Breaking up is hard to do

It's expensive, unhealthy and antisocial. So why do smokers find it so hard to give up? Because it makes life seem worth living, says Kate Saunders

The first one shouldn't be too early in the morning. Ideally, you'll be sitting down with the paper and a pint of very strong coffee. You light one, and take a deep breath. Aaah. Out of the trough and into the light. The day can now be faced - even if it happens to be National No Smoking Day, which seems to come round more often than Christmas.

The first one shouldn't be too early in the morning. Ideally, you'll be sitting down with the paper and a pint of very strong coffee. You light one, and take a deep breath. Aaah. Out of the trough and into the light. The day can now be faced - even if it happens to be National No Smoking Day, which seems to come round more often than Christmas.

This annual guilt-fest, which falls tomorrow, brings many of us hardened smokers out in a rash of self-loathing. Another year gone by, and I'm still smoking. My teeth are brown and my house smells like a pub. After 30 years of 20 cigarettes a day, my kippered old body resembles something dug out of a bog. When I enter a room, I automatically look for either an ashtray or the nearest exit. Do you think I don't know that I am doomed? The awareness is eternal, and scatters a gloom that (ultimate perversity) only a cigarette can alleviate.

I'm bitter, too. I feel wretchedly misunderstood. No help exists for people like me; the miserable band of Hard Cases. I know that if I call the NHS helpline, I will be offered the usual flimsy crutches - patches, chewing-gum, good, old-fashioned willpower. Please. I've tried them all, and they don't come near to solving the basic problem. One day, I must put it to the helpline, to see what happens. "Hi, my name is Kate, and I can't give up because I'm the in grip of an existential crisis - I want to stay off cigarettes, but I hate my life without them."

Nicotine gum won't get near it. Unless they can offer me a team of shrinks, the Archbishop of Canterbury and a millionaire philanthropist, we'll all be wasting our time. I know how thoroughly the addiction is knitted into my life, because I have twice lived undercover as a non-smoker. For two periods of six months, I had a stab at being normal. The first time was 12 years ago, when I was pregnant, and doesn't really count because I always knew I'd start again after the birth (it was lovely; the embrace of an old friend).

The second time, however, around this time last year, was intended to be quite different. I was going to turn myself into a real non-smoker, whose smoking self was buried in the past. The spur was vanity. I saw a terrible photograph of myself. I was kissing my son, and my mouth looked like a puckered anus. This was my Belshazzar moment. Cigarettes were turning me into Dot Cotton. I read the writing on the wall, and knew the time had come.

I thought it would be easier this time. I could count on wonderful support, from partner, son, family, friends and society at large. I would not be alone. I kept coming across notorious smokers who had suddenly given up - even Beryl Bainbridge, heaven help us, once patron saint of chain-smoking novelists. I turned, as so many do, to Allen Carr.

Every smoker knows this name. Carr is the guru of giving up. His mega-selling book, The Easy Way to Stop Smoking, relates how a revolution in his thinking helped him to kick a habit of 60 a day. Essentially, it appears to be a basic form of cognitive behavioural therapy, retraining the brain so that it avoids destructive patterns of thought. And it seems to work - for some people, at least. In the beginning of my new life as a non-smoker, it worked for me. At last I had the courage to name the day. I rose early that morning, and applied to my thigh a patch the size of a bathmat. For one fraction of a second, I felt the crackle of the day's first hit. Then a curious nothing - no craving, no satisfaction. Neither ups nor downs. Was this what normality felt like? A beige world, of no extremes.

The patch dealt with only one side of the craving. It was rather like being on a drip. You don't want food, but your life loses its shape without the ritual and meaning of food. I found, as the days crept past, that I ached for those pockets of comfort that I had carefully sewn into my routine. I missed the refuge of the quick hit that lifts my spirits above the anxious moments, and helps me to bear the things in my life that I can't change.

The beige world has no troughs, but it is a steady downward slope. This is why I missed smoking more, not less, as the months dragged by. Life seemed a dreary business, and now that I had stopped smoking, there would be more of it to get through. It was as if a whole wing of the world had closed down, leaving only the dull galleries full of fossils and coins.

I gave up giving up after six progressively awful months, because I needed to finish a piece of work in a hurry, and I can't work properly without nicotine. Carr would probably blame my failure on the fact that I used patches, which he is firmly against. But I stopped using the patches after two weeks (it's just not the same), and stayed fag-free for several months after that. I blame the encroaching beige, which gradually dims to a sad, chilly grey.

I was ashamed of my weakness - but, oh God, the fierce and glorious pleasure of smoking again. I can't help thinking that cigarettes are lovely. I seem to be addicted to the way my body responds to them. I seem to need the constant swings between intense craving and total satisfaction.

Thirty years ago, when I was buying my first, furtive packs of Number Six, half the adult population smoked. It was possible to smoke on the top deck of the bus. There were smoking carriages on all trains. You could smoke at the cinema and the theatre. These days, it is increasingly hard to smoke anywhere. Yet a quarter of all adults are still at it, in the (stained) teeth of all the evidence that it is killing us. We labour under the delusion that cigarettes are actually holding us together.

The psychologist Oliver James, a lifelong smoker, thinks smoking can be seen as a symptom of our chemical make-up. "A raft of new studies shows that you don't have to be mad to smoke, but it jolly well helps," he says. "Half of smokers are depressive, 16 per cent anxious, 14 per cent angry and irritable. Clinically depressed people are four times more likely to smoke than the mentally healthy."

I fall into the depressive category, with some anxiety thrown in. The people I know with a similarly desperate smoking habit are all low-level depressives seeking a quick way out of the trough. Hardened smokers sometimes have a tiresome belief that all the "interesting" people will be found in the smoker's corner. It turns out that we're interesting to each other because we have matching neuroses.

"Eighty per cent of smokers do it primarily to self-medicate emotional problems," says James. "They are using cigarettes as a form of antidepressant or tranquilliser, a drug of solace for negative emotions."

He cites a "definitive" study, published in 2001 by the American psychologist David Gilbert. Gilbert measured the neuroticism and depressiveness of 96 female smokers for five weeks. Half of them were paid to stop smoking for a month. After a month without nicotine, the quitters were still suffering. The more depressed a smoker had been before quitting, the greater the increase in her symptoms afterwards.

For these unfortunate women, smoking helped to keep problems at arm's length - James calls it "Smoke or go bonkers". Gilbert's study demonstrated that losing cigarettes can be horribly similar to losing a lover. When you feel that you can only cope by limping from moment to moment, something in a cigarette brings you at least an illusion of control. This is why the Health Secretary, John Reid, famously - and compassionately - spoke up for the smoking poor, and hinted that middle-class types should stop nagging them to give up. Dr Reid, after all, knew what he was talking about, because he was once a heavy smoker himself.

I now understand that in cases like mine, more effort is required. It's going to be harder than average because smoking is mainly a symptom of something more complicated. Sooner rather than later, I must have another stab at giving up. Just for the moment, however, I prefer the frying pan to the fire.

HOW TO BE A QUITTER: THE EXPERTS' ADVICE

PROFESSOR JOHN WEST

Director of tobacco studies at UCL

There are some people for whom nicotine really hits the spot and who are sensitive to its effects. Their brains change in response to nicotine. If you look at whether someone is going to be a smoker, they are likely to follow in the footsteps of their parents. If a child is adopted, they are likely to have the smoking patterns of their biological rather than their adopted parents. So there is a genetic component, and people genetically likely to be smokers will struggle in the long term.

Many people do say they have feelings of bereavement when they give up. We need to think about why people feel that they are losing a friend. I think that the explanation must be pharmacological. It's known that nicotine affects the reward pathways in the brain, but I think it must tap into social pathways as well.

There will be some people to whom you can just say: "You really need to give up", and they will. There's another group who will benefit from patches, gum and counselling and then they will be OK. And then there is another group, probably the largest group, who will still struggle after eight to 12 weeks. We need to recognise that in the NHS. Should we give them long-term support, which is expensive? Or should we equip them for life without cigarettes? Or should we give them some sort of replacement, like methadone for heroin addicts?

If you are one of these people who find it most difficult to give up, you should treat your condition as a chronic condition and keep trying and keep medicating yourself with patches or gum, which is all we have at the moment. Try to accept that you are in it for the long haul.

ALLEN CARR

Author of The Easy Way to Stop Smoking

I, too, found it terribly hard to give up smoking. I was such a bad smoker, and my family were all such heavy smokers. I thought it was because of my family. I knew I was an intelligent and strong-willed person, but I couldn't achieve giving up smoking, and yet I hated it.

But when I got through it, I realised that smoking was a confidence trick. The addiction tricks you into thinking that you need cigarettes to relax or to concentrate, or because you have an addictive personality. There is no such thing as an addictive personality. At one time, 90 per cent of the adult men in this country were cigarette smokers. They can't all have been addictive personalities.

In order to give up, you need to make mental preparations. What we do is remove all the illusions about smoking. We talk about quitting, but not giving up, because we make them realise that there are no benefits of smoking whatsoever. So when they put out their last cigarette they are not losing a friend but getting rid of an enemy.

AMANDA SANDHOOD

Research manager at ASH, an anti-smoking pressure group

About 70 per cent of smokers would really like to stop, but few manage to quit because they are enslaved by nicotine. The good news is that there are 11 million ex-smokers in the UK, so people are doing it.

If you just go cold turkey, 98 per cent of people will go back to smoking within 12 months. For each additional level of support, the chances of quitting are increased.

So you can go to NHS groups and also use nicotine replacement therapy and other services and then your chances of quitting are up to 20-30 per cent after a year, particularly for those with strong motivation. It's almost pointless to try to quit if you're not extremely motivated.

VICKI WATSON

Founder of the National Society of Professional Hypnotherapists

Some people have more difficulty giving up than others. There are those with what Freud called oral personalities, usually people who have suffered trauma in their early years, and these people like to have things round their mouth. They might eat a lot, or bite their nails, or smoke. These people also often try to spread themselves a bit thin: they like to please everyone, and take on too much, so they get stressed, and smoke to alleviate that stress. Other people who have trouble quitting are those with low confidence.

For people that are having trouble quitting for these reasons, hypnotherapy could be a helpful tool. It is a very visual tool and it can change the way you see yourself. It can also help you to see yourself in a different light, by allowing you to focus away from what you tell yourself and what other people tell you, which can really help people with confidence problems.

DR HAYDEN McROBBIE

Research fellow at the Tobacco Dependence Research and Treatment Centre

For smokers that do find it difficult, the best thing they can do is get some help from the NHS Stop Smoking Services. With this help, smokers are up to four times more likely to quit than "going it alone".

Treatment is in a group or one-to-one. Coming into a group, you are quitting with 15-20 other people. There is a lot of extra support both from the other smokers giving up with you, and the stop-smoking specialists. Group members are often able to come up with many different strategies to help you get through the worst. There is even a little bit of social pressure involved - after all, no one wants to come along to the next session and say that they have smoked.

In addition to the support, smokers should use medication such as nicotine replacement treatments because these will increase their chances of success.