Why it's so hard to quit smoking — and how to boost your odds of stopping for good
If you or someone you know has unsuccessfully tried to stop smoking, know that it’s an incredibly common experience. “Studies show that those who attempt to quit smoking make about six attempts before completely stopping smoking, and, therefore, relapse is the rule and not the exception,” Mary Rezk-Hanna, assistant professor at the UCLA School of Nursing, whose research focuses on tobacco-related diseases, tells Yahoo Life. “The good news is that approximately 70% of smokers want to quit.”
If so many people want to stop, why is it so difficult? The main culprit is nicotine, which is a highly addictive substance that breeds both a psychological and physiological dependence. Here’s what you need to know about how nicotine reliance starts — and how to increase the odds of ending it for good.
How nicotine works
If nonsmokers had a three-step system as simple as light, inhale and exhale to achieve a sense of euphoria, surely they would become dependent on it too. And that’s basically what nicotine does to smokers. Mariya Javed-Payne, a somatic psychotherapist with Awaken Consulting Services who specializes in addiction, explains that an inhale of tobacco smoke infiltrates the blood-brain barrier — the hard-to-permeate wall of cells that protects the brain from infection — and triggers the release of feel-good hormones like dopamine, serotonin, glutamate, norepinephrine and acetylcholine.
Dr. Maya Vijayaraghavan, director of the UCSF Smoking Cessation Leadership Center, adds that all of this happens within 20 seconds, which is why it’s so easy to go back for another hit. Nicotine is also a stimulant that can increase focus, notes Javed-Payne, which is another reason people rely on it.
Repeatedly following this cycle convinces the brain it needs nicotine just to feel OK, according to the Centers for Disease Control and Prevention. The dependence, of course, is also at the expense of smokers’ health because, along with nicotine, they inhale carcinogens within tobacco, including hydrogen cyanide, formaldehyde, arsenic, ammonia and carbon monoxide. Rezk-Hanna notes that these harmful chemicals aren’t present just in cigarettes, but also in pipe tobacco, cigars and hookah shisha.
While smoking is initially mentally addictive, over time it becomes physiologically addictive too, meaning going without it can prompt physical withdrawal symptoms such as irritability, restlessness, anxiety, insomnia, difficulty concentrating and fatigue, says Vijayaraghavan.
“Smoking, like all addictions, is a self-soothing behavior,” says Javed-Payne. “The brain and body become habituated to using a substance to regulate emotions and stress. Self-soothing is core to our neurobiology and lives in the deep brain, where emotions are regulated. Addictions tend to ‘hijack’ this area of the brain, where our reward pathways and emotional regulation live, and create a loop of cravings, withdrawal and behaviors to soothe the discomfort.”
Expert-recommended tips to quit smoking
Tobacco use is the leading preventable cause of death, contributing to 480,000 deaths annually, according to the Food and Drug Administration. Quitting smoking completely can add as much as a decade to your life, along with the positive environmental and public health impact it has by eliminating second- and third-hand smoke, Rezk-Hanna points out. If you’re looking to quit smoking, or want to help someone you know, try this expert advice:
Follow the 2-method approach
Experts agree that a combination of pharmaceutical intervention (such as nicotine patches) and psychotherapy has been shown to be the most effective in quitting smoking.
Therapy “can be very supportive in helping an individual understand how smoking is a coping mechanism, and to address the underlying emotional drivers that contribute to the behavior,” Javed-Payne explains. “Therapy can also help you develop new coping strategies, which are necessary for quitting a behavior.” Group psychotherapy can be especially instrumental in not feeling alone and finding peers who are going through the same process, she adds.
Nicotine replacement therapies such as nicotine patches, gum, lozenges, inhalers and nasal spray “have also shown great efficacy” in helping people quit, says Vijayaraghavan. What’s more, “they all are covered by Medicaid, and the gum, lozenge and inhaler are available over the counter,” she notes.
Lifestyle changes that support a healthy mind-body connection and lower stress, such as meditation, breath work and exercise, may also make quitting easier. “Brisk walking and being out in nature can be a good stress reliever, produce endorphins and provide a healthy alternative,” Javed-Payne suggests. “There are also wonderful apps out there nowadays that can be a cheerleader and coach on your quitting journey, sending you daily affirmations and reminders.”
While some people successfully quit cold turkey, Vijayaraghavan stresses that assisted attempts like the above are much more likely to be successful — and no one should be ashamed of utilizing tools that are proven to work.
Have a plan
“Setting a quit date and sticking to it can help you plan your path to being nicotine-free,” says Javed-Payne. “Planning in advance how you will manage triggers and cravings and alternative coping strategies can increase your success.” Smokefree.gov can help you create a personalized plan.
Know that e-cigarettes may not be the answer
A new study published in Cochrane Database of Systematic Reviews found that e-cigarettes may help smokers quit more effectively than traditional nicotine replacement. However, the experts Yahoo Life spoke with are leery about the findings. “Currently, e-cigarettes are regulated as tobacco products and not as cigarette smoking cessation aids,” says Rezk-Hanna. “We do not know the health risks associated with long-term use of e-cigarettes.”
The CDC says they can contain harmful substances, and Javed-Payne notes that e-cigarettes are “just as addictive” as smoking. “Although they may have fewer chemicals than regular cigarettes, they contain many harmful substances that can lead to cancer and other chronic illnesses,” she says. “There is still research to be done on the long-term effects of vaping and e-cigarettes. Several compounds have been identified in e-cigarettes that are known to be toxic and carcinogenic.”
In contrast to the new study’s findings, Vijayaraghavan points out that observational studies and meta-analyses have shown that consumer use of e-cigarettes that are available on the market, unsupervised and outside of clinical trial conditions, does not aid in smoking cessation. And many people who use e-cigarettes also smoke conventional ones, she adds, “increasing addiction and harm.”
Guidance from the United States Preventive Services Task Force states: “The evidence is insufficient to assess the balance of benefits and harms of using e-cigarettes for tobacco cessation.” Only when e-cigarettes “pass” the efficacy and safety tests, meaning they are truly effective in long-term smoking cessation and do not cause long-term harm, Vijayaraghavan says, can they be considered as medication or a medical device. “In this scenario, they could be considered a smoking cessation aid and be available with a prescription and under supervision of a health care provider,” she says.
Seek support — and keep trying
Javed-Payne recommends talking to family, friends and a physician who can offer guidance and regular reminders about the benefits of quitting. “It’s OK if it takes multiple tries,” she says. “Nicotine is sneaky and it can feel like having one cigarette won’t hurt, but as the saying goes, ‘One is too many and a thousand isn’t enough.’ It can often reactivate the reward pathway and start the cycle again.”
She shares: “When I finally quit smoking, after attempting at least 60 times, I kept a list in my pocket all day for all the reasons I wanted to quit and would pull it out when I had a craving. I had another list of alternatives that I could do instead of smoking. The lists would center me back when I had an urge, and after putting some days together, the obsession finally left. I am now nine years smoke-free.”
