CASE STUDY
Sam (tobacco use disorder)

Sam is a 43-year-old married man who was referred to you by his employee assistance program for help with quitting smoking. He reports to you that he has been trying to quit “cold turkey” without success and has noticed that he has been smoking even more than his typical pack per day. Sam first started smoking cigarettes when he was in college. At that time, he considered himself to be a “social smoker” – smoking one or two times per week, when out with friends. He recalls a distinct shift in his smoking habits when he transitioned to his first full-time job after college, noting that the transition to “being a full-fledged adult” was difficult for him and he would pick up a cigarette at the end of the work day as a reward or to relieve stress. Over time, his smoking increased to the point where he felt like he needed to smoke throughout the day. He worried that if he didn’t have the cigarette his body was expecting he might have symptoms of withdrawal or he might not be able to manage his stress. He has always been aware of the potential negative health effects of smoking but has told himself that if he quit smoking “soon” he would be okay. He also believes that smoking has helped him to keep his weight in check – he struggled to maintain a healthy weight as an adolescent and is convinced that he will “gain a ton of weight” if he quits smoking. In recent years, as public establishments have become smoke-free, he has become self-conscious about his smoking habit and actively works to hide it from others, particularly his 4-year-old daughter. He is seeking help with smoking cessation now because it is negatively impacting his marriage (his wife reminds him daily, “You promised me you would quit”) and he worries that he won’t be able to keep his habit a secret from his daughter much longer.