Sarah

Age at interview: 33

Brief Outline: Sarah, 33, gave up smoking four months ago. She is White British, works for the expert patient programme, community interest company (CIC), has no children. Sarah started smoking as a teenager with a friend. Later she worked abroad as a dancer and smoked about 30 a day. After trying Quitline, and hypnosis, she finally quit with the support of a colleague and is now saving the money she would have spent on cigarettes.

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Sarah can remember smoking her first cigarette was when she was about 14. She sneaked off with a friend and bought lots of things to disguise the smell. Now she can’t remember ever being a ‘social smoker’. She thinks that by 18 she was smoking ‘properly’. By that time she was conscious of her weight, and instead of ‘reaching for a chocolate bar’ she ‘reached for a cigarette’. When she was a dancer abroad at the age of 19, she could smoke up to 30 cigarettes a day and ‘not really think about it’. She was in Japan where cigarettes were cheap and everyone smoked ‘far more than her’. She didn’t know how as a college student she managed to afford to go down the pub and smoke cigarettes. Her ‘cigarette of choice’ was Marlboro Lights, and later Marlboro Silvers when she was trying to quit. Later, she depended on cigarettes during the time she had anorexia nervosa as she could do something that didn’t take in any calories. She thinks this is why quitting smoking was particularly hard for her, as she feared putting on weight, and the breaking of a habit was something that she found difficult. Her Mum was recently diagnosed with lung cancer, and yet wasn’t a smoker.

Sarah managed to quit smoking about six years ago, but only for a short while. At that time she went for hypnosis to give up smoking, but later had a panic attack. She says ‘not everyone can go under’ and she ‘was awake the whole time’. She bought the Allen Carr book but didn’t read it. Now, Sarah thinks that smoking actually helped keep her alive to a certain extent when she had an eating disorder – there was a reason for her to smoke as smoking relaxed her enough to be able to eat. Sarah has osteoporosis because of her anorexia, and smoking is known to decrease calcium absorption. She was told to give up but this wasn’t ‘enough of a reason’ for her to quit. She ‘really loved smoking’. She now finds it hard to remember what it was that she liked about it. A lot of smoking she says was ‘quite habitual’, and because of her eating disorder she had to have a cigarette before every meal and after every meal. She had to do lots of things before eating and that was ‘the last one to go’. A colleague helped her recognise that she wasn’t going to achieve something unless she really wanted it and that it wasn’t ‘an overnight thing’. At work she was involved in supporting others to learn and apply self-management skills and also used the same tools personally. The quitting phone service didn’t work for her and so she found her ‘own answers’. She didn’t have time to go to a support group and her experience of support group for other things was something that she ‘didn’t particularly enjoy’. Her colleague supported her to explore ‘what she was nervous about’. She hasn’t had any follow-up from her GP to see how she got on. However the pharmacist congratulated her along the way. She made a paper mâché money box and put the money she would have used for cigarettes in there. She has saved £800 in the four months she has given up smoking. Now she wants to use that money to have fun with her mum and family, and not to say no to an opportunity just because of money. She used patches, which she felt gave her the nicotine to keep her cravings at bay. However, more than anything she feels she really wanted to give up this time. The month before she quit she ‘hated it’ and was smoking about 30 a day.

Now Sarah does a lot of yoga, and gets the work/life balance better. Since she has given up she finds that her flat doesn’t smell, her clothes smell better, she doesn’t ‘have to’ have a cigarette, and doesn’t panic when she can’t find her cigarettes or her lighter. She says she has ‘more choice’. She doesn’t really resent having smoked as she ‘loved it’ but she is also ‘pleased she is not smoking anymore’. Her sense of smell is a lot better, but not her sense of taste. She hasn’t gained any weight either – the one reason she thought she continued.

Sarah had heard good things about hypnotherapy and tried it. She had a panic attack after one of the sessions and didn’t try it again.

And so you went to hypnosis at one point?

Yes.

And it helped. Tell me a bit more about that?

I’m not really sure what to say. It didn’t work for me. But I’d heard miracles about it. How people had gone and said that they, you know, they were going to quit. They not only quit, they started going to gym three times a week and they still do and it was all wonderful. It didn’t work for me. But I think you know, hypnotism, it’s not everybody can go under and they couldn’t hyp me. I couldn’t. I was awake the whole time. They couldn’t whatever it is, go to that. I fought it apparently. So…

And was it during a session that you had a panic attack?

No it was afterwards. It was afterwards. Because I think a little bit of it had come off on me in the fact that my… it’s really weird to explain, like physically I didn’t want to reach for a cigarette. Like my head was saying no don’t do that, no don’t do that, but my body was going you need a cigarette. I was lit… so I was having this battle going on. That I didn’t quite know what to do with. So yes, I found that really difficult. But I think that was probably because I hadn’t gone under enough. I hadn’t gone deep enough for it to really work for me.

Sarah worried about putting on weight, and this initially put her off trying to stop smoking, but in the end she didn’t gain any weight.

Have you what sort of physical effects have you noticed in doing it…?

Honestly none, none. I’ve not gained any weight. I realise that I probably am very aware of that. But, you know, the assumption. …it was funny actually. The I went to a, I went to a health promotion event, and there was a Quitters stand there. And a lady came up to me and she said, I think I’d just been out for a cigarette. This was some months ago when I… And she said, oh she gave me one of the things. She said, “Let me give you one of these. Do you want to explore quitting?” And I said, “Well, actually yes, I do.” I was kind of thinking about it at the time and she said, she said to me, “Wow, you know, there’s nothing but, there’s nothing but gains to quitting smoking. And I guess the only gain that you might not want is the stone that you’re going to gain.” Hm. That was it. I wasn’t going to quit any more. That put me off for about three months. That was, yes, that didn’t help me. But... again that was an assumption that everybody’s going to gain weight when they quit smoking.

You know, I know there’s evidence to suggest that most people might, but you don’t have to, not really.

Sarah had an eating disorder and smoked before and after every meal. She couldn’t risk giving up until she knew she could eat without smoking.

I mean lot of it for me was, it was quite habitual. So, I would always have, you know, I woke up in the morning, I had a cigarette. Then I did something else, then I had a cigarette. Because of my eating disorder I had to have a cigarette before every meal and after every meal, and I literally couldn’t sit down to a meal unless I’d had the cigarette. Which is why there was always that fear that it would affect my eating disorder as well. I mean that was a long time ago. So I think I had to explore some of those issues first.

Why did you have to have one before and after a meal?

I have some bizarre things I had to do before and after a meal. So I think that, you know, I had to wash my hands. I had to have my necklaces in a certain place. I had to do an awful lot of things and that was because I was ill you know, and smoking was one of them. And it was probably one of the last ones to go. But I had to know that actually I could sit and have a meal without having to have a cigarette before I could quit or even contemplate quitting. So I think it was two pronged. One I loved it. In some places I loved it. And then in other places it was keeping me well. It was allowing me to eat for some bizarre reason.

Sarah used to buy ‘posh’ brands when she was abroad; she preferred ‘light’ low tar cigarettes.

So what brands did you like? Did you buy?

Do you know what? In Japan I can’t remember. They had lots of really bizarre brands. I remember the most common cigarette brand I couldn’t smoke. Everybody smoked it. It was really cheap. I can’t remember what they were called. But I couldn’t smoke it, because it made me all light headed. And I could only ever put it down to the cigarette brand.

But my cigarette of choice was always Marlboro Lights. More recently just as I was quitting Marlboro Silvers, but I couldn’t really find that brand any more.

When I go abroad if I ever have the chanced I loved Davidoff White and Vogue Lilacs makes me sound particular posh doesn’t it but they were exactly the same price when you were abroad, [laughs] it’s just to get they were my preferred.

What was it that you preferred about them?

They were all really, really light. Really light. I think the Vogue Lilacs and the Davidoff Whites I particularly like. They were white tipped. I don’t like the yellow tipped ones. I don’t really know I think I liked the packets. Oh I’m such a woman. Yes, no I really don’t know but I was always, it was the light of the cigarette the better. It made it more okay I guess.

meaning light in terms of …

Nicotines and tar yes.

Sarah tried to quit smoking whilst dealing with an eating disorder. She had a panic attack and then worried how she would cope without cigarettes.

And I think that as I became well, whilst I was making changes to my life, that as, smoking was the one thing that I kind of kept as a constant. And I think that’s why I found quitting smoking particularly hard because it has a number of other sort of potential things that it could, and I fear the thing like putting on weight. Well particularly that one. But also the breaking of a habit which I find really quite difficult and I, I guess I’ve always, it’s always concerned me that that would bring about symptoms of my anorexia if I, you know, too big a change too much, too, too fast.

So yes, I did manage to, I tried hypnotherapy. And I never forget, I went along and I had this hypnotherapy session. I must have been 27 at the time, and I was still reasonably unwell. I wasn’t it, I wasn’t using a lot, I was quite well, but I wasn’t a hundred per cent. And I went along and whilst I didn’t want, my mind didn’t want a cigarette any more, physically my body needed nicotine and I had a complete panic attack and I remember parents who were sat there, there all wanted me to really quit up smoking, quit smoking. And I remember my Dad saying, “Okay now, I’m worried. Now I’m worried. Where are the cigarettes. Let’s give her a cigarette.” [Laughs]. Because it was all too much and I think that that you know, again just re-enforced my concerns really, that I was just going to have panic attacks. It was going to increase my anxiety.

To motivate herself, Sarah made a money box to save all the money she would have spent on cigarettes in order to spend it on something special in the future.

But to prevent, I guess whilst exploring my own ambivalence, I got creative. I’m a little bit of a creative person and I made a paper mache money box out there and that money box, and I will be checking it’s still there when you leave [laughs], that money box doesn’t take coins. It only takes notes, because I couldn’t buy a packet of cigarettes with a coin. And every other day I put a note in there, and that to me is okay. Once it’s in there I can’t get it out. So I can’t delve in to go and buy some cigarettes. So I’m committing my cigarette money to its destination once it’s in there because I can’t get it out and, and I think that making that was a hands on process for me. It was a really fun creative process for me, and I made it with a reason. I was still smoking when I was making that, but I was making that with a purpose and as I made it the purpose grew and I actually then became quite excited about stopping smoking. Rather than being ambivalent I was quite excited about how I was going to use my money box. Which sounds completely crazy now. But how I was going to use my money box and what I was going to do with, you know, at the end of it.

What are your thoughts?

What I’m going to do at the end of it. Do you know what I don’t really know now. Oh there’s loads of things I want to do. There’s loads of things I want to do. I want to get my bathroom tiled. I want to do this and I want to do that. But right now, I, it’s funny when I was doing it, it was things like I wanted to go to New York for my birthday. But I think the other flip side is, you know, with my Mum not being very well, actually the littlest things in life have been so much so. You know, right now, actually I don’t want to go across the other side of the world, even if it is for a weekend. I want to be nearby to home. So, you know, I guess it’s just, I want to buy my Mum a big bunch of flowers when I want, instead of buying a packet of cigarettes. And whatever it may be, I want to be able to, to share stuff. You know, to, to, to not have to say no to an opportunity because I can’t afford it. And to know that I can, even if I have to smash my money box [laughs].

Sarah tried NRT gum and patches, and chose patches as she didn’t have to taste anything.

I guess it is just about exploring and there are so many different things on the market nowadays to support you, and if you decided that actually I want some kind of nicotine replacement, jumping to the first one that’s offered, isn’t necessarily the right thing, because there are a lot.

So how did you make that decision about which one to go for in this flooded market?

I didn’t, I wanted, I always, I just wanted patches. I wanted something quick and easy that I could put on and I didn’t have to taste. Because it was what was missing for me was the nicotine and I felt that if I started taking I don’t know chewing gum, if I started using the chewing gum or the inhaler, I’d probably knowing my own characteristics would just get addicted to using one of them. Whereas with the patches I had a process, a stepped process that I would go through to, you know, to get to the end of it. So I think that’s why.