Smoking Out The Tobacco Urge
Tue, 01/31/2012
Israel Correspondent
A nurse in the pulmonary institute gives a patient a pulmonary function test.
A nurse in the pulmonary institute gives a patient a pulmonary function test.

Jerusalem — Naomi Ohayon, a 52-year-old mother of four, smoked for over 30 years until she quit the habit — hopefully for good — a month ago. “I’d tried just about every stop-smoking program out there,” Ohayon said from her home in the southern city of Beersheva. “Once, I quit for three days, the other times I couldn’t stop at all.”

Ohayon, who has asthma and chronic obstructive pulmonary disease (COPD), said she became increasingly motivated to kick the habit as her health deteriorated.

“I couldn’t breathe. It was difficult to sleep. I desperately wanted to quit but I was addicted. But my oldest son begged me to quit, over and over, so I kept trying,” she said.

Eventually, Ohayon’s quest brought her to the Smoking Cessation program at Shaare Zedek Medical Center in Jerusalem, an hour-and-a-half-long drive from her home. The only hospital-based anti-smoking program approved by the Ministry of Health, it opened to the public a year and a half ago and has a success rate topping 50 percent.

“I feel very good. Baruch Hashem, I can breathe better. I can walk much more outside — stroll even. I thank God and his messengers at the hospital,” Ohayon said, her voice growing emotional.

Although Israel’s anti-smoking laws have made it increasingly difficult for Israelis to light up in most public places, many of those who have been smoking for years continue to find it nearly impossible to quit. 

According to the Ministry of Health, 23.8 percent of Israeli adults smoke. About 33 percent of Jewish men and 25 percent of Jewish women smoke, while 40 percent of Arab men smoke, but only 10 percent of Arab women.

An alarming 11 percent of Israeli students in the 10th and 11th grades (ages 16-17) smoke on a regular basis.

Gabriel Izbicki, director of Shaare Zedek’s Pulmonary Institute, which runs the smoking cessation program, said his program relies on a multi-disciplinary approach, in the belief that addiction is a complex matter that requires both physical and mental health support. 

“We’re the only program that mixes pulmonary doctors and an addiction specialist, especially with regards to tobacco addiction,” Izbicki said. “We work on the psychological aspects of addiction and, if needed, prescribe various drugs.” 

Unlike programs offered by the country’s HMOs, which treat large groups of patients with one approach, Shaare Zedek’s program is customized for each patient.

Patients must fill out a questionnaire and learn about the medical risks of smoking and the benefits of quitting. Participants are placed in small groups of 10-15 people, which allows for group support. Each participant undergoes a pulmonary function test for the early detection of emphysema. Patients are then interviewed by a respiratory technician or therapist, who may also instruct them on proper breathing exercises for those who already have decreased breathing abilities.

A physical examination and interview with a lung specialist then follow. The patient also meets with a psychiatrist for mental evaluation and support. The psychiatrist looks for underlying problems and stresses in the patient’s life, stresses that may lead to smoking or undermine a patient’s ability or desire to quit. Regular counseling is available as needed throughout the entire yearlong program. Regular group meetings are scheduled, as needed, for additional peer support. The doctors may also prescribe different medications that help patients to stop smoking. 

“After the first two or three weeks, the group meets again and, based on the exams and questionnaire, are given personalized treatment,” Izbicki said. We see them again after four to six weeks, when they must stop smoking.”

Patients are encouraged to call a hotline to report any problems or to simply seek support.

“They get back to me within 24 hours, even Dr. Izbicki,” Ohayon said. “That’s helped a lot.

About 100 patients attend the program, whose $250 fee (not reimbursed by the HMOs, which have their own programs), covers the costs of tests, the program’s nurse and the addiction specialist.

The physicians run the program to help society, and receive no payment, Izbicki emphasized.  

Although the program has helped two groups of young people, the doctor said, the majority of participants are considerably older.

“If we work with people in their 50s and 60s, they usually have some sort of irreversible damage. It’s never too late, but the effect is much bigger if we’re able to stop or prevent smoking in teens and young adults.”

Izbicki said that “thousands” of smokers would benefit from the program, “but can’t, because they can’t afford it.”

Ohayon said she had already spent thousands of shekels before turning to Shaare Zedek, but that “if it works, it’s worth it.”