By Cynthia Billhartz Gregorian
MCT

He quit his pack-a-day habit because he's watched cigarettes hurt too many people, including his grandparents, who died of lung cancer, he said.

Plus, smoking's getting too expensive.

This is Wolbert's third attempt at quitting. The first two times, his doctor prescribed Chantix, a drug that blocks nicotine receptors in the brain, and wished him luck.

Wolbert, who learned of about Freedom From Smoking from a co-worker, is confident he'll succeed this time.

Health and family organizations believe that the economic downturn, combined with higher tobacco taxes, makes this a good time for health care providers to help people like Wolbert quit smoking. And yet, they say, that's not happening.

And even when they did, slightly more than a third were offered prescriptions for over-the-counter nicotine replacement products or prescription drugs like Chantix. Only 15 percent were offered self-help materials, informed about classes and counseling programs, shown a video about quitting or referred to a cessation specialist.

And that's a shame, he said.

"In many ways, doctors are the best advocate for getting an individual to never start or quit," Kuhlenbeck said. "They carry a lot of weight with their patients."

EMBARRASSMENT FACTOR

Experts point to embarrassment on the part of smokers who have tried unsuccessfully to quit in the past as one reason they don't bring it up.

"They're fatalistic about it," he said. "After they've tried getting a patient to quit a couple of times, they get discouraged. But I tell them that quitting is the most effective tool we have to lower the risk of lung disease and heart disease. And the more times they try to get patients to quit, the more chance they have of being successful."

Castro adds that a lot of doctors don't incorporate discussions about smoking into their general assessments of patients because they're too busy.

"They're usually focused on medical problems, but we try to encourage them to think of smoking as a vital sign," Castro said. "You get their blood pressure, pulse, height and weight, and if they're a smoker, you ask if they're interested in quitting. A number of physicians have already adopted this."

COLD-TURKEY CHALLENGE

A lot of smokers think they can quit cold turkey.

"I didn't talk to a doctor about it," he said. "I think a lot of times, people don't want to quit, and they use excuses to start again."

"I'll eat some candy or something," Harris said, laughing.

Kuhlenbeck said a multiprong approach that includes prescriptions for nicotine replacement products or drugs like Chantix combined with counseling, have proved most effective.

"Doctors should be referring them to a counselor who can talk about when and why they smoke," he said. "What are the triggers? Is it when you're drinking at the bar or driving home from work? And what can you do instead of smoking? Then you balance that counseling with pharmaceutical therapies and figure out how they affect the smoker."

This puts doctors in an uncomfortable position.

"When health care providers do talk to patients about quitting then go to prescribe something, insurance won't pay for it," Castro said. "So it's a matter of, 'Yes you should stop smoking, but I can't help you get financial help for it.'"

Kuhlenbeck believes the higher rate among lower-income individuals correlates with a lack of access to health care. Compounding that are differences in their social settings and family histories — factors that are best addressed with therapy to help determine triggers and smoking alternatives, and then set up support systems among family and friends.

"Smoking is an addiction, and that's one piece that doesn't get catalogued well," Kuhlenbeck said. "It's often defined as a habit. But there's a psychological and physical addiction, and it's embarrassing and incredibly challenging to overcome."

The Freedom From Smoking program is free for Wolbert, who works as a computer support technician in Washington U.'s department of internal medicine.

"It's my mind-set this time," Wolbert said. "Freedom From Smoking has helped a lot. But this time, I'm going into it as though I'm celebrating that I'm quitting rather than worrying about not being able to and how hard it was."