Blame Bogart and Bacall
Feb. 19, 2001 -- Back when Humphrey Bogart and Lauren Bacall attracted moviegoers in hordes to To Have and Have Not, Key Largo, Dark Passage, and other flicks, part of the appeal was Bogie's suave lighting of his-and-her cigarettes. Sexy, sexy, sexy.
Of course, that was before the U.S. Surgeon General's warning about the health risks of cigarettes, and these days we know better. Yet knowing and doing can be two different things: Plenty of real-life couples still mimic the movies, smoking not just after sex but while watching TV, talking about the family budget, drinking coffee, or discussing problems. Need to stall when your partner asks why the checkbook balance is so anemic? Take a drag before you answer. Waiting on your always-late beloved? Temper your anger with a smoke.
Trouble can brew, however, when one or both spouses decide it's time to give up cigarettes. Whether they enroll in smoking cessation classes or try self-help measures, they probably aren't taking into account the role smoking plays in their relationship and the needs it serves. And so, their chances of success are dimmed.
That's the view of Arizona researchers who say smoking can serve many functions in a relationship, and that couples who are aware of that -- and learn substitute behaviors or develop substitute rituals for smoking -- may stand a better chance of becoming long-term quitters.
"Smoking doesn't happen in a vacuum," says Michael J. Rohrbaugh, PhD, professor of psychology and family studies at the University of Arizona, Tucson. "It becomes part of the relationship pattern and keeps it going."
Rohrbaugh and five colleagues are studying the idea that smoking is intertwined within an intimate relationship, their work funded by a grant from the National Institutes of Health's National Institute on Drug Abuse. So far, 13 couples, ranging in age from their 30s to their 60s, are enrolled in the study. The goal over the next two years of the three-year study is to enroll a total of about 50 couples, and to determine if taking the role of smoking into account will help make them long-term nonsmokers. To qualify for the study, the couple must include at least one partner who smokes at least a half pack a day despite having a heart or lung condition.
The stories Rohrbaugh's team has heard so far from couples (whose names have been changed here) in the university-funded pilot study bear out their hunches.
There's Mary, a long-term smoker, who says she heads to the back porch, cigarettes in hand, when she wants to be alone. Her solo smoking is a clear signal to her partner that she needs her space.
There's Joe and Evelyn, who light up every morning, sitting in the garage on their favorite lawn chairs. It's their time to talk, Evelyn says, adding, "If we didn't smoke in the garage, I doubt we'd talk much -- and he wouldn't even miss me."
And there's Ann, who says she talks better when she has a cigarette in her hand. She always smokes when she and her husband, Harry, argue. When Rohrbaugh's team observed this couple in the lab, using one-way mirrors, the couple spoke more softly to each other, and more intimately, when they were smoking.
How the program begins
In the first of 10 counseling sessions, spread over three to six months, the team assesses how, and to what extent, smoking fits into a couple's relationship. Is smoking seen as an ally, an invader, or both?
Drawing on medical literature that has studied problem drinkers and how they interact in an intimate relationship, Rohrbaugh's team notes that researchers find drinking can be "a kind of lubricant that promotes positive relationship stability, at least in the short run." Smoking, he says, sometimes serves the same function.
The relationship dynamics are different, the Arizona researchers have found, if only one partner smokes. With two smokers, they have found, smoking serves functions not just for the individual (stress reduction, boredom relief) but can be "the glue that holds the relationship together."
When both partners smoke, Rohrbaugh has found, they can have a mentality of "It's us against the world," especially as fewer Americans smoke. About 28% of the U.S. population, age 12 and older, smoked in 1998, according to the National Institute on Drug Abuse.
On the other hand, when just one partner smokes, the habit can become a source of tension, with the nonsmoker nagging the other to quit, and the smoker defiantly refusing.
Finding new rituals
In the early sessions, "we try to plant seeds of how things can be different,'' Rohrbaugh says. They suggest that couples who smoke together envision a smoke-free life and what it might mean. Better health? An easier time socializing with nonsmoking friends? No more pressure from family members or friends to quit?
The couples also might think about what could replace their smoking habit in specific situations. Instead of a post-sex smoke, perhaps a soak in the Jacuzzi, a warm shower, special music, or aromatherapy candles would suffice.
Partners who use cigarettes to signal to a nonsmoking spouse that some time alone is needed must develop another strategy to communicate that need.
By session three, Rohrbaugh's team hopes the couples or smoking partner are ready to set a quit date. They offer advice on tapering-down aids such as nicotine patches and other medications.
Smokers call the study leaders daily to report in, informing the research team about how many cigarettes they smoked the day before, what their feelings were, what their relationship experiences were, and other details.
Other authorities weigh in
Those who work with smoking cessation programs and couples counseling say the concept makes a lot of sense. For years, Harriet Braiker, PhD, a Los Angeles therapist, has told smoking couples she counsels: "You need to understand the function smoking is playing in the relationship."
The possible scenarios are many, she says. Two smokers who quit together may have a hard time trusting that the other is not cheating by smoking in private. If one partner quits, the reformed smoker may have a holier-than-thou attitude. Nagging also can affect the relationship.
Braiker remembers a reformed smoker married to a smoker, who refused to kiss her husband because of his tobacco breath. This went on, she says, for four years. They had sex -- and two kids -- but no kissing.
Some couples have told Braiker that smoking brings them closer. "It's an odd kind of togetherness," she says. One couple told her: "So, we'll die at the same time."
Nina Schneider, PhD, a UCLA researcher who has investigated nicotine sprays and other cessation methods, says the concept studied by Rohrbaugh makes sense to her, too. But she awaits additional scientific scrutiny of it, and says comparisons of quit rates should be made between smoking couples who receive the counseling about smoking's effect on relationships and those who do not. But it the idea bears out, she says, it would be a welcome addition to help those who thus far haven't been able to escape tobacco's grasp using existing methods.
Kathleen Doheny is a Los Angeles health journalist and regular contributor to WebMD. Her work also appears in The Los Angeles Times, Shape, and Modern Maturity magazines.
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