Health: Resolutions up in smoke: You can quit on No Smoking Day - but for how long? Annabel Ferriman reports

Click to follow
The Independent Culture
'IT IS easy to give up smoking. I've done it a hundred times,' said the author Mark Twain, in a phrase which is daily echoed by smokers round the world. On Wednesday, No Smoking Day, more than 2 million Britons are expected to kick the habit, but only 700,000 will last through the day. By the end of the year, the number who are still tobacco-free will have shrunk to 50,000.

While it is easy to understand why some smokers relapse within hours or days of giving up, it is harder to see why someone should go back after nine months, or even ten years. Why do people throw away the effort they have put into giving up and suffer the ignominy of defeat after months or years of success?

Smokers offer the most bizarre reasons for lapsing. One survey, conducted by the Office of Population Censuses and Surveys, produced such excuses as: 'The shock of winning at bingo'; 'The doctor suggested it as consolation'; 'Because of midges on the west coast of Scotland'; and 'I used to sing in a band and my voice went high when I gave up smoking'.

Psychologists who have studied the phenomenon have come up with some rather less idiosyncratic answers. Carelessness and crisis are the two most important reasons for lapsing, explains the smoking expert Martin Jarvis. 'Some people relapse because they think: 'I have beaten smoking. It is no longer a problem. I am no longer a smoker. I can have the odd cigarette. It won't have any meaning.' Then they find they are having a second, and a third, and then they are back where they started,' says Dr Jarvis, a clinical pyschologist at the Imperial Cancer Research Fund health behaviour unit, at the Maudsley Hospital, London.

That was what happened to John Salter, a 40-year-old economics lecturer at Manchester University, who gave up twice, in each case for three years. 'Carelessness is a good way of describing it. The first time I went back I was at a New Year's Eve party in Rome. I was out of my normal environment, so I thought I could do unusual things without them having any effect. The second time I was at work, in the office of a smoker. Because you feel you're a non-smoker, your guard is down. I didn't think I was at risk. I wouldn't have done it in the first six months, because I knew I was at risk then. You think you can have one, and that will be it. You don't necessarily have another for a few days, but you're on your way back.'

The second strong factor in making people smoke again is an emotional crisis, some kind of trauma or stress. 'Someone's marriage may break up, or they might have an accident and someone offers them a cigarette,' says Dr Jarvis. 'They have a cigarette because, when they were smokers, they particularly valued it as a stress reliever. Although they have not had a craving for a long time, they get a reminiscence effect. Alternatively, it might be some kind of self-punishment. If the world is being beastly to me, why the hell should I care about myself?'

Patsy Youngstein, a 44-year-old mother of three in west London, recognises herself as someone who took up smoking again in order to relieve stress. 'I do not know if it helps, but you think it is going to,' she said.

Youngstein, a former actress, started again after seven smoke-free years, when she suffered post-natal depression after her third baby. 'I gave up smoking when I was 30 in order to have children. I wanted to avoid any danger to the baby during pregnancy and I thought it was unhealthy to smoke round the children. I did not miss it because I was so busy bringing up babies.

'But after my third child, I had post-natal depression quite badly. I definitely regret taking it up again. It was helpful from a purely selfish point of view, but it is unfair on the people around you. Your children see your dependency on it. They give me hell for it. I think I could have done without it, but it was the first thing I went for in a time of stress.'

Rosie, a 42-year-old probation officer, who does not want her real name used, relapsed after 10 years because of the same kind of emotional crisis. 'My reason was stress. I was getting divorced and I was facing the possibility of losing my children, so it was really serious stuff. But it was also to do with a complete change of lifestyle. I had been a teacher before having children. Then I spent a large part of my twenties continuously pregnant. At 32, I went back to university; I went from being in a predominantly non-smoking environment to a group of friends who mostly smoked roll-ups. That's what I now smoke.'

Rosie's story reflects the third factor psychologists consider important in accounting for why some people relapse - social pressure, either direct (being offered a cigarette, or being persuaded to smoke) or indirect (just being in the presence of smokers). It is obviously easier for people to 'stay stopped' if their partners do not smoke, and if friends and colleagues are also non-smokers.

The clinical psychologist Stephen Sutton has reviewed the literature on smoking lapses (one cigarette) and relapses (a long-term return to the habit). He has found social pressure is the second most common reason given, after 'negative emotional state' - which includes anxiety, depression and stress. But Dr Sutton warns we should not take at face value many of the academic studies, because they rely on smokers remembering why they lapsed. Apart from the fact that memories may be faulty - and that smokers may put their lapses in the most favourable light - such an analysis does not look at any underlying factors.

'It may be that smokers trying to give up are frequently anxious, depressed and angry; so discovering that they are in one of these moods when they lapse does not really explain it. To take an extreme example, virtually all lapses take place when people are wearing clothes. Does this mean that wearing clothes is a high- risk situation for smoking and should be avoided in order to maintain abstinence?' asks Dr Sutton who, like Dr Jarvis, works at the Maudsley Hospital's health behaviour unit.

He recommends a different approach - studying situations in which smokers relapse while also considering the characteristics of the smokers themselves. Those with a family history of smoking, for example, are much more likely to relapse than others.

But many people do not fit into the neat categories created by psychologists. Diane Allard, a 32-year-old freelance marketing consultant from north London, is a case in point. She had managed to give up with the aid of Allen Carr's book The Easy Way to Stop Smoking (Penguin pounds 6.99) and sustained her smoke-free way of life for three years, despite the pressures of the post she then held at Amnesty, which involved organising huge celebrity concerts.

Was her lapse to do with 'negative mood' or social pressure? Or was it what Dr Jarvis defines as 'carelessness'?

'Everything went well for a while,' Allard says, 'and although I had initially put on weight, I had managed to lose most of it. Then we had a lot of family troubles. Several people in the family died. My husband had started smoking more heavily. I went to his office before a funeral and suddenly I felt I needed an indulgence. On that occasion, I just had one cigarette, but then a few days later I had another - and so on. I realise, looking back, that I was gradually introducing people to the idea that I was a smoker again. When I had sussed out that people were not going to beat me, or criticise me or ridicule me, I took it up again.'

Penny Ross, former director of Quit, a charity specialising in helping smokers to stop, claims that situations encountered for the first time since giving up can be dangerous. 'A funeral is a sad but classic example,' she says. Others include an unexpected celebration or party, or a holiday. 'You imagine it will be possible to smoke just for today, or the holiday, fondly believing that your desire to smoke will disappear as soon as you get off the plane.'

Most former smokers who lapse believe they can control the addiction and smoke perhaps one or two a day, or three or four a week. But people who are genuinely light smokers are rare. 'There are very few smokers who get to the position of having one a day,' says Dr Jarvis. 'Some alcoholics manage to go back to light drinking, but for the average person smoking is more compulsive.'

It is rare for someone to have one a week, or one a month. 'When you talk to people,' says Jarvis, 'they say they know someone like that. But when you look at the data, the proportion who smoke less than five a day is very small. Nor do you know how many of those are stable, light smokers rather than people temporarily cutting down or trying to give up.'

So is there ever a moment when smokers can consider themselves safe from temptation? 'For the individual,' says Dr Jarvis, 'you can best define it in terms of self-perception - a shift in self-image. There is a time at the beginning when people see themselves as attempting to quit, when they are fighting to get through each day. Then there is a shift when they see themselves as people who have given up, when it is no longer an issue, when they define themselves as ex-smokers. That usually occurs during the first year. But people must always regard themselves as vulnerable. They should not get over-confident.'

The only way I managed to give up, in my mid-twenties, was by promising myself that I could take it up again in my sixties. Now, 20 years later, I cannot wait for my 60th birthday.-

(Photograph omitted)