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An escalating problem


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Take the first step … again and again



Sonia Booker (left) and her son, Carl, formed a buddy system to support each other in their efforts to stop smoking. (Ernesto Arroyo photo)
Sonia Booker, 79, is good at keeping secrets. She was able to keep her cigarette smoking hidden from the parishioners at Holy Tabernacle Church where she was a choir member and usher. She even tried to keep it from her doctor.

“I was ashamed,” she admitted. But she couldn’t keep the secret from herself. The constant hacking cough and the escalating cost of cigarettes finally got the better of her.

She did answer truthfully when the doctor asked her about her smoking habits. She thought the answer “now and then” would do, but the doctor’s quick response was “Stop.”

Like most people, it was hard for Booker to change this behavior. She started smoking around the age of 25 because her friends did. At one time she was up to two packs a day. Even the health warnings that began to surface 50 years ago did not have an impact. “We can hear and not pay attention,” she explained.

Eventually, circumstances changed. Though Booker had not made the decision to stop smoking, certain events began to get her attention. The doctors found a spot on the lung of her sister, who was also a smoker. The health warnings began to scare her.

Booker quit — again, and again and again. Therapists warn that relapses are common. Booker started again after the death of one of her sons.

She noticed, however, that she began to taper off without even trying. “I could be out most of the day and not even think about smoking,” she said. “When I came home and saw the pack sitting there, I automatically grabbed one.”

The first step toward healthier habits is to recognize and accept the unhealthy behavior — without recriminations. “Don’t judge yourself,” explained Dr. Nicole Christian, a resident in psychiatry at Massachusetts General Hospital (MGH). “We are indeed creatures of habit.”


Nicole Christian, M.D.
Resident in Psychiatry
Massachusetts General Hospital
Motivation to change is key — and individual. Outside encouragement is helpful, but the need to modify a habit comes only from within and is particular to each person.

Generally, the biggest impetus to change is that people get tired of their behavior and its ramifications. “When they get to the point that ‘enough is enough’ that’s when the change begins,” she said.

And change should be measured in small victories. “Many people try to do too much at one time,” said Christian. “Take small steps.”

For instance, if you smoke 10 cigarettes a day, cut it down to nine. If you are trying to exercise, a vow to exercise five days a week will in all probability end in failure. “Try one day a week,” she advised. When you’ve mastered that, try two.

People tend not to recognize successes — they’re looking at too big a picture. “We have to learn to pat ourselves on the back,” she said. “We need to feel good about ourselves. The smallest positive change is a step in the right direction.”

Christian is a student of the Benson-Henry Institute at MGH which espouses the mind/body theory. Mind/body medicine teaches individuals how to take control of their lives, use their own healing power to reduce stress and other negative behaviors and thoughts, and thus maintain or regain health.

The relaxation response, which is pivotal to mind/body medicine, adopts deep breathing and repetition of a sound, word or phrase while setting aside intruding thoughts. Sudden urges for unhealthy behavior, such as a cigarette, can be put aside by deep breathing.

Christian described the pairing of the relaxation response to mindful eating, a technique which forces the eater to deliberately pay attention to what and how one eats. It involves eating slowly, savoring every morsel while absorbing the texture and smell of the food. Mindful eating, according to Christian, enables a person to eat more slowly but feel full on less food — a boon to those trying to lose weight.

Another tool Christian recommends is an “appreciation journal” in which a person writes down every day things he or she enjoyed or achievements no matter how small. “People tend to be more optimistic when they use the journal,” she said.

Booker had another sort of motivational spark — an anti-smoking TV spot by the Boston Public Health Commission. An actress warned of the dangers of smoking; a toll-free number (800-QUIT-NOW) was listed on the screen. “I was smoking at the time,” said Booker. “I got right up and made the call.”

Meet Sonia

Courtesy of the Boston Public Health Commission
That was Feb. 26, 2011 and she has not looked back.

She admits that she needed a bit of help to stay on track. That help comes in the form of her son, who quit the day before she did. They lean on each other to prevail.

According to Booker she did not change too many habits. She still associates with friends who smoke. She allows smoking in her house. She has made a few accommodations, though.

“I don’t drink coffee anymore,” she said, acknowledging the camaraderie of caffeine and nicotine. And she takes a brandy only every once in a while. Alcohol is another trigger.

So far so good. Her coughing stopped a month after she stopped smoking. She now has money for other uses. She knows she has saved a penny here and there — and added an incalculable number of healthier days to her life.