By Doug Brunk, San Diego Bureau. Share your thoughts and suggestions at clinicalpsychiatrynews@elsevier.com
The day Dr. Robert L. Kistner turned his back on cigarette smoking was Jan. 1, 1982, a behavior he began as a 14-year-old growing up in St. Louis.
“I smoked through high school, college, and through medical school and the Air Force,” said Dr. Kistner, now a vascular surgeon who practices in Honolulu. “As I got into practice in the 1960s, I was still smoking more and more.”
For him, taking drags from a cigarette “was a very enjoyable thing to do. It was relaxing. I smoked long and heavily. I really hungered for cigarettes.”
When the first Surgeon General's Report on Smoking and Health came out in 1964, “it became obvious that there was something bad about the stuff,” Dr. Kistner said. “But the horrible extent of it and its far-reaching effects that we now know really well were just becoming fact. Ultimately, I was faced with [the notion that], 'this is something I really enjoy but it's not pleasing to other people and it's not good for me.' It's something I had to get rid of because I began to preach to people that they shouldn't be smoking and then I'd be reaching for a cigarette. It was incompatible.”
His two young daughters also gave him flak about his habit. “Fortunately, they did not take up smoking,” he said. “They were turned off by the smell of it and the dirty ashtrays. My wife, on the other hand, enjoyed smoking, but never was addicted. She could take it or leave it.”
Dr. Kistner gradually weaned himself from cigarette use in the late 1970s. First, he chose to not smoke during his workday when he was around patients. Next, he decided he wouldn't smoke at work or at home. Then, he lit up only when he left Hawaii on business travel.
In the end, he appointed Jan. 1, 1982, as his cold turkey quit date. He has not smoked since. “For some reason, my mind was made up enough that I didn't smoke and it didn't make any difference,” he said. “It was a conviction. From that point on, for 6 months or 6 years, I'd walk around where somebody was smoking and just smell it. But I had no desire to pick one up and take a puff.”
He went on to note that physicians who currently smoke are “not only hurting themselves, but they're hurting their environment–not just by smoking but by giving the example of smoking. It's very much against the [medical] profession. I'm not a student of the physiology of addiction, but as in many things [the urge to smoke] is controllable by a very strong intellectual conviction, [the notion that] 'this is something I want to do.'”
From Basketball to Cigarettes
Smoking was commonplace in Dr. Richard D. Hurt's home town of Murray, Ky., in the early 1960s. He picked up smoking after dropping his basketball scholarship at Murray State University.
“After my first year of college, it was obvious that I was going to have to do something else to make a living besides play basketball, because I had a good shot, but I was a little bit slow and couldn't jump very high,” recalled Dr. Hurt, an internist who directs the nicotine dependence center at the Mayo Clinic, Rochester, Minn. “That's not a good combination. So I dropped my scholarship, joined a fraternity, and started drinking and smoking like what I thought everyone else did at the time.”
He described himself as a heavy smoker from the get-go, puffing three packs a day of Marlboros and Belairs through the rest of college, medical school, an internship, 2 years in the Army, and his residency.
During his Army assignment, he discovered that if you inhale tobacco through a pipe, “you really get a hit to your brain,” said Dr. Hurt, who is also a professor of medicine at Mayo Clinic College of Medicine. “The pH of pipe tobacco is 8, which means that half of the nicotine is in a freebase form. I smoked a pipe for awhile until I read an article from a Scandinavian study [that] said that cigarette smokers who switch to pipes or cigars end up smoking them like they used to smoke their cigarettes. So they have worse outcomes. I went back to smoking cigarettes. I didn't want to have a worse outcome.”
Like many other smokers, Dr. Hurt spent years trying to quit; sometimes for as little as 30 minutes, other times for as long as a week.