Transcript

806: I Can't Quit You, Baby

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Prologue: Prologue

Sean Cole

Late last year, I got some not-so-great health news that kind of scared the hell out of me. Basically, I was diagnosed with mild emphysema, lung disease, and two-- what they're calling small, benign nodules. One on each lung. It's like scar tissue. I'm trying to focus on the words mild, small, and benign.

The cause wasn't mysterious. I'd been a daily cigarette smoker for about 35 years. It used to be a pack a day when I was younger, sometimes more. I'd cut it down to maybe a half or a third of that later on. And I'd been meaning to quit for a long time. But I just never tried to, not really. And now it felt like I had no choice, which, before I tell you what happened next, I feel like I should explain what a huge change that was going to be.

I always say I started smoking when I was 15 and started inhaling when I was 16.

Partly, I just wanted to be like the people in the British TV dramas I was watching on PBS, pulling these perfect, little, white cylinders out of silver cases that snapped shut. I remember I painted an empty metal Band-Aid container light blue and kept my Salem menthols in there, puffing at them in my parents' driveway.

In my 30s and 40s, I was the guy in the friend group that always had cigarettes. I'd smoke during the shortest of walks, like from this office to the hotel bar across the street. I'd smoke after a 10-mile training run for a half marathon. You smoke in your car, someone would ask. And I'd say, yeah, that's why I bought it. Whenever I imagined myself stranded in the woods or on a life raft in the middle of the ocean, the panic I felt was about not having enough cigarettes with me.

So the prospect of stopping for good always felt like trying to strand myself on purpose, like everything in me opposed it. The emphysema diagnosis was in early November. I figured I'd put off quitting until after Christmas when I didn't have to work for a bit. Whenever I went too long without smoking, my cognition would slow down to where I could barely think.

December 28, I'll stop, I told myself, and started practically counting down the cigarettes. I recorded voice memos through all of this. This one's from December 21, a week before quitting day.

This is one of the last times I'll be sitting here, smoking out the window, looking at the World Trade Tower.

[EXHALES]

And then I guess going forward, I'll just sit here and-- I don't know-- think or something.

This is how much of a smoker I was. I didn't even realize that when you don't smoke, you don't have to go and sit by the window. But the thing I'm really here to tell you about is how I was planning to quit. I was going to read a book, "the book" for people in my situation. It's called Allen Carr's Easy Way to Stop Smoking.

You might have heard of it. It's sold millions and millions of copies. It's pretty famous. A lot of famous people read it and then kvell about it on television. James Spader is a fan.

James Spader

It was so easy. It was so perfect. And it was all because of this book.

Sean Cole

Ellen DeGeneres--

Ellen Degeneres

The Easy Way to Stop Smoking, Allen Carr wrote it. And everybody who reads the book stops. And so I stopped. And I'm so glad I quit because I had a monkey on--

Sean Cole

Ashton Kutcher--

Ashton Kutcher

And the great thing is, while you're reading the book, you get to smoke. He tells you when to light up. He's like, all right, light one now. And you're like, oh, absolutely.

Sean Cole

That part's a big selling point.

James Spader

He insists that you keep smoking while you're reading the book. And then when you finish it, you stop.

Allen Carr

My method is known as the Easyway.

Sean Cole

This is Allen Carr, recorded back in 2005.

Allen Carr

And it will enable any smoker to quit immediately, permanently, and actually enjoy the process. Before you dismiss my claims, bear in mind that I've been proving them for over 20 years. That's why my book and global network of clinics are so successful.

Sean Cole

This book is the only thing that's ever given me a shred of hopefulness about stopping smoking. It literally always felt impossible in the past. And now here's this guy saying that not only would I be able to do it, but actually be happy about it. That's the true measure of success, Allen Carr says, not just stopping, but becoming a happy non-smoker.

I couldn't imagine being happy not smoking. I couldn't imagine that a bunch of words could get someone to stop feeling an incredibly strong urge, that words alone could make something that seems so impossible actually happen. What type of witchery was afoot here in this book?

And all the stories in today's show are about that, people casting spells to try to make people completely change their directions in life in some way. Oh, and you get to listen to me try to quit smoking. Stay with us.

Act One: The Straw That Broke Joe Camel's Back. / Can I Still Be a Joker and a Midnight Toker? / The Unbearable Lighterlessness of Being.

Sean Cole

Act One, The Straw that Broke Joe Camel's Back. We're actually not sure about that title. There's a couple of others here that we liked.

Act One, Can I Still be a Joker and a Midnight Toker?

Or this one, Act One, the Unbearable Lighterlessness of Being.

Anyway, the book is relatively short and really, really repetitive. He says you have to follow every instruction to the letter. And the way it works-- Carr says most people who try to convince you not to smoke will tell you the reasons you shouldn't, health risks, all the money you spend, whatever. But he says smokers already know all of that. If any of that actually worked, Allen Carr says, you'd have quit by now.

Now what he does instead is the opposite. He names all of the reasons you give for smoking, all the things you like about it or think it's offering you. And he carefully explains why every one of those reasons is bogus. He describes it as a kind of deprogramming, ultimately removing any desire for a cigarette.

And a lot of the precepts make a lot of sense. For instance, he says smokers believe that smoking helps them focus and concentrate. But he says they're just kidding themselves. That's just an illusion. All smoking does is remove the distraction of nicotine withdrawal. So you only think it's helping you think better.

There are tons of fallacies like that, he says. And smokers perpetuate them without even realizing it. This is from the book. He says, "smokers claim that the cigarette relaxes them and helps them to handle stressful situations. But they also claim that it helps them get going in the morning and that it gives them a boost. How can a drug that relaxes you or relieves stress also stimulate you? This contradiction illustrates the truth about smoking. The cigarette just doesn't do any of the things we tell ourselves it does."

I should say he distinguishes Easyway from just going cold turkey, or what he calls the willpower method. Those poor souls aren't real nonsmokers, he says. They're just smokers who aren't letting themselves smoke. And what kind of life is that? Whereas if you have no desire to smoke anymore, you don't need willpower. You also won't be irritable or depressed or gain weight or any of the things that, according to most people, make quitting hard.

Also, the reported success rate for willpower alone is really low. And it depends on who you ask. But it might be as low as 3% to 5%.

Cutting down doesn't work, Allen Carr says, because it just makes every cigarette seem that much more precious. That's why he says to just smoke as you normally would while you read the book.

Also, he really wants you to sit with it. How's the taste? What's it really feel like, going down into your lungs? And don't even get him started on nicotine replacement therapy. Patches, gum, all that stuff, that's just going to keep you wanting cigarettes. He'd get into arguments on this point, like this one on Sky TV, with someone from a smoking cessation charity.

Allen Carr

It's not nicotine replacement therapy. It's nicotine maintenance. You're actually giving them nicotine, the drug they're addicted to. And that keeps their body craving nicotine. It's absolute nonsense.

Sarah Ward

You are giving them nicotine. But it's stepping them down gradually so that they can come off it.

Allen Carr

Can you tell me the proved rates of success on nicotine replace?

Sarah Ward

It's much greater than willpower alone.

Allen Carr

That's what the adverts say. It's four times greater. Four times greater than what?

Sarah Ward

Four times greater than just using willpower alone.

Allen Carr

But willpower doesn't work.

Sarah Ward

No, it doesn't--

Allen Carr

So it's four times greater than nothing.

Sarah Ward

Well, and if you--

Sean Cole

Allen Carr never had any training in psychology or medicine. He says one day, he just realized what a con smoking is, and took things from there, started working with individual clients in the early '80s, then group seminars, then the book, and ultimately, an organization that operates in more than 50 countries around the world.

For my money, his cred was even better than that of a therapist or a psychiatrist. He was a smoker for about as long as I was, and much heavier, sometimes a hundred cigarettes a day. He had tried to quit a lot of times before hitting upon his method, at which point he just stopped on a dime. If only he'd figured it out way sooner. Allen Carr died of lung cancer in 2006. He hadn't been a smoker for about 20 years.

I felt this growing excitement as I read the book. I was starting to beat out my fear of quitting. At one point I wrote in a notebook, "Allen Carr is right about the taste. It's foul. Smoke felt bad going down my lungs. I think my thinking about smoking has genuinely changed."

The night before my final day of smoking, I felt like a kid on Christmas Eve Eve, sort of thrilled and wishing the day would just hurry up and get here already. Allen Carr said this might happen. The next night, December 27, I smoked my final cigarette, a sort of a ritual built into the process. For some reason, I wanted to be outside, walking the neighborhood. I smoked it maybe faster than any cigarette ever, knocked the burning ember off the butt, threw it in somebody's trashcan, and said, out loud, goodbye cigarettes.

And when I woke up the next day, I wanted a cigarette more than I ever remember wanting one first thing in the morning, which is not what the book says is supposed to happen. I don't know what I did or didn't do or what exactly went wrong. But suddenly, the way felt anything but easy.

In the book, over and over again, Allen Carr says some version of, the actual physical withdrawal from nicotine is a very mild, slightly empty, insecure feeling. It's so mild that most smokers don't even notice it throughout their smoking lives.

I've also heard that the physical withdrawal only lasts three days. Or is it a week? Or is it three weeks? And after that, it's merely psychological. I've heard the individual cravings last anywhere from three to five minutes and then they pass.

All I can say is in my experience, all of this is utter horseshit. I don't even understand the concept of individual cravings. In my case, withdrawal has meant a constant, crazed yearning that varies in tolerability throughout the day.

This is how I described it a couple of weeks in. "It's like a worldwide itch, like all of my limbs are phantom limbs, like I swallowed a live animal much larger than me that promptly died.

And now I have to walk around with it inside of me, soul and all. Or it's like opening all these awful, little packages in which there's something I can't see, that painfully stings me. And there's no telling how many more I have to open, nor for how long. It is the thing I'm thinking about more than any other thing and more than all of the other things." This was on January 13.

Voice Memo

I've had a bunch of snacks. And nothing makes it better. Literally nothing makes it better. Everything makes-- everything that I do instead of smoking makes me want to smoke more. This is the worst day of the nonsmoking that there's been so far. Day-- what is it? We're now going into day 17.

I don't fucking know. I don't know. They're hard. They're all hard.

Sean Cole

The thing about thinking something's going to be easy is that when it's ultimately not, it makes it that much harder, like yeah, if I can't do it, I must be an idiot. And thinking back on some of the passages in the book, I felt gaslit, like my lived experience was being questioned. This is Allen Carr on a British talk show sometime in the early aughts.

Allen Carr

We talk about these terrible withdrawal pangs. You say to somebody, well, where did it hurt you? Where? Show me.

Sean Cole

I can say exactly where. January 18, it's like three weeks in. I had this attack. I was on the corner in my neighborhood, trying to decide whether to go home or go to the bar. I chose the bar. And my brain was like, oh, we're walking a bunch. Time for a cigarette, huh?

And I said, no, we don't do that anymore. And my brain was like, what do you mean? It's time for a cigarette. And I said, no, it's not. And then it's like I was physically punched in the solar plexus with something electric that sent a shock up through my face and head. I screamed.

Voice Memo

crazy. I just literally turned to walk in the other direction. I just went, fuck, Like fuck. Oh, my fucking god. Well, it better get better at some point.

Sean Cole

It got worse. I've gained weight. I've been drinking more. I went a month with no nicotine at all and then gave in and started having a nicotine lozenge here and there. I have about two a day now, which naturally made me relitigate everything Allen Carr had said. It also made me wonder why wasn't this working for me if it works for so many people.

So I started looking for answers. And I stumbled across this podcast that was way more revelatory to me about my addiction than anything in the book.

Andrew Huberman

Welcome to The Huberman Lab Podcast, where we discuss science and science-based tools for everyday life.

Sean Cole

You might be familiar with Andrew Huberman. He's kind of a neuroscience rock star now, has a lab at Stanford School of Medicine where he researches neurobiology and ophthalmology. But apart from that, he's made it a personal mission to explain how your brain and body work so you can maybe make better choices. And he has an episode on nicotine, which made me feel like someone had put their hand on my shoulder, looked me in the eye, and said you, Sir, are not insane.

Again, Allen Carr's central premise is that all the things smokers like about smoking, that it relaxes us and focuses us and gives us a boost, Carr says that the only thing we're feeling is just the withdrawal going away. But according to Huberman, that's not true at all. Scientists have been studying the brain chemistry of this for years, decades.

And just to be super abbreviated about it here-- podcast is two hours long-- nicotine juices up your brain with these three chemicals: dopamine-- you've heard of dopamine, people think it causes pleasure. But it's also the thing that makes you want pleasure. It motivates you, makes you strive, pursue.

Acetylcholine, which I had never heard of, helps you focus, come up with ideas, plus-- this is weird-- you have acetylcholine receptors on your muscles too, which Huberman says could explain why some people feel more physically relaxed on nicotine-- and then epinephrine, which you could just call adrenaline. So when Allen Carr says the nicotine itself doesn't give you a boost-- it gives you a boost. And when you put all of that together--

Andrew Huberman

We now have a very clear picture. Reward pathways are turned on. Attention is turned on. Alertness is turned on. You feel better than you felt a few minutes ago. Your blood pressure is up. Your heart rate is up. Your preparedness for thinking is elevated as well. And yet your body is somewhat relaxed. That's a very interesting state of mind and body-- interesting because it's somewhat ideal for cognitive work.

If you were going to sit down and work on a book or you were going to sit down and try and figure out a hard math problem or you're going to write a letter that's been really challenging for you to write or maybe that you're really excited to write but that you've been slow to get out the door for whatever reason here-- I'm talking about my own habits of procrastination-- well, that state of being very alert, but your body being relaxed, is almost, if not the optimal state for getting mental work done.

We're talking about one molecule, nicotine, found in plants like tomatoes and potatoes and the tobacco plant, one molecule that can trigger activation of all the circuits for focus and motivation in one fell swoop. That is remarkable.

Sean Cole

When I got in touch with Huberman and we sat down for a conversation, he said this stuff was obvious to him the first time he smoked a cigarette. He was 14, same time he had his first cup of black coffee.

Andrew Huberman

I thought that was about as good as it gets until I took my first drag off a cigarette. And then I realized, wow, wow, wow, nicotine just makes everything look a little different-- feel focused and relaxed. That's a very hard combo for most people to just drop themselves into.

Sean Cole

Unfortunately, nicotine also has a lot of harmful side effects. It constricts blood flow, can cause heart problems. And just to say the whole second half of the podcast is about how incredibly bad tobacco is for you. Huberman doesn't smoke anymore or use any kind of nicotine. I ran him through some of Allen Carr's claims about nicotine. And he did give me his take on them, although warily.

Andrew Huberman

I have to be careful because I don't want to discourage anyone from using a resource, like this book, that could help them move away from an unhealthy practice.

Sean Cole

Sure, sure.

Andrew Huberman

So I don't want to undermine his efforts because I think that the effort is a noble and important one. But--

Sean Cole

He says Allen Carr's right, that you can get so dependent on nicotine that you don't derive any benefit anymore and just smoke so you can feel normal. That can happen with any addictive drug. But he says there are tons of studies supporting the idea that nicotine helps with focus. And no, it doesn't curb your stress. But it might make you better able to handle stress because you're more keyed up and vigilant. So if the central premise of the book is flawed and nicotine can do all of these enjoyable, useful things--

Sean Cole

Why do you think, if you were to conjecture, would this system that didn't work for me, per se, work for so many people when--

Andrew Huberman

I was thinking about that. I think I know why. So from a neurobio-- I look at everything through the lens of biology, much to the discomfort of people close to me. But I can say that the book did a very interesting thing. I have to give him credit.

What he did is, he tried to bypass all the deeper biology of dopamine-acetylcholine addiction, et cetera. And what he did was, he said you've got a forebrain. Your forebrain can tell itself stories. By telling itself stories, you can set context. So let's tell yourself a story.

And the story is this. Withdrawal doesn't really exist. Or it exists but nicotine--

Sean Cole

It's not that bad or whatever.

Andrew Huberman

--the biology of nicotine doesn't really exist. And when you feel uncomfortable, that's-- in other words, he used the lack of knowledge about the way it really works, in the reader, to trick the reader into tricking themselves into bypassing what would potentially be a much more complicated process.

Now for some people-- and apparently, celebrities-- it worked for them. But what if I came along with just the tiniest bit of knowledge to the contrary? Or what if someone like you has an experience to the contrary? Well then bam, you're right back in square one. I guess it just doesn't work for me. Or there's something wrong with me.

Sean Cole

Something wrong with me. That's what I'd been feeling like. And that's sort of endemic to the method, like if it doesn't work, it's because you didn't follow all of the instructions. Or you didn't understand part of it. Read it again. Or call us. Or attend the live seminar.

In one edition of the book, Allen Carr writes that if you're thinking I'm still craving cigarettes after reading it, then quote, "you are being very stupid. How can you claim I want to be a non-smoker and then say I want a cigarette? That's a contradiction. If you say I want a cigarette, you're saying I want to be a smoker. Nonsmokers don't want to smoke cigarettes. You already know what you really want to be. So stop punishing yourself."

Having this information, knowing what nicotine was and is no longer doing to me, was comforting because I was like, it's not in my imagination. I wish I'd known all this before I'd stopped, that I'd had more of a map of the landscape, instead of just pretending I wasn't even on the continent.

This was March 31, the day after I talked with Huberman. It's three months in.

Voice Memo

I've been trying to get dressed for-- I don't know, like 10 or 15 minutes. Everything's just a little bit harder since I stopped smoking.

I'm slower. I'm slower. And I'll forget-- I mean, supposedly it's good for-- nicotine is good for working memory, meaning-- why did I come into the kitchen again? Oh, yeah.

And I've no working memory anymore. And so it takes me forever to do simple things. And they're not as-- fun? That's not the word for getting dressed. But they're not-- it just feels like-- everything feels a little bit like a chore. Oh, goodness.

Sean Cole

There have been lots of news stories about Allen Carr's Easyway. He was interviewed a ton in the UK when he was alive. And the people who took over the organization after him have done a lot of press. But looking high and low, I hadn't seen anyone question the scientific accuracy of the method, even though most of the biology Huberman talks about has been known for a little while. So either I'm missing something, which happens a lot, or nobody's ever raised this particular issue with them before.

Sean Cole

So he'll be there. I did actually pour you a cup of--

John Dicey

Oh, that's fine Thank you.

Sean Cole

So I sat down with John Dicey, Allen Carr's successor. He's the global CEO and senior facilitator of Easyway now. He also took the seminar himself to quit smoking, and says he was so enthralled by how well it worked that he, quote, unquote, "hassled and harangued Allen Carr to let him get involved."

They butted heads sometimes. But John really considers Carr to be a genius. I asked him if they'd ever talked about brain chemistry when Carr was alive. He said they had, although--

John Dicey

He wasn't really interested in the science side--

Sean Cole

He wasn't?

John Dicey

No, I think he-- neither am I, really.

Sean Cole

Really?

John Dicey

I've got to say, it's one of those things-- I don't really think it has much to bring to the table, if that makes sense.

Sean Cole

Because he talked-- he would say that he was the world's leading expert on quitting smoking.

John Dicey

Yes.

Sean Cole

You're smiling as I say that.

[LAUGHS]

So he wouldn't-- as the world's leading expert in quitting-- self-professed world's leading expert in quitting smoking-- be necessarily curious about that stuff?

John Dicey

Yeah, I think he was busy doing other things. So in terms of the Easyway method. It's now being applied to, I think it's 15 or 16 different addictions or issues.

Sean Cole

There's the easy way to stop drinking, the easy weigh, W-E-I-G-H, to lose weight. There's one about being addicted to your phone-- lots of things. I should say an updated version of the book, different from the one I read, addresses brain science for the first time. But it's very selective. And it still claims nobody's ever had any pleasure or benefit from nicotine.

I started taking John Dicey through what I'd learned from Andrew Huberman, the research that contradicts what's in the book, and that might help explain why, for a lot of people, it's not going to be easy to walk away from smoking.

Sean Cole

So when the book says that it doesn't physically aid in concentration, just scientifically, it does aid in concentration.

John Dicey

I told him. He's wrong.

Sean Cole

You think he's wrong?

John Dicey

I don't think he's wrong. I know he's wrong.

Sean Cole

He's a neurobiologist.

John Dicey

I don't care what he is.

Sean Cole

Uh-huh.

John Dicey

That's what-- I'm not being disrespectful to him.

Sean Cole

Yeah, no, sure.

John Dicey

He has a theory. His theory--

Sean Cole

Well, it's based on-- it's based on--

John Dicey

He's just wrong--

Sean Cole

--tests--

John Dicey

--on many levels. And I'm struggling to understand why there's a desperation to prove or believe that nicotine does something when it doesn't. I've never heard so much nonsense in my life. I'm sorry. Very nice guy, I'm sure. And I'm sure he believes what he's saying. But it's absolute nonsense.

Sean Cole

I think that's where we're misunderstanding each other because I'm not looking for positives of nicotine. I was just looking for what is the mechanism. I was just like looking for what is the mechanism. And when I learned about the different neurochemicals that nicotine evokes in the brain, it just felt like-- that the method was predicated on a lie, that nicotine--

John Dicey

Your feeling is that you would-- you'll take nicotine for the rest of your life?

Sean Cole

No, although--

John Dicey

Why not?

Sean Cole

Huh?

John Dicey

Why not?

Sean Cole

Well, it wasn't my plan. It wasn't my plan because--

John Dicey

Why isn't it your plan? Why isn't it your plan if it's giving you these tremendous benefits? You struggle without it. Why wouldn't you just take it for the rest of your life?

Sean Cole

I think because there are health detriments that are nothing like--

Things got spicy with John Dicey. He emailed me more than once, weeks after the fact, to say he was still reeling from the interview, doesn't understand why anyone would push back at the Allen Carr Easyway method. We've only ever done good in the world, he said. That's like kicking a cat. And why would anyone ever suggest there was a benefit to nicotine, other than maybe the tobacco companies or big pharma?

John Dicey

If it was true, I could almost live with that. If nicotine did make it easier for people to concentrate, non-nicotine addicts to concentrate, I could live with that. I'm genuinely interested to look at the studies you've looked at. If there were advantages to it, I'd certainly acknowledge that. But there aren't. It's just--

Sean Cole

I guess, how can you say there aren't when you say that you haven't looked at the science, that it's just not-- and that's fine that it's not interesting to you. But when it's not interesting to you, and so you haven't really read about it, and Allen didn't really read about it, then how can you say it's not true?

John Dicey

It's just-- it's irrelevant, isn't it? I don't know. I wouldn't want to spend too much time discussing whether the moon is made out of cheese. I'm pretty sure it isn't.

[LAUGHTER]

Do you know what I mean? I think it's hugely dangerous to talk about that there might be benefits to nicotine when it's just simply not true. It's unfortunate the book didn't work for you. And I'm really sorry about that. And I wish you'd reached out for help at the time because it doesn't have to be this complicated. It really doesn't.

I'm really pleased you're not smoking. And I hope you're as well as you can be with the prognosis and everything like that.

Sean Cole

Yeah, thank you.

John Dicey

If you think this understanding has helped you continue not smoking, that's brilliant. But you-- are you well? You sort of--

Sean Cole

Thank you for asking. I think I'm OK. So basically, they say that the emphysema is mild, that it affects--

John Dicey says the organization doesn't make any claims about the success rate of the book. For any measurable success, they always point to the seminar they give, which Allen Carr always said was about 90% effective. He based that figure on only about 10% of seminar goers taking advantage of the money-back guarantee. In order to get your money back, you have to do the session two additional times for free. Anyway, the company has backed off from that claim in recent years.

The seminar was put through a couple of randomized, controlled trials where it was pitted against methods that offer both behavioral support and pharmacology, nicotine replacement, that kind of thing. The more recent and bigger of those studies found that 19% of the Allen Carr people were still quit after six months versus 15% of the other group.

With the margin of error, that basically means they're on par. Although 19% success still means that the method didn't work for four out of five people in the study. John Dicey told me he doesn't think those studies are a good reflection of what the results are, out in the real world.

Voice Memo

I'm literally-- [COUGHS] --looking through my kitchen window, watching police officers smoke on the fire escape of the precinct.

And this is four months in. Wherever you look, wherever you smell, there it is, your past.

It's like you broke up with someone who was horrible for you. And then you leave your apartment and that person is on every street corner, wafting their perfume at you, which was and remains intoxicating, literally.

And then you go back to the confines of your apartment. And you look out the window. And there they are, blowing kisses at a brick wall.

Now I can't tell whether I'm talking about the metaphor or the physical reality.

Sean Cole

I actually may have stumbled into a really good, though, kind of worrying explanation as to why I'm not in the percentile-- whatever it is-- of Allen Carr success stories. I talked with a prominent psychiatrist who's had patients that use the method. So she's familiar with the book. Her name is Anna Lembke. She runs the Addiction Medicine Dual Diagnosis Clinic at Stanford. She also wrote a book called Dopamine Nation, which is where I learned that nicotine increases dopamine levels by 150%, which is 50% more than sex.

I called her to talk science. But our conversation became a little like a therapy session at some points. I told her there's this thing that happens in the shower when I first turn the water cold at the end. It makes you feel good after, not during. And weirdly, I don't just crave a cigarette right at that moment. It's this very specific sensation, like I'm taking a big whiff from a glass ashtray that I just emptied but haven't washed out yet. It's not a gross feeling. It's a wanting feeling.

Anna Lembke

Does it happen immediately, when you turn the-- feel first feel the pain of the cold water?

Sean Cole

Yes.

Anna Lembke

OK, so that's very interesting. There's a whole, famous series of experiments showing--

Sean Cole

She told me there were these studies done where they would take a rodent and get it addicted to some drug by letting it press a lever over and over again to receive that drug. But then if you take the drug out of the equation, it'll eventually stop hitting the button because-- what's the point? And then it wanders off to do other things in the cage to amuse itself. However--

Anna Lembke

If, then, you take that same animal and you expose it to a painful foot shock, the animal will immediately run over to the lever and wildly start pressing it--

Sean Cole

Whoa.

Anna Lembke

--as a way to-- yeah, isn't that interesting? So I suspect that is what is happening to you, that by having cold-water showers, what you're doing is you're shocking your body with a painful stimulus, which is then triggering your automatic neurological safety and compensatory mechanism, which is to smoke a cigarette.

Sean Cole

Whoa. That's wild. Wow.

Anna Lembke

Yeah, yeah, in other words, you've created an elaborate, neurological circuit around smoking. And even months after you've stopped smoking, that neurological circuit is still healthy and firing away in response to significant stressors.

Sean Cole

People talk about the physical addiction to nicotine and the psychological addiction to nicotine. That sounds physical to me. It's--

Anna Lembke

Oh, yeah, it's very physical.

[SIRENS WAILING]

Sean Cole

All this time, I'd been focusing on the damage that smoking had done to my lungs, 35 years worth of damage. I somehow hadn't thought in terms of doing that amount of damage to my brain too. That'll take a long time to repair, Anna Lembke told me, especially given my age. My brain isn't as plastic as it once was.

And there's another school of thought, she said, a more depressing one, which wonders whether the damage could be so far gone I can't repair it.

It'll always be in this state of perpetual neurological withdrawal, which might require some kind of intervention.

Anna Lembke

And in your case, that might look something like nicotine replacement therapies for life, potentially--

Sean Cole

For life?

Anna Lembke

Hi-- what's that?

Sean Cole

For life?

Anna Lembke

Yeah, for life, and potentially at higher doses than what you're currently taking.

Sean Cole

Wow.

Anna Lembke

So-- yeah, so we used to use nicotine replacement therapy just to help people quit. But more and more, we're now using them in the maintenance phase, where people are just using them for years to decades. And again, the thinking there is that wow, the ideal is that with sustained abstinence, your brain would heal and you would return to whatever your pre-smoking baseline was.

But in reality, what we see is that some people don't get to that place, and that they may need some form of nicotine to feel and function OK, going forward, indefinitely.

Sean Cole

Whoa. So it's possible that I've broken my brain, sort of, my dopamine receptors, to the point where they're just not going to return to normal?

Anna Lembke

Yeah. That's possible. I don't like to hear you say that your brain is broken. But I guess just to think about it a little differently, it just could be that you no longer have the brain plasticity to completely reverse the changes.

Sean Cole

I had to listen back to that part of the interview a few times to fully feel the bomb drop of it. I know it's not an official diagnosis or anything or even an unofficial one. I don't want to overreact. But the impact is something like when I learned I have lung disease. Permanent brain changes and lack of plasticity makes me think of aging, which makes me think of dying. Nicotine replacement for life, for the rest of my life-- how long is that going to be?

And still, even assessing all of that damage, knowing all of the havoc that smoking has wreaked on my body, still I wish there was some dimension in which I could keep doing it. If you're wondering, it's now been seven months. And I still haven't smoked a cigarette. Every now and then, I almost wake up to it all over again, like, I'm still not doing that?

Talking with Anna Lembke confirmed this idea that had been pecking at me since I first read the book. Allen Carr says there's only one kind of smoker and that any smoker can find it easy to quit. But I talked with a lot of people who had tried the method, folks it both worked for and didn't. And I just think there's different kinds of smokers.

I think there's a certain kind of smoker, like me, for whom there's just a lot of anger lurking in it. It's like every hour or a couple of hours, we climb up to the roof and fling ourselves off of it as a petulant fuck you to being alive. After all, we started doing this thing when we were kids, like 15, 16. No wonder there's such a delicious nihilism to it for some of us. It's like my 15-year-old fingers were still lifting the cigarette up to my 51-year-old lips.

I can't think of a lot of other behaviors that aren't associated with survival-- but it's even the opposite of survival-- that I did every day for that long. There's a line in one of the editions of the book I have, where Allen Carr writes, "if health, happiness, and freedom aren't enough to inspire you, then you have bigger problems than smoking." I underlined that passage. And in the margin, I wrote, "this is possible."

Coming up, when you wish you knew how and whether to quit someone, and then you receive possibly the most well-articulated relationship advice of all time. That's in a minute, from Chicago Public Radio, when our program continues.

It's This American Life. I'm Sean Cole, sitting in for Ira Glass. Today's program, I Can't Quit You, Baby, stories of being on the verge of a big change, not wanting to let go, and the people who give you that final push.

Act Two: A Spoonful of Sugar

Sean Cole

We now present act two of our program. Act Two, A Spoonful of Sugar.

When we were putting together this week's show, one of the other producers here thought of this advice column she read, years ago, where the person writing in wasn't sure if they should quit a relationship or not. It was the column Cheryl Strayed used to do, called Dear Sugar. Here's the letter.

"Dear Sugar, I'm in my early 20s. I've been in a serious relationship with the same guy for six years, on and off, and the off portion taking place when I was younger. I have been very distracted and have been second guessing the relationship for a while now. But I can't come to grips with losing this person, that seems to be right for me, permanently. And of course, I don't want to break his heart.

Then again, I don't want to settle and have regrets later in life. I feel like we want different things out of life and we have different interests. But I just can't decide. I've talked to him about my feelings, for the record, but to no avail. We went on this little break. But god knows breaks never work.

Basically, my biggest fear is being alone and never finding anyone that measures up. It doesn't help that my closest friends are settling down with their boyfriends and are talking about marriage. Cringe. Honestly, I feel like marriage and that kind of commitment represents a loss of personal identity. I'm not sure why. But I would love your advice, Sugar. Please help. Sincerely, Scared and Confused.

Here's Cheryl Strayed, reading her response.

Cheryl Strayed

Dear Scared and Confused, I lived in London when I was 20. I was technically homeless and desperately broke. But I didn't have the papers an American needs to get a job in London. So I spent most of my time walking the streets, searching for coins that people had dropped.

One day, when I was searching for coins, a man in a business suit approached and asked me if I wanted an under-the-table job, three days a week at a major accounting firm that has since collapsed due to corruption. Sure, I said. And this is how I became coffee girl one two three.

Coffee girl was my actual job title. The one two three was tacked on to communicate the fact that I was responsible for providing coffee and tea to all the accountants and secretaries who worked on the first three floors of the building. It was a harder job than you might think.

Coffee girl, men would call, as I passed them with my tray, often snapping their fingers to draw my attention their way. I wore a black skirt over white tights and a black vest over a white shirt. And I was almost always out of breath.

Banned from the elevator, I had to race up and down steps in a stairwell, that ran along the back of the building, to get from one floor to the next. That stairwell was my sanctuary, the only place where nobody snapped their fingers and called me coffee girl.

During my breaks, I'd walk down to the first floor and go outside and sit on a patch of concrete that edged the building that housed the major accounting firm that has since collapsed due to corruption. One day while I was sitting there, an old woman came along and asked me where, in America, I was from. I told her. And she said that years before, she had visited the place in America where I'm from.

We had a nice conversation. And each day after that, she came along during the time when I was sitting on the patch of concrete. And we talked. She wasn't the only person who came to talk to me. I was in love with someone at the time. In fact, I was married to that someone. And I was in way over my head.

At night, after I made love to this man, I would lie beside him and cry because I knew that I loved him but that I couldn't bear to stay with him because I wasn't ready to love only one person yet. And I knew that if I left him, I would die of a broken heart. And I would kill him of a broken heart too.

And it would be over for me when it came to love because there would never be another person who I'd love as much as I loved him, or who loved me as much as he loved me, or who was as sweet and sexy and cool and compassionate and good, through and through. So I stayed.

We looked for coins on the streets of London together. And sometimes, he would come and visit me at the major accounting firm that has since collapsed due to corruption, while I was on my breaks. One day, he came while the old woman was there. The man I love and the old woman had never come at the same time. But I had told him about her. And I had told her about him too.

"Is this your husband," the old woman exclaimed with jubilant recognition when he walked up. She shook his hand with both of her hands. And they chatted for a few minutes. And then she left. The man I loved was silent for a good while, giving the old woman time to walk away. And then he looked at me and said, with some astonishment, "she has a bundle on her head."

"She has a bundle on her head," I said. "She has a bundle on her head," he said back. And then we laughed and laughed and laughed, so hard it might, to this day, still be the time I laughed the hardest. He was right. He was right.

That old woman, all that time, all through the conversations we'd had as I sat on the concrete patch, had had an enormous bundle on her head. She appeared perfectly normal in every way but this one. She wore an impossible, 3-foot tower of ratty old rags and ripped up blankets and towels on top of her head, held there by a complicated system of ropes tied beneath her chin, and fastened to loops on the shoulders of her raincoat.

It was a bizarre sight. But in all my conversations with my husband about the old woman, I'd never mentioned it. "She has a bundle on her head," we shrieked to each other, through our laughter, on the patch of concrete that day.

But before long, I wasn't laughing any more. I was crying. I cried and cried and cried as hard as I'd laughed. I cried so hard I didn't go back to work. My job as coffee girl one two three ended right then and there.

"Why are you crying," asked my husband as he held me. "Because I'm hungry," I said. But it wasn't true. It was true that I was hungry. During that time, we never had enough money or enough food. But it wasn't the reason I was crying.

I was crying because there was a bundle on the old woman's head, and I hadn't been able to say that there was, and because I knew that was somehow connected to the fact that I didn't want to stay with the man I loved anymore. But I couldn't bring myself to acknowledge what was so very obvious and so very true.

That was such a long time ago, Scared and Confused. But it all came back when I read your letter. It made me think that perhaps that moment delivered me here to say this to you. You have a bundle on your head, Sweet Pea. And though that bundle may be impossible for you to see right now, it's entirely visible to me.

You aren't torn. You're only just afraid. You no longer wish to be in a relationship with your lover, even though he's a great guy. Fear of being alone is not a good reason to stay. Leaving this man you've been with for six years won't be easy. But you'll be OK. And so will he.

The end of your relationship with him will likely also mark the end of an era of your life. In moving into this next era, there are going to be things you lose and things you gain. Trust yourself. It's Sugar's golden rule. Trust in yourself means living out what you already know to be true. Yours, Sugar.

Sean Cole

When that producer brought it up at the weekly story meeting, someone else said that she had read the same column, and that it was what made her decide to divorce her husband. Said the same thing happened with a friend of hers, read the column, left the relationship. This is what I'm talking about, about a kind of spell being cast.

Cheryl told us that of all of the thousands of letters she's gotten in the 13 years she's had the column, this is the most common predicament people find themselves in. All over the world, people are wondering, is it time to get out? Something like a third of all of her letter writers ask her this question.

An adaptation of Cheryl Strayed's columns is now streaming on Hulu. It's called Tiny Beautiful Things. Our audio version of this column was produced by Diane Wu.

Act Three: Tender Resignation

Sean Cole

Act Three, Tender Resignation.

Sometimes the words that convince someone to quit a thing aren't advice, aren't supportive. But they're just as effective in getting you to let go, maybe more so. This next story is a case like that. And it's from producer, Zoe Chace.

Zoe Chace

To start this next quitting story, I have to take you back a few months, to November, 2022, election night. We ran a story about an election administrator. Lots of people with that job have quit in the last few years because of harassment and death threats from people who believed the last election, or last elections, were stolen. Not this guy, not Heider Garcia in Tarrant County Texas, home of Fort Worth.

He'd never be driven out by conspiracy theorists. In fact, he'd figured out, it seemed, this rare way to work with them, to invite them in.

Heider Garcia

So there was this one time--

Zoe Chace

One example-- during one election, one of the activists came in to where the votes are tallied. And this activist was like, if I were in charge, I would make the walls glass so you could see the election machines and where every cable goes. Heider was like, OK, I hear you.

Heider Garcia

So I told him, what about if we rearrange the room so the machines are not in this little cabinet under the desk, but up where you can see them. And you can-- He said, well, maybe that would be a start.

So the next election, they came back in the runoff. When they walked in the room, I told them, all the machines are on top of the tables. You can see them back there, against the glass. They're labeled, what each one of them does. This is what you wanted, right? And so he had that moment of, OK, well, you got me on that one. And it's little things like that we keep doing, right?

Zoe Chace

Heider gave out his cell phone to anyone who wanted it. There was this one activist in particular, Aubree Campbell. She had this channel on Telegram about election fraud stuff. And she posted about Heider a lot. And she called him all the time. And she called him on election day.

Aubree Campbell

So there's a picture going around. And it's and it's purported to be a map of outages of all of the machines. Is that-- are you having issues with that? I'm going to send it to you to-- just so you see what this is--

Heider Garcia

All right. Yeah, send it to me. I'll take a look, see what it is. Please. That'd be great.

Aubree Campbell

Yeah, I--

Zoe Chace

He and Aubree had built up a real relationship, even though they didn't agree on anything. She came by on election night to hang out and watch everything and ask more questions. It really seemed to me like nothing could deter him from this job. The reporter who brought us Heider's story, Natalia Contreras, she talks about Heider's radical patience with the election conspiracists who used to fill his office. And election administrators in the rest of the country looked to Heider as a model for transparency, openness, efficiency.

The Secretary of State of Texas back then, not a Democrat, a very conservative guy, said to Natalia last year, if you were building a prototype for an elections administrator, you would just copy Heider Garcia.

But an April 16, 2023, Heider released a letter. It begins, gentlemen, please accept this letter as my formal resignation from the position as election administrator for Tarrant County. Five months after we ran that story, Heider had quit.

Some people in the county were pretty upset. They spoke up at this public meeting. One of the people was Aubree, the voter-fraud activist who was always questioning him.

Aubree Campbell

I was also shocked at Heider's resignation. I've been working with him. He is transparent. I want to give him that credit. It is a loss because he's built these systems. And he knows more about these computerized voting systems than most people on this planet. I don't think it's necessarily a win for the movement or for Tarrant County. But--

Zoe Chace

So what happened? Heider wouldn't talk about it for this story, citing his new job. He's on this federal election advisory committee now. But here's what we figured out. And a lot of this is based on Natalia's reporting for Vote Beat.

It actually all started the night we were down there, election night. One of the elections Heider was overseeing was for who would be his new boss, a position called County Judge, the guy who would be in charge of Tarrant County. The winner was a man named Tim O'Hare. He heavily featured election-fraud issues in his campaign, claiming that voter fraud is rampant-- it is not-- that the 2020 election was possibly stolen from Trump-- it was not.

Heider had dealt with scores of election skeptics. But now one was his boss. One of the first things Tim O'Hare did, when he got into office a few months ago, was set up an Election Integrity Task Force, like he'd promised during his campaign, to investigate election crimes. There was a big press conference.

Tim O'Hare

We encourage everyone to report actions that they have concerns about, whether it's at the voting booth, whether it is--

Zoe Chace

Heider was not consulted about the task force. And when the task force was announced, he was not there. A reporter asked if Heider was part of the Task Force.

Tim O'Hare

The Task Force is made up of investigators and deputies. So he is-- I fully expect him to cooperate with it. But he's not part of the Task Force, per se.

Zoe Chace

It's worth mentioning even if you believe there is a major problem with voter fraud, which lots of officials in Texas do, Tarrant County got a special shout out in the big 2020 election audit that Texas did for running its election so smoothly, a quote, "quality, transparent election." That was Heider.

So the Election Integrity Task Force was one thing. They also fought over the budget. Money had been approved for Heider to buy an expensive attachment for a mail-sorting machine. But O'Hare wouldn't vote to release the funds for it. There was an awkward back and forth at a public meeting, with O'Hare questioning him, like, why was this necessary.

Tim O'Hare

Is there some other way that it's going to save money? Because that's not saving money.

Heider Garcia

No.

Tim O'Hare

OK.

Heider Garcia

No. This is not an investment to save money. This is an investment to make a labor incentive.

Tim O'Hare

Did you not say, earlier, that you thought it would save money?

Heider Garcia

Nope. No, no, I said I don't even think that I can come up with a number to save money. We're never going to get $150,000 back in year one. That's not what I'm here to-- it's an investment in a cleaner, smoother, more efficient operation. But it's not a case of saving money.

Tim O'Hare

I think this is a total waste. OK.

Zoe Chace

This was a real change for Heider, the golden boy of Texas elections. To a certain degree, what made Tarrant County elections so secure, efficient, and transparent was the pricey election equipment. So Heider was accustomed to getting his requests approved. Heider's previous boss, a Republican, once told Vote Beat, "if Garcia tells us he needs something, then we're going to get it for him."

Around this time, Heider and Tim O'Hare met in his office, where things clearly did not go well. Heider mentioned it at the end of his resignation letter. it ends, "Judge O'Hare, my formula to administer a quality, transparent election stands on respect and zero politics. Compromising on those values is not an option for me. You made it clear in our last meeting that your formula is different, thus my decision to leave. I wish you the best. Tarrant County deserves that you find success."

I reached out to Tim O'Hare. He didn't respond. But one thing that came out later, on a radio show that O'Hare was on, was he didn't like the way Heider talked to reporters-- at all. That seems like a central problem he had with Heider. He said someone had given him a public-records request of Heider's communications. And he didn't like what he saw in his texts with the press. Funny. That was my favorite thing about Heider.

So it was one guy that got Heider to go. After dealing with countless voter-fraud activists over the years, Heider and Tim O'Hare had a meeting. And then Heider quit. Or you could say it was more than one guy. O'Hare had been put in office by the voters, in an election that Heider had made sure it was fair.

Heider's last day was Friday, May 19. Aubree gave Heider a copy of The Federalist Papers. She inscribed it, "thank you for your assistance with my current understanding of Texas election procedures. Please take time to relax. And I hope you enjoy perusing these early writings of the founding fathers."

When we drove away from Heider's office that election night in 2022, I felt like we had witnessed this little scene that could be a model for how elections offices could be in the election-conspiracy era, where the administrators and the skeptics would be able to-- if not agree, at least coexist through elections. Heider, running around, making sure his workers were getting what they needed, while all night long, this one woman in a red, white, and blue dress followed the ballot bags around with a clipboard, taking notes.

It felt oddly peaceful, stable. I was kind of optimistic. Yeah no-- six months later, I don't see it that way.

Sean Cole

Zoe Chace is one of the producers of our show.

The program was produced today by Aviva DeKornfeld. The people who put together today's show include Jane Ackermann, Bim Adewunmi, James Bennett II, Phia Bennin, Chris Benderev, Jendayi Bonds, Michael Comite, Valerie Kipnis, Miki Meek, Katherine Rae Mondo, Stowe Nelson, Sara Parish, Nadia Reiman, Lilly Sullivan, Frances Swanson, Christopher Swetala, Matt Tierney, and Julie Whitaker.

Our managing editor is Sarah Abdurrahman. Our senior editor is David Kestenbaum. Our executive editor is Emmanuele Berry. Special thanks today to Nikki Glaser, Jennifer White, William Georgides, Anthony Perullo, Viki Merrick, Ben Bianccini, Aditya Murkerji, Grace McCants, Julie Snyder, Rob Mohr, Gary Holl, Jamie Knapp, and Miranda Suarez.

This American Life is delivered to public radio stations by PRX, the Public Radio Exchange, and our website, thisamericanlife.org, where we have all this new merch, great new t-shirts, lots of stuff. There's a beautiful illustration of our show's co-founder, Torey Malatia, on one of the shirts. Go check it out, thisamericanlife.org.

Thanks, as always, to my boss, Ira Glass. He was in the park the other day. And he jumped into this double Dutch routine with some kids. He was like, left, right, cross, turn. He was a natural. Killed it. And very proud of himself. "I mean, that's a very hard combo for most people to just drop themselves into."

I'm Sean Cole, back next week with more stories of This American Life.