It's not just about not being able to quit, Rebecca Bush explains. It's about the anger and shame and embarrassment of not being able to quit.
"You have a bad temper," says Bush, who smoked on and off for about 25 years. "You feel depressed, and you feel stupid: How can this stupid little cigarette do that?
"It causes you to not like yourself, and you don't realize until you're over it that it's not you, it's the chemical, it's the drug."
Just more than a year ago, Bush gave up smoking for, she hopes, forever. Now, she feels better. She has more energy. And, Bush says, "I like myself better."
As incentives for giving up smoking go, being able to like yourself better isn't bad, particularly if all that business about smoking's horrendous health effects seemed too, well, theoretical.
Coincidentally enough, this week would be a fine time to give quitting one more try, because Thursday is the 36th annual Great American Smokeout.
The event, created by the American Cancer Society, encourages Americans to give up tobacco, which the U.S. Centers for Disease Control and Prevention says even today "remains the leading cause" of preventable death and illness in the United States.
According to the CDC, about 19 percent of U.S. adults were cigarette smokers in 2010. And, while the percentage of Nevadans who smoke still ranks above that national figure, the state is doing better than it did even a decade ago.
"When I started at the district in 1999, Nevada had the highest smoking rate in the nation," says Maria Azzarelli, tobacco control coordinator for the Southern Nevada Health District. "We were the smokiest state in the nation."
Today, about 22 percent of adult Nevadans smoke, Azzarelli notes, while youth smoking here declined from 33 percent in 1999 to 17 percent in 2009.
"In Clark County, especially, we were at almost 31 percent smoker prevalence," Azzarelli adds. "Now, we're at 12.8 percent in 2010. So there's been a lot of work done and a lot of progress made."
It also means there's still a way to go.
Dr. Mitchell Forman, dean and professor of medicine at Touro University Nevada College of Osteopathic Medicine, says research suggests that smoking harms nearly every organ of the body, and reduces not only the health but the life expectancy of people over time.
"Certainly coronary artery disease. There's a greater incidence of heart attacks and strokes for smokers," Forman says. "Cancer, and not just lung cancer. We're talking a slew of other cancers, including oral cancer, throat cancer and esophageal cancers."
Not to mention, the CDC says, smoking's links with leukemia and bladder, cervical, kidney, stomach and uterine cancers, and smoking's linkages with sudden infant death syndrome, low birth weight babies, stillbirths, pre-term deliveries and infertility. As well as, Forman adds, smoking's association with autoimmune diseases, rheumatoid arthritis and vascular problems that can, for example, complicate the management of diabetes.
So why not just quit? Because, Azzarelli says, "it's a very powerful addiction. It's one of the most difficult things to quit. The average person takes between seven and 11 attempts to quit. It takes over your body chemistry, so it's a very difficult process."
Smoking isn't a habit, or a vice, or a weakness, adds Elizabeth Fildes, founder of the Nevada Tobacco Users' Helpline (1-800-784-8669), which since 1997 has offered Nevada smokers ages 18 and older counseling and evidence-based stop-smoking strategies. "This is an addiction."
Nicotine is an incredibly addictive substance and a cigarette a "sophisticated delivery device" that enables nicotine to hit the brain in less than six seconds to produce chemical changes that include a pleasurable increase in dopamine, Fildes says.
"And a pack a day gives you 200 hits a day," she notes. "My patients tell me, 'I've quit alcohol, I've quit heroin, and this one is hard.' "
Yet, despite knowing how cigarettes work physiologically, "it's prevalent in our society that it's a habit, that you could just put it down," Fildes says. That attitude can deter smokers from seeking help, and it's "why we hire professional addiction counselors, because we want to treat it as an addiction and not as a bad habit."
Bush, 63, smoked off and on for about 25 years. She started when she was about 18 and has been successful in quitting, albeit only intermittently. Before calling the helpline one last time, she had been smoking for about 10 years straight.
"It's very hard to stop," Bush says. "It was like every day those last 10 years I woke up in the morning and said, 'I'm gonna stop today,' and every day I broke that. And it's really hard on you mentally because you keep feeling like a loser."
Bush tried 12-step groups, when she could find one. She tried going cold turkey. She tried nicotine patches. But nothing worked for long.
Finally, she called the Nevada Tobacco Users' Helpline. Fildes says most of the smokers who call the helpline already have tried quitting on their own.
The service is designed to remove two significant obstacles -- that is: excuses -- that might keep smokers from trying to quit. First, the helpline is free. Second, counseling is done over the phone (although in-person one-on-one sessions with counselors and weekly group sessions also are available).
"I don't think I could have done it without that place. I needed that one-on-one supervision," Bush says.
Bush availed herself heavily of the phone counseling sessions during the first two weeks after quitting. "And you don't need an hour or anything like that, like you would with a regular therapist," she adds. "You only need five minutes.
"Sometimes it went on longer, if something was going on that was causing me stress or something. But, usually, I only needed a few minutes -- just, 'Yeah, OK, this has been a hard week.' At the beginning, I was talking to them almost every day, then it got to once a week and then once a month."
Fildes says each patient's stop-smoking strategy is tailored to his or her needs. Bush's regimen, for example, included taking a prescription medication called Chantix, which prevents the brain from experiencing nicotine's pleasant effects.
"What I loved about that was, there was no withdrawal," Bush says. "I was only on it a couple of weeks, then I didn't need to be on it."
Bush's most recent go-round with the helpline actually was her second. The first time, "I could stop, but I kept relapsing," she says. "I'd go for two months and then relapse, and it was just mortifying to tell them. But they were so nice. There wasn't any shaming about it, and that helped a lot."
The helpline receives about 15,000 calls a year, Fildes says, and the quit rate is more than 40 percent for clients who complete five counseling sessions.
The helpline initially was funded by money Nevada received through a 1998 multistate settlement with tobacco companies. After state legislators reallocated that money to other uses, the health district obtained a $14.6 million grant from the CDC to continue the helpline and fund anti-tobacco education efforts here.
However, the CDC grant expires in March.
"That's when it's going to get really scary," Azzarelli says.
The stakes are high, she adds, because health care costs related to smoking total an estimated $565 million a year in Nevada.
But, in the meantime, the Great American Smokeout is as good an occasion as any for smokers to become nonsmokers and for nonsmokers to reaffirm their determination to never start.
"From what I've read, from what I know, from my personal experience seeing patients for almost 40 years now, there is nothing redeeming about smoking in any form," Forman says. "It's bad for your health, it shortens your life and it will create problems for both you and your family. There's nothing good about smoking."
Bush loves not smoking, but knows that her current smoke-free lifestyle isn't guaranteed.
"I have to always know that I am a nicotine addict," she says. "The thing that helps me most right now is that I don't want to go through that process of withdrawal again. It was too much work.
"And I like myself for stopping. I hated myself all those years for not stopping, and it feels better to like myself."
Contact reporter John Przybys at firstname.lastname@example.org or 702-383-0280.