This column is going to be on a very personal level. I am going to focus this column on nicotine dependency. The story will begin with my family, and then I will tie that story into nicotine dependency in treatment.
So, here we go. My father was in the Navy during World War II. He was on a mine sweeper. These are boats that sweep for mines. The risk of being blown up at any time would certainly be great. I have a framed picture of my dad's mine sweeper hanging in my family room.
My father met my mother in their home town, Egg Harbor City, New Jersey. They had met before my dad enlisted in the Navy. Both of them smoked nicotine. As my mother would say to me years later, "We never knew that smoking was bad for your health. Everyone did it." At the time, the evidence was not there to suggest otherwise.
My father was fortunate in that, at the age of 39 years, he one day throw his cigarettes out and cut smoking cold turkey. I questioned him on why he finally came to that decision. He stated that he was getting short of breath and was coughing up "black gunk." My dad was incredible in that, when he decided to do something, he did it. He had this all-or-nothing kind of mind set (which I have inherited). He was of Checkloslvakian/German decent, so he was quite tough. I admired him for making this decision and actually carrying it out.
Now, my mother was another story. She smoked one pack of Salem daily. My mother was one of those smokers who never had any symptoms. She never coughed and never was short of breath. I had come to the conclusion that she liked cigarettes and cigarettes liked her.
As I was growing up and going to grammar school, we learned that cigarette smoking was bad for your health and that it caused lung cancer. The evidence was now there, and Dr. C. Everett Koop, as Surgeon General, appointed by President Ronald Regan, is the one whose major platform was to end smoking nicotine. He called for a smoke-free America by the year 2000 (Koop, 1988). I was closest to my mother, and I would come home and beg her to stop smoking as I did not want her to die. My pleas were to no avail.
I was fortunate to start working in a hospital as an orderly at the age of 18 years and, within 6 months, entered an associate degree nursing program full-time. At the age of 20 years, I was working as a nurse. Nursing has been my entire career. As a nurse, I really started to focus on my mother and her smoking. I have to admit that I really did not understand dependent behaviors at this stage of my career. One day, I went down to her house and I scolded her for smoking. I told her that I was going to make her stop smoking. I went into her hall closet, where she kept all of her cartons of cigarettes, and I took every last carton and brought them to my house. That evening, she came knocking on my back door. There were tears in her eyes, and she pleaded for me to give her her cigarettes. I went and retrieved them, and I handed them to her. I concluded that she would probably never stop smoking.
Years later, my mother was admitted to the hospital with a cancerous polyp in her colon. She had Stage I colon cancer and needed a colon resection. She was admitted to the hospital a couple of days before the surgery. The surgeon had ordered a medical consult with an internal medicine physician. This physician had ordered an arterial blood gas. I was in the room when he examined her and told her the arterial blood gas report. Her PaO2 (oxygen concentration) was 58. He told my mother the following: "Phyllis your oxygen concentration is so low that you qualify for home oxygen in the Medicare program." I told my mother that you may not be symptomatic but you are doing damage to your lungs and that you better really think about quitting cigarette smoking.
The hospital that my mother was in was the hospital where I was then the Vice President for Nursing/Chief Nursing Officer. The hospital had gone smoke free. There were four wings of this hospital that came together in a square. There was this open square where they had put a gazebo. A physician could write an order to allow a patient to be brought to the gazebo to smoke. I met with my mother's physicians and told them that under no circumstances are you to tell my mother about the gazebo. She cannot smoke in this hospital as that is the rule. They all agreed.
My mother was in the hospital for 10 days. She had been on a morphine patient-controlled analgesia pump for pain management postoperatively. It is amazing what a little morphine can do. My mother never smoked again. That hospital admission (and I do believe the morphine) got her to quit smoking.
Legislation in many states has mandated that no smoking can occur in an area of a hospital's campus. New Jersey is no exception. In fact, New Jersey was one of the first states to ban cigarette smoking in any public building. The only exception is the casinos in Atlantic City.
A few years later, my mother had an abdominal aortic aneurysm. She had to have that resected with a graft placement. She questioned me as to where I thought the aneurysm came from. I told her it was most likely from smoking cigarettes for around 47 years. My mother died at the age of 78 years of metastatic non-Hodgkin's lymphoma in 2004. Four years ago, her younger brother died suddenly of a ruptured thoracic aneurysm. Many in the family (including myself) have been screened. We have learned that aneurysms do run in our family, so now I think that my mom's smoking, along with her genetic history, is what most likely caused her aneurysm.
So, where do I fit in this smoking picture? I was the youngest in my high school class and could not drive until February of my senior year in high school. I became best friends with Bill (South Jersey Bill, not IntNSA Bill). We met in French class. He was a year older than I was, and he had a car and he drove. Bill was the adolescent experimenter. He introduced me to alcohol and cigarette and cigar smoking. I was 16 years old at the time. Peer pressure is a big thing with adolescents, and I wanted to fit in. So, when Bill introduced me to cigarettes, I really tried to smoke them. My father and I oftentimes were at odds with each other. I also called it that we "locked horns." He found out that I was smoking. This really upset him. The more that I could upset my father, the better. I really tried to smoke. I tried desperately to inhale cigarette smoke, but every time that I did it, I turned green and got really bad chest pain. After 1 week of trying cigarettes, I threw them out and have never touched one since then. I always stated that even aggravating my father by smoking was not worth it as cigarettes made me sick. I consider myself to be extremely fortunate in having the adverse effect of cigarettes so early on in my experimentation.
Working with clients with substance use disorders over the years has taught me that a person has to come to the decision to stop using substances. It really cannot be another person's decision. I see now why I could not get my mother to stop smoking. My desire for her to stop smoking was not her desire. I have also learned that only taking a medication to stop smoking oftentimes does not work. Just like any other dependency, clients with nicotine substance use disorders need to engage in counseling and group work for their dependency on nicotine.
Many clients in the addiction treatment center that I practice at come in and, when questioned about smoking cigarettes, they tell me that they vape. Secondary to the negative consequences of vaping, the vaping epidemic clients are not permitted to vape in our facility.
Clients are permitted to smoke cigarettes outside the facility in a protected area.
As a healthcare provider, I feel that it is my moral and ethical duty to discuss with clients who smoke the negative consequences of cigarette smoking. The facility that I practice in has smoking cessation products. We have these products as needed orders in all admission order sets. I make the clients aware that these products are available. All they have to do is ask nursing staff. I also tell them that they may not yet be ready to quit smoking as they may want to concur their major dependency first. I call my interaction with these clients "planting the seeds." I just hope that other providers, when the client leaves us, will continue to water these seeds.
Footnote: My high school friend Bill quit smoking in his 20s. He and his wife and I and my wife are still best friends.
REFERENCE