DOCUMENT RESUME

ED 405 298 SP 037 174

TITLE Beat the Smokeless Habit. Game Plan for Success.Third Edition.

INSTITUTION National Cancer Inst. (NIH), Bethesda, Md.; PublicHealth Service (DHHS), Rockville, Md.

REPORT NO NIH-94-3270PUB DATE Jun 93NOTE 21p.

PUB TYPE Guides Classroom Use Instructional Materials (ForLearner) (051)

EDRS PRICE MFO1 /PCO1 Plus Postage.DESCRIPTORS Athletes; Baseball; Colleges; College Students;

Health Education; *Health Materials; *HealthPromotion; Higher Education; Instructional Materials;Pamphlets; Prevention

IDENTIFIERS Chewing Tobacco; *Smokeless Tobacco

ABSTRACTThis guide was originally designed for professional

baseball players but it is now distributed to college athletes. Thefacts and strategies apply to any athlete in any sport. Use ofsmokeless tobacco or snuff greatly increases the risk of developingoral cancer and other serious medical conditions. The first part ofthis guide explains the health risks and gives facts about the use ofsmokeless tobacco. It includes a self-test to determine addiction totobacco. The second section offers a "9-Inning Game Plan" for kickingthe habit permanently. The "innings" include: (1) Decide to Quit; (2)

Pick a Quit Date; (3) Cut Back before You Quit; (4) Right Before YourQuit Day; (5) Quit Day; (6) Your First Week Off Smokeless; (7) YourSecond Week Off and Dealing with Triggers; (8) Going the Distance;and (9) Celebrate Your Success. Sections are illustrated withphotographs of popular sports figures and include motivationalquotations. (JLS)

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Reproductions supplied by EDRS are the best that can be madefrom the original document.

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U.S. DEPARTMENT Of EDUCATIONOffice of Educational Research and Improvement

EDUCATIONAL RESOURCES INFORMATIONCENTER (ERIC)

0 This document has been reproduced asreceived Irom the person or organizationoriginating etMinor changes have been made to improvereproduction quality

Points ol view or opinions staled in this docu-ment do not necessarily represent officialOERI position or policy.

3P

Game Pion for SuccessNational Institutes of Health National Cancer Institute

2 BEST COPY AVAILABLE

ASmokeless tobacco use represents a significant risk to your health. It is not a safesubstitute for cigarettes. Use of smokeless tobacco, especially snuff, greatly increasesyour chances of developing oral cancer and other serious oral conditions.

So, if you use snuff or chewing tobacco, I urge you to follow the game plan for quittingin Beat the Smokeless Habit and ask you to discourage others from startingparticularly youngsters who look up to you as a role model. 99

Louis W. Sullivan, M.D.Former Secretary of Health and Human Services

This guide was designed originally for MajorLeague Baseball. But the demand for it outside ofprofessional baseball has been so great that it isnow distributed to college athletes nationwide.As you'll see, the facts and strategies in Beat theSmokeless Habit apply to athletes in any sportandto nonathletes, too. ,1

Jeff Cooper, M.S., A.T.C.President, Professional Baseball Athletic TrainersSocietyHead Athletic Trainer, Philadelphia Phil lies

it Major League Baseball is pleased to play a role indistributing this guide. It is a valuable tool foranyone who wants the facts about smokelesstobacco and how to quit. 99

Robert W. Brown, M.D.President, American League

@ appEq@mil&5

THE FACTS ABOUTSMOKELESS TOBACCO

Most Smokeless Users Want to Quit 2

Quitters Win 2

Does Smokeless Improve Your Game? 3

Smokeless Tobacco and Baseball:A Short History 4

Know the Dangers 6

Are You Hooked on Nicotine? 7

Making the Decision 8

9-INNING GAME PLAN

1/

001*241111149-

First Inning: Decide to Quit 9

Second Inning: Pick a Quit Date 10

Third Inning: Cut Back Before You Quit 10

Fourth Inning: Right Before Your Quit Day 11

Fifth Inning: Quit Day 13

Sixth Inning: Your First Week OffSmokeless 13

Seventh Inning: Your Second Week Off andDealing With Triggers 15

Eighth Inning: Going the Distance 16

Ninth Inning: Celebrate Your Success 16

The first part of this guide is for everyonewhetheror not you use smokeless tobacco or want to quit.

If you use smokeless tobacco, the second part gives you a 9-inning plan for kicking thehabit and staying off. You can use this page as a checklist to keep track of your progress.

1

Most SmokelessUsers Want To Quit

Recent surveys of majorand minor league playersshow that 30-45% of players dipor chew. Most of them wantto kick the habit.

Nine in ten said theythought snuff and chew-ing tobacco were harmful.

Over half had whitepatches or gumproblems where theyheld the tobacco intheir mouths.Two-thirds were tryingto quit or cut down.Most said they wanted aguide to help them quit.

Quitters WinMany players who used to

chew or dip have quit already.

For most, health concernswere the main reason:

"My doctor told me it wasworse than smoking. And whenhe did a scan of my stomach foran injury, he told me I had somebleeding. The juice from theSkoal kept my stomach constantlyirritated. "(Danny Darwin, Red Sox)

"The dip was eating throughmy gums. It just burned. It gotso bad I had a doctor look at it.He said to me, What you have isthe first stage of cancer.' I toldmyself 'That's it, man.' I'd beenthinking about quitting and thatmade my decision a whole loteasier." (Kelly Gruber, BlueJays, Toronto Globe Mail,May 9, 1987)

Many quit for family andloved ones:

"It was after the Series andmy dentist and my wife were afterme to stop. I guess it was my wifewho really made the difference."(Dan Quisenberry, formerRoyals reliever, "GoodMorning America," March 8,1988)

"Ned Bergert, Angels' trainer,started using smokeless tobacco

2

in the minor leagues. He wasstill chewing and dipping whenhe became a trainer for theAngels: 'Heck, it was free for thetaking in the clubhouse.' Then,one afternoon, he was mowinghis lawn and his 3-year-old sonwas following behind him,pushing a toy mower. Andspitting. 'I turned around andsaw him spitting like I was.That started the wheels turning.I quit a few days later.' "("Baseball wiser about theuse of smokeless tobacco,"Los Angeles Times, J.Weyler, April 9, 1988)

And some made quittinga personal challenge:

"Once I realized that itwasn't gonna be that easy for meto quit, because it's an addic-tion, then I set my mind to it.(Mike Fitzgerald, 1992Expos)

"It's a great feeling to be ableto overcome the habit becausethere is no reason that any-thing should control you. Andthis stuff does control you."(Tony Welborn, formerminor league pitcher)

"I didn't want to lose theability to do what I wantwith my life." (TerryMulholland, Phillies)

Many players had to try afew times before they made it.Like quitting smoking, quittingsmokeless often takes morethan one try. Each time,however, your chances ofsuccess go up.

Does Smokeless ImproveYour Game?

No. There is no evidencethat players who use smokelesstobacco have an edge on thosewho do not.

Using smokeless tobacco in-creases your heart rate andblood pressure within a few min-utes. This can cause a buzz orrush, but the rise in pulse andblood pressure places an extrastress on your heart that mayreduce your overall stamina.

Studies have found thatsmokeless tobacco does notimprove athletes' reaction time,movement time, or total re-sponse time.

And, in an anonymous poll ofmajor and minor league playerswho were using smokelesstobacco or who had quit, not asingle player said he thoughtdipping or chewing sharpenedhis reflexes or improved hisgame.

Most said they dipped orchewed for "something to do,"out of habit, because they were"hooked," as a ritual, as a way torelax, or because it was "part ofthe game."

Once you're "hooked" onchewing tobacco or snuff, youmay notice withdrawal reactions(see page 13) when you go toolong without a dip or a chew.But if you quit, these reactionswill last just a week or two. Inthe long run, you're going to feelbetter and strongerfree of theneed for tobacco.

"Quitting didn't hurt my per-formance in any way. I feelbetter. More in control. Allaround better. My lungs, mywind, my appetite are better. Andnow I can taste my food."(Danny Darwin, Red Sox)

Texas Ranger Nolan Ryanand Astro Mike Scott, formerdippers, agree. They reportthat quitting did not hurt theiron-field performance. ("AWarning to Chew On,"M. Madden, BostonGlobe, March 14, 1987)

"I know it doesn'tenhance myperformance."(Andy Van Slyke,Pirates)

I'm sure it doesn'thelp me on the field.It's just a bad habit."(Tim Wallach,Dodgers)

3

Smokeless Tobacco and Baseball:A Short History

When the rules of baseballwere first laid down in 1847,chewing tobacco was the mostpopular form of tobacco used.But when it was found thatspitting spread TB, the lead-ing cause of death at the time,tobacco chewing dropped.Many chewers switched tomachine-rolled cigarettes,thinking they were "safer."But smokeless tobacco stayedon in the ballpark. The play-ers chewed tobacco to keeptheir mouths from getting dryin the dusty parks. Peer pres-sure played an important role,too. Here's how formerDodger pitcher Rex Barneyremembers it:

"When I first broke into theDodgers' system, I was just akid, 18 years old. And we hada coach, an old guy namedBarney De Forge, or somethinglike that.... I was sitting in thebullpen one night, and DeForgesaid to me: 'Kid, you want toget into the Major Leagues?'

"I said, 'Sure, that's what it'sall about.'

"He says, You don't chewtobacco, do you?'

"I said, 'No.'"He said, Well, you'll never

get there unless you chewtobacco.'

`In those days, if you had 25players, 24 chewed tobacco.Very naive, I said 'OK' I triedit. The only thing I rememberis chomping down a couple oftimes and getting deathly ill. Iwas supposed to start the nextnight, and I was still so sick Icouldn't even leave the hotel. Isaid to myself, 'If that's what ittakes to make the MajorLeagues, I'll never make it.' "

4

O

Babe Ruth, one of baseball's greatest heroes, chewed tobaccoand smoked cigars throughout his careerlong before the dan-gers of tobacco were known. He died a tragic death, at only 53,from a throat cancer commonly caused by tobacco.

Photo courtesy of the National Baseball Library, Cooperstown, New York.

(From "Chaws," R. Blount,Jr., Sports Illustrated, July4, 1977)

Smoking caught up withthe game starting in the1950s. When baseball gamesfirst went on TV, cigarette adsbecame prime features. InNew York, team loyaltiescould be told by the brand ofcigarette a fan smoked.Willie Mays recalled thatwhen he started with theGiants, chewing had prettymuch died out, and mostplayers smoked the "teambrand," ChesterfieldsR.

But, in the 1970s, when thedangers of smoking becameclear, many players went backto chewingthinking it wassafer than cigarettes. Snuffdipping entered the scene forthe first time. Nolan Ryandescribed the change thisway:

"When I first broke into thebig leagues, 30-40% of the Metssmoked, and only three of theremaining players on the 25-man roster chewed. No onedipped. Chewing peaked in the1970s, and dipping took over.The switch began with freesamples of dip coming into theclubhouse."

Supplying free samples tomajor league, minor league,and college teams and recruit-ing players to appear in adsfor dip were part of the to-bacco companies' all-out adcampaign. During this time,the use of moist snuff in-creased fifteenfold amongboys ages 17-19.

Now the word is outsmokeless tobacco is NOT asafe alternative to cigarettes.It can cause addiction, seriousmouth problems, and mouthcancer. In 1987, warninglabels went on the cans andpouches. In 1988, many clubsbanned free samples from theclubhouse. In 1990, MajorLeague Baseball issued areport on the hazards ofsmokeless tobacco and an-

© Copyright San Francisco Giants.

HI and LOIS 6

By Brianand

Greg Walker

BUT NOW AMGONNA BE

IF I CAN'T"PRACTICE F

Copyright King Features Syndicate.Reprinted with special permission. All rights reserved.

nounced new efforts to helptoday's players beat the habitand to help prevent the next

generation from gettinghooked.

5

Know the DangersMouth Problems

Some problems caused bysmokeless tobacco may seemminor, like tooth stains, badbreath, and losing your taste forfood.

But chewing tobacco andsnuff can cause serious damageto your teeth and gums. Thesugar in smokeless tobacco cancause severe tooth decay. Thegrit in chew and dip can weardown the enamel surfaces of theteeth. And the strong chemicalsin chewing tobacco and snuffcan cause the gums to pull awayfrom the teeth in the placewhere the tobacco is held. Gumdamage is very hard to repair,and it can lead to tooth loss.

The most serious problemsare white patches and soresinside the mouth. Leatherywhite patches develop wherethe tobacco comes in contactwith the gum and cheek. Thesepatches, called leukoplakia (loo-ko-play-kia), are caused by thecancer-causing chemicals in thetobacco. They can turn intomouth cancer over time. Redsores also may be cancer warn-ing signs. These problems arenot rare. In a recent study,white patches were found inalmost half (46%) of over 400

Gum damage in a 24-year-old whodipped a can a day for four years

6

a" ° 0 0-eava

White patch (leukoplakia) in a 28-year -old who dipped snuff for 12years

major and minor league playerswho used dip or chew. Theywere most common in snuffdipperswhite patches werefound in 69% of the players whoused 2-3 cans of dip per week.

Warning Signals: Checkyour teeth and gums for dam-age and pull your lips back andlook closely at where you holdthe tobacco. If you see a whitepatch, a red sore that doesn'theal, or a lump on your cheek,tongue, or gums, see yourdoctor or dentist right away. Aspecial test (biopsy) may beneeded to see if it is precancer-ous. If a cancer does develop,it must be treated right away.Even if you don't see a problemnow, have your mouth checkedby a doctor or dentist every 3months.

Mouth Cancer

The toxic chemicals in chew-ing tobacco and snuff can causemouth, head, and neck cancerover time. Long-term snuffdippers are 50 times morelikely to get mouth cancer. Butlong-term users are not the onlyones at risk. Sean Marsee, an

Oklahoma track star, startedusing snuff at age 12. He died ofmouth cancer at the age of 19.Mouth cancer is very hard tocure. Some forms spread rapidlyto other parts of the body. Thisis why you should quit now,while you're ahead of the game.

"I dipped Skoal for only 6years. And right behind where Iput it, I had a growth that thesurgeon thought was benign. Itturned out to be cancer. I'mlucky they got it in time." (JackDavis, former minor leaguepitcher)

Former Cubs first-basemanSteve Fox also used chewingtobacco for 6 years. He devel-oped white patches in his mouthand a sore on his tongue thatdidn't heal. The doctors toldhim he had mouth cancer. Halfof his tongue was removed, andhe had to learn to talk all overagain: "Now, when I see ayounger player with the can in hisback pocket, I want to go up andgrab him and say, 'Why are youdoing this?' I want to tell himthat he can live without it, thatthere's no way it's worth the pricehe might have to pay, that no oneshould ever have to go throughwhat I went through."

A fatal mouth cancer in a 28-year-old who dipped a can a day for 10years

Are You Hooked on Nicotine?You become addicted

over time. Slowly, youmove to hard-core use.Many college, minor-league, and major-leagueplayers told us what thisprocess was like for them.To find out how addictedyou are, check the state-ments that apply to you.

Early Signs ofAddiction

You no longer get sick ordizzy like you did whenyou first used dip orchew. This is one of thefirst signs of addiction.

"My first dip was Copen-hagen. It was a hot Septem-ber afternoon and I wasshagging fly balls in centerfield. My buddy told me totry and I did. I'll never

forget how sick I felt."(Andy Van Slyke, Pirates)

"I started out dipping in1974. I was sitting in thebullpen and a guy said, 'Hey,try this' and gave me someSkoal. I put it on my lipand walked maybe 100 feetand I started getting dizzy.It made me almost sick, so Ispit it out. After 15 min-utes, I was all right. So Iwent back down to thebullpen and did it again.That's how I got started."(Dave Tomlin, pitchingcoach, Expos)

You find yourself dippingor chewing more often,and in more differentsettings. You've switchedto stronger products(with more nicotine).

"I first started dipping inthe park and soon I wasdipping all the time."

"It got to the point whereI needed a dip all the time.For every at bat I'd put in anew one."

"I started with Skoal andmoved up to Copenhagen.Before I knew it, I was doinghalf a can a day."

Know the Score onNicotine Addiction

Smokeless tobacco isjust as addicting as ciga-rettes. This is becausethey both contain nicotine,a highly addictive drug.There is nicotine in alltobacco products, butsmokeless tobacco con-tains more nicotine thancigarettes do.

Holding an average-size dip or chew inyour mouth for 30minutes gives you asmuch nicotine assmoking 4 cigarettes!

LOWEST > MEDIUM

HawkenRKodiakRSkoal BanditsR

SkoalR

A 2-can-a-week snuffdipper gets as muchnicotine as a 1-1/2-pack-a-day smoker.

Each tin of snuffcontains a lethal doseof nicotine.

All brands of snuff areharmful and addic-tive. But somebrands deliver moreharmful chemicalsand more nicotinethan others do:

HIGHEST

CopenhagenRRed ManR Snuff(not chew)

This list is provided for information only. The National CancerInstitute does not endorse the use of any tobacco product.

"Recognizing that I was addicted is what led me to quit.Being addicted to something, being controlled by something,goes against what I believe in." (Greg McMichael,Atlanta Braves).

10

7

Signs ofHard-core Useand Addiction

You fire in your first dipor chew early in the day.

"If you can dip beforebreakfast, that's when you knowyou're hard-core."

"I don't enjoy the first one ofthe day. But I have to have it."

1:1I You find it hard to gomore than a few hourswithout it. You start tofeel like you need it.

"When Igo too long withouta dip, I can't stop thinkingabout it."

"If I were sick to my stomachall day long, if I had the flu andwas bedridden, I'd still want tohave it."

1:11 You have strongcravings when you try toquit.

"I get real nervous andgripey and tense without it. Mylip hurts if I don't have it. I getshaky."

"Right after I quit, I was anervous wreck. Nicotine, Ineeded that nicotine. Theminute you walked by me and Ilooked at your pocket and sawyou had a lid in it, I'd ask youfor some, even if I didn't knowyou."

How do you score?

Give yourself one point forevery item you checked.

Add an extra point if yousmoke cigarettes on a daily orweekly basis.

If you scored 4 points ormore, you are probably highlyaddicted to nicotine.

To break this addiction,all you need is a week ortwo off tobacco, even ifyou're a hard-core user.Cutting back can make iteasier (see page 10). Socan nicotine gum or skinpatches (see page 12).

Making the Decision"I look at it the same way I

look at injuries. I think abouttaking care of things for thefuturefor those years downthe road. Do it now, quit forthe future." (Former dipperJeff Cooper, trainer,Phillies)

AN8

Where Are Youin Your Plans to Quit?

I'm not ready to quit yet.If you're really not ready to quit, save the next sectionof this guide for when you're closer to taking action.For now, look it over for ideas you can use when youare ready. See your doctor and your dentist forcheck-ups and ask about your risks. And talk to guyswho have quit.

I'm ready to quit in the next few weeks or months.You're ready for the next section! The 9-inning gameplan breaks quitting down into steps you can manage.

"You can't just say, 'I'mgonna quit.' You've gotta reallysay, hey, I'm gonna do it' andmean it, and do somethingabout it." (Tony Welborn,former minor leaguepitcher)

"When you decide to quit,you don't do it for the fans, yourfamily, or your friends. You doit for yourself only. It takes alot of willpower to quit. But itcan be done." (Mickey Cobb,former trainer, Royals)

EEDEZ _JEo_iff]n"

The best way to quit smokeless is to have a quit date and a quitting plan. Quitting onthe spur of the moment without a plan is harder. Quitting "cold turkey" is easier whenyou're prepared.

These next 8 pages give you tips from players who have quit or tried to quit. Kicking thesmokeless habit can be tough, but it can be done, and you can do it. These methods make iteasier. Try the ones you think will work best for you.

For extra help to set up a quit plan, you can call the National Cancer Institute's toll-freecancer prevention hotline at 1-800-4-CANCER (M-F, 9 a.m.-5 p.m.) and talk with an experiencedcounselor.

1st Inning:Decide to Quit

Quitting smokeless to-bacco is not something you doon a whim. You have to wantto quit to make it throughthose first few weeks offtobacco.

Know your reasons forstopping. Don't let resent-ment over outside pressuresor bans get in your way.

Focus on all you don't likeabout chewing or dippingthe mess, the inconven-ience, feeling that you'rehooked, the dangers. Seeyour dentist or doctor.Have your mouthchecked. Ask whysmokeless tobacco is badfor you. Find out howquitting can help.

Here are some reasons given by other players. Are anyof them important to you? Write in your own reasonstoo.

To avoid healthproblemsTo prove I can do itTo please a loved oneTo set a good examplefor my kidsTo set a good examplefor young fansBecause it's banned onthe fieldMy girlfriend hates it/My wife hates it

I:I My doctor or dentisttold me to quit

[:1 To keep a competitiveedgeI have sores or whitepatches in my mouthI don't like the tasteI have gum or toothproblemsIt's disgusting

1:1 I don't want it to controlmeOther reasons

is 12

"I started thinking about thenegative aspects of it [smokelesstobacco] and the positiveaspects. I couldn't come upwith any positive aspects. AndI just didn't see where I wasbenefitting from it."(Nolan Ryan, Rangers,NBC "Today Show," July31, 1990)

9

2nd Inning:Pick a Quit Date

The first step is to pickyour quit date. Even if youthink you're ready to quit now,we suggest that you take atleast a week to get ready.This gives you time to:

get psyched up for quit-tingcut back before you quitby tapering down, cuttingout dipping or chewing ina few of your favoritesituations, or switching toa lower nicotine snuffcheck with your doctoror dentist about nicotinegum or skin patches

There is no "ideal" time toquit, but some times arebetter than others. Low-stresstimes are bestlike the off-season or spring training,when you're under the least

pressure. Everyone has theirown quit timepick yours.

"I quit on my son's firstbirthday." (Glenn Hoffman,former Angel)

"I quit in the off-seasonbecause during the season,it was tough. You see every-body doing it and you think`I want one.' " (Tony Wel-born, former minorleague pitcher)

Having a quit date inmind is important, nomatter how far off it is.But it's best to pick a date inthe next month, so you don'tput it off too long. Pick a datethat looks good for you andwrite it in below.

My quit date will be:

3rd Inning:Cut Back BeforeYou Quit

Cutting back can makequitting easier. It can helpeven if you plan to quit "coldturkey" on your quit day.There are many ways to cutback. Three are describedhere. You can try any or all ofthem.

(1) Taper down. Cut backto half of your usual amountbefore you quit. If you usuallycarry your tin or pouch withyou, try leaving it behind.Carry substitutes instead-

10

gum, hard candies, sunflowerseeds.

"I tapered down and left thedip in my garage. That way Ihad to walk a way to get it."

"I'm trying to quit. Insteadof having two dips in themorning, I'll have one. I neveruse it anymore during a gameor practice."

(2) Cut back on whenand where you dip andchew. This will weaken yourhabit. First, notice the times

and places when your habit isstrongest. What eventstrigger dipping or chewing foryou? Do you always reach fora dip after meals? when youwork out? during battingpractice? when you're on thefield? on the bench or in thebullpen? relaxing withfriends?

'Whether it's taking groundballs or fly balls, if there's apoint in the game or during theworkout where it's not competi-tive, where you can just prac-tice and relax, that's when I'llwant to chew."

"I have to have one after ameal."

Now, pick three of yourstrongest triggers and stopdipping or chewing at thosetimes. This will be hard atfirst, but it makes a big differ-ence later. By the time youquit, you'll be used to goingwithout tobacco at the timesyou want it most.

1)

2)

3)

For instance, if battingpractice is one of your strong-est triggers, plan to stop chew-ing or dipping completelyduring batting practice. Don'tcarry your pouch or tin. Use asubstitute instead. If you can'tstop all at once, go as long asyou can (at least 10 minutes).

Try to increase this time asyou approach your quit day.

Notice what friends andteammates who don't dip orchew are doing at these times.This will give you ideas forsmokeless substitutes.

(3) Switch to lower nico-tine snuff if you're using amedium- or high-nicotinesnuff product like SkoaVor Copenhagen ?. This way,you cut down your nicotinedose while you're gettingready to quit. This can help toprevent strong withdrawalwhen you quit. Page 7 tellsyou how several brands stackUp.

"The advice I would give isthat if you started low, likeHawkenR and moved up theladder to SkoalR and then to

Copenhagen?, you should try tocome back down the ladder thesame way."(Dave Tomlin, pitchingcoach, Expos)

No matter how you cutdown, remember:

There is no safe way to usetobacco. The goal of cuttingdown or switching is to QUIT!The only health benefits comefrom quitting completely.

And don't switch to ciga-rettes! If you smoke, don'tsubstitute cigarettes for dip orchew. In fact, this is a goodtime to quit smoking. Thatway you can get over all yournicotine addiction at once.

4th Inning:Right Before Your Quit DayBuild a Support Team

Let friends, family, team-mates, and your athletictrainer know you're quitting.

Warn them that you maynot be your usual, won-derful self for a week ortwo after you quit. Askthem to be patient.Ask them if they'll be onhand to listen and en-courage you when thegoing gets rough.Suggest ways they canhelp, like joining you fora run or a walk, helpingyou find ways to keepbusy, telling you theyknow you can do it.If they've quit, ask themfor tips.

"I'd call up guys who hadquit on the phone and askthem for advice." (NormCharlton, Mariners)

If they use dip or chew,ask them not to offer youany. They don't have toquit themselves to be sup-portive, but maybe some-one will want to quit withyou.

"Two years ago, afriend and I quit to-gether, so we helpedeach other. We bothwent cold turkey andkept on each other."(Brad Robinson,former minorleague player)

0

11

Getting Ready for Quit DayThe night before your

quit date, get rid of all yourtobacco. Be sure to checkyour locker, your car, yourequipment bagany place youmight have stashed a tin orpouch.

Stock up on substitutes.Try gum, hard candies, cloves,cinnamon sticks, or toothpicks.A lot of guys like sunflowerseeds, made famous by ReggieJackson. Look for seedswithout salt.

Keep tobacco substitutes inthe same places you used tostash your dip or chew.

*What About NicotinePatches or Gum?

If you were bothered bystrong cravings or withdrawalwhen you tried to quit in thepast, nicotine skin patches orgum may help. They can reducecravings, tension, anger, andtrouble concentrating.

Nicotine patches and gumwork by giving you a low dose of

nicotine (without any of thecancer-causing chemicals intobacco). This way, you cangradually wean yourself off thenicotine while you focus onbeating the smokeless habit.

You must have a prescriptionfrom your doctor or dentist touse nicotine patches or gum.

Ask your doctor which is best foryouthe patch or the gum. Toavoid harmful levels ofnicotine, you must stop usingall tobacco before you startusing nicotine gum or skinpatches.

About NicotinePatches

Patches are worn on theupper body and arms. You use anew patch every day. Thematerials that come with yourprescription will give youdirections.

There are four different patchproducts HabitrolTM,NicodermR, NicotrolTM andProstepTM). They are similar,except in how many hours of theday they are to be worn (16 or 24hours) and for how many weeksthey are to be used. Most are tobe used for up to 3 months.

Most products use a step-down approach. Over time, thenicotine dose is reduced byusing smaller sized patches. Forinstance, the dose might be 21mg (for 4-8 weeks), 14 mg (for 2weeks), and then 7 mg (for 2weeks). Ask your doctor ordentist how long you should usethe patch and when or whether

12

you should switch to a lowerdose.

The most common patch sideeffect is skin irritation. To helpprevent rash or swelling, be sureto move the patch to a new spotevery day. If you have a hardtime falling to sleep at night, or ifyou are bothered by baddreams, ask your doctor abouttaking the patch off beforebedtime.

"Quitting was a lot easier withthe patch. I just didn't get thosestrong cravings. "(Rod Carew,Hitting Instructor, CaliforniaAngels)

About NicotineGum

Nicotine gum (NicoretteR)comes in 4 mg and 2 mgstrengths. Starting on your quitday, use one piece of gum every1-2 hours. Add more pieceswhen you feel tense or on-edge.Do not use more than 30 pieces

15

of the 2 mg gum, or 20 pieces ofthe 4 mg gum, a day.

For the gum to work, youmust use it properly. Do notchew it like regular gum. In-stead, chew each piece SLOWLYuntil you feel a tingle in yourmouth. Then stop chewing andhold it between your cheek andgum until the taste or tingle isgone. Then chew it again.Throw each piece away after 20-30 minutes.

Chewing the gum too fast ortoo long can cause hiccups,nausea, gas, or a burning sensa-tion in the mouth or throat. Ifthis happens, take the gum out,wait 15 minutes, then chew anew piece, slowly.

Carry the gum with you allthe time. But don't let it be youronly tobacco substitute. Start tocut back after 3-4 weeks. Worktoward stopping the gum in 3-6months. If you start with thestronger gum, you can switch toa lower dose before you stop thegum.

5th Inning:

Quit Day!Make your quit date

special right from the begin-ning. You're doing somethinggreat for yourself.

Change daily routines tobreak away from tobaccotriggers. Try changing theorder in which you shower,dress, and eat breakfast. Getright up from the table aftermeals. Use time on the bench

to take a few laps around thefield.

Make an appointment toget your teeth cleaned.You'll enjoy the fresh, cleanfeeling and a whiter smile.

Keep busy and active.Start the day with a longer runor workout. Aerobic exercisewill help you relax--running,jogging, walking, cycling,

swimming. Plus, it boostsenergy, stamina, and all-around fitness and curbs yourappetite.

Stick with low-caloriesnacks if you're concernedabout your weight. Try pop-corn (without butter), sugar-free gums and mints, freshfruits, and sliced vegetables.

Read 6th- and 7th-inningtips for the next 2 weeks.

6th Inning:Your First Week OffSmokeless and CopingWith Withdrawal:The First Week Is the Hardest

Withdrawalsymptoms don'tlast long.Withdrawal isstrongest the firstweek after youquit. The worstpart is over after 2weeks. After amonth, you'll feelbetter than whenyou chewed ordipped. So bepatient withyourself.

For these reactionsUrges to dip, cravingsespecially in the placesyou used to dip the most

Feeling irritable, tense,on-edge, restless, impatient

Trouble concentrating,feeling "spacey"

Constipation/irregularity

Hunger, a craving for sweets

Try

Waiting it out (each urge lasts only3-5 minutes, whether or not you dip orchew). Deep breathing and exercisehelp you feel better right away. Trythe 3 D's (see the next page).

Walking away from the situation.Deep breathing and exercise to blowoff steam. Ask others to be patient.Nicotine gum or patches help, too.

Going easy on yourself. You'll thinkand feel better soon.

Adding fiber to your diet (whole grainbreads and cereals, fresh fruits andvegetables).

Drinking GatoradeR or fruit juices.Reach for low-calorie sweet snacks(like apples, sugar-free gums, andcandies).

13

The 3 D's:For Getting ThroughTough Times

Deep breathing: Takefour slow, deep breaths inthrough your nose andout through your mouth.Great for high-pressuresituations.

+++Doing something else:Reach for gum, seeds, ornontobacco mint orherbal smokeless substi-tutes; take a quick walk;leave the scene of theurge. +++

Drinking water: Upto 8 glasses a day. Icechips are good, too.

Some Players Look Back on TheirFirst Two Weeks Off Dip and Chew

"When I first quit, it wasn'tbad. I was ready for the shakesand cravings. I chewed a lot ofgum when I first stopped. Now Ionly chew gum when I'm on themound."(Danny Darwin, Red Sox)

"I just quit cold turkey. I'd getcravings after lunch and dinnerand would chew lots of bubblegum and sunflower seeds."(Norm Charlton, Mariners)

"The first day was the worst. Iwas counting the hours. In twoweeks, I felt fine." (SteveDavis, former Blue Jay)

14

17

"The first three days, I wascrazy. I chewed gum and toldmyself I just was going to do it.After two weeks, I was out of thewoods. I felt much better."(Ted Landon, former minorleague pitcher)

"For the first two weeks, I wasalways looking for tobacco. Afterthat, as long as it was out ofsight, it was out of mind. Ichewed a lot of gum. " (GlennHoffman, former Angel)

"I climbed the walls for 2weeks and was extremelyirritable. The best thing I did tocope with tobacco cravings was togo for a run. Any physical activityhelped. Or I'd get up and getsome coffee." (Dick Martin,trainer, Twins)

7th Inning:

Your Second Week Off andDealing With Triggers

You've made it through thehardest partthe first week.If you can stay off one week,then you can stay off 2. Justuse the same willpower andstrategies that got you this far.

Cravings may be just asstrong this week, but they willcome less often and go awaysooner. Other signs of pro-gress (the 7th inning stretch!)

Withdrawal symptomsease up;Food tastes better; andYour confidence on thefield starts to return tonormal.

"I had high blood pressurelast year. When I quit the dip,it returned to normal."(John Franco, Mets)

"I wake up in the morningmore clear-headed now. Myblood pressure is down and myaerobic capacity is up."(Terry Mulholland, Phillies

Be Prepared forTemptation

You're probably still both-ered by tobacco thoughts andurges. They will be strongestin the places where you dippedor chewed the most.

The more time you spend inthese places without dipping orchewing, the weaker the urgeswill become.

Know what events andplaces will be triggers for youand plan ahead for them.

We asked a few players todescribe their triggers:

"Every once in a while I getthe urge when I smell the stuffor see someone doing it. I findmyself reaching into my backpocket."

"Spring training: Igowithout a dip all winter, andonce I come into the park Iwant a dip."

"Boredom, sitting in thedugout, fishing in a pond,hitting a golf ball."

"Right after a meal or whileI'm having a drink."

"Putting my cleats on."

Players who quit describehow they coped with triggers:

"Smelling it still triggersurges, and I counter them bythinking how harmful dip canbe."(Dick Martin, trainer,Twins)

"I still get urges from time totime when I see someone dip-ping. So I get up, walk of andhave a piece of gum or coffee.`Out of sight, out of mind.'"(Danny Darwin, Red Sox)

Write down some of your triggers. And writewhat you'll do instead of dip or chew. It may be assimple as reaching for gum or seeds, walking away,or thinking about how far you've come.

Triggers What I'll Do Instead

IS

15

8th Inning:Tips for Goingthe Distance

Congratulations! You'vebroken free of a toughaddiction. If you can stay off2 weeks, then you can stay offforever.

Keep using whateverworked when you first quit.Don't expect new rituals totake the place of smokelessright away. You know, it tooktime to get used to chewing ordipping at first, too.

Keep up your guard.Continue to plan ahead forsituations that may catch youoff guard.

What if youshould slip?

Try not to slip, not evenonce. But, if you do slip, getright back on base.

Don't let feelings of guiltlead you back to chewingor dipping. A slip doesnot mean "failure."Figure out why youslipped and how to avoidit next time.Get rid of any leftovertobacco.Pick up right where youleft off before the slip.

If slips are frequent, oryou are dipping or chewingon a regular basis, make anew quitting plan. Quittingtakes practice. The smokelesshabit can be tough to beat.Most users don't quit for goodon the first try. Don't give up!Figure out what would havehelped. Try a new approachnext time. Talk to your doc-tor, athletic trainer, or coachfor extra help. Or call 1- 800 -4-CANCER.

"The biggest reward isknowing that you did it."(Tony Welborn, formerminor league pitcher)

9th Inning:Celebrate Your Success!

Congratulations!You've done it. You'vebeat the smokelesshabit. You'reimproving your healthand your career. Therewards that come withquitting will make youa better player.Celebrate with thepeople on your"support team." Offeryour support to friendsand teammates whoare trying to quit.

16

"Kicking the tobacco habitwas a personal victory for me.It gave me a real sense ofaccomplishment and pride."(Rod Carew, HittingInstructor, CaliforniaAngels)

1 0

1/

CreditsAuthorsC. Tracy Orleans, Ph.D.Gregory N. Connolly, D.M.D., M.P.H.Stephen Workman, M.P.H.

ContributorsThomas M. Di Lorenzo, Ph.D.Herbert Severson, Ph.D.

Editorial AdvisersGayle Boyd, Ph.D.Virginia Ernster, Dr.P.H.Thomas Glynn, Ph.D.Marianne Haenlein, Ph.D.Sherry Mills, M.D., M.P.H.Barbara Rimer, Dr.P.H.John Slade, M.D.

Dedicated toJoseph W. Cullen, Ph.D.

Special ThanksTo the players, coaches, trainers, and team physicians who shared theirexperiences with us and gave us suggestions about this guide, especiallyto Ned Bergert, Mickey Cobb, Jeff Cooper, Ron McClain, and DavidWatson, M.D., and to the Major League Teams Physicians Association andthe Professional Baseball Athletic Trainers Society for their sponsorship.

Other AcknowledgmentsRichard Amacher, Athletes Against Tobacco: Pennsylvania Division,Bobby Evans, Linda Fleisher, Richard Hansen, Jack Henningfield, SusanGeorge, Mark Leavitt, William R. Lynn, Joan Magee, Jeffrey McKenna,Brian O'Gara, Jeffrey Orleans, Jesse Orleans, Paul Prox, Luis Salcedo,Nina Schneider, and Janet Telepchak

Additional Photo CreditsCalifornia AngelsThe National Collegiate Athletic AssociationThe Professional Baseball Athletic Trainers Society

Special NotePlayer affiliations are for the year 1993 unless otherwise noted. Donrusscards courtesy of Leaf, Inc., Bannockburn, IL.

Produced byThe development of this guide was supported through contract # NO1-CN-05275 from the National Cancer Institute (Project Officer, William R.Lynn). For more information about smokeless tobacco, or for additionalcopies, call NCI's Cancer Information Service at 1-800-4-CANCER.

June 1993 Third Edition (6/93)

29

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National Institute of Dental Research

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NIH Publication No. 94-3270

Revised June 1993

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