Why Quitting is So Hard: The Reality of Tobacco Addiction

There is no question that nicotine is the addictive substance in tobacco that makes quitting so difficult. In summarizing the vast body of evidence on nicotine addiction, the Centers for Disease Control made the following statement:

“Nicotine is the psychoactive drug in tobacco products that produces dependence. Most smokers are dependent on nicotine, and smokeless tobacco use can also lead to nicotine dependence. Nicotine dependence is the most common form of chemical dependence in the United States. Research suggests that nicotine is as addictive as heroin, cocaine, or alcohol. Examples of nicotine withdrawal symptoms include irritability, anxiety, difficulty concentrating, and increased appetite.”

Nicotine addiction has both biological and behavioral components that work together to make it difficult to overcome:

1. Biological: Very simply stated, nicotine is rapidly absorbed into the bloodstream and quickly travels to the brain, where it binds with receptors throughout the brain, leading to the release of a brain chemical called dopamine.

• Dopamine stimulates sensations of pleasure, motivation and reward. The sensations can be both relaxing and stimulating.
• Nicotine levels drop relatively quickly, which causes a sense of craving which, if not alleviated by more nicotine, can lead to symptoms of withdrawal.
• The more the brain is exposed to nicotine, the higher the number of receptors and the amount of dopamine released, creating a cycle of increasing need for more nicotine.

2. Behavioral: Working hand in hand with the biological aspect of addiction, smoking develops very strong associations with other daily behaviors.

• These triggering behaviors, or antecedents, can be different for each individual and include things like having a cup of coffee, after a meal, driving in the car, talking on the phone, drinking an alcoholic beverage, even simply getting out of bed in the morning.
• Stress, or emotional responses to stress, is a common triggering behavior for many smokers.
• The trigger, or antecedent, leads to the act, or behavior, of smoking in a predictable, and often unconscious, cycle.

The good news: Research shows that addressing both of the components of nicotine addiction can increase the odds of long-term success in quitting. Using one of the available smoking cessation aids and identifying and managing behavioral triggers are important steps that allow tobacco users to take control and overcome nicotine addiction.

Smoking Cessation Aids:

There are 2 general categories of smoking cessation aids, nicotine replacement therapy (NRT) and oral medications. Some NRTs are available over the counter, while others, as well as the oral medications, are available by prescription only.

Non-prescription (over the counter) NRT:

• Nicotine gum (available in generic and brand name)
• Nicotine patch (available in generic and brand name)
• Nicotine lozenge

Prescription-only aids

• Nicotine inhaler
• Nicotine nasal spray
• Bupropion SR (Zyban): oral medication
• Varenicline (Chantix): oral medication

Smoking cessation aids are covered by most health insurance. Co-payments are often applicable. Calling the insurance provider is important to determine available coverage.

Although the available aids have been determined to be both safe and effective, it’s important for smokers to consult their healthcare providers, even before using over the counter NRT, to help determine the best smoking cessation aid for their individual needs and medical histories.

Identifying and Managing Triggers:

Identifying what triggers the urge to smoke is a big step in the direction of taking control and managing the behavior of smoking. Becoming conscious of the triggers is important because the antecedent-behavior cycle can often become automatic. Since most triggers are not likely to go away and are accompanied by cravings, learning to manage them with other, specific behavioral strategies is essential.

• Keeping a journal of smoking behavior can help identify and track details like time of day, activities, thoughts, and feelings prior to and while smoking
• Talk to family and friends and see if they have noticed particular details about behaviors or moods leading up to smoking
• Once triggers are identified, think about which one(s) represent the greatest challenge
• Plan a strategy of alternative behaviors to use when triggers occur, particularly for those that are most challenging.
• Regular exercise, deep breathing and other relaxation techniques can not only manage stress that triggers the urge to smoke, but also the stress associated with nicotine withdrawal.