Why is it so hard to quit?
Smokers are not weak willed nor are they simply making a bad lifestyle choice. They are victims of a powerful drug addiction.
The vast majority of smokers in Australia want to quit, and most make repeated attempts to do so. About 40% of smokers try to stop smoking at least once each year.
However, long-term quitting is an elusive goal for many smokers. Only about one in 25 smokers who tries to quit ‘cold turkey’ is successful. Even among those who do quit, there is a steady drop off over time. After being abstinent 12 months, about one in two quitters will relapse at some time.
Most smokers keep failing to quit because they are addicted to nicotine. Within several hours of quitting, smokers experience powerful urges to smoke and nicotine withdrawal symptoms, such as irritability, restlessness and disturbed sleep. Nicotine has been rated by drug addicts as the most difficult drug of all to give up.
About eight out of 10 smokers are addicted to nicotine.
Eighty per cent of adult smokers start smoking before 18 years of age, usually for all the wrong reasons. Adolescents are very sensitive to nicotine and quickly become addicted. Ten per cent of teenage smokers start to become addicted within two days of inhaling from a cigarette for the first time.
We now know that some people are more prone to becoming addicted to nicotine than others. 60-70% of the chance of becoming addicted is determined by your genes.
For example smokers who metabolise (break down) nicotine more quickly are generally more addicted. These patients smoke more cigarettes and find it harder to quit.
Like other drugs of abuse, such as cocaine and heroin, nicotine acts on the reward pathway in the brain. Nicotine gets to the brain in 10-20 seconds and attaches to the receptors on the brain cells, like a key in a lock. This releases dopamine which can produce a feeling of pleasure. As you smoke more, the brain makes more nicotine receptors and you become more and more needy of nicotine.
Within a few hours of the last cigarette, the dopamine levels fall and cravings and withdrawal symptoms develop. As a result, you need another cigarette to feel normal again, and the cycle continues.
Click here to see a video on how nicotine acts in the brain.
Other reasons why people smoke
Over the years, smoking becomes part of your daily life. You learn to associate smoking with certain activities such as drinking a cup of coffee or the smell of smoke. Exposure to the trigger creates a strong urge to smoke (a conditioned or learned response). Quitting means changing your routines, avoiding certain places or trigger situations.
Also, nicotine can make smokers feel more alert, temporarily relieve anxiety or depression, reduce hunger and may help to control of body weight. Some people smoke partly for these effects.
Some people feel that smoking gives them comfort and company and is their ‘best friend’ and experience a powerful sense of loss or grief when they quit.
Doctors now see smoking as a chronic (long-lasting) medical illness. Most smokers try and fail to quit repeatedly and this is a normal part of the process of quitting. Don’t be too hard on yourself if have an unsuccessful quit attempt. Very few smokers quit easily on their first attempt.
The only real failure is to stop trying. Each time you try to quit, you learn something and it is easier next time.
Although some smokers can quit without help, many need assistance. However, for most people motivation to quit is just not enough and it is necessary to get professional advice and support along with using stop-smoking medication.
The best time to quit is now. For every year you keep smoking your life expectancy is shortened by 3 months on average. Smokers live 10-12 years less than non-smokers and the earlier you quit the sooner the healing can begin.
How addicted are you?
The Fagerström Test for Nicotine Dependence is used to assess how addicted you are to the smoking habit. Smokers with a higher score generally find it harder to quit and may need more support and more intensive treatment.
Click here to do the test.
For a more detailed discussion of nicotine addiction click here.