Nicotine Addiction: Why Is It So Hard To Quit Smoking? | CCFANicotine Addiction: Why Is It So Hard To Quit Smoking? | CCFA
30 Sep
Nicotine Addiction: Why Is It So Hard To Quit Smoking?

According to a 2018 Canadian Community Health Survey, almost 11% of Canadians smoke cigarettes each day. Another 5% identify as occasional smokers, and a little over 21% used to smoke every day but have since given it up. Of everyone who has smoked at least one whole cigarette during their lifetime (roughly half of the Canadian population aged 12 and older), roughly three quarters have, at some point, been daily or occasional smokers (the remainder are “experimental” smokers who tried it once only) [1].

In spite of concerted efforts by governments around the world to reduce smoking, about one fifth of the world’s population engaged in regular cigarette smoking in 2016, including more than 24 million children aged 13-15[2].

In spite of these numbers, which indicate that most people who try smoking end up as regular or semi-regular smokers, the use of cigarettes is generally regarded as a bad habit rather than a nicotine addiction. According to several studies, though, six or seven out of ten smokers want to quit in the next six months, and it may take the average smoker as many as thirty attempts before they are able to quit successfully [3].

These figures do not factor in the troubling rise in the use of electronic cigarettes (e-cigarettes), or “vaping”, which is increasingly prevalent especially among young adults: about 31% of Canadians aged 20-24 years claim to have tried electronic cigarettes in 2015 [4].

Why is smoking so harmful?

Cigarette use is the leading cause of preventable death in adults in both Canada and the United States. The danger comes from multiple sources: according to the American Lung Association, traditional cigarettes contain about 600 ingredients, at least 69 of which are known carcinogens. When cigarettes are burned, they produce over 7,000 chemicals, posing significant risk not only to the smoker, but to those who are in close proximity [5].

Nicotine [6]

Classed as a stimulant, nicotine is a nitrogen-containing chemical that is produced naturally by tobacco plants, and synthetically in laboratories. Not only is nicotine highly addictive, it exposes people to other ingredients in cigarettes that are dangerous.

The appeal of nicotine is that it improves memory and creates a heightened sense of alertness, while simultaneously making the user feel relaxed. Like most addictive substances, it creates a surge of dopamine – the feel-good chemical in the brain – leading to a sense of contentment.

However, nicotine also comes with a host of harmful side effects that can affect almost all of the body’s systems. These include the following:

  • Narrowing of the arteries due to plaque on the arterial walls
  • Increased risk of blood clots
  • Insomnia and nightmares
  • Dizziness and headaches
  • Digestive complaints, such as ulcers, diarrhea, nausea and vomiting
  • Increased risk of stroke
  • Muscle aches and pains
  • Increased risk of diabetes

In addition, smoking during pregnancy can result in risks to the child, such as obesity, diabetes, high blood pressure, developmental delays, and behavioural challenges.

The fact that it takes most smokers several attempts to break their addiction is testament to the belief held by many that nicotine is at least as difficult to give up as heroin. While there is no physical danger to stopping “cold turkey”, this can result in some uncomfortable withdrawal symptoms, including:

  • Cravings
  • Emotional symptoms, such as depression, anxiety and mood swings
  • Irritability
  • Inability to pay attention to a task at hand
  • Restlessness, especially at times when the person would typically be smoking, such as after meals
  • Weight gain

Smoking and cancer

Although nicotine itself does not carry any known cancer risks, at least 69 of the chemicals in cigarettes do. These chemicals include benzene, chromium, cadmium, acetaldehyde, ethylene oxide, and many more [7].

According to the Canadian Cancer Society, 72% of lung cancer cases in Canada are a result of smoking, with smokers 20 times more likely to develop lung cancer than non-smokers.

The risk does not end there: smokers are at increased risk of developing the following cancers [8]:

  • Mouth
  • Laryngeal
  • Lung
  • Liver
  • Pancreatic
  • Ureter
  • Ovarian
  • Cervical
  • Bladder
  • Colorectal
  • Kidney
  • Stomach
  • Acute myeloid leukemia
  • Esophageal
  • Pharyngeal
  • Nasal cavity

Is the damage done by smoking permanent?

Many people who have been smoking for a long time believe that since the damage done is permanent, there is no point to them stopping. However, people of any age, who have been smoking for any length of time, can experience health benefits, some of which start almost immediately after the last cigarette was smoked.

The following is a timeline, starting from the quit date, of how and when giving up smoking can impact a person’s health [9]:

  • 20 minutes to one hour: the heart rate returns to normal, blood pressure starts to drop, and circulation starts to improve
  • 12 hours: excess carbon monoxide is flushed out of the body, increasing oxygen levels
  • 1 day: blood pressure continues to drop and oxygen levels in the body continue to rise, making physical activity noticeably easier
  • 2 days: damaged nerves responsible for smell and taste start to heal, resulting in a richer sense of smell and improved appetite
  • 3 days: the last of the nicotine works its way out of the system, producing withdrawal symptoms – this is the point at which the former smoker is at highest risk of relapse
  • 1 month: lung capacity improves, coughing and shortness of breath decrease, and athletic strength and endurance increases
  • 1-3 months: circulation continues to improve
  • 9 months: the cilia – hair-like structures in the lungs responsible for the expulsion of mucous – recover from smoking-related damage, resulting in a decrease in the frequency of lung infections
  • 1 year: the risk of coronary heart disease decreases by half
  • 5 years: blood vessels shed the plaque that was narrowing them, and the risk of dangerous blood clots and strokes starts to fall
  • 10 years: the risk of developing lung cancer has halved, and the risk of mouth, throat and pancreatic cancers is significantly less
  • 15 years: the risk of coronary heart disease and pancreatic cancer has reduced to the same level as that for someone who has never smoked
  • 20 years: the risk of smoking-related deaths has dropped to the same level as that for a nonsmoker

What are the best ways to quit smoking?

There is no way to get around the fact that quitting smoking is extremely difficult. According to the Ontario Tobacco Research Unit, most smokers who attempt to stop start smoking again about a week later.

The good news is that the longer you can stick it out, the more your chances of success improve. Someone who has been smoke-free for two years has a 92% likelihood of staying that way [10]. The cessation aids that are effective vary widely from person to person, and are discussed below.

Nicotine replacement therapy [11]

While some people revert to smoking as a result of stress or an inability to abstain in the presence of friends and family members who smoke, the number one cause of relapse is the nicotine withdrawal symptoms.

Nicotine replacement therapy (NRT) has been devised as a way to reduce these withdrawal symptoms and improve the chances of the person trying to stop smoking. It works by enabling the former smoker to ingest nicotine in a less harmful format while eliminating exposure to the harmful chemicals in cigarettes.

NRT comes in several forms, including gum, nicotine patches (transdermal nicotine systems), nasal sprays, lozenges and inhalers.

You can improve your chances of success with nicotine replacement therapy by following these tips:

  • NRT is designed to help manage the physical symptoms of withdrawal from nicotine. It is most effective when used in conjunction with a smoking cessation aid like counseling or a support group, that will help you with the psychological symptoms.
  • Start using NRT as soon as you stop smoking, instead of waiting for a day or two.
  • Ensure that you use your NRT aid for a long enough period of time. Many people stop using it too soon and revert to smoking.

NRT should not be used without the advice of a doctor in the following circumstances:

  • You are still smoking or using any other tobacco products
  • You are a child or teenager
  • You are pregnant or breastfeeding
  • You smoke fewer than ten cigarettes a day – in this case, a lower dose nicotine patch may be better

Counseling and support groups

Like most addictions, smoking is often rooted in context. People smoke their first cigarette for all kinds of reasons, such as peer pressure, a desire to “fit in”, and as a response to a stressful situation. Through individual counseling, you can be guided through the process of exploring the issues that made you start or continue smoking. With the help of a therapist, or through the stories of people who have been through experiences similar to yours, you can learn some tools and coping strategies to use at times when you would regularly smoke. This method can be highly successful when used with lozenges, nasal spray, nicotine gum, or other aids that are designed to help with symptoms of nicotine withdrawal.

Prescription medication [12]

An extended-release form of the antidepressant bupropion (Zyban) has been approved by the FDA as a smoking cessation aid. It works by increasing the levels of some of your brain chemicals, thereby reducing cravings and nicotine withdrawal symptoms. Since bupropion takes several days to take effect, it is most effective if you start your prescription about a week prior to your planned quit date.

Another prescription alternative is varenicline (Chantix). This medication controls withdrawal symptoms by blocking the nicotine receptors in your brain. Like bupropion, it should be started about a week before you smoke your last cigarette.

Self-help

In some cases, people can stop smoking without the use of any smoking cessation aids. You have a greater probability of succeeding if you have a quit plan that lays out how you are going to quit. Some tips that may help ensure success include the following:

  • Consider whether you are going to quit “cold turkey” or gradually reduce your consumption of cigarettes.
  • Choose a cessation date several weeks in advance, and use the intervening time to improve other aspects of your lifestyle, such as nutrition and active living. This can help accelerate the health benefits when you do quit, and it can get you into the psychological mindset of following a healthy lifestyle.
  • Find a healthy ritual that you can follow at times when you would usually light a cigarette. This could mean doing a few clues of a crossword puzzle, knitting a couple of rows of a sweater, or reading a few paragraphs of a book.
  • Implement a no-smoking rule in your home for people who visit.
  • Avoid places where you are more likely to encounter large numbers of smokers.
  • Get rid of smoking-related items, such as ashtrays and lighters.

Final thoughts

Everyone is different – former smokers will tell you that the experience with smoking cessation varies widely from person to person. Some people can go it alone, while others may need Zyban, nicotine gum, or nicotine patches. If you are wanting to quit smoking, it is important that you don’t do so impulsively, by following the method that worked for your brother, your co-worker, or your neighbour. Different things work for different people, and you will be more likely to succeed if, before your planned quit date, you take some time to think about what is most likely to work for you and how you can best control the craving.

And if you do revert to smoking, don’t be down on yourself. That simply means that the method you tried was not quite right. Revisit your plan, see what tweaks you can make, and try again! Within days, you will start to feel like a healthier version of yourself.

Sources

  1. https://www150.statcan.gc.ca/n1/pub/82-625-x/2019001/article/00006-eng.htm
  2. https://www.swissinfo.ch/eng/world-no-tobacco-day_a-graphic-look-at-global-smoking-trends/44152766
  3. https://bmjopen.bmj.com/content/6/6/e011045
  4. https://www.canada.ca/en/public-health/corporate/publications/chief-public-health-officer-reports-state-public-health-canada/2016-health-status-canadians/page-14-what-influencing-health-smoking.html
  5. https://www.lung.org/stop-smoking/smoking-facts/whats-in-a-cigarette.html
  6. https://www.medicalnewstoday.com/articles/240820.php
  7. https://www.cancer.gov/about-cancer/causes-prevention/risk/tobacco/cessation-fact-sheet
  8. https://www.cancer.ca/en/prevention-and-screening/reduce-cancer-risk/make-healthy-choices/live-smoke-free/smoking-shortens-lives/?region=qc
  9. https://www.medicalnewstoday.com/articles/317956.php
  10. https://www.otru.org/documents/quitting-smoking-in-ontario/
  11. https://www.cancer.org/healthy/stay-away-from-tobacco/guide-quitting-smoking/nicotine-replacement-therapy.html
  12. https://www.mayoclinic.org/healthy-lifestyle/quit-smoking/in-depth/quit-smoking-products/art-20045599

Photo credit: Rosewoman. This picture has a Creative Commons attribution license.

Canadian Centre for Addictions

These posts are written by the staff of CCFA based on the ongoings and observations in the addictions and recovery industry. We're a private drug and alcohol rehab with an inpatient location in Port Hope, Ontario, Canada and an outpatient location in Toronto, Ontario, Canada.

Addiction Problem, Cigarettes, Nicotine, Quitting Smoking

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