As a worksite wellness health coach, part of my job is working one-on-one with tobacco users. Over the years, my clients and I have had a lot of good laughs together over the question, “Don’t you realize that smoking is bad for you?” Most of them have had this question posed to them hundreds of times by friends, family, and complete strangers. As they point out, “Of course I know smoking is bad for me. I would have to literally live under a rock to not know that smoking increases your risk for cancer, heart disease, diabetes, etc. Lack of knowledge is not why I am still smoking.”
When you ask them why they still smoke despite their understanding of the health risks, common answers are, “I’m not ready to quit yet,” or, “Honestly, I just like smoking.” Others say things like, “I’d like to quit, but I find it very difficult.” It may seem so inexplicable to you why anyone would intentionally continue a behavior that puts him or her at a significantly greater risk for life threatening diseases. Why are they not so scared that they will do whatever it takes to quit? Are they fooling themselves into thinking it won’t happen to them? Are they stupid? Do they just not care?
My only response, as a behavior change specialist, is to point out that we all have perfectly sane reasons for the crazy things we do. It may seem inexplicable to you, but there is a reason, whether chemical, emotional, or behavioral, for why a person would knowingly engage in a risky behavior. Tobacco use is not the only lifestyle choice where we see this phenomenon. For example, doctors often report that heart attack patients will come into the emergency room and nearly die on the table, only to recover and return to the exact eating and (lack of) exercise behaviors that caused their heart attack in the first place. They simply won’t change. Not even after their behavior literally caused them to die (the doctor’s lifesaving efforts are the only reason they are not a corpse in the ground.) So why don’t we change when we know we should?
One potential and very powerful reason is learned coping mechanisms. I first stumbled across this idea when talking with a client who asked me, “So when you feel stressed, what works for you?” I do not consider myself a particularly virtuous person, and yet I’ve made it through thirty-five years of life without any major addictions to report. I don’t use tobacco, alcohol, or food (most people’s stress management “go-tos”) to make me feel better when the going gets tough. I don’t take five minutes away from a bad work environment to calm my nerves with a smoke break. I don’t unwind at the end of a hard day with a drink. If a guy dumps me, I don’t nurse my hurt feelings with a pint of ice cream.
Does this mean that I walk around all the time feeling stressed out, overwhelmed, and emotionally raw? Of course not, no one can survive like that. Stress hormones are as deadly to the human body as any vice when left unchecked over time. Biologically speaking, stress is an important trigger that is meant to spring us into problem-solving action.
As a result of not having any of the aforementioned vices, I’ve developed a completely different set of coping skills. When my feelings are hurt, I take a soothing bath. When I’m angry over a conversation, I go for a run to get my good-feeling endorphins going. If I’m trying to solve a challenging problem, I call up as many people as will answer the phone and talk it through until I feel comfortable with a chosen solution. If I find myself in a persistently stressful work environment, I take action steps to change my job. I don’t do these things because I am some pillar of strength, but when you don’t have cigarettes, booze, and sugar to turn to, you have to find some way of making the stressful feelings go away! Thirty-five years of using these coping mechanisms have made them not only effective for me; they have become my automatic responses to stress.
Now let’s return to the example of our tobacco users. During all of those years when I was working on developing my coping skills, my tobacco using friends were doing the same thing with one key difference, they’d stumbled upon something that would calm their nerves and relieve their stress chemically without them having to do anything more than step outside and smoke a cigarette for five minutes. When they attempt to quit, they are suddenly confronting life’s stresses without the use of their primary, perfected coping mechanism and no other practiced coping mechanisms that their body can trust to work as effectively as the cigarette. There is a very high likelihood that their body will override their will power and they will find themselves choosing to go back to smoking. In fact, it takes most tobacco users eight to eleven attempts at quitting before they actually achieve it!
Here’s something else to consider when it comes to vices and coping mechanisms. Smoking is widely recognized as bad for you and smokers often do feel motivated to change their behavior due to social pressure yet it’s still extremely hard to do. Now imagine how difficult it is to give up our socially accepted vices such as ice cream or an after-work drink or two on a bad day. Rarely do you hear people saying to “ice cream users” things like, “I know your boyfriend dumped you, but did you know that sugary foods like ice cream can cause diabetes? You should really not eat that.” In fact, we often bring ice cream to our friends when they’re feeling sad because we’re trying to be nice! It doesn’t even occur to most people that this might not be an appropriate response to stress and may actually make our problems worse (you’ve been dumped AND you have diabetes).
Quitting unhealthy behaviors is challenging in the best of circumstances. There are a lot of resources being placed in front of us on a daily basis citing the dangers of unhealthy behaviors. Perhaps our focus when dealing one-on-one with someone who has an unhealthy habit should not be to continue harping on the risk. A more effective approach is to support them in practicing healthier coping mechanisms until not just their brain, but their own chemically driven body feels confident that stress can be effectively managed without their unhealthy choice.