ADDISON COUNTY ­­— Chuck Arel, 68, smoked two packs of cigarettes a day for most of his life after starting when he was 14.
On Nov. 26, 2012, after several failed attempts at quitting, he smoked his last cigarette.
“I knew it wasn’t healthy. I knew for a long time that smoking wasn’t good for anybody,” the Vergennes resident said. “But it’s not an easy habit to quit.”  
Arel developed emphysema, and until quitting he had a chronic cough at night.
In the 15 years before quitting, he had cut back to a pack a day. After hearing constant pleas to quit altogether from his wife, children and grandchildren, he tried stopping with Chantix, a non-nicotine prescription drug that helps mitigate nicotine withdrawal.
But the drug didn’t address the psychological habit, and the effort didn’t last long.
“There was all kinds of different situations where I would usually have a cigarette,” he said.
For example, going out to the garage to work on a project he would light one up. Or after dropping his granddaughter at school. Or driving in his car.
Then, a year or so ago, he found out about Vermont Quit Network, a tobacco cessation program backed by the Department of Health and a state preventative care initiative called the Blueprint for Health.
In Addison County, Porter Hospital hosts the Blueprint organization and the health programs it coordinates.
“It’s a good program, it’s a very good program,” Arel said, adding his counselors “were great, they were just absolutely excellent.”
Arel was hardly alone as a two-packs-a-day smoker. About 95,000 Vermonters smoke, around 15 percent of the population. He also was not alone in his attempts to quit: In 2011, 55 percent of smokers in Vermont tried to stop.
The statewide Vermont Quit Network offers four options to help smokers quit: online at VTquitnetwork.org, by phone at 1-800-QUIT-NOW, one-on-one with a tobacco cessation counselor, or in a group setting.
Many people see the best results with the “in-person” cessation programs, which Arel used when he finally quit.
“Some people like to do it over the phone, some like to do it on their own online, but I think for some they really like the individual attention and the one-on-one face,” said Melanie Clark, who recently left her job as tobacco prevention coordinator at the Open Door Clinic in Middlebury. Clark says her mother quit smoking using the one-on-one program.
BLUEPRINT ARRIVES
But for a while during the past year, Addison County didn’t have that option as the program went through a transition.
According to Porter Hospital spokesman Ron Hallman, Porter and its primary care network had an in-person tobacco cessation program for more than 20 years that was cut when the Department of Community Health Outreach was eliminated after the recent recession.
Now, thanks to the arrival of the Blueprint for Health, smokers who attend regional primary care providers have access to in-person cessation programs, which were recently rebranded “Quit Partners.”
Part of what the Blueprint provides area practices and health centers are behavioral health consultants, including three tobacco cessation counselors. They run the Quit Partners program in Addison County, working with patients like Arel either one-on-one in the primary care office or in a group setting.
“We’ve been trained to help motivate people to make behavioral changes,” said Michele O’Neill, a Blueprint behavioral health consultant who does tobacco cessation counseling.
The first step counselors often take with tobacco users who want to quit is setting a quit date, a goal to strive toward. The counselor and the patient develop strategies and tools to achieve that goal.
One of the primary strategies is coming up with distractions and other ways to avoid situations that trigger a craving for a cigarette.
“A very common trigger is a cup of coffee in the morning. Driving in the car seems to be a trigger for a lot of people, after dinner, after a meal, after sex,” said O’Neill, who added alcohol to the list.
In a group setting, participants discuss which strategies work to avoid these triggers and which do not.
For example, many people discuss ways to avoid smoking while commuting.
“By the time they get to a certain place they’ve lit up a cigarette,” said O’Neill. “Taking a different route to work might shake that up, (or) maybe only taking one cigarette with them in the car that they have access to.”
Arel said that in the weeks after he quit, he tried to avoid stores where he could buy cigarettes altogether, or if he did go near them he would make sure not to have money in his wallet.
Nicotine replacement therapy (NRT) often goes hand-in-hand with counseling and discussion. The Vermont Quit Network provides free nicotine patches, lozenges and gum. O’Neill and the tobacco cessation counselors work with patients to determine appropriate doses and use patterns.
LONG PROCESS
Quit Partners participants take different amounts of time and prefer different methods.
O’Neill encourages people to use the group format along with NRT, as Arel did.
“The group is very supportive. It’s a really great way for people to get that extra peer support,” she said. “Lots of the suggestions and ideas that are shared in a group are really powerful.”
Many people start using Quit Partners because of health reasons. It is estimated 800 Vermonters die each year from tobacco-related diseases.
Others choose to quit for financial reasons. Smoking two packs day can mean $100 a week for cigarettes.
“A lot of them are motivated by money. It costs so much to smoke,” said O’Neill.
Finally some, like Arel, feel pressure to stop from their friends and family.
Most people share the fact that they need multiple efforts to stop. The average person attempts seven times before finally quitting. People come to tobacco cessation with varying levels of motivation, and it usually doesn’t happen until the participant is exceptionally determined, experts said.
“In all aspects of the work that we do with people we are always trying to move them forward, motivate them to try something different and new,” said O’Neill.
Arel found that motivation on his second or third try with the Quit Partners program.
“I was determined this time that I was going to quit,” he said. “I would say stick with that Quit (Partners) program. It does work, just get yourself convinced that you are going to quit.”
Arel admits his desire for cigarettes hasn’t completely disappeared.
“I feel like I could have a cigarette at any time,” he said. “But I don’t, of course.”
Lately, he has started instead carrying around a stone from his granddaughter’s stone collection.
“Whenever I want a cigarette I … feel that stone, because she wanted me to quit,” he said.