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Quitting Smoking

Raymond Shred, PhD
Registered Psychologist

So, you want to quit smoking. Every smoker quits, eventually. In an old BC comic strip, one cave man asked the clerk at the Advice Rock, "What is the best way to quit smoking?" The answer: "Voluntarily."

There is much misunderstanding about smoking tobacco and how and why it is harmful. Most people understand that the main and most addictive ingredient in tobacco is nicotine. However, most people don’t know how it works or why it is so addictive.

According to medical sources, smoking is one of the major causes of preventable death. However, nicotine itself does not cause cancer. It is the ingredient that makes the smoking habit such a hard one to break. It keeps smokers inhaling the 100’s of toxic chemicals that make cigarette smoke so harmful.

Many people’s experience in quitting smoking is that they are only successful for a brief time and then they go back to their old habit. In fact, they often smoke more after they go back to it than before they quit. One of the important research findings about nicotine is that the smoker’s tolerance level for nicotine never goes down. When people start smoking (once they get past the throwing up and other symptoms of adjusting to taking in a poison) they find that they need to smoke more and more over time to get the same effect. People often end up smoking a pack or two packs (20 to 50 cigarettes) a day. However, the tolerance level does not change and even 25 years after they quit, a former smoker will feel compelled to smoke as much as they did when they quit, if they start again.

Nicotine is addictive because it mimics one of the main chemicals in our brains. Our brain communicates by using chemicals (called neurotransmitters) to send signals from one brain cell to the next. The neurotransmitter fits into receptor sites on the second cell and one of the more common receptor sites are called nicotinic receptors. When nicotine is ingested it fills up these receptor sites and our brains produce less acetycholine, the neurotransmitter that usually goes there. Part of the acute withdrawal pains that occur when we stop smoking are caused by the absence of both acetycholine and nicotine. It takes about three days for our brains to start producing sufficient acetycholine again. This is why the first three days are the hardest for smokers trying to quit and the withdrawal pains are most severe.

Another reason that quitting smoking is so difficult is that there is more than one habit that must be broken or replaced. There is: a) the physical addiction to nicotine, b) the psychological addiction to smoking as a stress relief tool, c) the social aspects, and d) the numerous environmental cues that smokers associate with the habit.

The physical addiction is at the same time the simplest and the most difficult aspect of quitting smoking. One simply needs to stop smoking for a period of time and the physical cravings will stop. However, cigarettes are a nefarious and efficient delivery system for nicotine. Nicotine is one of a few substances that cross the blood-brain barrier almost instantly. The smoke gets the nicotine into the lungs and then into the blood stream. Then, it is pumped almost directly into the brain. Although the physical addiction is strong, it can be effectively managed with a nicotine replacement product such as the patch.

Smokers frequently tell themselves and others that they need a cigarette to calm down because they are stressed. Smokers typically are more relaxed after going out for a cigarette. However, it is more likely that they relax because they take a break from what they were doing and are outside in the fresh air, breathing deeply – that part is a standard relaxation skill taught by most psychologists. But, nicotine is a stimulant. Having a cigarette to calm down is like having a cup of coffee to help you sleep.

Relationships based on smoking tend to be rather shallow. Most smokers respect those who want to quit and they will not smoke around the person quitting. Also, the longer a person stays away from smoking the more they will be repelled by the smell of rooms inhabited by smokers. In fact, being exposed to second hand smoke can create cravings in a former smoker, even 10 years after they have quit. If your still-smoking-friends don’t respect your need to have a non-smoking environment, they probably don’t have your best interests at heart. You should also note that second-hand smoke can cause cancer and heart disease as well as asthma and the recurrence of ear infections in children.

Finally, almost anything can be associated with the need to light up and have another smoke. Walking out of an office building or a movie theatre are potent cues to many smokers; the first cup of coffee or a beer after work are other cues. One of the ways to counter all of those cues is to work at changing your view of yourself. Making up a list of the reasons that you want to be a non-smoker is a very good starting point. Reminding yourself of the items on the list at least once a day will help you change your mind.

Overall, nicotine is one of the most addictive substances to which we are exposed. Understanding this and developing a plan to manage the factors that make it addicting is a way to break that habit. The issues addressed in this brief article can apply to almost any behaviour you want to change. Identify the factors that create the urge, understand how it really works and what you need to do to change it, seek support from family and friends (if you must, find new friends), and work at changing your self-image from smoker to non-smoker. While it may be difficult, you owe it to yourself and your family to be successful.

Dr Raymond Shred
Registered Psychologist
Nanaimo, British Columbia
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