Why is it so hard to quit smoking?

First Posted: 1/20/2014

While browsing the Internet one day for the latest research on quitting tobacco, I stumbled across the American College of Chest Physicians website. For the first time, I saw a new approach to tobacco cessation that was logical, step-wise and patient-centric. This was no mirage, but a thoughtful, team-based approach to tobacco cessation.

If you have never smoked a cigarette or dipped tobacco on a regular basis, you are not going to understand this part of the article. Why is it so hard to quit using tobacco? Because the person feels absolutely miserable when they do. And not just for a few hours or days; it can go on for weeks in some cases.

Withdrawal is very patient-specific and symptoms can vary based on how much of your misery is secondary to nicotine withdrawal vs. habit vs. hand/mouth stimulation. The motivation to smoke is key to the behavior and must be addressed if we are to find the answers to controlling symptoms.

Why is it so hard to quit? From a nicotine dependence standpoint, there is withdrawal. Nicotine hits receptors in your brain that are associated with the pleasure of eating food and drinking beverages. These same receptors are also associated with fight or flight survival, alertness and memory.

As teenagers, when most folks start smoking, brains generate more receptors to function at its best in a nicotine-rich environment. So when that brain tries to function without nicotine, it feels sluggish and slow — well, miserable. There are other folks who aren’t as reliant on nicotine, but have used smoking as a way to calm themselves during times of high stress. Removing themselves from a high-stress area, meeting friends for a 10-minute break and taking deep breaths all lead to feeling calmer and more balanced.

Finally, there is some credence to the idea that smoking is a way to self-treat anxiety and depression. As the cigarette/dip is taken away, the symptoms of sadness, fatigue, feeling out of control and worry surface, resulting in feelings of — you guessed it — misery.

There has been concern in the past about a higher suicide rate among those trying some of the newer medications for tobacco cessation. However, an unfortunate fact is that tobacco users — particularly heavy users — have a much higher incidence of suicide than the general population. This certainly supports the belief that many use tobacco to control symptoms of anxiety or depression. A good program needs to evaluate for these disorders as well.

If you have been thinking about quitting smoking or dip, talk to your primary care physician about the options available, or feel free to call Gibson Cancer Center at 910-671-5762.

Some insurance plans under the Affordable Care Act offer tobacco cessation services at no out-of-pocket cost to the patient. Visit healthcare.gov to learn if this is offered through your plan.

We can tailor a program to help you kick the habit. Hope to hear from you soon.

Physician Assistant Catherine Gaines is the patient navigator for Gibson Cancer Center, an affiliate of Southeastern Health. She can be reached at gaines01@srmc.org.