Why is it difficult to quit smoking?

It is estimated that almost two-thirds of smokers in the UK want to quit smoking. But, only 30-40% of them will try to quit annually. In fact, ASH (Action on Smoking and Health) claim that 60% of current smokers say that they find it hard to go even one day without a cigarette. So why is it so difficult to quit?1

If you're one of the many smokers who wants to quit, it's important to understand the physical and psychological aspects of quitting, as well as the options available to help you on your journey.

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Physical aspects

The nicotine contained in tobacco is what makes smoking so addictive. In fact, it's addictiveness is compared to that of heroin or cocaine. When you inhale tobacco, nicotine is absorbed by the lungs and travels quickly to the brain. When it reaches the brain, it alters the balance of two chemicals – dopamine and noradrenaline. This alteration provides smokers with a temporary feeling of relaxation and a change to their mood and concentration that most find pleasant.

When you quit smoking your body is deprived of nicotine, and you start to suffer physical withdrawals and cravings for it. You can begin to feel these withdrawals as quickly as 30 minutes after your last cigarette, when you will begin to start craving the next one. When you quit smoking you may suffer from physical symptoms such as:

  • Intense cravings for nicotine
  • Headaches and difficulty concentrating
  • Common cold or flu-like symptoms
  • Nausea, constipation or diarrhoea
  • Fatigues, dizziness or insomnia
  • Increased hunger, appetite or craving for sugar
  • Irritability, anxiety or depression

The good news is that these physical symptoms peak two to three days after quitting and usually disappear within weeks.

Psychological aspects

Even though the physical withdrawals only last for a few weeks, some people can find themselves craving cigarettes long after this. These long-term cravings are because there are psychological aspects to quitting, not just physical.

Smoking is a habit and over the years a smoker can become psychologically dependent on cigarettes – using them to combat boredom, anxiety and stress or as a social crutch. When quitting smoking, you may find your life is surrounded by psychological triggers that make you crave a cigarette long after the physical nicotine addiction is gone. Typical triggers are:

  • Feeling bored, stressed or anxious
  • Drinking alcohol or having a cup of coffee
  • First thing in the morning or after a big meal
  • Driving in your car
  • Breaks from work
  • New social situation
  • Being around other smokers

For many long-term smokers, there can also be an emotional element to smoking – the feeling that they have lost their best friend.

But despite these psychological aspects, studies show that quitting can actually have a hugely positive effect on your mental health. A 2014 study published in the British Medical Journal found that those who quit smoking experienced a reduction of depression, anxiety and stress. They have improved positive moods and quality of life compared to current smokers.2

Nicotine in the new age

A new age of nicotine replacement therapy (NRT) products now provides smokers with multiple options to replace their nicotine supply temporarily as a quitting aid to wean smokers off of cigarettes and tobacco over time. These include the following types of NRT:

  • Nicotine gum
  • Nicotine tablets and lozenges
  • Nicotine patches
  • Nicotine inhalers and sprays (nasal spray and mouth spray)

The idea is that by temporarily maintaining the body's supply of nicotine without smoking cigarettes, you can first deal with the psychological aspects of breaking the habit, before reducing your dosage and dealing with the physical aspects. A study by the Cochrane Library involving 50,000 participants across 150 trials that the rate of quitting smoking increased by 50 to 70% when using NRT.

A course of nicotine replacement therapy (NRT) will normally last eight to twelve weeks in total. The dosage you will require when you begin using a NRT treatment is dependant on how often you smoke. This dosage will decrease throughout the course of treatment until you eventually stop.

Some of the side effects associated with nicotine replacement therapy include:

  • Headaches
  • Skin irritation (caused by patches)
  • Nose / throat / eye irritation (caused by nasal spray)
  • Dizziness
  • An upset stomach
  • Sleeping difficulties

Effect of e-cigarettes in the 21st century

E-cigarettes (also referred to as vaping) have become hugely popular alternatives to smoking cigarettes in the 21st century. Refillable containers contain nicotine and flavours, but no tobacco. Some see them as a healthier alternative to traditional smoking as they don't contain the tar and carbon monoxide found in tobacco products.

In recent years, many smokers in the UK have started to use electronic cigarettes as a quit smoking aid. However, as they are a relatively new product the long term health effects and success rates of e-cigarettes are not yet known. They run on batteries and are generally difficult to obtain. Also, when an e-cigarette breaks, the user is more likely to return to smoking regular tobacco in order to keep nicotine cravings at bay. E-cigarettes do contain fewer chemicals and can also aid psychological factors that are associated with quitting smoking by essentially keeping your hand busy.

Stop smoking program/help

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