In order to understand why smoking is so difficult to stop, it is worth understanding the mechanisms that keep you addicted to smoking. Addiction is a behaviour over which an individual has impaired control (RCP 2000). This can be a physical, psychological and social dependence to a substance.

 

Although cigarettes are full of different harmful substances (Tar, Carbon Monoxide etc), nicotine, which is not harmful, is the one that is addictive. Nicotine addiction is now recognised as a disease, (WHO: International Statistics of Diseases and related health problems) and was determined to be more addictive than heroin or cocaine (WHO: Tobacco Free Initiatives, 1999).

 

The nicotine acts on receptors in the brain and, when in contact with these receptors, cause a response to the 'feel good' hormones in the body. It is this release of Dopamine in the brain that encourages the smoker to repeat the action.

 

This positive reward for the behaviour is recognised due to the speed the nicotine gets to the brain (7 seconds), when delivered by the very efficient cigarette. Every time the smoker draws on the cigarette and inhales the smoke, the brain can easily associate the action with the reward. Once levels of nicotine in the blood stream drop, the receptors in the brain start to crave more. This withdrawal from the substance is the reason smokers are unable to easily give up.

 

This dependence can be recognised by:

 

• A strong desire to take the substance
• Difficulty in controlling use (amount/time)
• Higher priority given to substance use than to other activities & obligations
• Persist in using despite harmful consequences
• Tolerance: need for increased amounts to achieve desired effect
• Withdrawal

 

Withdrawal symptoms are of concern to most smokers. They may already be aware of the discomfort they feel when restricted from smoking and this may be the reason they feel unable to give up. Most smokers will have, at some time, encountered different severities of withdrawal and will be aware of the need to minimise these unpleasant responses to nicotine withdrawal.

 

The use of Nicotine Replacement Therapy is therefore advised, acting as a base level of nicotine to prevent the full effects of withdrawal being felt. Unlike the nicotine in cigarettes, NRT is not addictive. The brain does not make the same association as it does from smoking, due to the nicotine being delivered in a very different way and at a much-reduced speed.

 

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