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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

With the holidays approaching; I want to hear from all of those EXers out there who have tips for individuals newly to quitting or are planning to quit around the holidays - What are your best quit quips?


Smoking or using other forms of tobacco can be used as an escape or a coping skill for many things that the holiday may bring. A few examples are:  family arguments, celebrations, escaping awkward conversations, feeling lonely, feeling stressed, feeling down about over spending,  managing over eating AND many more.


Let’s begin a conversation about how these things can have an impact and how to prepare:


How do you begin planning for these things and what kinds of tools do you use to make sure you stay on track with your tobacco-free goals?


Ready, set, Go!


Virginia Fitch-Braun, MS

NDC Counselor/CTTS




Big Tobacco Wins

Posted by NDC.Treatment.Team Nov 28, 2018

The single most effective way to reduce smoking is to increase the price of tobacco. Raising the cost of a pack of cigarettes increases the likelihood that a person will stop smoking, reduces the risk of relapse among people who have stopped, and maybe most importantly, reduces the likelihood that young people will start smoking.  Many health organizations such as the American Lung Association and the World Health Organization recommend increasing cigarette taxes as a basic tenet to reduce smoking rates and to decrease the health costs associated with smoking.


On November 6 two states, Montana and South Dakota, had initiatives on the ballot to raise the cigarette tax, and to use that revenue to increase access and affordability for health insurance.  Despite the proven benefit to health that passage could have had, big tobacco went all out to defeat these measures.  Altria/Phillip Morris and Reynolds America spent more than $17 for every man, woman, and child in Montana, and over $24 million dollars in total, in both states with a combined population of less than 2 million.   


Their big money campaign won, the initiatives were defeated, and the citizens of Montana and South Dakota lost. Big tobacco makes many claims to have ‘changed’, but they have not! They still prioritize their profits over the health of our nation.


Virginia Fitch-Braun, MS

NDC Counselor/CTTS

The holidays are just around the corner, and as you navigate your way to a smoke-free life, sometimes this time of year can be particularly daunting for a multitude of reasons.  While the holidays are often characterized in terms of enjoyment and togetherness, the inevitable “nuts and bolts” of the holidays can be rough for many people.  The November and December holiday celebrations, parties, and the like can often be quite difficult as we deal with family members, financial concerns, and/or the inevitably busy schedules of this time of year.


For those quitting tobacco, the stresses of this time of year can seem even harder. While quitting tobacco involves looking at the addiction component, it also involves making huge behavioral changes.  These changes are often the most difficult, as it involves really looking at those parts of your life that can be the most troublesome when quitting tobacco – and considering how to handle them now as a non-smoker.  These moments are often more “front and center” at the holidays than perhaps any other time of the year.


So what times of the holidays can be the biggest triggers times for you to smoke? 

Some use cigarettes as an escape route, to dodge uncomfortable or unwanted encounters with family or friends – Think of other ways you can leave a situation and practice – it will come in handy.


What about those times in the car on the way to Grandmother’s/Parents/Grandchildren's house?

Keep a water bottle handy, or try singing some holiday tunes with the radio, streaming from your phone, CD, or your iPod Touch.


What about the family members who still smoke – how do you deal with that?

Unfortunately, while most smokers really do want to quit; many are threatened by those who have quit and may try to do what they will to make you relapse.  Remember your goal – to stay quit, and to see how proud you will be of yourself as you achieve this goal.  Use “I messages” to express YOUR SINCERE DESIRE to quit tobacco will help you get the point across to those family members who may not be as supportive as you would like. Similarly, enlisting the support of one of two family members or friends that can be staunch supporters of your efforts can go a long way when those inevitable cravings or urges begin to overwhelm you.


There are situations that pop up; have a backup plan for how you plan to deal with them so on the day, your last resort is not to light up.


Throughout this eventful season:

Check on your self-care what can you do for you to make getting through the holiday chaos a bit easier? Holiday giving doesn’t always mean others, if we are constantly giving and never practicing self-care we can wear ourselves out. Be good to yourself this holiday season!


Barb Dallavalle, MA, LP

NDC Counselor/CTTS

The Great American Smokeout began in the 70’s in Massachusetts to ask people to give up cigarettes for a day and donate the money towards a high school scholarship fund instead. This idea caught on across the country as the American Cancer Society adopted it and got nearly 1 million smokers to quit in 1976. Historically, the Great American Smokeout was designed to help individuals to quit and to change the attitudes of society around smoking, resulting in an increase in community programing and smoke-free laws. It is believed that by starting this, many smoke-free advocacy teams have started and have taken great strides into what our tobacco-free culture is today. Just to name a few of the groundbreaking campaigns that has occurred are: truth about chemicals, suits against manufacturers, Master Settlement Agreement, “corrective statements” advertising, and many more. There is obviously more to come now with the e-cigarettes, cigarettes, and heat-not-burn products.



Although with programing, education, and preventative measures; we have decreased the amount of individuals who start smoking through raising awareness and advocacy; I always wonder what this day means to many of you?


Some say this day is just another “Hallmark holiday” that adds pressure or unnecessary attention to their smoking behavior. Then there are some who use it as a quit date or the start of a goal to get the “ball rolling.”



Making a decision to quit is a personal choice, therefore whatever way and whenever you decide to quit, just know you are making your own history whatever day it falls on!


Virginia Fitch-Braun, MS

NDC Counselor/CTTS

A smoking relapse can happen to anyone. You may have a gone a few months without smoking, but then one night for some unknown reason, you are out with friends and you decide to bum a smoke.


If this has happened to you, know you are not alone.  It is common for many people that quit smoking not to achieve long-term abstinence on their 1st, 2nd, or 3rd try. Mark Twain is reported to have said, “Quitting smoking is easy: I've done it thousands of times.”  In fact the average number of quit attempts is 30 times.  


When relapse occurs, it is common for people to feel depressed and identify themselves as a failure. BUT you are not a failure.  The truth is quitting smoking is hard work!!! Remind yourself to FORGIVE and ACCEPT that this is a challenge but to keep working towards your goal.


Reflect and re-frame your relapse. Think of it as an opportunity to gain more insight into your smoking behaviors and habits. Examine the things that have worked for you during past quit attempts and make a list.  Simultaneously, make a list of the things that did not work so well or put you at risk to smoke. All of this Information can be used to better prepare, better plan, and better manage your next quit.  Staying focused on “I’m a failure” makes it easy to stay stuck, as that colors the whole mind set and can cloud your vision.


Just like learning a new skill, staying quit takes practice and persistence --- the most important thing is that you keep TRYING! Think of quitting like learning to ride a bike.  You are likely to fall off a few times, but the only way to learn how to ride is to get back up and keep attempting until you are successful. I love this analogy demonstrated well on YouTube, it truly gets at not only the complexity of learning this skill but how your brain can adapt the new changes.

REMIND yourself WHY you are QUITTING and Keep Going Until You’re Smoke-Free


Heather Kraling-Coons, MA

NDC Counselor/CTTS


Reference: Chaiton, M., Diemert, L., Cohen, J. E., Bondy, S. J., Selby, P., Philipneri, A. & Schwartz, R. (2016). Estimating the number of quit attempts it takes to quit smoking successfully in a longitudinal cohort of smokers. BMJ Open, 6 (e011045).


The saying “stop bogarting… (Something)” stems from none other than famed film actor Humphrey Bogart. He was well known for perpetually having a cigarette hanging from his lips. Almost every movie scene he has some form of tobacco in his mouth. Tobacco was as much of a co-star as Lauren Bacall. Bogart continued to smoke and make very successful films until he died at the age 57 from lung cancer. The saying has morphed into meaning “to hold on to something and not share or pass it on”.


With regards to resentment we want to “stop holding onto it and let it go”, perhaps replace it gratitude?


Individual people that use tobacco have variance in the intensity of tobacco/nicotine dependence. While a few people only have minimal withdrawal and seemingly are able to quit without much help, the fact is most people cannot quit so easily. They may have significant withdrawal symptoms, urges, cravings and are at high risk for potential relapse for many months after stopping smoking. Many recovering smokers express anger and resentment towards tobacco, big tobacco companies, and at themselves. You may feel resentful because quitting tobacco was so difficult for you. Do you know someone that was able to “just throw” their cigarettes out the window and never smoke again? Most of us do, but if you could have quit that way, you would have done so a long time ago. A “quick fix” is not realistic for most people. For most, their addiction is far too intense for a “quick solution.” How about that for some resentment (and understandably so)?


So, now what…How do we begin to turn resentment into gratitude? 


Well it takes practice. Moving away from resentment requires moving toward “something” more life giving (and that “something” is the attitude of gratitude). Resentment blocks action; gratitude lets us move forward toward new possibilities. Resentment makes us cling to negative feelings; gratitude allows us to let go. Release your resentment and focus on being grateful for the progress you have made (or plan to make).


One possible exercise that can help is writing a “Good-bye” letter to tobacco. The “Good-bye” letter can help start the process of replacing resentment with gratitude. It gives you a chance to tell tobacco why you have left it behind so you are able to move forward.


Laura McConahey

NDC Counselor/CTTS


Weaken the Roots

Posted by NDC.Treatment.Team Oct 24, 2018

Quitting smoking was one of the hardest things I have ever done. I had quit many times, and like many went back to it for stress relief or when life got hard.  The last time I quit I made my mind up that I was not just quitting, but I was quitting for good – I was all in- and I would never smoke again.  I changed the way I thought about smoking.  Smoking was no longer going to have control over me and my life. 


Smoking thoughts were deep roots that had been planted in my brain for years!   Changing the way I thought about smoking was not always easy, but very important if I were to live smoke free. The old smoking beliefs (roots) were being weakened whenever I was able to change my thinking and tell myself something positive about quitting.  New roots started to grow and these were good, healthy roots.


 “One thought at a time” became my mantra.  Here are a few of the things I started to tell myself over and over again. 


I want control over my life

I am choosing to live smoke free

Smoking is dirty and it smells

Smoking is not an option

I am strong, healthy and want to live a long life

Smoking is not my identity


Just because it worked for me doesn’t mean will work for you, we are all different in a way unique to us. What are some things that you can do today that will help to weaken those old, unhealthy roots? Make a list of positive things you can tell yourself when you are thinking about smoking.  Practice them, memorize them, and use them until your new healthy roots start to take shape.


Therese Shumaker

Supervisor/ NDC Counselor/ CTTS


You Are Not Alone

Posted by NDC.Treatment.Team Oct 17, 2018

There is a complex relationship with depression and smoking. Rates of smoking are higher among individuals with depression.  


Individuals attending our tobacco treatment programs, note not only do they notice a change physically but they notice a reduction in anxiety and depression. It has been said, they no longer feel anxious about where, when, or how they will have a cigarette; therefore they do not have that sense of urgency in their day to execute an escape plan to light up.  Individuals also mention after several weeks of being quit, their mood has improved and they no longer feel they have to isolate from others. Isolation can occur in individuals who experience a depressed mood due to lack of motivation as well as individual using substances as they feel often like they are alone. Note these are anecdotal instances but it coincides with studies that have shown a decrease in anxiety and depression (to the extent of an anti-depressant) after several weeks of being quit.


There are probably a number of reasons underlying this complex relationship between depression and smoking.  Some people may use the boost they get from nicotine to treat underlying depression.  To complicate this picture, depression can be a nicotine withdrawal symptom.  Another cause of a depressed mood can be the feeling of loss and sadness that some smokers experience when they stop using tobacco.  When a person stops smoking, daily rituals that may have been a part of their life for many years are missing, and this may feel like a loss.  Feelings of loss can lead to other symptoms of depression.


Addressing depression can be an important part of your quit plan to not only quit but to avoid relapse back to smoking.  If you feel you might be experiencing symptoms of depression, talk with your health care provider.  There are ways to treat your depression while you continue on your smoke-free journey.


Counseling – Talking about what you’re experiencing can help improve knowledge of what it is you are going through and help to cope with the loss of no longer smoking.


Medication – While many medications are used to treat the symptoms of depression, Bupropion is often used for individuals who want to quit and have a history of depression. Varenicline may not be a medication suitable for you but talk with your health care provider if you believe a medication may help you in your quit.


Lifestyle Changes – Healthy eating, daily exercise, practicing relaxation techniques, and building a supportive network are activities that can help improve your mood.


As you begin to Re-Learn Habits, remember that depending on what is going on in your life, it is sometimes natural to feel down or sad.  However, if these feelings continue or become worse, be sure to speak with your care provider about what may best benefit you.


Virginia Fitch-Braun, MS

NDC Counselor/CTTS

Last week, that the Food and Drug Administration (FDA) seized documents from the JUUL company in an investigation of marketing of e-cigarettes to young people.


The action by the FDA is especially important given that JUUL accounts for more than 70% of the e-cigarette market, and that new studies are finding e-cigarettes are a gateway into nicotine addiction and tobacco use.


JUUL is not the only company that needs to be closely monitored to prevent direct and indirect marketing to young people.   As we discussed in an earlier blog, public health groups are asking the Federal Trade Commission (FTC) to stop tobacco companies from secretly using social media to sell their products to kids. 


Marketing an addicting and potentially deadly product directly to youth should be considered heinous.  Tobacco and e-cigarette manufacturers should of course proactively cease any direct or Indirect marketing to young people.  In the absence of moral leadership in these companies, strong action and close monitoring by the FDA and the FTC can serve a vital role to protect our young people.


Mike Burke, Ed.D

Program Director and NDC Counselor/ CTTS

Let’s practice: take your tobacco use

Think about your current (or past) thoughts about yourself and smoking.

Think of some of the fears around quitting or remaining quit.

Think about how these thoughts are affecting you and your ability to quit or remain quit



Take a deep breath in.


Now Exhale


Sometimes we need to put a wedge in the thought process to allow ourselves to examine some of the messages we are saying to ourselves.



NOW that you are aware of these thoughts, give yourself permission to feel that way. It is okay to express these emotions.  Once aware, determine a new thought or new behavior that better aligns with your values



Take this information with you and see how practicing acceptance can change your perspective and the paths you choose.


Virginia Fitch-Braun, MS

NDC Counselor/CTTS

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