Quitting smoking is by no means an easy task to accomplish. Almost every smoker has had this experience, at least after the first quit attempt. Before you decide to quit smoking, you need to understand two basic things.
How are cigarettes addictive? Why is quitting smoking so hard?
There are many good reasons to quit smoking: the negative impact on daily life, the smell on clothes or hands, family, friends and partners who don’t approve of the habit, and the most obvious and important reason — irreversible damage to your health. These concerns are justified because the probability that a lifelong smoker will die prematurely from the consequences of smoking is about 50 per cent.
Tobacco addiction: toxins and the role of nicotine
Cigarette smoking is the main cause of cancer, cardiovascular disease and lung disease - the consequences of years of ingesting more than 4000 toxins per cigarette. One of the most well-known substances contained in cigarette smoke is nicotine. What many people do not realise is that whilst nicotine is addictive, it is almost insignificant in the development of smoking-related diseases. These are mainly caused by the numerous toxins of tobacco combustion.
In fact, nicotine is one of the primary reasons why smokers continue to reach for cigarettes. This is further supported by a study from the USA, stating: Seventy per cent of smokers say they want to quit smoking and every year 40 per cent quit for at least one day. Within the first month, 80 per cent already relapse into addiction and every year only three per cent succeed in quitting smoking. Nicotine is absorbed most efficiently into the lungs via inhalation when smoking cigarettes. After being absorbed through the extensive lung tissue, it goes from there directly into the bloodstream. The substance reaches the brain within 10 to 20 seconds. The faster the nicotine reaches the brain, the greater the feeling of relaxation and the addictive potential.
Physical and psychological challenges of quitting smoking
Tobacco addiction, like all other forms of addiction, consists of an interplay between two components. On the one hand, physical (physiological) aspects play a role; on the other hand, learned or conditioned behaviour (psychological) is also of great importance. In order to be successfully smoke-free, it helps to become aware of the underlying mechanisms in the body and psyche.
Physical dependence - neurotransmitters provide positive feelings
The effect of nicotine in the brain is decisive for physical dependence: it binds to nicotine-sensitive receptors of nerve cells in the brain's reward centre, which leads to the release of dopamine. Dopamine is one of the messenger substances which enables the communication between nerve cells and causes positive emotional experiences (such as feeling relaxed or calm). This is the first step leading to addiction because experiencing this feeling of positivity leads the person to reach for the cigarette again. In response to repeated nicotine intake, the number of binding sites on the nicotine-sensitive receptors in the brain increases, and tolerance develops.
The amount of nicotine ingested during daily smoking leads to an almost complete saturation of these receptors. Each cigarette smoked during the day leads to a constant nicotine concentration in the blood plasma, therefore preventing withdrawal symptoms from occurring. Symptoms of withdrawal become noticeable in smokers during smoke-free periods, as the body begins to break down nicotine immediately after the last puff. As a result, binding sites are no longer occupied by nicotine. When this occurs, a renewed desire to smoke develops, which is only satisfied by smoking a cigarette.
Aside from nicotine, other components of cigarette smoke are also responsible for the development and maintenance of tobacco addiction. Condensation products in cigarette smoke, so-called monoamine oxidase inhibitors, slow down the breakdown of neurotransmitters such as dopamine, which increases the addictive potential of cigarette smoke.
During nicotine withdrawal, the happiness hormone dopamine is released less strongly, and positive feelings are absent. Feelings of anxiety and stress also arise, which are strong incentives to relapse. The resulting negative feelings are additionally due to the activity of neuronal networks that are also activated in stress reactions. The smoker in withdrawal often resigns and interrupts the attempt to stop smoking. This leads to a relapse.
Psychological dependence (conditioning) - the neuronal aspects in the brain.
At the same time as the dopamine release in the reward centre caused by nicotine, areas of the brain involved in learning processes are also activated. The fatal thing is that smoking and its perceived positive effect become associated with certain situations – the cup of coffee in the morning, a good meal or a conversation with friends, a visit to a bar – as well as actions related to smoking – taking the cigarette – sensory perceptions while smoking – smell, taste, feeling of smoke in the throat – and emotional states – stress, sadness. The repeated experience of such situations changes neuronal connections in the brain so that long-lasting conditioning to these stimuli develops, resulting in psychological dependence. The desire to smoke is partly maintained by such conditioning.
Smokers who attempt to stop smoking feel a very intense and recurring urge to reach for a cigarette again. This feeling remains long after the withdrawal symptoms have subsided and is triggered again and again by certain moods, situations or external factors associated with smoking. If these neuronal connections in the brain are not sustainably broken through a change in behaviour and identity, smokers can often relapse again months or even years later.