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Rates of cigarette smoking vary widely, and have changed considerably over the course of history—since cigarettes were first widely used in the mid-20th century. While rates of smoking have over time leveled off or declined in the developed world, they continue to rise in developing nations.
The tobacco that is used in cigarettes, pipes, and cigars contains a highly addictive substance called nicotine, which is readily absorbed into the bloodstream when a tobacco product is chewed, inhaled, or smoked.
Nicotine stimulates the adrenal glands, which release epinephrine or adrenaline, when it enters the bloodstream. When epinephrine is released into the body, it stimulates the central nervous system, increasing heart rate, respiration, and blood pressure. Behaving much like other addictive drugs—think cocaine or heroin—nicotine increases levels of the neurotransmitter dopamine, thus affecting brain pathways that control reward and pleasure.
For many tobacco users, long-term brain changes induced by continued nicotine exposure result in addiction—a condition of compulsive drug seeking and use, even in the face of negative consequences. For many regular tobacco users, brain changes occur from sustained nicotine exposure, which result in addiction. And like other addictions, when you try to quit you may suffer unpleasant withdrawal symptoms, which in the case of nicotine include irritability, headaches, and trouble sleeping. Smoking also causes psychological dependence. This means that you’ve gotten used to smoking, and it’s hard to break the habit of having a cigarette in your hand at certain times.
About half of cigarette smokers die of tobacco-related disease and lose on average 14 years of life.
Every year in the U.S. over 392,000 people die from tobacco-caused disease, making it the leading cause of preventable death. Another 50,000 people die from exposure to secondhand smoke. Tragically, each day thousands of kids still pick up a cigarette for the first time. The cycle of addiction, illness and death continues.
Cigarette use by pregnant women has also been shown to cause birth defects, including low birth weight, fetal abnormalities, and premature birth. Second-hand from cigarettes has been shown to be injurious to bystanders, which has led to legislation that has prohibited smoking in many workplaces and public areas.
To quit smoking successfully, you will need to deal with both physical addiction and psychological dependence.
There are two sides to being dependent on smoking:
Physical dependence, or addiction, is when your body gets used to having a chemical that it doesn’t produce on its own. This can happen with legal drugs such as tobacco and alcohol, controlled substances such as prescription painkillers, or illegal drugs such as heroin and cocaine. Over time, your body develops a tolerance, which means you need more of the same chemical to get the same effect. So the enjoyment you used to get from a one cigarette may take two or more to achieve.
Smoking gets the nicotine into your lungs, where it goes directly into your bloodstream, so after you finish your cigarette, the nicotine level in your blood starts to drop. When your body has gotten accustomed to nicotine, the lower nicotine level makes your body feel like there’s something wrong. This leads to unpleasant feelings and eventually withdrawal symptoms. These unpleasant feelings go away when you have another cigarette. So every time you smoke, you are slowly conditioning your body to need to smoke more.
Nicotine is as addictive as heroin or cocaine, but for many smokers, breaking out of the psychological dependence–or the smoking habit–can be harder to deal with than physical addiction. Psychological dependence is when you get used to smoking, and it becomes a part of your daily routine. You may get used to smoking at certain times, such as when you first wake up, or at cigarette breaks during your workday. Or you may always smoke during certain activities–for instance, after a meal, or when you go out with friends. Smoking can become linked to these activities in your mind–and then a meal, or a night on the town may just feel wrong without a cigarette.
You may also find yourself coming up with excuses, or rationalizations that help you tell yourself it’s OK to have one more cigarette.
After psychological dependence develops, you may need to find new habits to replace the old ones, or come up with different things to hold, or to put in your mouth.
The biggest risk factor for getting hooked on smoking is smoking itself. If you don’t smoke, you can’t get hooked. But there are risk factors that make a person more likely to smoke, and others that make a smoker more likely to become dependent on smoking.
Risk factors for smoking include:
If you smoke, risk factors for tobacco dependence include:
Smoking is also a risk factor for many other conditions, including:
This is not a complete list, and if you smoke around other people then you put them at risk as well. Smoking while pregnant or in a house with a newborn can put your child at risk for sudden infant death syndrome. Smoking around children can also exacerbate asthma, ear infections, and colds.
Quitting smoking is a good idea whether or not you’re dependent. But being dependent can make quitting much more difficult. To assess how dependent you are, your doctor will ask you questions or have you complete a written questionnaire about your smoking habit, your physical and mental health, past efforts to quit, and other related topics. Getting a full picture of your smoking patterns can help your doctor develop a better treatment plan for you.
You may be dependent on cigarettes if:
Physical withdrawal symptoms when you quit smoking may include:
Withdrawal can also cause changes to your mood and behavior, such as:
Quitting smoking isn’t easy. The average smoker needs seven tries over the course of five years to finally kick the habit. But you can succeed.
Without medical or psychological help, the success rate for any one attempt to quit smoking is about 4% to 7%. But the odds of staying smoke-free at six months goes up to about 25% with nicotine replacement or other medicines, and more if you add behavioral or supportive therapy.
Two out of every five ex-smokers were successful on their first attempt. And even if you don’t succeed on the first try, you can learn from your mistakes and do better next time. At present, there are more ex-smokers than smokers in the United States, and ex-smokers have outnumbered smokers since 2002.
Once you do quit smoking, your outlook for a long and healthy life improves. And the benefits get better the longer you stay smoke-free:
Your best chance of staying smoke free is if you work with your doctor and follow your doctor’s advice. But on top of that, there are things you can do on your own that can help you improve your odds of success:
Don’t give in to the temptation to have just one cigarette–because just one can easily become just two, just three, or just a pack or two. But if you do slip up, remember that one slip does not doom you to failure, either. Learn from your mistakes, and get back on track.
If you smoke, some doctors and health organizations recommend that you get a computed tomography (CT) scan of your lungs once a year after age 55. Others advise against it, because routine CT scans may turn up harmless conditions and lead to invasive tests that do more harm than good. If you’re a smoker aged 55 or older, talk with your doctor about the risks and benefits of lung cancer screening.
The easiest way to prevent nicotine dependency is not to smoke. Different people respond to tobacco differently, and some need only a small amount to get them on the road to dependence.
If you are planning to quit smoking, or in the process of quitting, there are many tools at your disposal to help prevent a relapse. We discussed a few of these in the Living Without Smoking section. We will discuss others in the sections to come, particularly in the next section, Medication and Treatment.
Several medicines can help you quit smoking. These are grouped into two main categories: nicotine replacement and non-nicotine treatments. For some smokers, it may be best to combine both types of medicine. There are also counseling programs that can help you cope with psychological dependency.
Nicotine replacement treatments give you the nicotine without the other harmful chemicals that you inhale when you smoke. Nicotine replacement is available over the counter in many forms, including:
With a prescription from your doctor, you can also get:
With nicotine replacement medications, the goal is usually to decrease the dosage a bit at a time, so that the cravings and withdrawal symptoms don’t hit you all at once. But even before you finish with your nicotine replacement, you’ve already decreased your exposure to some of the most harmful cancer-causing chemicals in tobacco.
If you are planning to become pregnant, you should arrange to finish your nicotine replacement before your pregnancy. If you are already pregnant or breastfeeding, talk with your doctor before starting nicotine replacement. There may be another treatment that is healthier for your baby and more suitable for you.
You should match the amount of nicotine you use so that you start nicotine treatment with the same amount or less than you got while you were smoking. If you have a hard time finding the right dose, or if you smoke fewer than 10 cigarettes per day, you should talk to your doctor before starting nicotine replacement.
There are also several prescription non-nicotine medications that help you quit smoking without nicotine.
Counseling is another important tool to help you quit smoking. Psychological counseling helps you learn techniques to help you quit. You can seek help from a psychologist or a hospital, or from a number of other sources, including the Internet, a help line, or sometimes through your own workplace.
Alternative treatments such as hypnosis, acupuncture, and magnet therapy are not supported by scientific evidence, but these methods are mostly harmless, and some people swear by their effectiveness. If you want to try hypnosis, ask your doctor to recommend a licensed hypnotherapist.
Methods such as meditation and exercise programs have shown some promise in early studies, but more research is needed to see if they are effective.
Recently, software developers have made applications that you can download to your smartphone to help you quit smoking. These apps offer different methods to quit–some help you set goals and track your progress, while others incorporate games or help you track your cigarette cravings. Apps to stop smoking are relatively new, and there is not enough evidence yet to tell how effective they are.
Electronic cigarettes have been rising in popularity as a “safe” alternative to smoking or as a way to smoke in places where smoking is not allowed. As of yet, we don’t know whether e-cigarettes are actually safer than traditional cigarettes, or whether they are an effective tool to help you quit. Because they are not regulated by the Food and Drug Administration, some e-cigarettes may contain other harmful substances, such as diethylene glycol—a toxic chemical used in antifreeze. Early studies suggest that when it comes to helping smokers quit, electronic cigarettes are no more effective than other nicotine replacement products.
Other unproven methods that may have harmful side effects include herbal supplements, products that change the taste of cigarettes, smokeless tobacco, and nicotine lollipops or lip balms. Using these products is not recommended, but if you do use them, you should tell your doctor, as they may interfere with other medicines you take.
When you’re ready to give up smoking, the first step is to make a plan. Don’t be daunted if you’ve tried to quit and failed in the past. Most people need several attempts before they can finally quit smoking for good.
Choose a quit date that’s far enough away to prepare yourself, but not so far that you have time to change your mind. Ideally, your quit day should be less than a month away, but some people may choose a date with personal significance, or the third Thursday in November, which is the date of the Great American Smokeout.
If you plan to use medicine to help you quit, talk with your doctor early on, so you can make a plan together that suits your needs, and so you can have your medicine on hand when you need it. Some medicines may need to be started before your quit day.
On the days leading up to your quit date:
Just before your quit day, get rid of all your cigarettes, ashtrays, and lighters at home, in your car, and at your office.
On your quit day, don’t smoke at all–not even one last cigarette or one last puff. That’s the most important thing. To help you stay smoke-free, you may:
Take your medicine and/or go to your counseling sessions, if they’re part of your plan
If you’ve tried to quit smoking before and it hasn’t worked, you may be wise to see your doctor and develop a plan together to help you quit. You may also want to see a doctor if:
You can get help quitting smoking from your usual primary care or family doctor. If you need additional help, you can ask your doctor for a referral, or you can find out other options by calling 1-800-QUIT-NOW.
When you go to see your doctor, it’s good to have a list of the questions you’d like to have answered. Take a moment to write down some of the things you want to know. Your questions for your doctor might include some of these:
Other useful resources to help you learn about quitting smoking can be found at:
National Cancer Institute. http://www.smokefree.gov
American Lung Association http://www.lungusa.org
American Cancer Society Guide to Quitting Smoking http://www.cancer.org/%20healthy/stayawayfromtobacco/guidetoquittingsmoking/index
Centers for Disease Control and Prevention Office on Smoking and Health http://www.cdc.gov/tobacco
Nicotine Anonymous http://www.nicotine-anonymous.org
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