When Jim Franzen quit smoking in 1993, after 43 years as a smoker, it was his thirty-fifth attempt. Like many smokers who want to quit, Franzen, a Ventura resident and artist for the Disney Studios, had tried everything - nicotine chewing gum, the nicotine patch, even going it alone "cold turkey."

"I'm an alcoholic and I had given up alcohol," Franzen said, "but that was nothing compared to cigarettes. Booze is addictive, but it's not as portable as cigarettes. And even a drunk doesn't reinforce the habit as much as a smoker. The pack-a-day smoker gets four-hundred hits daily; no drug gets reinforced as much as that."

According to the Cancer Prevention Center at the University of California, San Diego, 46 million Americans--26 percent of the adult population--still smoke. Of those, current estimates show that over 80 percent would like to quit. And of the 2,500,000 smokers who attempted stopping in California in 1993, less than 10% succeeded.

It comes as no surprise to smokers who have tried to quit that the smoking "habit" is now widely recognized in medical and scientific literature as full-blown drug addiction. A common scenario of nicotine withdrawal symptoms includes irritability, anxiety, headaches, difficulty concentrating and memory loss, insomnia or an excessive need for sleep, inertia, increased appetite, weight gain, digestive changes, constipation, even depression.

If it sounds as bad as a Biblical plague or the tests of Job, it is - ask anyone who has tried. And that's just the beginning. Once through the initial 3-7 days of acute withdrawal, ex-smokers face a life-long struggle to stay quit. They must combat a complex mix of habitual behaviors, social rituals, and psychological and emotional dependence that require constant vigilance - all this while resisting the lure of a drug that remains legal, easily available, and - compared to other potent drugs - socially acceptable.

Now for some good news: More than three million Americans quit smoking every year, according to the National Cancer Institute, and the success rate of quitters is steadily climbing. Society's increasingly negative view of smoking, scientific discoveries concerning nicotine addiction and brain chemistry, and the growing sophistication of structured smoking cessation programs create a climate in which there has never been more help for quitters.

If you've decided that you can no longer ignore the nagging of your family and the unarguable ill effects on your health (is that you wheezing at the top of the stairs?), you may wish there were a magic formula. Should you join a program, or go it on your own? What can you expect on the road from "Smoking" to "Non," and who has the map?

Franzen says that for him, the biggest boon to finally breaking the habit was the support and inspiration he received from the American Lung Association's Freedom from Smoking clinic, which he used in conjunction with the nicotine patch. "When I got cravings during the program and after, I would call my fellow addictees and we'd compare notes. I needed people I could talk to who were having the same problems, who wouldn't judge me, and I needed to meet people who have quit, because I figured if they could do it, I could do it. I know it's not for everyone, but for me it's a miracle. I feel like I'm really done with cigarettes now."

The Freedom from Smoking program is one of many options for the Ventura County resident that offer support and teach a variety of coping strategies and skills to help the smoker quit. Most incorporate techniques from behavior modification and cognitive therapies, as well as health education, group counseling and support.

"A large part of breaking the habit is creating new ones," says Jerry Leavitt, assistant director of the American Lung Association and facilitator of the Freedom from Smoking clinic. "Physically, the nicotine leaves the system in 72 hours, but as hard as that stage is, it's short- lived. Most people find the on-going psychological addiction much harder to deal with.

"We're conditioned to want that cigarette at certain times, and it serves a lot of purposes for us: We use it to deal with stress. It's a break from routine, it's a social thing, it's how we cope with loneliness, with boredom, and for some, the cigarette becomes a substitute for friends, and a source of comfort."

A standard approach is to give the smoker two to four weeks before quitting to observe and record their smoking habits, tracking when and why they smoke and noting the behaviors and emotions that trigger the desire for a cigarette.

Lynne Rowe, program director for the Smoking Cessation Research Institute in Palo Alto, says that a period of preparation for quitting is essential. "The smoker has all these rituals. You get in the car and you light a cigarette. You finish a meal and you have a cigarette. It's helpful to give them time before they quit to think about these trigger points, and to create positive replacements."

Once trigger points are identified, the group and facilitator help the smoker devise coping strategies. Some suggestions: change your routine; distract yourself by doing a crossword puzzle or taking up needlepoint; avoid places and people that might tempt you to smoke; soak in a hot bath; chew on stick cinnamon, toothpicks, sugarless gum. According to Rowe, it's important to think of smoking cessation in positive terms, to replace the pleasure you get from smoking with other pleasurable activities. "You want to take away the feeling of it being a burden," she says. "If it's a burden, it's doomed to fail."

But habits are more than a collection of behaviors; the rituals around smoking and the effect of nicotine itself, which acts as both stimulant and relaxant, become the smoker's way of dealing with emotional stress. "Most people start smoking when they're young because they think it's cool," Leavitt says. "But then it becomes a way of managing stress, and it becomes so ingrained as a way of dealing with emotions that, oddly enough, we use it to cope with pleasurable feelings as well as with negative feelings--like the cigarette after the meal, the cigarette after sex. The earlier you started smoking the less apt you are to have developed alternative coping strategies."

Of course, Leavitt points out, living a life that is free of stress and emotion is not possible. "But non-smokers manage, so there are other ways of dealing with it, and the smoker needs to learn them." Stress management and relaxation techniques form the backbone of a number of smoking cessation programs. One widely-taught method involves learning to breathe.

"It's essential to breathe deeply to control stress," says Leavitt. "The smoker typically takes shallow breaths, except when smoking. People who have gone through this program and quit successfully tell me that the single most helpful thing they learned was deep breathing."

Along with stress management, most programs encourage the quitter to begin a physical conditioning program, which helps combat stress and control weight. "It's good if you can do something aerobic, but it doesn't have to be a lot," Georgette Davis, facilitator of the American Cancer Society's Fresh Start program says. "I teach people stretching and relaxation and tell them that if a craving is strong, take a 5 minute break and stretch, or get up from the desk and go for a fast walk. The more you exercise the faster you'll work the nicotine out of your system and feel better. It helps if people see the whole process in a positive way - as part of the creation of a healthy life-style."

As well as helping smokers through the difficult initial period of withdrawal, stress management offers smokers new ways of coping with feelings that cigarettes may have helped them to ignore. Dr. Nina Schneider, a smoking cessation researcher for the UCLA School of Medicine and the VA Hospital in Brentwood, has studied tobacco dependence and run smoking cessation clinics for over twenty years. "It's as if we each carry a tool kit, and we reach in there and pull out a tool for dealing with whatever comes up--a tool for anger, for socializing, for aggression, for being tired. But smokers, the first tool they reach for is a cigarette. That's why it's important to visualize ahead, to anticipate situations and strategize solutions in advance. In clinics I'll say to people, Okay, you don't smoke. Now here comes something that's difficult for you to cope with - what will you actually do instead of smoke?"

Davis encourages smokers to learn to deal with emotions directly, and to become more assertive about needs and wants. "Go in your bedroom and beat a pillow and scream, if you have to. Allow yourself to cry. Ask yourself if the situation is one that can be changed by communicating with another person directly, then do that if possible. I've seen a number of smokers who are leading packed lives - they're working and then coming home and taking care of the kids, they never have a moment to themselves - and part of the process for them is learning to put themselves first.

"I always tell my classes, `Okay, you've been good to your family, good to your friends - now it's time to be good to yourself.'"

Most programs allow the smoker to use nicotine replacement therapy in addition to the program, and leave this to the discretion of the individual in consultation with a physician. Both the gum and the patch work by delivering a steady dose of nicotine that is gradually decreased over time. The patch is self-applied once a day, while the gum is self-administered in prescribed doses as needed throughout the day. Both require a prescription.

While not a magic potion that will automatically turn a smoker into a non-smoker, nicotine replacement can be a powerful ally. "The patch is not a panacea," Rowe says. "People think that it will completely take their cravings away. It doesn't. But it will mitigate them and ease the withdrawal process."

Rowe recommends that if nicotine replacement is used, it should be combined with a counseling or support program. "It is essential, while on the patch, to focus on the behavioral and psychological aspects of your smoking - changing your habits, learning to deal with emotions and stress without smoking. Ideally, by the time you come off nicotine altogether, you think of yourself as a non-smoker."

According to the National Cancer Institute, nearly half of adults who once smoked have quit; of those, ninety percent say they did it on their own, without the aid of a formal cessation program.

That doesn't mean that you should discount the help you might receive from a program: like-minded buddies to share ups and downs with, somewhere to vent when times get rough, and a wealth of health information and coping strategies. But experts agree that whether you choose to participate in a structured program or go it alone, the key to success is if the smoker really wants to quit.

"You want to get people when they're motivated," Rowe says. "Not because their spouse wants them to quit, not because their doctor says they have to, but because they want to - then you give them a structure to enact that commitment. Of course some things will work better than others, but across the board the key to success is to identify and develop strong personal reasons for quitting."

In most programs, the smoker is asked to write out a list of reasons for quitting, then to whittle the list down to a primary motivation. When tempted to smoke, repeat your primary motivation to yourself: "I want to live to see my grandchildren grow up," or "I want to wake up in the morning with clear lungs and be able to breathe freely." For many smokers, reminding themselves of their goal gives them the impetus to withstand the temptation to return to smoking.

Strong motivation also creates a willingness in the wanna-be ex-smoker to set priorities and to make allowances for the process of withdrawal. In order to stop smoking, you may find it necessary to take time off work, for example, to allow yourself a period of time that is as stress-free as possible; you may want to tell friends and family that you are giving up smoking and ask their forbearance during your inevitable mood swings; and you'll need to forgive yourself if your behavior and performance do not always match the level that you have come to expect.

"The problem is we're all looking for quick fixes, and there are none," Franzen says. "If you're going through withdrawal, you will suffer. You will have bouts of anxiety, there's just no way around it, and it won't be over until it's over. Stopping any addictive practice requires being ready and motivated to do whatever it takes."

Ask anybody who has successfully quit and they will tell you that leading a smoke-free life is worth it in the end. Dulanie Ellis-LaBarre, a script supervisor and mother who lives in Ojai, quit smoking 3 years ago. "The illusion I lived under as a smoker was that smoking made me more calm, but it turns out to be the opposite," she says. "I'm much more calm, patient and tolerant, and my moods are more even now that I'm off the roller- coaster of smoking and craving. As hellacious as quitting smoking is - and it is, it's the worst and nothing else compares--once you get through it, the view from the other side is glorious."

Rachel Altman.

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