Why the nicotine patch fails, and what to do about it.

The smoker should take part of a straw

Through which, when breathing, should draw

For the smoking cessation

It bring relaxation

And that, with the patch, is the flaw.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. A month in the Arctic followed a month in Iowa followed 3 months in British Columbia, to which we have returned. Any identifiable patient information has been included with permission.


I hate tobacco with a passion which I restrain to as to not alienate patients. I ask people, on a scale of 1 to 10, how ready they are to quit.  If they say 1 or 10 I move to another topic.  If they say anything else, I ask them to tell me why they aren’t LESS ready to quit, and to name the best three things about smoking.

Smokers most commonly say “stress relief” as the best thing about smoking. I used to argue, pointing out that smokers smoking have the same level of stress as non-smokers at baseline; the stress the patient felt, I would say, comes down to nicotine withdrawal.

That approach didn’t help anyone quit; if anything it hardened the person’s commitment to death by tobacco.

Recently, I have started to point out that if a person wants stress relief, the deep breathing exercise that every smoker has mastered brings half the stress relief of smoking. Inhale like you’re getting the best drag of the day, I say, and your stress level will go down.

(Recently the FDA approved a device to treat high blood pressure.   Really an app, it gets people to slow their breathing.)

I think the nicotine patch fails so often because the people don’t get the stress relief of deep breathing.

Today, a patient who had already figured out that strategy announced he planned to get some straws and to breathe through, to give him something to do with his hands.

And, just like that, within an hour I had two more patients intending to quit smoking.

I advised both to get a soda straw, cut it in half and carry the half where they carry their cigarettes. And to breathe through the straw as if smoking a cigarette.

This simple, brilliant technique will answer the habit strength question, help with stress management, give the person something to do with their hands which also includes the mouth, and give the person much the same velocity of air as breathing in through a lighted cigarette.


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