Why Is It So Hard To Quit?

You need to remember your smoking habit has been developed over a number of years. It is a “facilitated” process. You were not born a smoker. No one is genetically inclined to smoke. You were NOT predetermined to be a cigarette smoker. There might be genetic vulnerability to dependence or obsessive compulsive issues but not specifically to smoking or tobacco use. Usually in the teenage / adolescent years you started thinking about smoking. You started experimenting with it. You may have started to use regularly: on the weekends, several days a week, every day.

You started off “bumming” cigarettes from your friends. You smoked only a few cigarettes a day but it was now time to supply your own cigarettes. Maybe you became the supplier and shared with your friends. A few cigarettes turned into a half a pack. May be up to a full pack. But do you remember? It’s a little difficult to quantify how much you were smoking back then because you bought a pack of cigarettes. Some were for you, some for your friends. You ran out so you used some of your friends’ cigarettes until you could get another pack. When did you start buying cigarettes by the carton? This is adolescence / early adulthood.

90 percent of smokers started by the age of 21, and half of them became regular smokers by their 18th birthday. Everyday, approximately 4,000 children between 12 and 17 years of age smoke their first cigarette; an estimated 1,300 of them will become regular smokers. Half of them will ultimately die from their habit.

Then you transitioned from regular use to dependent use. Dependence involves neurologic changes within the brain, such as changes in (can you guess) nicotine receptors! Dependence also involves behavioral associations which are unique for the smoker in the pharmacologic response to nicotine, i.e. urges. You need to smoke to prevent the start of withdrawal symptoms. This is the magic point where it is exceedingly more difficult to stop smoking. It is so difficult at this point the expected smoking cessation long-term success rate without assistance is only three percent.

Physiology of nicotine addition vs. physiology of the “pleasure centers”

It is a habit. It is part of your daily routine. Just as you sleep, eat, go to the bathroom, you also smoke. It is ingrained into your life.

You are psychologically dependent.

You are physically dependent to smoking. This aspect is characterized by stimulating the pleasure response in the brain and creating a false sense of a “relaxed state” (which, as mentioned in other parts, is actually alleviating the beginnings of withdrawal). Nicotine dependence has many similarities to cocaine, amphetamine and opioids (heroin and narcotic pain killers) by increasing dopamine in the nucleus accumbens in the brain. There are nicotinic acetylcholine receptors throughout the central nervous system.

You are “addicted” to nicotine. The term “addiction” can be problematic. Even the medical community has changed the definition over the course of many years. The three classic criteria are:

(1) Tolerance – A condition in which higher doses of a drug (nicotine) are required to produce the same effect as during initial use; often leads to physical dependence.

(2) Withdrawal (physical dependence) – The characteristic signs and symptoms that appear when a drug that causes physical dependence is regularly used for a long time and then suddenly discontinued or decreased in dosage.

(3) Compulsion (psychological dependence) – An irresistible impulse to act, regardless of the rationality of the motivation.

You are behaviorally dependent.

You are ritually dependent. You buy your cigarettes at the same place. You have a ritual of how you “prepare a pack,” open the pack, put the cigarette in your mouth, light the cigarette, inhale the cigarette, blow the smoke, flick the ashes, crush out the cigarette.

You are socially dependent. How many of your friends smoke? How much of your recreational life involves smoking? I am in the hopes this aspect is lessening due to restrictions of smoking in public access locations. But there are still backyard picnics, tailgating at sporting events, etc. in which smoking is as much a part of the social event as conversation, food, and wine…