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Giving Up the Ghost

When it comes to qui!ing smoking, you’re on your own
BY LYNN CUNNINGHAM (HTTPS://THEWALRUS.CA/AUTHOR/LYNN-CUNNINGHAM/)
ILLUSTRATION BY ALËNA SKARINA (HTTPS://THEWALRUS.CA/AUTHOR/ALENA-SKARINA/)
Updated 10:21, Jun. 8, 2016 | Published 7:00, Oct. 22, 2014

IHAD EXPECTED an austere, sanatorium-like atmosphere, with staff in crisp lab coats, the walls
plastered with rules and bumper sticker–#pe slogans: Rehab is for qui!ers, maybe. Instead, the place
skews toward homey, or at least as homey as a medical facili# can be, with nary a motivational
poster to be seen. My room features a Murphy bed, a small desk, a wall-mounted TV, and an
inoffensive print; brown and beige are the dominant colours. $e space is reminiscent of an upscale
dorm or a highway motel, except for the syringe disposal receptacle in the bathroom.

But ma!ers of decor are not top of mind on this Friday in January, as I stand outside the entrance
of the building. Instead, I’m focused on cigare!es—or, more precisely, smoking as many of them as
possible in the time le% before 4:30 p.m., when nine other people and I will hand over our packs
and lighters, and put our faith in the Mayo Clinic’s Nicotine Dependence Center.

AHALF-CENTURY AGO, I lit up for the first time. It was 1964, the same year that United States
surgeon general Luther Terry released a depth-charge report unequivocally drawing a direct link
between cigare!es and lung cancer, chronic bronchitis, emphysema, and coronary heart disease. Or,
as the New York Times headline succinctly put it, “Cigare!es Peril Health.” Being fourteen at the
time, I didn’t read the Times, but the news filtered into my hometown of Guelph, Ontario—the site
of an Imperial Tobacco factory, where, it was said, workers got free cartons. My friends and I
mordantly joked that every cigare!e we smoked would shorten our lives by ten minutes. Because
we were immortal, this didn’t seem like a big deal.

At school, I belonged to the science club and entered fairs with projects like “$e Miracle of Rayon.”
I was an A student in home economics; my pocket money came from babysi!ing. In short, I was
something of a nerd, and desperately wished for an edgier image, which I believed smoking
bestowed.
At the time, nearly half of Canadian adults were smokers, and in that Mad Men era you could light
up just about anywhere—planes, banks, movie theatres, even doctors’ offices and hospital rooms. To
object to someone smoking was rather like being the cran' neighbour yelling at kids for playing
hockey in the street. $ese days, though, the 16 percent of us who still smoke daily are the ones
beyond the pale—which is to say a car’s length or two from building entrances, if we’re obeying the
omnipresent signs.

I could claim that an extremely belated road-to-Damascus experience led me to rehab, but the fact
is, for years now, you have had to be either terminally dense or a Big Tobacco executive (not
mutually exclusive categories) to deny the health risks. It wasn’t even the pariah status, the death-
ray glares of disapproval that lighting up automatically incurs. True, that contempt—and its flip
side, a self-image hovering below zero—was one of the reasons I’d quit numerous times over the
past five decades. I had stopped for as li!le as a week and as long as seven years, the la!er an
interregnum that went up in flames during an evening that featured a lot of (n and too much
wine; suddenly, cadging a cig seemed like a good idea. Within a week, I was back to a pack and a
half a day.

$is time, there were two things that influenced me to kick the habit. One was my kid, twen#-
three years old and a smoker since he was fi%een. I know he’s not immortal, even if he doesn’t, and
my guilt about being a noxious role model is intense. $e second, at the risk of seeming to have
skewed priorities, was the money. I was smoking two large packs a day—fi%y cigare!es, about
thir# more than what’s currently defined as heavy smoking—which translated to a ludicrous
$8,750 a year. On the cusp of retirement, with its decreased income, I realized I couldn’t afford to
keep smoking if I still wanted to live indoors.

Cigare!es are expensive, but, as I learned, so is qui!ing. Knowing that a period of policed
abstinence and sharp-eyed supervision would be critical to ge!ing me through the first few days, I
started looking for a residential cessation program. I anticipated finding dozens of choices. Seek
live-in treatment for drugs or booze, and you can generally be accommodated speedily in a free,
non-profit 12-step program. If you can hang on for a while, your stay at a private facili# will be
covered by most provincial health care plans; with a decent extended health plan, you may not even
have to wait.
Nicotine addiction is both more common and more deadly than dependence on alcohol or other
drugs, and, according to one study, costs the Canadian economy $17 billion a year. But being strung
out on tobacco is treated almost exclusively through outpatient programs and other measures of
debatable utili#, such as the helpline number tucked into every pack. (I called once, three weeks
into an a!empt. $e woman on the other end of the phone said, essentially, Carry on, and wished
me luck.) I discovered that there is just a hand(l of residential cessation programs in North
America. One, located outside O!awa, I crossed off my list as soon as I encountered the New Agey
phrase smudging materials.

So here I am at the Mayo, in unprepossessing Rochester, Minnesota, a ci# that’s never been on my
bucket list. About once a month, the Nicotine Dependence Center takes over the fourth floor of the
Colonial Building, on the eastern edge of the clinic’s considerable downtown campus. $ere’s a
simple reason why the program isn’t offered more frequently, and it unites all ten of us would-be
qui!ers: unlike most people, we can afford the $5,500 (US) price tag for the eight days, plus airfare
and the cost of the patches, gum, and other nicotine replacements that are central to the clinic’s
treatment model. (Nicotine itself, while highly addictive, is not carcinogenic, nor does it cause the
myriad other health issues associated with cigare!es.) In my case, the total comes to more than
$7,000 (US). Not a pack’s worth of the cost is reimbursed by my provincial health plan or my
employee benefits.

$e truth is that we don’t (nd cigare!e rehab because we don’t consider smoking a true addiction.
Today, people are said to be hooked on everything from Facebook to Oreos, but being an Internet
fanatic or cookie monster is not the same as experiencing the panic' tightening in the gut, the I’d-
do-anything-for-a-hit feeling, that strikes when you’re running short of fill-in-the-blank—smack,
booze, Oxys, cocaine, cigs. Unlike those other substances, though, cigare!es are both legal and,
when used as intended, apt to kill their consumers. It’s impossible to contemplate these dissonant
facts without engaging in some conspiracy theorizing. Might there be a connection between
cigare!es’ still-law(l status, despite their indisputably lethal nature, and the $7.3 billion in
tobacco-related tax revenue the federal and provincial governments reaped last year? A%er all, if
everyone actually quit, that’s a lot of dough forgone.

Behind these counterintuitive policies is the big lie that smoking is merely a bad habit. As the
industry’s disingenuous slogan of the 1980s and 1990s had it, “My pleasure, my choice.” But it’s not
just Big Tobacco that advances this perspective. Last February, Globe and Mail columnist Margaret
Wente articulated a common outlook: “If addiction is a disease, it’s a peculiar one.” Her point was
that, unlike those with so-called real diseases, addicts get themselves into trouble and can jolly well
get themselves out. “$e disease model of addiction implies that the victim is helpless,” she wrote.
“It denies the role of personal agency, which is probably the most important force of all when
facing down your demons.”
$is is reminiscent of how wartime post-traumatic stress disorder was once chalked up to LMF—
lack of moral fibre. It’s the a!itude of those who unhelp(lly recount how they just got up one day
and pitched their cigs, the implication being that you could do the same if you weren’t such a
gormless loser. And it’s a point of view that even permeates anti-tobacco campaigns, which over
the decades have morphed from concern for the addict—“Smoking kills”—to stigma-driven shock
and shame. $ink of that American Cancer Socie# poster featuring the ravaged older woman,
puffing away, with the slogan, “Smoking is very glamorous.” Cruise the Internet a bit, and you’ll
find images that are even more jolting. One substitutes a cigare!e filter for a woman’s nipple (i.e.,
smoking is bad for breastfeeding babies); another, aimed at teenagers, equates smoking with being
forced to perform oral sex. In these ads, there is no acknowledgement of cigare!es’ extraordinary
addictive power. We don’t expect drug users to just kick the habit, but that idea permeates cigare!e
discourse. $e message is as clear as a No Smoking sign: when it comes to qui!ing, you’re on your
own.

IN THE MINUTES BEFORE Friday’s 4:30 p.m. relinquishing of our cigs and lighters, everyone
chain-smokes (riously outside the Colonial Building. We aren’t acquainted yet, but there’s lots of
nervous banter as we mainline our nicotine, huddled in twos and threes. Do any of us really believe
the bu!s we’ve just ground out will be our last? Still, once inside, we all participate in the disposal
ritual—everything’s tossed into an ordinary plastic bag, which doesn’t strike me as sufficiently
ceremonious—and then we have our initial group therapy session. Besides me, there are six men
and three women, two of whom are also Canadian.

A decade ago, I realized I was drinking too much—more than a bo!le of wine a night—and
to!ered off to Alcoholics Anonymous. $ere, we called them drunkalogs—tales of humiliating
things done while under the influence of booze. At the exotic end of the spectrum were exploits
like a!empting to steal a plane or losing a rental car; more common were heartbreaking accounts of
domestic upheaval, workplace flame-outs, sordid affairs. In smokers’ rehab, our versions are more
quotidian. Illicit puffs in airport washrooms figure prominently, with a couple of the guys trading
stories about their favourite spots at Chicago O’Hare. An entertainment entrepreneur spins a
hilarious story about smoking up a hotel room and simply leaving the several-hundred-dollar fine
in cash when he checked out. $e parents of younger children describe John le Carré–level
diversionary tactics to prevent their kids from learning their secret. I recount having missed a
plane in Dublin a few years ago because I was indulging my addiction rather than lining up for the
securi# check, a dumb-ass move that cost me $500 in rebooking fees; it’s too pain(l to confess to
the group that I missed the moment of my mother’s death because I’d nipped out for a hit. None of
these anecdotes addresses the ma!er of compromised health, but they don’t really have to, since
one of us, a fellow in his late fi%ies, has barely finished chemo for lung cancer.

$e absence of the titillating or outlandish in our stories perhaps explains the dearth of
motivational books or movies for the would-be non-smoker. Prior to my trip to the Mayo, a diligent
search for bu!ing-out memoirs, something along the lines of Mary Karr’s Lit, or Augusten
Burroughs’s Dry, turned up just one. Lighting Up features an overexcited subtitle—How I Stopped
Smoking, Drinking, and Everything Else I Loved in Life Except Sex—that fails to su)est the mix of
chaos and catharsis that makes a good taking-the-cure account. On the flick front, finding nothing
about tobacco at all, I thought I’d screen some of the booze-and-drugs rehab movies I’d watched
when I decided to quit drinking—28 Days; Clean and Sober; My Name Is Bill W. What I hadn’t noticed
ten years ago was that everyone in these movies smokes all the time. In fact, being a nicotine fiend
is kind of a thing among reformed drinkers. Bill Wilson of AA fame apparently smoked like a
chimney. Caroline Knapp, the author of the acclaimed memoir Drinking: A Love Story, died of lung
cancer at for#-two. As Burroughs observed, “Everybody in recovery smokes.” You can see the
problem. Popular culture basically doesn’t acknowledge smoking as a dangerous addiction, nor does
it lend it the patina of romantic dissolution that might garner users more sympathy—or be!er
treatment options.

IUSED TO WONDER WHY I am the only member of my family with addiction issues. $en I
realized a strong vein of clinical depression runs through our history, and addiction is o%en a co-
occurring condition. My father stru)led through many dark days; one of my sisters commi!ed
suicide; my cousins knock back antidepressants, and so do I. I saw my first psychiatrist at eighteen,
when even taking a shower began to seem too hard. I can’t recall when my drinking shi%ed from
recreational to alcoholic, but it spiked during a period of high drama: My kid (step-grandson,
actually)—who, tragically, has fetal alcohol syndrome—was a rebel without a cause by the time he
was thirteen. My husband had his own alcohol issues. $ere was also my then-undiagnosed bipolar
disorder, which co-occurs with alcoholism up to 50 percent of the time. At the Mayo, we don’t
spend a lot of time comparing our psychological profiles, but I quickly realize that I’m not alone.
$ree of the others are addicts-turned-teetotallers; another takes a pharmacopoeia of medications
that rivals my own.

Scientists trying to understand people like us have found that the brain of the zebrafish, a
freshwater member of the minnow family, is a good substitute for the human organ when it comes
to studying addiction. $e Center for Tobacco-Free Living, a public-information space at the Mayo,
features a big tank labelled Zebrafish, in recognition of their key role in research. But the tank’s
occupants are imposters—the real zebrafish were so small they kept ge!ing sucked into the filter.
It’s not hard to see a metaphor here, with the doomed creatures representing smokers trapped and
enslaved by Big Tobacco. $is interpretation, embraced by the Mayo program, is comforting: it’s not
my fault.

Still, I have to acknowledge that being a cigare!e addict isn’t all tubercular coughing and grimy
ashtrays. Smoking doesn’t come with the perils associated with other #pes of dependence—jail
time, homelessness, personal chaos. Plus, there’s that first-puff-of-the-morning kapow, the
immediate rush of nicotine to the brain, a high that doesn’t fade no ma!er how long you’ve smoked
—no chasing the dragon, trying to recapture the sensation of your initial hit. It makes for great
anecdotes, like the time I realized the only other occupant of a New York theatre’s gri!y li!le
smoking area (except for a bodyguard) was Pierre Trudeau, then on his second stint as prime
minister. And then there’s the camaraderie of smokers at events, puffing away alfresco and joking
that we are the most interesting people there. (Or were. Recently, experiences like this past New
Year’s Eve have been more #pical: inside, the other guests were playing a boisterous game of Rob
Ford charades—hammered on the Danforth; I have more than enough to eat at home—while I shivered
alone on the porch with my Rothmans Special.)

But these golden moments account for just a fraction of the half-million-odd cigare!es I’ve
consumed in my life. According to Dr. Richard Hurt, the founder of the Mayo program, I’ve mostly
lit up because the numerous nicotine receptors in my brain have been calling out for another hit.
Why some people can smoke and not get hooked is what those zebrafish are helping to illuminate.
Clearly, I’m not addiction-proof, and neither are the members of my Mayo posse.
In our discussions throughout the week, there is a major hitch—the word cigare!e comes up
constantly, just as we’re all trying to bat away the constant fantasy of lighting up. Still, between
Friday a%ernoon and the end of Sunday, the chance that anyone could sneak away for a fix is about
zero, since the only way off the ward is in the company of a staff member. We call it lockdown,
although there’s no bolted door or elevator code, just a lot of eyes; each night, an unnaturally alert
person occupies a desk with a view of all the room doors, just in case. Sunday a%ernoon finds all
ten of us trooping through the maze of tunnels that anchors downtown Rochester, shepherded by
our wellness coach and making self-conscious jokes about holding on to the rope. $ere’s an
unspoken acknowledgement that, for many of us, this is not our first time in such a situation,
whether because of previous rehab stints or in-patient treatment for mental-health troubles. In a
movie, some of us might be sullen or transgressive; in real life, we’re just happy to get a decent cup
of coffee in town.

By Monday, we’re allowed out in pairs, and on Wednesday we can go solo. $is presents limited
risk, since—thanks to the clinic—the entire downtown seems to be a non-smoking zone. Other
than the escalating freedom, the days are largely the same, starting with a 6:30 a.m. reveille,
followed by breakfast and morning check-in visits from Dr. Hurt. From 9 a.m. to 5 p.m. there are
classes and lectures: stress reduction, relapse prevention, nutrition, wellness, group therapy.
Everyone fixedly chews nicotine gum or puffs inhalers. One woman cries, but it’s because she gets
the news that a beloved pet has died.

In fact, the most dramatic day is the last. Not because of the sadness of saying goodbye—we liked
one another fine, but everyone’s been too busy not smoking to be particularly social. Instead, on the
final day, we almost can’t get home. A nas# storm causes airline delays and cancellations across a
swath of the eastern US. It’s a cosmic test that, a week before, would have seen us all puffing away
determinedly. Instead, we take over a group-therapy room, pull out our computers and phones, and
a!empt to get away from the spot where, a few days earlier, we were wishing aloud we could stay
at forever. Some scramble for the Twin Cities to catch alternate flights; I make it as far as Chicago.
For the first time in many years, I don’t end up chain-smoking outside the terminal.

$e next day, we all check in by email. Everyone made it home, and no one smoked.

IN 1992, my husband was diagnosed with lung cancer. He lost one-third of his le% lung, but was
spectacularly luc', and is still alive today. Not surprisingly, he quit smoking, and so did I—for a
while. But even his near miss wasn’t enough to cure me.

Recently, I tried to determine the odds of a heavy smoker like me ge!ing lung cancer. One source
says the chance of dying from the disease is 18.5 percent for women who smoke twen#-five or
more cigare!es a day; another that a female smoker has a 13 percent chance of succumbing to it.
Lung Cancer Canada’s news is more dire: “For long-time smokers, the chance of dying from a
smoking-related cause is, on average, 1 in 2.”

I haven’t yet developed cancer, but a test in rehab revealed that I have early-stage chronic
obstructive pulmonary disease, which encompasses both emphysema and bronchitis. $e Canadian
Lung Association website explains dispassionately that “COPD makes airways swollen and partly
blocked by mucus. It also damages…the tiny air sacs at the tips of your airways. $is makes it hard
to move air in and out of your lungs.” $ose people you see lu)ing around oxygen tanks? Odds are
they have COPD. $e unequivocal message from the doctor was that if I kept smoking, I would
eventually have my own oxygen tank, which would accompany me until my deeply unpleasant
death.

Perversely, I’m happy about this news—it is another compelling reason to stay off cigare!es, and
there are moments when I need to marshal every one of them. One such time comes four months
a%er my Mayo sojourn. Up until that point, it seemed that the urge—the need—to smoke had been
success(lly eradicated. $en an administrative foul-up leads to a three-week wait for a vital piece
of ID for my kid; without it, he can’t get a new passport, and hence can’t accompany me on a
planned trip to Paris. While definitely a First-World problem, it’s the kind of situation that would
normally have me chain-smoking obsessively. $e image of the oxygen tank keeps me, if only just,
from snatching a cigare!e out of a stranger’s mouth. Eventually, the crisis passes.

Well, sort of. By the time I land at Charles de Gaulle, I have started drinking again, for the first time
in ten years—half a glass of Chardonnay in the airport lounge, a mini-bo!le of Merlot on the plane.
And today, although I’m not consuming anything close to the quanti# of wine I once did, I haven’t
stopped. Initially, I thought that I might have grown out of my unwholesome a!raction to alcohol
—that I can have a casual drink now and then, without returning to (ll-blown alcoholism. $is is,
of course, a delusion. Maybe I am simply incapable of qui!ing more than one vice at a time.

$at bout of investigating lung cancer data turned up one more bit of relevant info. Remember how
my teenage pals and I joked about each cigare!e reducing our lives by ten minutes? Turns out we
may have been right—except we underestimated the toll. In a 2000 BMJ paper, researchers
calculated that each cigare!e could knock eleven minutes off a smoker’s lifespan.

I have smoked away a decade of my life.

"is appeared in the November 2014 issue.

Lynn Cunningham was honoured for outstanding achievement by the National Magazine Awards
Foundation in 1999.

Alëna Skarina counts among her clients the Globe and Mail, the National Post, and Chatelaine.
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