- The Washington Times - Sunday, October 8, 2000

Pills, patches and gum are proving to be useful tools for smoking cessation. However, none of them works without another essential element: motivation.

"You have to want to quit," says Mary Ann Clynick, coordinator of tobacco cessation education for Inova Health Source. "Motivation is the key to who succeeds."

Sometimes it just takes a hard look at the medical facts to get someone ready to begin the process. Other times, it takes a scare, such as a heart attack, to get smokers moving, Ms. Clynick says.

No matter what starts the process, Ms. Clynick says it is important to continue it with a plan. The plan typically begins with an initial visit, during which she assesses the smoker's habit and gives him or her a nine-point quiz to determine how much of the habit is physical, psychological or habitual.

The first visit usually concludes with a little aversion therapy, such as a look at the harm smoking does to the human body. When Danielle Stewardson, an Alexandria teen-ager, went to Inova's clinic to break her pack-a-day-habit, Ms. Clynick showed her a movie of a woman with advanced emphysema.

"I went in thinking I really didn't want to quit," Danielle says. "Then I saw that movie that was really detailed, and it changed my mind."

During the second meeting, aids such as nicotine replacement and Zyban are discussed, as is "a day in the life."

"This is the backbone of the recovery plan," Ms. Clynick says. "We have to map out where the cigarettes are, what triggers smoking and how to plan what to do in these situations. We write down how they are going to approach each situation."

Ms. Clynick also has the smoker write down his or her main reason for quitting and tape it to the mirror or carry it around for reinforcement.

Then comes the countdown to quit day. When it arrives, a truly motivated smoker is exhilarated by the prospect, she says.

"When quit day comes, some people treat it like the start of the Olympics," Ms. Clynick says. "A lot of people say the first day is so much more comfortable than they thought. It is the third day that has the worst effects of physical addiction."

Sherry McClellan, a Waldorf, Md., former smoker, says she slept away the first day without cigarettes. When she went back to work the second day, she did everything differently to break her old patterns.

"Instead of sitting at lunch, I would walk around, then eat," says Ms. McClellan, 44. "I was really conscious of picking up new habits."

Once the quitting process has begun, Ms. Clynick recommends the buddy system, in which people going through the same process give each other encouragement, and a maintenance session, in which she counsels the now former smokers how to be on the lookout for stressful situations that could trigger a relapse.

Ms. McClellan hasn't smoked since January and has found that going to a recently founded support group at the law firm where she works has helped keep her on track.

"It's been great," she says. "I know I have quit already, but I have enjoyed listening to the other people in the group. It is very encouraging because they are in the process of quitting. I have been through that already, and I know I don't want to be there again."

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