Quitting Smoking...Are Smokers Physiologically Poised to Fail?
Where smoking is concerned, there is good news and bad news. The good news is smoking rates are at an all-time low in Canada. The bad news is there are still 4.2 million people in Canada (about 14.2% of the population) who still smoke, with the majority of smokers being between ages 20 and 35.1 This means that people are picking up the habit all the while knowing the highly advertised health-related dangers associated with tobacco use.
Why is this the case? Some of the well-documented health risks include cardiovascular disease, stroke, peripheral vascular disease, cancer (lung, breast, prostate, bladder, gastric, esophageal, and many more), peptic ulcer disease, COPD and many other lung-related disorders.2 There is essentially a laundry list of negative effects of smoking, yet people are still willing to smoke. This is because in addition to the risks, people actually derive quite a bit of benefit from smoking in the form of euphoria, relaxation, and stimulation, which can be a significant motivator to continue the habit. Nicotine, the main pleasure-deriving compound in tobacco, travels to the brain once it has entered the bloodstream, and binds to receptors called nicotinic acetylcholinergic receptors, similarly to how a key inserts into a lock to open a door.3 These receptors, or locks, are located in the pleasure centre of the brain, called the mesolimbic system, and when unlocked release dopamine, which induces euphoria and relaxation.3 Furthermore, nicotine inhibits enzymes that breakdown dopamine, leading to a prolongation of the pleasurable effects, and promotes the release of cortisol and catecholamines (for example, adrenaline), which stimulates the body, providing a sense of stamina and vitality.3
Smoking may be increasingly more socially unacceptable, but when viewed from a physiological perspective, it is understandable that people may decide to turn to cigarettes to relieve psychological and physiological stress.
That being said, a large proportion of smokers wish to quit; however, are struggling to do so. While approximately 70% of people wish to cease smoking, only about 4-7% actually succeed without intervention.1 What makes it so difficult? It has to do with the physiological effects of nicotine on the previously mentioned nicotinic acetylcholinergic receptors, or the dopamine locks in the brain. When exposed to nicotine (the key) over a continuous period, the brain automatically will create more locks to soak up as much of the nicotine as possible, while releasing about the same amount of dopamine.3 This is known as tolerance. What this means is that it takes more and more nicotine to produce the same effect. When an individual tries to cease smoking (especially if when quitting ‘cold turkey’), there are an increased number of locks needing keys to release dopamine and derive pleasure, far more than what can be satisfied by normal neurotransmitters in the body, such as acetylcholine.
This leads to the withdrawal symptoms experienced, such as feelings of depression, agitation, and restlessness, which makes quitting smoking a very unpleasant experience.2 Fortunately, over time your brain will delete or downregulate those additional receptors back to the normal quantity, and this will help to ease the withdrawal, releasing you from the physiological dependence of nicotine.
Here are some tips for smoking cessation:
- Motivate yourself – often people wait until they experience a health-related crisis to fully commit to smoking cessation, but you can motivate yourself with positive reinforcement before this occurs. Some use a reward system, such as saving the money they would have otherwise used to purchase cigarettes to buy a luxury item for themselves (for example, a vacation or a boat or flying lessons).
- Change your daily habits – smoking is often associated with certain activities during the day, such as your morning coffee or your break at work. Change your habits or routine so that you avoid those activities while quitting smoking. Instead of drinking coffee while reading the morning paper, take your coffee to go and drink it in the car on your way to work, or go for a walk during your break, instead of heading to the smoking area.
- Quit as a team – make a pact with a family member or friend to quit smoking together, so that you can motivate each other and provide encouragement when the other person is feeling vulnerable.
- Have a plan – there are certain occasions that often go hand-in-hand with smoking, such as an evening out with friends. Make a plan ahead of time to deal with those cravings that may arise, especially if your friends are smokers as well, and be prepared to battle the urge to smoke in such situations.
- Get help – there are many pharmacological and psychological support systems available to help you quit. Ask your physician about medications to help reduce cravings and support groups to assist with motivating you to continue your quitting process, even in times of stress.
Most of all, remember that it can take several attempts before you are successful. In fact, it can take up to 30 tries before a person fully kicks the habit. If you know someone who is working on quitting, try to be as sensitive and supportive as possible, as this may be the most difficult thing they have ever attempted to do.
Candice Griffin is eVitality's founder, and is now pursuing a career in medicine. Read more about her here.
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1. Propel – Centre for Population Health Impact. Tobacco Use in Canada: Patterns and Trends 2015. Retrieved from www.tobaccoreport.ca.
2. Rigotti, N. MD. Benefits and Risks of Smoking Cessation. Retrieved from www.uptodate.com.
3. Govind, A. et al. Nicotine-induced Upregulation of Nicotinic Receptors: Underlying Mechanisms and Relevance to Nicotine Addiction. Retrieved from http://www.ncbi.nlm.nih.gov.