Failure to Quit
Biologic, psychological, behavioral, and cultural factors all play a role in nicotine addiction, making it one of the hardest addictions to kick. Although nearly a quarter of American adults continue to smoke, the great majority of them want to quit. Unfortunately, quitting is very difficult. In one study of women smokers who said they wanted to stop smoking, 80% of them were unable to. About half of people who quit return to smoking. Even after years of not smoking, about 20% of ex-smokers still have occasional cravings for cigarettes.
Some experts that the three major areas responsible for the inability to quit are the following:
- Mental Performance. Nicotine improves concentration and thinking, and stopping temporarily impairs it.
- Stress. Although smoking many not reduce stress, stopping certainly increases it.
- Weight gain. People gain an average of five to 10 pounds when they quit.
Depression is also an important factor for relapse in many people. The first two weeks are critical in determining quitting failure rates, so smokers should not be shy about seeking all the help they can during this period. Although withdrawal symptoms can be intense, treatments are now available to reduce them. Withdrawal symptoms, even intense ones, do not fully explain why so many people fail to quit and why so many relapse. The smoker is up against an army of obstacles to quitting.
In any case, the attempts to quit are never a waste of time, since the amount of smoking is reduced during these periods. People who keep trying still have a fifty-fifty chance of finally quitting.
Individual Risk Factors for Failure
Researchers have been trying to discover individual risk factors or sets of behaviors that can help predict why specific people fail to quit. Some factors include:
- Being female.
- Being a heavy smoker.
- Inhaling deeply.
- Being a long-term smoker.
- Having severe withdrawal symptoms.
Among many studies, however, only one found a single consistent factor for failure to quit:
Cheating during the first two weeks of withdrawal, even with the patch, nearly guarantees smoking again in six months. In one study, nearly half of the people who did not cheat during the first two weeks were still not smoking after six months.
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| The many methods of quitting smoking include counseling and support groups, nicotine patches, gums and sprays, and incremental reduction. |
Women and Smoking
On average, 21.5% of American women still smoke. Over three million women have died from smoking-related illness since 1980, and women now account for over 39% of all smoking-related deaths, a number that has doubled since 1965.
Smoking poses greater risks in women than in men. For example, in women who smoke, the risk for a heart attack is about 50% greater than in male smokers. Some studies indicate that the risk for lung cancer may be higher in women smokers. Smoking is also linked to many reproductive problems. Women who smoke pose a greater danger not only to their own reproductive health but, if they smoke during pregnancy, to their unborn child.
Unfortunately, studies also show that women have a harder time trying to quit smoking and have less success with abstinence programs than their male counterparts. Reasons for this disparity may include the following:
- Nicotine has different effects on mood in women compared to men. It appears to reduce anxiety, discontent in aggression in women and enhance these traits in men. Women who quit, then, may experience greater anxiety and stress than men who quit.
- Women are not as physically dependent on nicotine as men are, but they are more behaviorally addicted, which is the more powerful deterrent to quitting. (This may be the reason why nicotine replacement, which only reduces cravings, tends not to be as effective in women.)
- Women may fear weight gain after quitting more than men do.
- Pregnant women cannot use most smoking cessation aids.
- Certain phases in the menstrual cycle may reduce the response to drugs that are used to help women quit smoking.
- Men may be less supportive than women in helping their partners to quit.
- Women trying to quit may miss the feeling of control associated with smoking more than men do.
On the positive side, evidence suggests that when women quit their lung function seems to improve more rapidly than in men who quit.
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Addictive Aspects of Nicotine
Nicotine addiction involves biologic, psychological, behavioral, and cultural factors, and some researchers feel it is as addictive as heroin. In fact, nicotine has actions similar to cocaine and heroin in the same area of the brain.
Depending on the amount taken in, nicotine can act as either a stimulant or a sedative. Cigarette smoking (either the nicotine or the oral process of smoking itself) has definite immediate positive effects:
- It relieves minor depression.
- It helps suppress little fits of anger.
- It enhances concentration and short-term memory.
- It produces a modest sense of well being.
- Whether nicotine reduces stress is uncertain. Some evidence suggests that it reduces symptoms of stress in women although it may increase them in men.
The addictive process of smoking has a specific daily cycle:
- Heightened Effects of First Few Cigarettes. Most smokers have a special fondness for the first cigarette of the day because of the way brain cells respond to the day's first nicotine rush. Nicotine, particularly taken in the first few cigarettes of the day, increases the activity of dopamine, a chemical in the brain that elicits pleasurable sensations, a feeling similar to achieving a reward.
- Gradual Tolerance. Over the course of a day, however, the nerve cells become desensitized to nicotine. Smoking becomes less pleasurable, and smokers may be likely to increase their intake to get their reward. A smoker develops tolerance to these effects very quickly and requires increasingly higher levels of nicotine.
Withdrawal Symptoms in the First Two Weeks
Withdrawal is a difficult process, but treatments have been developed to reduce its effect. Abstaining from all cigarettes during first two weeks of quitting are critical in achieving success, so smokers should not be shy about seeking all the help they can during this period.
Withdrawal symptoms begin as soon as four hours after the last cigarette, generally peak in intensity at three to five days, and usually disappear after two weeks, although some may persist for several months. The symptoms of withdrawal include both physical and mental difficulties.
Physical Symptoms. During the quitting process people should consider the following physical symptoms of withdrawal as if they were recuperating from a disease and treat them accordingly as they would any physical symptoms:
- Tingling in the hands and feet.
- Sweating.
- Intestinal disorders (cramps, nausea).
- Headaches.
- Respiratory symptoms as the lungs begin to clear, including sore throats, coughing, and other signs of colds.
Mental and Emotional Symptoms. Tension and craving build up during periods of withdrawal, sometimes to a nearly intolerable point. One European study found that the incidence of workplace accidents increases on No Smoking Day, a day in which up to two million smokers either reduce the amount they smoke or abstain altogether.
Nearly every moderate to heavy smoker experiences more than one of the following strong emotional and mental responses to withdrawal:
- Feelings of being an infant: temper tantrums, intense needs, feelings of dependency, and a state of near paralysis.
- Insomnia.
- Mental confusion, vagueness, or difficulty concentrating.
- Irritability, restlessness, impatience, or anger.
- Anxiety.
- Depression, which is common during withdrawal and over the long term. In the short term it may mimic the feelings of grief felt when a loved one is lost. As foolish as it sounds, a smoker should plan on a period of actual mourning in order to get through the early withdrawal depression.
Long-Term Depression
There is a significant association between cigarette smoking and a susceptibility to depression. People who are prone to depression face a 25% chance of becoming depressed when they quit smoking, and this increased risk persists for at least six months. Whats more, depressed smokers have a very low level of success. Only about 6% remain smoke-free after a year. There are strong reasons for this:
- Smoking may be masking depression, which can become severe even after the early stages of withdrawal have passed.
- For some smokers, the future physical damage incurred by smoking is an abstraction, which fails to motivate quitting when measured up against the very real emotional pain triggered by nicotine withdrawal.
- Not only does the smoker suffer, but the negative emotions often harm relationships with friends and family, who might even urge the ex-smoker to take up cigarettes again.
People who suffer from depression while quitting might do better using a combination of emotionally supportive therapy (as opposed to behavioral therapy), nicotine replacements, and antidepressants, such as bupropion (Zyban). If severe depression lasts beyond the withdrawal period, professional help should be sought as soon as possible.
Weight Gain
Quitting smoking does increase the risk for weight gain--with an average gain of five to 10 pounds. Studies are mixed on whether this weight gain is permanent in most smokers or not. Certainly, it is a major factor in relapse.
Effects of Smoking on Calories. Smoking uses up calories--about 200 a day according to one study. A 1999 study reported that smoking increases energy expenditure in men by 3.6% at rest and by 6.3% during physical activity. (Actually, the higher level during exercise was only because the men inhaled more deeply during that time.)
Reasons for Weight Gain after Quitting. Quitting can add five or more pounds, due to the following reasons:
- Obviously, the body is working better. After quitting, the bodys metabolism slows down, and food is digested more efficiently.
- Insulin levels increase, enabling the body to process more sugar for energy.
- People snack as an oral substitution.
How to Keep the Weight Off After Smoking. Exercise can be very helpful in controlling weight. To use up the 200 calories gained from quitting smoking, one need only take an extra 15-minute daily walk and eliminate 100 calories a day from meals. Even a moderate increase in physical activity among middle-aged women who have quit smoking can help keep weight gain to a minimum.
Using Zyban, nicotine gum, or both also appears to help protect against weight gain, at least while these drugs are being used.
A small study suggested that drinking caffeinated beverages (such as coffee or tea) while on nicotine replacement may enhance energy expenditure and so may help prevent weight gain. Avoid drinking coffee in the evening, however, since sleep disturbances can be a problem during withdrawal.
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