With Mayo Clinic behavioral counselor Jennifer A. Kern, M.S., C.T.T.S.

One thing that I've seen come up in a number of reader comments is the fear of quitting tobacco use. Fear is a powerful animal and frequently a driving force in determining the choices we make. People generally go to great lengths to avoid what they fear, because it means venturing out of a comfort zone and into a new, unfamiliar reality.

There are several ways in which fear is directly linked to tobacco cessation or the resistance to it that I think are worth mentioning.

For one thing, as previously stated many people fear the discomfort that tends to accompany withdrawal. Some dread the mood changes and even physical symptoms that can result from stopping tobacco use. As we've discussed, the proper use of medications can minimize these symptoms and help you manage the chemical and physiological changes you may experience.

Another thing that some people fear when quitting is the sense of loss that may come with giving up that "old friend." It's not uncommon to go through a kind of mourning period when quitting tobacco use. Many feel they are losing a companion of sorts — "someone" who used to celebrate with them and cry with them, "someone" who has been a consistent, reliable part of their daily life for years. Dealing with the grief process that ensues is an important part of quitting for the long haul.

Others find that they fear a change in identity. In our society, there is a strong distinction made between "smokers" and "non-smokers." If you've always seen yourself as a "smoker," the status change to becoming a "non-smoker" can be daunting, even if it is a positive change. This may be complicated by a larger group identity, where smoking is present in social or family interactions. Joining the smoke-free camp may mean no longer fitting in with a group in the same way as before. Such a change can be intimidating since groups generally provide a sense of belonging and thereby a certain level of security.

As if these weren't enough, there is also a general epidemic fear of the unknown. As human beings, we like things that are reliable, consistent, foreseeable. Making changes in our lives is something we fear, because we cannot know in advance what the outcome will be. By breaking away from our familiar habits we surrender our comfort and subject ourselves to the risky state of unpredictability. What we usually find, however, is that once we face our fears they no longer have any power over us; we become free and stronger beings.

Fear has a profound presence in our lives and a strong influence on our behavior, yet it can be conquered. I open the floor to all of you and look forward to your thoughts on the fear factor.

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