Quitting Smoking. How to Escape from the Deadly Loop of Tobacco Dependency

Tobacco, the underestimated drug

Drug dependency is a mental disorder that affects a person’s behaviour and results in uncontrolled use of the addictive substance. The person addicted continues to take the substance despite the adverse physical, psychological, and social consequences. Scientists consider tobacco a drug. The use of tobacco is a significant contributor to poor health including cancers. E.g. lung and pancreatic cancer, heart and brain infarctions, as well as chronic lung diseases. Tobacco use is legal in almost all cultures, making the “entry barrier” significantly lower, especially for young people. This article describes various aspects of tobacco use/dependency with the main focus on how to quit smoking. Key treatment approaches for smoking cessation are counselling, medication, and hypnosis. This will address all your questions about how to stop smoking.

In hopes of encouraging a safe and healthy lifestyle, there will also be a few words on prevention as an inspiration to the young and old not to enter this deadly loop of smoking. Better than quitting smoking is to not start in the first place!

Freud’s tobacco dependence

Stopping smoking can be a long and not always victorious battle. The best example is the story of Sigmund Freud, the inventor of the first method of psychotherapy, called psychoanalysis. Freud became addicted to tobacco in his twenties. He daily often smoked more than 20 cigars. Despite doctors’ warnings about chain smoking, he was unable to quit smoking. Freud continued to smoke even after his doctor diagnosed him with oral cancer in 1923. Despite 33 surgeries over the next 16 years and a large prosthesis in his mouth to separate his sinus from his jaw, Freud never quit smoking.  

There have been great advances in psychology and medicine since Freud’s days, and with sound, individualized therapy for smoking cessation including various treatment modalities, millions of people quit smoking and remain smoke free the rest of their lives.         

Developing the dependence                                                                                              

Most smokers use tobacco products regularly. This is because smokers are addicted to nicotine, crave it, and need ongoing consumption of nicotine to avoid withdrawal symptoms. Even only a few hours of smoking will trigger neurological adaptations and most smokers soon find a level of smoking that they maintain over time. A scientific study indicated that 80% of the smokers who were questioned reported that they want to stop smoking. Another 10% said they would like to cut down (Inaba & Cohen, 2007). Yet, the addiction to cigarettes makes quitting smoking difficult.

Nicotine, tolerance, and withdrawal

Unlike other drugs, tolerance of nicotine does not continue to build. This means that most smokers habitually come to smoke a certain number of cigarettes a day without escalating consumption to ever increasing amounts. A smoker will come to depend on smoking to feel psychologically normal and physically well and relaxed. If the smoker suddenly stops nicotine consumption withdrawal symptoms, that include negative physiological and psychological effects, will occur. This is the very reason why it is difficult to stop smoking.

Neurophysiological approach

One of the most obvious characteristics of dependency is that the dependent person compulsively uses and abuses a substance despite negative health consequences. Research has shown that the addictive nature of nicotine is in part attributable to activation of the reward pathway. This pathway, also called the mesolimbic pathway, regulates feelings of pleasure. Nicotine increases levels of the neurotransmitter in the reward circuit. Scientists believe this underlies the pleasurable sensations that many smokers experience (Is Nicotine, n.d.).

Nicotine’s stimulating effect

Additionally, nicotine stimulates the central nervous system. The neurotransmitters play a role in this process. They affect heart rate, blood pressure, memory, learning, reflexes, aggression, sleep, sexual activity, and mental acuity. This stimulating effect can contribute to a smoker feeling more alert and mentally sharp. Smokers enjoy these feelings, which contributes to making it difficult for some to stop smoking. This is particularly true for individuals who report high levels of stress in their lives.

There are other chemicals implicated in the addiction to smoking. Scientists believe that some ingredient in tobacco causes a marked decrease in the levels of a particular enzymes (MAO). This enzyme is responsible for the breakdown of some neurotransmitters. Hence, when there is less MAO there will be higher output of the neurotransmitters which increases pleasurable feelings and the desire of repeated use (Is Nicotine, n.d.). Scientists have also found the chemical acetaldehyde in tobacco. In animal studies it was found that that this chemical reinforces the properties of nicotine and might contribute to tobacco addiction. This area of research also found that younger animals were more sensitive to the enhancing effects of acetaldehyde leading them to conclude that the brains of adolescents may be more susceptible to tobacco addiction (Is Nicotine, n.d.).

Psychological approach: habit, reward, regression

Behavioral, psychodynamic, and environmental factors associated with smoking must be addressed as relevant aspects of nicotine dependency. A substance can become addictive if it is rewarding causing a pleasure or enjoyment. There is strong evidence that those non-pharmacological factors (opening the box, lighting the cigarette, inhaling and tasting the smoke in the throat) play an equally important role in creating the habit as nicotine.

Operant conditioning

Dependencies, among them the nicotine addiction, is a learned behaviour. According to the principles of operant conditioning, rewarded behaviour will increase. The danger of drugs (among them tobacco) relies on their ability to initiate an immediate reward. This also explains why the addictive substance tends to replace other, more healthy sources of rewards. These other types of rewards are frequently delayed (such as the return of good health) whilst the drugs create a short cut to the reward system. As addiction progresses, the availability of natural, healthy pleasures, which require more effort, decline. This creates a powerful addictive vicious cycle. For the smokers, the feel, smell, and sight and the ritual of obtaining, handling, lighting the cigarette – usually during a break or in a relaxed atmosphere – are all associated with the pleasurable effects contributing to the above-mentioned operant conditioning.

Psychodynamic approach

From the psychodynamic point of view smoking is a regressive behaviour related to the earliest phase of human development which Freud called the “oral phase”. The satisfaction and relaxing effect of putting a cigarette in the mouth corresponds to the pleasure of a child suckling the mother’s breast.

Genetics and dependency

Scientists know genetics also play a role in addiction to nicotine. Inheriting different forms of 6 genes will dictate the feature of the brain receptor to which nicotine binds. This genetic variably offers an explanation for why some people develop a pack a day habit that they cannot seem to break, and others smoke a few cigarettes on occasion but do not have a compulsion to smoke.

Nicotinic acetylcholine (nACH) receptors

For quite a while researcher have been studying nicotinic acetylcholine (nACH) receptors. Meanwhile scientists identified genes that serve as a blueprint of proteins that serve as subunits in nACH receptors. Variations in the DNA that encodes these genes may alter the structure or amount of the proteins produced, which in turn can modify what happens when nicotine molecules attach to the receptor. In 2007, researchers reported about genetically altered mice that had no interest in self-administering nicotine which was attributable to the removal of the protein that is held responsible for positive-reinforcement properties of nicotine. Undoubtedly, the role of genetics in nicotine addiction plays a significant role.

Treatments to stop smoking

Quitting smoking is a clear option because tobacco addiction can be treated with several methods, often combining them. Nicotine substitution by patch, tablets or chewing gum (even the intravenous application of nicotine) has only little impact on cravings. Different studies have shown that the most satisfaction and reinforcement of the smoking habit occur when the peripheral, non-pharmacological factors are combined with the nicotine’s central effect. The majority of smokers who want to quit smoking attempt it on their own. However, rates of success for self-quitters are very low. Studies show that most smokers who stop smoking on their own relapse within the first week of their quitting attempt. Only about 3-5 % of individuals who quit on their own reach prolonged abstinence at 6-12 months post-quit.

Research clearly indicates that professional treatment and prolonged support for smoking cessation yields the highest success rates (Tobacco Addiction, n.d.). These treatment professionals include counsellors, psychotherapists, addictions specialists and psychiatrists. Psychologists and psychiatrists can discuss and offer methods to smokers that to increase success rates of quitting:

Counselling for smoking cessation

Among different psychotherapy methods Cognitive Behavioral Therapy (CBT) is the most frequently investigated and evidence-based treatment for quitting smoking. It trains individuals to understand their trigger situations, regulate their feelings, and identify adaptive coping mechanisms. It helps lay the foundation for a sustainable, healthy lifestyle. Therapists with addiction training will also provide general psycho-education on addiction including relapse prevention.

NRT: Nicotine Replacement Therapy

Nicotine replacement therapy is a good option for smoking cessation in addition to behavioral treatments to address withdrawal symptoms and cravings when smokers stop smoking. When nicotine consumption is abruptly stopped people can experience withdrawal symptoms within 2 – 3 hours of their last tobacco use. At the 2 – 3-day mark, these symptoms will peak. The severity of nicotine withdrawal symptoms hinges upon how long and how much a person smoked.

Withdrawal symptoms appearing immediately after smoking cessation:

• An intense craving for nicotine
• Anxiety, tension, restlessness, frustration, or impatience
• Difficulty concentrating
• Drowsiness or trouble sleeping, as well as bad dreams and nightmares
• Headaches
• Increased appetite and weight gain
• Irritability or depression (Nicotine, n.d., para. 3)

The Food and Drug Administration (FDA) has approved a number of NRTs

• Gum
• Inhalers
• Nasal spray
• Skin patch

Hypnosis

Treating tobacco addiction with hypnosis is effective method for stopping smoking. Clinical hypnotherapists with 3-5 sessions can set the stage on a subconscious level to remain smoke free. Everyone has their unique reasons for why they began smoking, and why they want to quit smoking. A clinical hypnotherapist can uncover and address subconscious causes for smoking, increase motivation to remain smoke free, and build ego strength to cope with daily life.

Pharmacotherapy for smoking cessation

The idea behind pharmacotherapy is that medication is used in conjunction with therapy, such as CBT. Medications serve the purpose of reducing cravings and preventing the desired effects of smoking.

Two medications approved by the FDA (Food and Drug Administration) are:

1. A dopaminerg antidepressant with an anti-craving effect Bupropion which is marketed under the name of Zyban/Wellbutrin

2. An agonist of the nicotine receptors

As is the case with all medications, a careful assessment by an experienced physician is necessary.

Smoking prevention

How to stop smoking is an important question once dependency has occurred. Our hope is to educate on the prevention of nicotine addiction as well. The simplest way to avoid development of any kind of dependency (among them smoking) is not to use the addictive substances. Most smokers begin to smoke as teenagers. Research shows that young people are particularly susceptible to tobacco marketing campaigns creating the image of being mature, sophisticated, and glamorous. Schools generally provide education on the use of tobacco and other addictive substances, but their impact is unclear. Parents still have the biggest impact on their children’s decision whether to smoke. The best way to prevent a youngster from taking up smoking is to have parents who do not smoke. Children from smoking households are more likely to begin smoking than children from non-smoking households.

Economics versus Healthcare

The Tobacco industry is one of the most lucrative branches of economy creating good financial rewards not only for the shareholders, but also for the governments due to tobacco taxes. Although the US government banned cigarette commercials in the US from television for over 30 years, tobacco products remain among the most heavily marketed. According to the American Lung Association, the tobacco industry spent an estimated $12.49 billion on advertising in 2006. In 2009, the Food and Drug Administration (FDA) in the United States made importance changes to limit tobacco advertising. This same year, the FDA also began to regulate tobacco products and initiated health warnings on all tobacco packaging and advertising. A similar development can be observed in Europe and the Middle East.

Summary

Tobacco smoking is one of the most addictive habits. The addiction can be established even after few days of smoking. The smokers are inhaling thousands of carcinogenic substances responsible for much higher cancer rate and other diseases such as chronic bronchitis. Moreover, smoking significantly increases the risk for atherosclerosis which is the main cause of the heart attacks and strokes. The physical condition of smokers is lower compared to their peer group of non-smokers. The life expectancy of long-term smokers is significantly reduced.

The best way to avoid the addiction is not to start. Smoking cessation is possible at every stage and can be successful for all smokers under all circumstances.