With the highest rate of smokers in the Middle East, Lebanon is finally catching up with World Health Organization recommendations, banning smoking in public places and outlawing adverts for cigarettes. The law will not come into full effect until September, but ahead of that, perhaps now is the right time to stub out that unhealthy habit. The Daily Star spoke to experts about the most effective ways to give up, and how to battle through your addiction. Dr. Chris Abbyad, clinical assistant professor at the Rafik Hariri School of Nursing, part of the American University of Beirut, has introduced group counseling sessions for faculty and students wanting to stop smoking. In small groups of around five or six, participants meet each week for 45 minutes to discuss their attempts to quit, and the major hurdles they face. Counseling, Abbyad says, is a vital component to quitting smoking, alongside Nicotine Replacement Therapy. “Our approach is not to be judgmental but to recognize that smoking is a very strong, physical addiction: about 200-300 times more addictive than heroin, extremely addictive. So this is why people have such difficulty coming off of nicotine,” Abbyad says. “If we’re talking about a serious addiction here, would you expect a heroin addict just to quit on their own? Not really.” So while NRT – which could come in the form of patches, lozenges, spray or gum – counters the physical side of addiction, therapy will help the smoker deal with the withdrawal symptoms. The Tobacco Free Initiative, a Lebanese non-governmental organization which focuses on smoking prevention among youths, does not provide counseling itself, but TFI’s president, Nadine al-Krab, also supports this method. “We really recommend people give up [by] using this double method,” she says. “Tobacco dependence very much relies on behavioral and social dependence.” Participants in Abbyad’s groups often set up group email lists, reaching out to one another when the desire for a cigarette is at its fiercest. Giving up can be a long process, Abbyad says: a friend of hers spent two whole years after quitting smoking yearning for a cigarette. During this period, having someone to talk to about it is important, Abbyad adds, whether that comes in the form of a group counseling session, or a friend who is quitting at the same time. “Having somebody to talk to is really important. When you really want to reach for that cigarette and you’re going through all the things in your mind, ‘I shouldn’t do this but I really want that cigarette,’ it’s very, very hard,” she says. For those trying to stamp out the habit, it is also important to get rid of all smoking products, such as lighters and ashtrays. It is also crucial to recognize the triggers that lead each smoker to reach for that cigarette, be they coffee, a beer, or a stressful moment at work, Abbyad says. She encourages group members to write down a list of their triggers, and what they will now do instead when those situations arise. During the initial quitting phase, it may be necessary to actually give up as many triggers as possible, although Abbyad recognizes that, “the hardest thing is when you’re going out with your friends, because you don’t want to cut yourself off socially.” “The Lebanese say, ‘You know, come on, one cigarette can’t hurt you.’ And so you’re having to fight all that while you’re struggling physically with the addiction, you’re shaking and you really want a cigarette, and then the peer pressure on top of that.” For those smokers who can’t face the thought of giving up their social life, even temporarily, Abbyad recommends planning for such events, and carrying NRT products with them if they know they will be in a smoky environment, full of triggers, as it is “better to take a nicotine lozenge than smoke a cigarette.” While it will be difficult to fully implement the smoking ban come September, Krab believes that, gradually, it will help smokers kick the habit. “If you are working the whole day in the office and you have to go outside to smoke, of course it will limit your inhalation.” In many cases, quitting smoking is about more than just beating the physical addiction: it’s about an entire lifestyle change. “People wake up first thing in the morning and they want a cigarette, they have a coffee, they want a cigarette. So you’re changing behavior as well as trying to give up the physical addiction, and that’s not easy,” Abbyad says. The journey will not be easy, but smokers trying to quit should not be hard on themselves – if you have a cigarette, this does not mean that you have failed, Abbyad says. “Don’t beat yourself up about this. You’ve had a cigarette, alright. Think about the things that led you to it, and think about planning for next time when you’re in that same situation. Try and build on what’s happened.” Most people who successfully quit have tried numerous times in the past, Abbyad adds, some as many as eight or nine serious attempts at giving up. But, she reminds, “Each time you’re building on your past experience, and it’s not a failure if you go back. If you fail the first time ... it just means you’re going to practice again and you keep practicing until you get better and better.” Smoking cessation classes are offered at Hotel Dieu. Please call 01-372 888 for more information.