that I favor is that being mindful of the present moment inhibits the automatic associations between the cue and the action by occupying working memory.  We really can’t focus upon more than one thing at a time.  The present moment awareness stops the mind’s conditioned leap from cue to action.  By stepping back from the jump from cue to action, one can then choose to attend to other things, like a deep breath, or a happy thought.  This new association begins to diminish the strength of the past reinforced habit.


I would be interested to hear from others about their use of mindfulness to help with craving?


Michael V. Burke, Ed.D

Program Director and NDC Counselor/ CTTS

There is a quote that is sometimes heard in the rooms of Alcoholics Anonymous; “If you hang around the barber shop long enough you just might get a haircut.”   For a person in recovery, especially early recovery, that quote holds one of the basic principles of recovery:   Avoid the people, places, or things that might trigger one to go back to their drug of choice. This is also pertinent for someone who is working on quitting smoking. Relapse triggers are everywhere and you must be prepared. Of course you won’t be able to avoid going to the gas station forever, but you could find another one that does not evoke those triggering thoughts.  You might not be able to quit drinking coffee, but could you go to a different part of the house to drink it, maybe a room that you never smoked in. You might not be able to get out of that traffic jam every day on your way home from work, but you can alter your routine in the car by changing the radio station, or using your fingers to tap a song on the steering wheel!


 What are some of your triggers for smoking? Prevent an unnecessary haircut – think about the people, places, or things that might get you back to smoking and develop a plan to deal with them.


Heather Kraling-Coons

NDC Counselor/CTTS

Did you make a New Year’s Resolution for 2019?  Maybe this was your year to quit tobacco; however, you have already found yourself barely holding your head above water. YOU started out with the best of intentions, but then it bombed…  YOU ARE NOT ALONE!!! Although good intentions, they are not often backed up by well thought out plans.  Your goal is clear, but the process is opaque. It is similar to the resolution, “I plan to go to the gym.” If you have not mapped out which days of the week and the time you plan to go, it most likely will not happen.  The best thing that you can do for yourself is set up a concrete but flexible plan with small achievable goals. 


Planning to Begin Again:


Think about all your quit attempts and focus on what worked for you. Reflect and try to identify the triggers that made you relapse to smoking.  You will then be able to gather more insight into your patterns and build your new plan.


Boost your support system!  Your loved ones, friends, or members of BECOMEANEX.ORG can help you stay on track and be there to motivate and encourage you.


Recognize that you may need to redefine your quit goal.  Maybe it is not complete abstinence at first, but it is reducing to quit.


Reward yourself for the progress you have made.  Consider taking the money that you are saving and use it to treat yourself to something you enjoy.


Quitting tobacco is a process, not an event.  You never fail unless you stop trying! When you have had a “slip,” and negative thoughts creep into your head, STOP IT! (as Bob Newhart would say). Treat yourself with kindness and encouragement just as you would when a friend or a child needs a pep talk.


Know yourself and your needs. Going “cold turkey” may work for some people, but others may need a little more support. Seek out alternatives that may work for you, whether counseling or medications.


Whatever the New Year means to you, whether it is using extra cash to pay bills from quitting tobacco, buying yourself something nice, doing it for your health, or taking a long overdue vacation, REMEMBER this is about YOU! You have decided to make this change and you are getting it done, one step at a time.


Heather Kraling-Coons

NDC Counselor/CTTS

A quote I keep running into when I work with individuals is “what consumes your mind controls your life.”


This quote I find rings true in many situations including smoking. If we are constantly focusing on something we want to avoid whether it be smoking, eating, drinking, and etc. we are hyper aware of our thoughts regarding those things and tend to obsess. The thoughts continue to grow until you do something about it, right? This becomes a pattern that gets repeated; thoughts and feelings arise then we activate a behavior to reduce the uncomfortableness.


For many of us,  the thoughts trickle in--- we start to focus on having that one cigarette, piece of cake, or a drink; we try to do something else to distract, then anticipation or anxiety builds as we try to “not” think about it, anxiety and anticipation still climbing ---- the thought/desire/anxiety reach a MAX….. And then what happens, “Crap I can’t take another second,” give me that dang cigarette, cake, beer, and etc. Then a sense of relief, the battle is over (for the time being).


This brings me to my next point “riding or surfing the wave.” It’s an idea that our thoughts, feelings, and even cravings have a peak then they dissipate. When I work with people, I try to help them sit on top of the wave, and hang out for a bit to lessen the impact over time.  How one might ask? By practicing the power of mindfulness (being aware instead of on autopilot) and deep breathing, one can master the wave. Sounds simple I know, disclaimer it takes practice and patience, but each time you sit on top of that wave without diving in, the peak gets smaller and shorter. A client of the NDC once said to me, “The craving will go away whether I smoke or not, so I choose to not.”


I’m not saying “distract” go read, watch tv, drink water, etc. as running away from a thought or feeling may not always work. Instead try to be curious about these thoughts and feelings as it can bring a deeper meaning to the craving and more information that will allow you to “master the wave.”


A starting activity is one we use here at Mayo Clinic:


  1. R Recognize what is happening – Notice the emotion/thought/feeling in the present, it can help to name it e.g. “I am feeling _____”
  2. A  Allow life to be just as it is – Allow doesn’t mean we have to like what is happening but we are open to softening the resistance to what is happening
  3. I Investigate inner experience – Asking questions like “ what happened to lead to this” “what do I really need in this moment?”
  4. N Non-Identification – Realization that your being is not fused to your emotion or thoughts- you are just there in the middle

While you do this: Use a non-judgmental approach to yourself and your thoughts/experiences.


Virginia Fitch-Braun, MS

NDC Counselor/CTTS

When I ask people why they may be thinking of quitting at this particular time, it often comes down to one of 3 things – health, money, or family.


And among those that say family – one of the biggest reasons specifically is grandchildren.


The thought of being the grandparent who needs to haul around an oxygen tank is a picture that many do not want to even imagine.  They want to be an active grandparent – building a tree house in the backyard, or participating in fun runs with the grandkids.


However, life often gets in the way of these plans.  Our smoking catches up with us, and all those times we tried to quit – well, it just never quite happened.   And then, our doctor is prescribing oxygen for nighttime… and then for 24/7 use.


And those plans?  Well they just evaporate away.  And the next thing you know, you are watching others your age running with their grandchildren and having fun, and you are left at the side lines.


For, even while quitting for the grandchildren is a motivator for many, it can be quite hard to see accepting the support of these youngsters in your life as you embark on such a big lifestyle change. Many feel embarrassed by their inability to quit, while their grandkids are learning in school about how bad smoking is for your health – and meanwhile, you are continuing to smoke.


However, remember that the change you are making can be a great reminder to your grandchildren that one can make changes at any time in your life – it’s a good life lesson!  Some have found it very helpful and supportive to have the youngsters in their life put stickers on the calendar for every day you are smoke-free, or enjoy an afternoon outing for ice cream for you and the kids with the money you have saved from not smoking for the past week.  The kids will enjoy these activities, and they can celebrate with you as you continue to rack up more days in your new smoke-free life.


Yes, quitting smoking can really be a family affair, whether there are others who are trying to quit as well in your family or not.  Young children can play an integral role in assisting with this effort; feel effective in helping to make this change happen, while simultaneously giving built-in motivation to keep the cycle going.  Older children may find it helpful to aid grandma or grandpa in finding other interests to fill their time – such as learning a new board game, helping fix a flat tire on a bike, or assisting with studying for that upcoming geography test.


Remember that there is no real textbook way to do this, and what works for one family may not be the answer for yours.   But just as you were able to find the right motivation for you to make that decision to quit, you will find the right way to involve those natural support systems around you that you know and trust.


Barb Dallavalle, MA, LP

NDC Counselor/CTTS

What?! That can’t be right. Why would someone want to lose their job? Well I will tell you why. My vision is that one day in the future (hopefully not too distant) that my services would no longer be needed because smoking is a thing of the past. We have reached the END GAME!


There are a few different schools of thought on how we might accomplish such a daunting task these include: bans on advertising, increased taxation, mandate plain packaging or graphic packaging, increased promotion and availability to cessation services and enlargement of smoke-free spaces. One option that might deserve some attention is the ban on the sale of cigarettes. In fact, this has already happened in the US. Between 1895 and 1927, 15 states banned the sale of cigarettes entirely. Although these regulations were all eventually repealed (due to pressure from big tobacco and the enticement of tax revenues), these laws are within the power of the local and state government to reenact.  Of course, a ban on the sale of cigarettes would not completely eradicate all smoking (but it would probably do enough to eliminate my job).  Instead, possession of tobacco would not need to be illegal; people could grow their own for personal use, but not be allowed to sell it (most would not, but would have the option to).


The cigarette is the deadliest invention in the history of human-kind. If another product killed over half of its consumers that used it regularly, that product would be banned so fast it would make your head-spin. Somehow, (money) cigarettes companies have been able to manipulate their way and avoid being banned. 


The cigarette is simply too dangerous to be sold and to see the end of sales for this product would certainly be worth losing a job over.


What do you imagine would come of cigarettes being banned? Can you even imagine this?


Laura McConahey

NDC Counselor/CTTS


Knowledge is Power

Posted by NDC.Treatment.Team Dec 19, 2018

I remember that when I quit smoking it was helpful for me to have some “knowledge” of just how manipulative the tobacco industry is.  The industry manipulated me into thinking that smoking was the cool thing to do at age 15, and looking back; smoking prevented me from getting on the high school basketball team.  The industry kept me hooked on smoking making me believe that smoking was the key to being slender, but being slender did not help any with my sports performance because I was short of breath.  The industry kept me addicted for 20 years on and off and I think that “knowledge” was one of the things that helped me to ultimately quit for good.


The industry is still very strong and tries to distort and manipulate in various ways - here is just one example:


The Tobacco industry wants you and the people around the world to believe that they want to put an end to smoking. Have you heard about the “Foundation for a smoke-free world? “ This foundation is funded by the world’s largest cigarette maker – Philip Morris International. The company plans to contribute over $80 million annually over the next 12 years to the foundation, claiming that these funds will be dedicated to accelerating global efforts to reduce deaths and harm from smoking- with the ultimate goal of “eliminating smoking worldwide”


Sounds great, right?? Keep reading….


History has proven over and over again that the tobacco industry only looks out for its own interests - and that they are ultimately trying to protect itself from litigation threats and government regulation and to distract from the irrefutable evidence of the death and disease caused by tobacco use.


If the Industry wanted to eliminate smoking worldwide, they would just stop selling cigarettes and stop promoting their alternative products.


What are your thought about this?   Do you have other examples on how knowledge has helped you in other areas of your life? 


For more information on the industry and tactics used Truth Initiative does a great job at highlighting specific marketing ploys.


Therese Shumaker, MA

Supervisor/ NDC Counselor/ CTTS

Kids love to make snowmen when Minnesota gets hit with lots of white fluffy snow. This was the case a few weeks ago when we had our first big snowstorm.  A friend of mine sent me this picture of the snowman her neighbor’s children made.  These very young designers spent a few hours on this snowman making sure that all the details were in place. Look closely, did you notice the pipe in this showman’s mouth? 



Frosty the snowman was made into an animated television shown in 1969. In 1969 the smoking rates in this country were 40%.  Great changes have taken place over the past 50 years, but the children in this country are still being exposed to smoking messages in various ways – and as you can see from the picture children as young as 4 and 5 feel that it is important to depict cartoon characters as they were introduced 50 years ago!


Even today with smoking rates down to 14% in this country, the messages for smoking are sometimes hidden but they are still there, and these message give the idea that smoking is normal because frosty smokes.   Of the 2017 Oscar-nominated feature films that were rated PG-13 (excluding animation and documentary categories), 70 percent depicted tobacco use.


 What do you think about this?  


For more information on smoking in the movies, visit Smokefree Movies at the University of California, San Francisco.


Therese Shumaker, MA

Supervisor/ NDC Counselor/ CTTS

Filter Blog

By date: By tag: