Why Is it Hard to Quit Smoking?

Smoking is an Addiction

Of all the chemicals present in cigarettes, nicotine has been identified as the addictive agent by the American Heart Association. Similar to other addictive drugs, nicotine causes changes in the brain that lead to cravings and withdrawal symptoms. Nicotine addiction causes pharmacological and behavioral changes in the user, causing the smoker to continue using tobacco despite knowing the associated health risks according to the National Institute on Drug Abuse.

Nicotine affects the body immediately after inhalation. With every cigarette smoked, the smoker ingests one to two mg of nicotine. Considering the typical smoker takes 10 puffs per cigarette, that translates to 10 "hits" or doses of nicotine per cigarette. Someone who smokes a pack a day receives 200 hits of nicotine daily. Nicotine has a cumulative effect, building in the bloodstream with each puff. Although the half-life of nicotine is two hours (that is, it takes the body two hours to eliminate half the dose), each puff represents a separate dose and nicotine can persist in the body of a smoker up to eight hours after the last cigarette has been smoked. Immediate effects of nicotine include increased blood pressure, heart rate and blood flow and narrowed arteries. The carbon monoxide present in cigarette smoke robs oxygen from the blood, starving organs. Nicotine immediately stimulates the adrenal glands, which release adrenaline that further increases blood pressure, respiration and heart rate and gives the smoker a feeling of euphoria or energy. Nicotine also stimulates reward pathways in the brain, causing feelings of pleasure and reinforces the addiction.

As with other addictive substances, quitting smoking is associated with withdrawal symptoms that may begin within hours after smoking the last cigarette and last for months. Typical withdrawal symptoms include irritability, restlessness, impatience, hostility, anxiety and depression. Other symptoms may include attention deficit, sleep disturbances and increased appetite. Certain behaviors associated with smoking, such as the smell of tobacco or the process of handling and smoking cigarettes, can heighten the withdrawal symptoms.

Quitting smoking and breaking free of the addiction is difficult, so much so that 85 percent of all smokers who try to quit fail. However, quitting is possible. Nicotine is found in all tobacco products, including smokeless products, so switching from cigarettes to chewing tobacco will not effectively break the addiction. A number of nicotine replacement therapies are available to help wean smokers from nicotine addiction. Nicotine gum and skin patches contain lower overall nicotine levels than tobacco, but they effectively relieve withdrawal symptoms. Since these products do not provide the pleasurable aspects of smoking, they are not addictive and have little potential for abuse. Prescription medications, such as Zyban and Chantrix, are also available. These medications act on brain receptors and block the effects of nicotine if the smoker relapses and smokes a cigarette. Whatever nicotine replacement method is chosen, behavioral therapy is recommended. Support may be found in group discussions, one-on-one sessions with a therapist trained in addiction or online support groups. Behavioral support, either alone or combined with nicotine replacement therapy, enhances the likelihood of quitting.