When it comes to smoking, going cold turkey is easier said than done

GOING ‘cold turkey’ means quitting something, be it tobacco, alcohol, or drugs, by stopping taking them immediately. Instead of gradually weaning one’s self off these substances, it calls for just stopping. 

Back in February, Health Minister Khairy Jamaluddin announced that a new law will be introduced to ban smoking and possession of tobacco products, including vapes, for those born after 2005, as part of a ‘Generation End Game’ policy. 

The health minister said cancer cases had increased by 11% to 115,238 from 2012 to 2016, with lung cancer being the second most common form of cancer among men. 

According to the Malaysian Green Lung Association, smoking causes 27,200 deaths each year. 

So why is it so hard for cigarette smokers to quit, especially given all the evidence of how bad they are to one’s health? Why do so many smokers switch to vaping with the idea that they will wean themselves off cigarettes?

The National Health and Morbidity Survey (NHMS) 2019, estimated that 4.8 million Malaysians aged 15 years and above currently are smokers. Meanwhile, e-cigarette use has the highest prevalence among smokers aged 20 to 24.

“People smoke for many different reasons, they start and continue for different reasons as well. It's not as simple as knowing something is bad for you, and then quitting. 

“The primary reason is that nicotine is one of the most addictive substances known to humans, and it gives you a sense of pleasure whenever you take it (this works by stimulating receptions in your brain that produce dopamine). So quitting can be challenging for some,” said Dr Helmy Haja Mydin, respiratory physician. He is also a technical advisor assisting the Health Minister in formulating the new policy.

“50% of smokers want to quit, and most people quit a few times before quitting for good. The difficulties they face can be numerous - from withdrawal symptoms to having to work/eat in an environment where others are smoking,” said Dr Helmy. 

Five different experiences of going cold turkey

For many, quitting cigarettes is easier said than done. Attempts are made, oftentimes repeatedly, but for whatever reason they don’t stick. 

“The only time I was completely free of tobacco and nicotine was when I had to deal with dental issues.

“I even tried hypnotherapy but I was not able to let go of the habit because smoking had become my go-to escape to deal with stress. Tried vape pods instead but the sense of relief is not the same.

“The social aspect of it is also another factor why it is hard to quit cold turkey.

“That said, as a smoker who is trying to quit – I would not mind trying other interventions in my day-to-day for smoking cessation,” said one smoker, who goes by LL.

“The first step towards quitting is having a good idea as to why you want to quit (it can range from wanting better skin, to not wanting to harm your children to not wanting to get a heart attack) - everyone's motives are different, and it's important to recognise and indeed celebrate it,” said Dr Helmy, who is also co-founder of Asthma Malaysia.

Three other smokers that were spoken to for the purposes of this article all said that they started doing so when they were teenagers, from 15 to 17 years old. Usually the deciding factor to trying to quit was either some type of milestone, be it the birth of a daughter or a marriage, or at worst a health emergency.

“When I just got married I thought, ‘ok I want to stop’, but it only lasted for 9 months, then I started to be a social smoker,” said RR, a secretary. 

“Whenever I say I want to quit it won’t happen. I did try the patches, I did try the chewing gum, but it didn't work for me.”

“There was one time before that that I tried acupuncture, it worked because the cigarettes had no taste. But then after a while I started smoking again,” said ZD.

He tried quitting again in his 40s and was a lot more successful. 

“It was not hard initially, I was not feeling well, so because of that I didn’t smoke for a week, then I decided to just continue it. Then after that, the first two months or so were quite tough but because I had gone through a few weeks of not smoking then it stopped and that’s it,” he added.

For AF, a roadside food seller, quitting was a more drawn out process, with constant temptations to return to the habit.

“Started when I was 15 and a pack of 20 Dunhill was RM2.50 in '93. ‘Pengaruh rakan sebaya’ (peer pressure) you could say. I stopped in 2014 when I was 36. Had a terrible cough due to the flu. The kind you’re trying to cough out your lungs out through your throat and sneeze your brains out through your nose.”

“Didn't smoke for a week because of the terrible cough, then after I tried smoking, my regular brand tasted terrible. Bummed some ciggies off some friends - you name it, from Dunhill to Marlboro to Gudang Garam to Sampoerna Hijau. All of it tasted terrible. Decided on March 5th 2014 I would try to go cold turkey.”

“At the beginning, being around smokers, hanging out or lepaking at mamak, the smell of smoke can really overwhelm me. In the sense that I don't really like it, it smelled horrible to my nose. Really had to sit away from my smoker friends at the table. 

“I did have a dream that felt so real, I was kicking myself for relapsing when I woke up, but after a while thought to myself it was a dream actually. Imagine even after a year plus still dreaming of having that one last puff. But eventually I've gotten used to it,” AF added.

Richard N., a financial analyst in his 50s, went cold turkey when he was diagnosed with prostate cancer. The health scare shocked him into making an immediate change to his lifestyle habits, and it took him over a week to get over the headaches and withdrawal from nicotine.

“I decided to quit the same day I was diagnosed (with cancer). I had tried for years to quit, and it was always a gradual process using patches and gum - but I was never successful. I always went back to it. This time around I committed fully because getting cancer was my wake up call. It did the trick. I no longer smoke and going cold turkey was the way to do it for me, finally.”

“My friends did try to get me into the vaping scene. Wasn't really into it at first. Didn't really hate it, not loving it as well,” said AF. 

“So I've been more or less smoke free up to 5 years with the occasional teh tarik session where friends ask me to try this so and so flavour. Until that one time when one of my friends asked me to taste his freebase 0mg nicotine flavour and I was hooked. 

“Didn’t taste bad, loved the flavour, and I don't get dizzy or nauseated after puffing away all night. I guess that's how I got into vaping. Don't really miss smoking anymore when I got into vape, now do I. 

“That's an addict for you I guess. We fill our addiction and find some other thing to be addicted with.”

“Some will need assistance with nicotine replacement products, others may benefit from psychotherapy. It's also important to identify potential triggers that can cause a person to relapse and to restart smoking,” said Dr Helmy. 

If you need assistance to stop smoking, call the Health Ministry’s JomQuit hotline at 03-8883 4400 or visit www.jomquit.moh.gov.my. The National Cancer Society of Malaysia also runs a Quit Smoking Clinic and can be contacted at 1-800-88-1000. – The Vibes, June 7, 2022