Life After Cigarettes – Beyond Quitting

I’m often asked how I came to write Life After Cigarettes. “Aren’t there already a lot of how-to-stop-smoking books already?” “Does the world really need another how-to-quit book, even one with a special focus on women and weight concerns?”

Indeed there are a lot of how-to-stop-smoking books. Many of them are of dubious value – written either by charlatans or more often by people who found a method that worked for them after all else failed and are sincerely convinced it will also help others, despite the lack of randomized clinical trials that would really establish superiority and control for placebo effects. But there are are several written by recognized authorities and based on approved, well-tested methods. There are also a number of excellent books targeting not the end user but clinicians who want to learn how to help smokers quit. (To do this successfully, you really need to understand the unique pharmacological and behavioral rhythms of smoking and nicotine dependence; knowing how to treat alcohol dependence or other forms of drug dependence isn’t enough.)

Back when I was looking for an agent to help me identify a publisher for Life After Cigarettes, one of them asked me about the genre of the book. I told him it was in some ways sui generis – in a class by itself – and he frowned. (Well, to be exact, he e-frowned.) Publishers don’t know what to do with a book they don’t know what to do with. It’s much easier to market a book when it fits neatly into a well-established pigeon-hole.

Although does in fact classify the book under smoking, I have never thought of Life After Cigarettes as either a how-to book in general or a stop-smoking book in particular. It’s not a how-to book because it doesn’t include step-by-step instructions, each one building logically and systematically on the previous milestone. It doesn’t include lots of self-tests to help you identify what type of smoker you are or how dependent you are or any of the other things that might serve as the basis for choosing one quitting strategy over another. And it’s not a stop-smoking book because the central message has more to do with the weight increase and depression that can follow quitting than with quitting itself. Competent and accurate instruction on how to quit smoking is a good thing, but as noted, it’s already been done, and in at least a few instances, done well.

But wait, isn’t there a whole chapter in Life After Cigarettes on how to stop smoking? Yes, and here’s a little secret about that chapter – it was the very last one to be written. The material in that chapter, in a much sketchier form, was originally relegated to an appendix. Why? Because I felt strongly not only that my little book was not about how to quit smoking but also that to frame it as such would exclude an important part of the book’s potential readership – that is, former smokers who were dissatisfied with where they’d landed after quitting and wanted to go back and get it right. But the Powers that Be at Hunter House, my publisher, were very insistent that the words “how to quit” be included in the subtitle. My editors were refreshingly hands-off about the text of the book but much more directive about the title and indeed anything that appeared on the cover. Since my contract stated that in case of disagreement, Hunter House had the final say, and since I was committed to truth-in-advertising, I decided that if the cover was going to promise information on how to quit, I was honor-bound to provide it. Thus Chapter 7, Quitting for Good, was born. I placed it just before the final chapter, in order to emphasize that it was not part of the book’s main thrust but rather included as a courtesy to readers who had not yet found the help they needed on the “mechanics” of quitting. Like the rest of the book, it is not prescriptive; rather, it reviews available options and the scientific rationale for each, leaving the reader to match the method to her own preference.

In retrospect, I think adding this chapter was a good decision. I see it as a lagniappe, as the Cajuns say – something a little extra, a bonus – and I’m grateful to Hunter House for pushing me to include it. But as I say, it wasn’t part of my original plan.

But enough about what Life After Cigarettes is NOT. Although I didn’t believe I had a unique contribution to make to the smoking cessation literature, I saw a crying need for a book that dealt sympathetically but honestly with the topic of smoking and weight, a book that translated scientific findings into a motivational message that women could apply directly to their own needs, a book written from a woman’s point of view. The gap in the available literature was twofold: 1) Most such books are written by health professionals, mostly men, who with all the good intentions in the world just don’t get it. Deep down they don’t understand how someone can take a serious health risk just to avoid gaining weight—even though both men and women take all sorts of risks for reasons that are equally hard to defend if your sole aim is to maximize short- and long-term health. They exceed the posted speed limit to compensate for a late start, they go hurtling down steep hills on skis because it gives them a brief thrill, they drive home after an evening of drinking; the list goes on and on. 2) Virtually all such books claim to tell you how to quit without gaining any weight. Yet most women know, from watching their friends or their sisters or their mothers quit or from their own experience, that this isn’t a realistic expectation or likely outcome.  And anyone starting with the attitude of “three pounds and I’m gone” is on a fast track to early relapse.

What I really wanted was to create a space in which women smokers and ex-smokers would feel safe in confronting their profoundest fears about gaining weight. I believe that when they learn the scientific facts about the effects of smoking on appearance and about weight gain after quitting, they will understand that a few pounds are an excellent trade-off not just in terms of health but also in terms of appearance. The operative word here is “few.” I am convinced that the real, deep-down, bedrock fear of most women is not of gaining a few pounds but of weight spinning out of control – a fear compounded by the fact that quitters often gain a couple of pounds or more in the first week after their last cigarette. Women need to know that this the weight gain curve quickly tapers off. They need to know that managing weight gain so that it stays in the 5-10 pound zone, within a unit of BMI and within a dress size, is a realistic goal. They need the tools for doing so. That’s Life After Cigarettes’ niche, and I know of no other book that fills it.

© 2009 All Rights Reserved, Dr. Cynthia S. Pomerleau
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