The heart attack that Terese Erdelen had in November may be the nudge she needed to stay focused on her goal to quit smoking.

"I want to stay alive, and smoking doesn't do it," said Erdelen, 52, of St. Louis. "I don't want to go through (a heart attack) again."

Erdelen started smoking at 16 "to be like my friends."

During the next 36 years, efforts to quit lasted days or weeks at most.

"I always gave in," she said. "For me, part of it was a stress reliever. If I got stressed or anxious, I'd have a cigarette; any kind of slightly stressful situation, too many things going on, pulling me in a direction."

Stress was one of several triggers that told her to light up. And stress came in the form of social situations, jobs at work and home. Another trigger was simply the clock.

"I was accustomed to smoking at certain times of the day," she said. "In my car, on my lunch break. It's because that's the time to do it."

In September, she and a co-worker who often took smoking breaks together became stop-smoking buddies.

The effort was going well. Erdelen used nicotine patches, an over-the-counter replacement for the addictive ingredient in cigarettes.

"It helped me; took the edge off," she said.

But the wake-up call came in the first weekend of November. "I played in a golf tournament. I was tired, but it didn't feel like anything was happening."

But that night "I woke up coughing violently and I had severe chest pains," she said. "I couldn't catch my breath. I had pains along my jaw line, up and down my arm."

At St. Clare Health Center in Fenton, doctors implanted a stent to open a blocked artery.

Heart disease exists on both sides of her family, so she can't pinpoint that smoking caused the heart attack.

"But I feel like smoking accelerated any problem that might have been there," she said.

Once she started her cardiac rehabilitation at St. Mary's Health Center in Richmond Heights, she signed up for a new smoking cessation program there that starts next week.

Francesca Ferrentelli, one of the counselors with St. Mary's new smoking cessation program, said the program will deal mainly with the emotional and social components of cigarette addiction.

The sessions "help to find patterns, stressors, things that make them want to reach for a cigarette," Ferrentelli said. "Once we've identified those, we try to change their patterns of behavior.

"Our goal is to help them stay quit," she said.

Dr. Thomas Siler, a pulmonologist in private practice, said a smoking addiction is tough to end.

"We've heard heroin addicts say it was easier to end a heroin addiction than to stop smoking," Siler said. The addiction to nicotine is what makes cessation a monumental task, he said.

"It's the only drug I know of that both stimulates and relaxes," Siler said. "A smoker who wants to be calmed down, smokes a cigarette; he gets tired and needs a pick-me-up, he smokes a cigarette."

The cigarette smoke efficiently delivers the drug directly into the lungs and blood stream, he said.

"You can control how much you get by the depth of the drag on the cigarette," he said.

The smoke also delivers tar, a combination of substances including toxins that cause cancer and respiratory diseases, he said.

"There are some effective ways to quit smoking," he said. "But you have to want to quit. You have to put some effort in it."

The average smoker will quit repeatedly before quitting for good, he said. In addition, patients tell him of cigarette cravings years after stopping, he said.

Erdelen knows the challenge. She says she has no options.

"Where before, I knew I should do it. Now I want to do it; I have to," she said. "I want to be able to say I did everything I could."