He tried them all: group therapy, hypnosis, nicotine gum and a multitiered program whose most memorable feature was a rubber band. He wore it around his wrist and snapped it hard -- very hard -- whenever his lungs cried out for smoke.
Now, after a string of failed attempts to kick a 40-year tobacco habit, Maryland's top health official can finally say it: "The almost painful craving is gone."
It has been 10 months since Health Secretary Nelson J. Sabatini smoked his last cigarette, far longer than any past stretch without the lethal weed. He knows better than to claim final victory, but he talks like a man who is beginning to savor the likelihood of success.
"I don't honestly believe I am a true nonsmoker yet," said Mr. Sabatini, 52, who started smoking in his teens. "I really hope I don't have a cigarette tomorrow. But I feel pretty good. Pretty good that I've finally been able to do it."
Patch releases nicotine
This time, Mr. Sabatini used the nicotine patch, the latest and, some believe, the most effective weapon in the nation's anti-smoking arsenal. Changed daily for approximately three months, the patch releases a slow trickle of nicotine into the bloodstream, satisfying but slowly withdrawing the patient from the craving that keeps millions of Americans hooked.
Scientists writing recently in the Journal of the American Medical Association reported that the patch produced six-month abstinence rates of 22 percent to 42 percent -- an extraordinarily high rate for any anti-smoking tool.
Although the health secretary gives the patch plenty of credit, he says there were other powerful forces at work.
First, there was his growing discomfort as a pack-a-day smoker running Gov. William Donald Schaefer's campaign to lower Maryland's sky-high cancer death rate -- the worst in the nation. The contradiction gnawed at him.
"It was kind of stupid and hypocritical to be in this job and $H smoke, to campaign for prevention," he said.
Credit, he said, also goes to the news photographers who dogged him outside Senate hearing rooms, hoping to catch him cigarette-in-hand as he waited to testify for priorities such as a tobacco tax increase. He said they unwittingly reinforced his resolve to quit.
And finally, four decades of smoking had taken their toll on his lungs. He had an irritating wheeze, a smoker's cough and a disturbing hiss whenever he exhaled while trying to sleep. "You can't empty the lungs -- it's trapped air," he said, adding that the condition seemed to clear up just weeks after he smoked his last cigarette.
Colleagues had been troubled by his labored breathing for years. Dr. Mary Mussman, the health department's physician-adviser, said she noticed it as soon as Mr. Sabatini arrived at the agency five years ago as deputy health secretary.
"All of us mentioned at the time that we liked the guy, but we better not get too close to him and expect his leadership because he's a walking time bomb," she said.
But they developed a close affection for him and began gently cajoling him to quit. Over the years, co-workers would take him aside to inquire about his health. Dr. Mussman recalled how she and a local physician walked him out to his car one day and gave him a little pep talk.
"He acted kind of surprised that somebody would take enough interest in his health and the role smoking was taking on his health to walk him out to his car," she said. "I think he was softening up then."
Several years ago, he and his wife, Marilyn, reached an accord: If he couldn't quit for all time, at least he could refrain from smoking in her presence. "I know enough about smoking and addiction to know that no one can make you quit smoking if you don't want to do it yourself," Mrs. Sabatini said. "I know that doesn't work. So it was just a mutual thing."
The secret smoker
She said her husband was so good about honoring thei agreement that at restaurants he would frequently slip off to the men's room to light up rather than smoke in her presence.
"Our friends started to say, 'Why don't you just let him smoke?' They were beginning to thinking he had a problem with his kidneys."
He can laugh now at the creative excuses he dreamed up to smoke in privacy.
"I'd take the garbage out in stages. I'd do a lot of errands. I'd fill the car with gas. I'd run out and get firewood, one log at at time. I'd smoke out the window. You know, you can smoke in the shower," he said.
Mrs. Sabatini also smoked in the early 1960s, when the two were students at Lewis University in Illinois. That was before the surgeon's general's warning. Tobacco companies hired students to distribute free packs, and smoking seemed a mark of sophistication.
Later, during her first pregnancy, she gave up cigarettes and acquired an aversion to the smell of burning tobacco. But he kept on smoking.