Cassie

Age at interview: 22

Brief Outline: Cassie, 22, is currently trying to give up smoking. She is Mixed Black African Caribbean/White British, is studying and lives in London in shared accommodation. Cassie had her first cigarette when she was 7 but started smoking regularly when she was 13. She has always suffered with asthma and first tried to quit when she was 18. She is currently trying to stop and has cut down considerably. She plans to attend a drop-in clinic to get more support.

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Cassie had her first cigarette when she was 7 years old. All of her family smoked in the house and she says cigarettes were readily available. She started smoking regularly at 13 and used to buy 50 cigarettes every weekend. Later she smoked 25 a day, and says she was ‘aware of the health implications’. However she has always had a sore throat and was diagnosed with asthma at the age of 9 months. She also thinks that her voice has changed over the years because of smoking. When Cassie’s Mum found out she smoked she was ‘very angry’ and upset as she was under-age. Cassie in turn thinks that her mum used cigarettes as a ‘pillar of strength’ to help her cope. The first time Cassie tried to quit was when she was about 18 and she got ‘patches’ from the doctor; she says that it wasn’t bad, even though she still had her ‘morning cigarette’. She thought she just had to get over the ‘three-day hump’ and then it would be ‘plain sailing’, but it wasn’t. She tried again six months ago and has recently tried nicotine replacement patches once more. She had had problems with skin irritation with the patches, and she tried lozenges but doesn’t like the taste. She has found the inhalator more useful although she worries she will still have the habit of putting something to her mouth. She thinks it’s the habit she has to break, rather than the physical addiction.

Cassie says she has always wanted to give up smoking but it had ‘got a hold of her’. She says that her GP was ‘very rude’ to her and was ‘trying to tell her off’ about smoking. She prefers the asthma nurse that she sees, and she trusts her as she had previously smoked and has now given up. Cassie fears that her current attempt is ‘not going so great’. She said the pharmacist ‘wasn’t very encouraging’ and didn’t really talk to her. When she ran out of her prescription, she didn’t go back to him. She is down to smoking 7-8 per day and wants more support to stop. In the university holidays she couldn’t get the support she wanted, but when she moves back to London she wants to go to a drop-in centre. She has also used the internet and started blogging about her quitting attempt, but then stopped as she thought she might look ‘silly’ and worried people would see her fail.

Cassie has chronic asthma so she says she really ‘shouldn’t smoke’. She now smokes loose tobacco because cigarettes ‘hurt her chest’. When she was 17 her lung collapsed during an asthma attack and she was in intensive care for 5 days. However, the first thing she did when her friends visited her was to ask to be taken outside so she could have a cigarette. She says that the psychological ‘grip’ of smoking is very strong and she says that she has even been through a bin to find the end of a cigarette. In the future she would like to get ‘behind’ some of the reasons why she smokes. She says now she is ‘waiting for the thing’ to make her stop. She says she does love smoking - ‘the taste and the smell’ - but that she wants to give up because of the health implications. She has asked others about the best way to stop and wants better support, with more personal interaction. There are also a couple of things that make her nervous about quitting smoking, namely, coughing more and putting on weight, both things that she has heard from other people. She isn’t doing as well as she wants to, and hopes to do better when she goes to London.

Cassie had always wanted to quit, even when she first started. She saw her brother try to give up several times but stopping was harder than she thought.

I’ve always wanted to give up smoking. Always. Since I, well possibly as soon as I started, because I knew, you know, it wasn’t the right thing to do. It got a hold of me, and when I was 18, I just decided enough was enough. I’d seen my brother quit successfully. Although he went back to it now. He’s quit many times and after six months gone back. But I saw him quit and I decided, you know, enough is enough. I, I don’t want to be smoking for the whole of my life, I really don’t. Because as much as I enjoy it, it’s not a nice habit, you know, you smell and it turns some people’s teeth yellow. It’s not very social any more, and slowly society is turning against it. So I don’t want to be smoking forever. And I’ve always had, thought, it’s just about being strong enough to beat it, and I’ve never wanted it enough to, to fully beat it. 

Back then I just thought I’d give it a try, because as long as I tried, then even if I fail, it doesn’t matter if I’ve tried. And I thought if I could just get through and quit the three day hump kind of thing, if I could just get through that, I thought then following if I had this pre conception that you know, the three day hump is all you’ve got to get over and then it’s plain sailing. But it really wasn’t. So I tried. But it was harder than I thought. So I just, you know, the easy option was to go back. So that’s what I did.

Aged 17, Cassie had a serious asthma attack and was taken to hospital.

I had an asthma attack and I was 17. I was at home. It just came on. I can’t really remember how I was, either it just happened or I was in the bathroom in the steam. And it was, it was quite bad. I used to have a lot of asthma attack when I was a child like. I was in hospital every two weeks or every month, you know, and but this was my worst. So because of my previous, I knew what an asthma attack felt like, but this felt different. You know, I was very hysterical and I was shouting and screaming, “Don’t let me die.” I still refused to go in an ambulance because I feel like that’s defeat, so you know, I stumbled to A & E. I got there. They put me in, they weren’t listening to me properly. They, I was telling them I can’t breathe. They thought I was just over reacting. They gave me medication but it took a long time, and I was sent to Intensive Care. I told the nurse that was on duty that my neck was hurting, and my throat was hurting and my neck, and they were like, “Oh it’s just because of the steroids.” And I’d been having steroids. I take steroids every day and night, you know, since I was 9 months old. So I knew I wasn’t the steroids. Then she said they got me some ice cream. Got me some ice cream and left me there for the rest of the night. I couldn’t sleep, because I couldn’t breathe. And then when the doctor came round in the morning I told her, and she felt my neck, and it was like is it bubble wrap? Yes. You could pop it, because I had a hole, I’d got a hole, well I’ve got a scar here now and at the back and all the air had escaped and gone into my throat underneath, between the layer between my skin and so you could pop it. And they said it was emphysema and pneumothorax and usually that’s associated with like old women isn’t it? Older women. But yes, it was very, it was very traumatic. And that should have stopped me from smoking really, because I mean that’s quite, that’s quite a big deal, especially at a young age to go through that, and to have that happen to you, when usually it’s an older women. But it didn’t. As soon as my friends came I was out there smoking, and I just carried on smoking. And they said it was caused by too much coughing. So as soon as they said that I didn’t think, yes, is it anything to do with smoking. I think they should have said to me, you need to stop smoking now. It’s not, it’s really not helping you. And I think people need to be more graphic, because I think we say, “Oh it will give you cancer.” People just think, oh that’s a possibility, it might not happen, I’ll take my chance. But I think we need to be more graphic and you know, have real people, you know, that have been affected and have got cancer and share their story.

Cassie’s friends didn’t like her smoking, and thought that her house smelt of cigarettes, but she still found it hard not to smoke.

And you said that some of your friends are really encouraging you to do it?

Yes, they are, they hate smoking. Yes, it’s pretty good. A lot of them, you know, they, they argue with me. They say you’re smoking holds us up because we can’t get on the bus, and they can’t get the tube because I always smoke and then I argue with them and I make them feel like it, go away, do your own thing. But I think it has the potential to break up friendships and relationships which is quite sad. And I think people should try and stop for that in itself. Luckily it hasn’t, it hasn’t damaged any of mine, but I’m sure before I used to smoke in the house and my friends came, and I’m sure they didn’t like it, I’m sure it wasn’t nice. And people would say, “Oh all I can smell is cigarettes.” Which didn’t make me feel very good, but it didn’t stop me, it just made me buy a body spray instead. But I wish it did. It just feels that there’s something, there’s something that will make me stop. But I’ve just got to find, or I’ve just got to push a button in my head that says, “No, no more.”

Because ultimately I am stronger and it sickens me to think that this little stick has so much power over me and I’m allowing that to happen. I do have the power to stop that. It’s just about finding it, you know.

When she was buying a pack every day Cassie didn’t notice how much she was spending on cigarettes, but now she realises how much money she has wasted on cigarettes.

But you know, I get very angry when other people ask me for my cigarettes, because I think buy your own they’re mine. You know. So I think maybe that’s the psychological thing, the need to keep hold of them so that I can carry on smoking, and I think, if I had like £5 left and that’ all I had till the next month or until next year, I would spend it on cigarettes rather than anything else. And if someone gave me the choice between food and cigarettes, may be not now, but before, I would have chosen cigarettes. Which is quite drastic.

And how’s it been with money and cigarettes?

Fine. Cigarettes do eat up your money very quickly. But I think, you know, because you’re buying them, if you, if you smoke a pack of 20 cigarettes. I don’t what the average price is - £6? Then you’re buying them every day if you’re quite a heavy smoker, so you don’t really notice your money going down, and you get so used to it, you don’t notice your money going down, but as, as I’m trying to quit, every time I do go buy it, you know, I don’t want to buy it because of the price now. I’m really bothered about the money I’m spending. It’s such a waste and I could, could spend it on something else. But before when I was regularly smoking all the time and not concerned about quitting the money didn’t even bother me. You know, as long as it’s there, it’s there to spend. So… it so much seemed worthwhile.

The pharmacist just gave Cassie forms to fill in when she asked for an NRT inhaler. She expected more support and interest.

My current attempt is not going so great. I gave up. I went to the pharmacist and I got the patches, but he wasn’t very encouraging. He didn’t even talk to me. He just like threw a form at me, got me to fill it out and then just gave me the patches and I asked for the inhalater because my Mum had it, and she’s trying to quit, and no words of encourage, no talking to me to find out how I feel about it. And just literally couldn’t wait to get me out the door. So I just felt really rubbish, because to me it’s a big thing and I kind of wanted the support, but I didn’t get it, and that put me off as well. So when they ran out I didn’t go back to him.

Cassie thought that her GP wasn’t supportive; the nurse who treated her asthma was much better.

Have you ever spoken to your GP about smoking? Either wanting to give up or on any connection in your appointments over the years?

I’ve spoken to my GP when I was like about 16, just about, you know, quitting and what was available and only in other times in them telling me I was stupid for smoking and being very rude to me, and trying to, you know, trying to tell me off. Which is not cool like, you need support, not someone trying to slap my hand like a child. So …because even my asthma nurse is more understanding than any GP that I’ve had, you know, they tell me, “Oh well you’ve probably got the lungs of a 40 year old. You know, don’t you understand what you’re doing to your body.” And it’s like, “Well I’m an adult of course I understand.” But I’m sure my doctor’s a non smoker, never having had smoked, so they don’t understand. So when it’s that situation I’m not going to listen to them.

What’s your asthma nurse like? You say she’s better than your GP?

She’s more understanding. Yes, well my asthma nurse is, she’s just quit smoking. So with her it’s easier for me to relate because she’s done it, and then it’s easier for her to relate with me as well, because we both talk and we both understand each other and she tells me things that nobody else has ever told me. Like she told me there’s an ingredient in cigarettes which opens the lungs because they want to get down as deep as they can. So then for me, it makes me feel like I can breathe better, but obviously the long term effects of smoking are going to cause me to have a lot of problems when I’m older. So she’s very real like, and she doesn’t hide anything. She tells me how it is, and she tells me what helps her and you know, that’s quite positive for me, because she has actually quit. Like she’s well I don’t know, somebody once said to me “a smoker never quits” And I don’t know whether that’s true, but I suppose she could go back to it, but for now she’s successfully done it. And that’s really good, because and I look to her and I think well if you’ve achieved that I can achieve it. She’s giving me advice and help so hopefully that will give me more of an advantage and help me be stronger. And then I’ll actually crack it and do it.

Cassie didn’t go to a support group - she associated them with the type of group alcoholics go to.

I wouldn’t like to go to a support group, because you know, I associated them with like  alcoholics and you know, kind of smoking, no, I don’t really see it as the same. They say alcoholism is a disease, but I don’t think smoking is. I think smoking is something you can get over if you really want to, because I knew people do. So I wouldn’t, plus I wouldn’t, it just doesn’t feel right going t a support group for smoking. It doesn’t. I think smoking is not taken, I don’t know taken seriously is the word, but you know, it’s not out there like it’s a big thing. You know, the government want you to quit smoking, but it’s not in your face, so then for a support group to be set up, I think it’s a bit much, you know, and whether that’s right or wrong is just because it’s not in my face and I don’t really see it as a big problem. But I’m sure, I’m sure there is a big, big problem because I’m sure there’s a lot of smokers in the country and a lot of, they are costing the NHS a lot.

Cassie is finding it really hard to cut down and her smoking varies between 2 and 8 cigarettes a day. She isn’t doing well since she has yet to have a day without a cigarette.

Yes, you know it varies by day. Each day I wake up and you know I don’t really know what’s ahead but I know I’m going to try. And sometimes, you know, I’ll go to bed thinking tomorrow I won’t smoke at all. I always did. I wake up and then I’ve told myself the night before, no cigarettes at all today. And then I think, well I really like the morning one. So I have the morning one, and then the morning one just kinds leads into the rest and then I miss the next two, and then I think I’ve waited long enough so I will smoke. I have yet to go a day when I haven’t had like when I’ve had none. But you know, the lowest I’ve probably gone to is about two and then the highest about eight on an average day, and it makes me really sleepy, really sleepy. I was sleeping 15 hours a day, like when I wasn’t smoking, and I loathed it. I didn’t like that very much that I was sleeping so much. I’m not sure why it happened. But I just felt like I was missing out on my life and I’d rather have a cigarette that wakes me up and keeps me awake during the day then to be falling asleep at 6 o’clock and the waking up like 10 o’clock the next day. Because you know, that’s not ideal.

I don’t think, I think, I’m not doing as well as I could be. That’s the honest truth and I have to be honest with myself.

Cassie had become a regular smoker by the time she was 13.

I took my cigarettes to school. I didn’t really care. I used to, I used to smoke in front of the teachers, I think by that point it had got to the point where I didn’t care anymore. Like I wanted a cigarette, I would… I remember my cigarettes being confiscated at school, and then I had to send my Mum in to get them back. And she got them back, but not to give them back to me. She just thought it was an invasion of my privacy and they shouldn’t have taken my possessions. So she got them back but then she kept them away from me. But I managed to get them back obviously. I would say I was smoking about ten a day, which is quite a lot for someone of that age isn’t it? I think it is.

Lots of people do.

Yes, but I speak to people now, and they are like older than me, and they are like I smoked. And I say, “How much do you smoke?” And they go, “Five.” And I’m like, and they’re like, “Yeah it’s a lot.” And I’m like, “No not really.” So I think at the age of 13 it’s a lot it really is. And you know, ten, ten a day, you know, in school breaks, before school, after school. I used to smoke in my room, in the baths, in the toilets, smoke anywhere like. So yes, I smoked quite a bit.

Cassie smoked because she loved the taste. It was hard for her to stop because smoking was so strongly associated with everyday activities.

You know, it’s just the ... it's hard because it was a mental habit for me. You know, I was used to picking something up and having something in my hands, putting it into my mouth and I guess its repetition. I’ve done it so much that you know, if I don’t do it, I feel weird. And certain places, I’ve always smoked in my bedroom, so I spend a lot of time. I like to be with my family, I spend a lot of time in the house, and going out as well. You know, I’ve always smoked when I walked to the bus, I’ve always smoked when I’ve walked to the shop. Basically I smoke, I used to smoke whenever I left my house to walk somewhere just so I wasn’t bored on the way. And I’ve always smoked in my bedroom, so being in them places, though I can’t escape them places, the habits still there, it’s still fresh in my mind, and I just think oh…

Because if I’m at home, now, most of the time cigarettes are on my mind you know, or if I’m outside and I smell it, I like the smell. I enjoy, I’m not one of them people that just smokes because I just, because I do, or because I’ve been doing it for so long, or because I’m addicted and that’s the only reason. It’s because I love the taste, I love the smell, I love it. I’ve always loved it. I just know it’s not the right… breaking the habit is, is very, very hard, and it’s something you need a lot of work on to do, and I think you need a lot of support.

Even when Cassie was in hospital with a collapsed lung, she got her friend to push her outside for a cigarette.

I remember being in hospital, my lung had collapsed. I was Intensive Care for five days. I was in a really bad way. And, as soon as my friends got there, the first thing I got them to do was put me in a wheelchair and take me outside to smoke. And I was choking and coughing up stuff and I was still puffing away, which is terrible. It just shows you how strong the addiction and the need to have it is. You know, I put my life on the line. I was in Intensive Care, I couldn’t breathe, it could happen again. Just the cigarette could trigger it, because at that time it was a trigger. And I was willing to risk it for a cigarette. So you know, the grip is really, really tight. And I think, you know, psychologically it really had gets hold of you.

How would you say sort of psychologically it’s got hold of you? What are the signs?

Signs? What are the signs? Just the need to smoke. I get very irritable if I don’t have a cigarette and I get, you know, I would, as much as it embarrasses me to say this, I would do anything to have a cigarette if I really wanted one. I’ve been through the bin to pick up my cigarette ends to see if there’s a bit left on there. I’ve been through the outside bin. You know, I’d go, I don’t know if I’d go as far as to ask a stranger, because I think that is, I don’t think it’s worse than the bin, but you know, I just find that very invading of from someone else. But you know, I get very angry when other people ask me for my cigarettes, because I think buy your own they’re mine. You know. So I think maybe that’s the psychological thing, the need to keep hold of them so that I can carry on smoking, and I think, if I had like £5 left and that’ all I had till the next month or until next year, I would spend it on cigarettes rather than anything else. And if someone gave me the choice between food and cigarettes, may be not now, but before, I would have chosen cigarettes. Which is quite drastic.