Why is it so Hard to Stop Smoking?

October 5, 2016

Health and wellness is a growing global trend as more and more people agree that in order to thrive you need to be healthy both physically and mentally. So you exercise regularly and you eat your five portions of fruit or veg daily, but healthy behaviour means very little if you smoke.

Research has shown that on average every cigarette smoked shortens a smoker’s life by about eleven minutes. So if you calculate smoking over a lifetime it reduces life expectancy by seven to eight years. And if the smoking doesn’t kill you, it has a myriad of other ways of making your life a misery: smoking facts show that it increases the risk of stroke, angina, emphysema, high blood pressure, thrombosis, asthma, cataracts, ulcers, erectile dysfunction and many more. Smoking is the single most preventable major cause of illness and early death, with nearly 1 in 5 deaths (in those aged 35 and above) caused by a smoking related disease.

Most smokers are well aware of the health risks.

So why do nearly 1 in every 5 adults continue to smoke?

And, why are 95 to 97% of unsupported quit smoking attempts unsuccessful?

Why is it so hard to stop smoking?

Tobacco smoke comprises of about 4000 different chemicals. These chemicals can be broadly divided into three main categories;


hydrocarbons or tars and

carbon monoxide – a poisonous gas.

It is widely acknowledged that it is the nicotine in cigarette smoke that keeps smokers hooked. When a smoker inhales tobacco smoke the nicotine is rapidly absorbed through the lungs into the bloodstream where it is carried directly to the heart and reaches the brain in around 6 seconds. In the brain the nicotine stimulates a receptor which activates the dopamine “reward” pathway with a massive release of dopamine, the feel good hormone. The smoker experiences an elevated mood and a feeling of calmness. Unfortunately this is short lived and within minutes the feeling starts to dissipate. In order to get the same feeling again the smoker needs to smoke another cigarette. To maintain this feeling the smoker needs to smoke regularly and if they miss a smoke they are effectively “punished” with nicotine withdrawal symptoms and a powerful urge to smoke. These withdrawal symptoms include anxiety, depression, irritability, listlessness and poor concentration. Having a smoke immediately extinguishes these symptoms and hence the perception that smoking reduces anxiety when in fact it is nicotine withdrawal that is causing the anxiety. Nicotine and other addictive drugs tap into a natural evolutionary mechanism that ensure that rewarding activities such as eating, drinking and sexual activity are repeated. This positive reinforcement mechanism operates primarily in the subconscious, setting up a powerful motivational urge to smoke which is often in conflict with the smoker’s beliefs, thoughts and plans. Health professionals involved with the treatment of addicts were asked to rank various habit forming drugs on their addictive potential on a scale of 1 to 100; 1 being low and 100 being high. Nicotine scored 99 out of 100 above crack at 97 and smoked metamphetamine at 98. This gives you an indication of how highly addictive nicotine is considered and why it is so notoriously difficult to treat.

Although the nicotine in tobacco is the main culprit for perpetuating the smoking habit, it is not the only factor supporting smoking behaviour.  Smokers report that they enjoy the sensory and tactile components of smoking, including the hand-mouth activity, taste, smell and sensations along the airways, and if these sensations are removed smoking satisfaction declines even when nicotine is replaced to prevent nicotine withdrawal.  So, aside from the powerful nicotine dependence, there are also sensorimotor cues that form part of this powerful recipe for smoking addiction.

To make the life of any smoker contemplating stopping smoking even more challenging there are additional factors called triggers that influence this addiction. Triggers, or secondary reinforcers, are formed when a habit is learned in the presence of repeated actions or circumstances. An example is having a smoke with a cup of coffee, or with a drink at a party. The pleasure experienced while smoking becomes linked with certain activities. If we use a 20-a-day smoker who puffs on each cigarette approximately 12 times we have a process repeated 240 times a day. Multiplied over a year this process is repeated 87 600 times. Over a decade this reinforcement process is repeated almost a million times! It’s no wonder the smoking habit becomes so deeply entrenched with these triggers or cues. This becomes a real challenge for smokers who are trying to quit smoking and encounter one of their triggers or cues.

Stopping smoking is hard and many ex-smokers say that quitting smoking was the hardest thing they ever did. However, millions of smokers have managed to quit smoking and any smoker who really wants to stop smoking can.

The best way to quit smoking involves a combination of the following:

  • A willingness to stop smoking – sounds simplistic but a smoker must want to quit smoking
  • The right attitude – to believe that they can stop smoking
  • Support – to teach problem solving, coping skills and to guide the smoker
  • Behaviour modification – trigger avoidance and management, creating a healthier lifestyle
  • Medication – products to help quit smoking & assist with nicotine withdrawal (if indicated)

Smokers who are serious about improving their health by stopping smoking should consider using an evidence based tobacco cessation programme give them their best chance of success.

Tips to quit smoking

Current research proves that the best way to quit smoking is through a tobacco cessation program which includes support, behavioural modification and traditional nicotine replacement therapy such as medical nicotine gum or patches.

You can triple your chance of successfully stopping smoking by using a combination smoking cessation programme such as GoSmokefree. Visit www.gosmokefree.co.za or email info@gosmokefree.co.za for more information.





This article contains opinions and facts and references to other information sources. You should always consult a registered healthcare professional for any personal advice.

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