The US Surgeon General has said, “Smoking cessation [stopping smoking] represents the single most important step that smokers can take to enhance the length and quality of their lives.”
It’s hard to quit smoking, but you can do it. To have the best chance of quitting and staying a non-smoker, you need to know what you’re up against, what your options are, and where to go for help. You’ll find this information here.
Why is it so hard to quit smoking?
Mark Twain said, “Quitting smoking is easy. I’ve done it a thousand times.” Maybe you’ve tried to quit, too. Why is quitting and staying quit hard for so many people? The answer is nicotine.
Nicotine
Nicotine is a drug found naturally in tobacco. It’s as addictive as heroin or cocaine. Over time, a person becomes physically dependent on and emotionally addicted to nicotine. This physical dependence causes unpleasant withdrawal symptoms when you try to quit. The emotional and mental dependence (addiction) make it hard to stay away from nicotine after you quit. Studies have shown that to quit and stay quit smokers must deal with both the physical and mental dependence.
How nicotine gets in, where it goes, and how long it stays
When you inhale smoke, nicotine is carried deep into your lungs. There it’s quickly absorbed into the bloodstream and carried throughout your body. In fact, nicotine inhaled in cigarette smoke reaches the brain faster than drugs that enter the body through a vein (intravenously or IV).
Nicotine affects many parts of your body, including your heart and blood vessels, your hormones, the way your body uses food (your metabolism), and your brain. Nicotine can be found in breast milk and even in the cervical mucus of a female smoker. During pregnancy, nicotine crosses the placenta and has been found in amniotic fluid and the umbilical cord blood of newborn infants.
Different factors affect how long it takes the body to remove nicotine and its by-products. In most cases, regular smokers will still have nicotine or its by-products, such as cotinine, in their bodies for about 3 to 4 days after stopping.
How nicotine hooks smokers
Nicotine causes pleasant feelings and distracts the smoker from unpleasant feelings. This makes the smoker want to smoke again. Nicotine also acts as a kind of depressant by interfering with the flow of information between nerve cells. Smokers tend to smoke more cigarettes as the nervous system adapts to nicotine. This, in turn, increases the amount of nicotine in the smoker’s blood.
Over time, the smoker develops a tolerance to nicotine. Tolerance means that it takes more nicotine to get the same effect that the smoker used to get from smaller amounts. This leads to an increase in smoking. At some point, the smoker reaches a certain nicotine level and then keeps smoking to keep the level of nicotine within a comfortable range.
When a person finishes a cigarette, the nicotine level in the body starts to drop, going lower and lower. The pleasant feelings wear off, and the smoker notices wanting a smoke. If smoking is postponed, the smoker may start to feel irritated and edgy. Usually it doesn’t reach the point of real withdrawal symptoms, but the smoker gets more uncomfortable over time. When the person smokes a cigarette, the unpleasant feelings fade, and the cycle continues.
Nicotine withdrawal symptoms can lead quitters back to smoking
When smokers try to cut back or quit, the lack of nicotine leads to withdrawal symptoms. Withdrawal is both physical and mental. Physically, the body reacts to the absence of nicotine. Mentally, the smoker is faced with giving up a habit, which calls for a major change in behavior. Both the physical and mental factors must be addressed for the quitting process to work.
Those who have smoked regularly for a few weeks or longer will have withdrawal symptoms if they suddenly stop using tobacco or greatly reduce the amount they smoke. Symptoms usually start within a few hours of the last cigarette and peak about 2 to 3 days later when most of the nicotine and its by-products are out of the body. Withdrawal symptoms can last for a few days to up to several weeks. They will get better every day that you stay smoke-free.
Withdrawal symptoms can include any of the following:
Dizziness (which may only last 1 to 2 days after quitting)
Depression
Feelings of frustration, impatience, and anger
Anxiety
Irritability
Sleep disturbances, including having trouble falling asleep and staying asleep, and having bad dreams or even nightmares
Trouble concentrating
Restlessness or boredom
Headaches
Tiredness
Increased appetite
Weight gain
Constipation and gas
Cough, dry mouth, sore throat, and nasal drip
Chest tightness
Slower heart rate
These symptoms can make the smoker start smoking again to boost blood levels of nicotine until the symptoms go away. (For information on coping with withdrawal, see the section called “How to quit.”)
Other substances in cigarette smoke
There is some evidence that other chemicals in cigarette smoke may act with nicotine to make it harder to quit smoking. The effects of smoking on monoamine oxidase (a brain chemical) and the substances called harman and norharman are still being studied. For some people, withdrawing from smoking causes more severe mood problems, which can result in worse cravings and more trouble staying quit.
Smoking affects other medicines
Smoking also makes your body get rid of some drugs faster than usual. When you quit smoking, it may change the levels of these drugs. Though it’s not truly withdrawal, this change can cause problems and add to the discomfort of quitting. Ask your doctor if any medicines you take need to be checked or changed after you quit.
Why should I quit?
Your health
Health concerns usually top the list of reasons people give for quitting smoking. This is a very real concern: smoking harms nearly every organ of the body.
Half of all smokers who keep smoking will end up dying from a smoking-related illness. In the United States alone, smoking is responsible for nearly 1 in 5 deaths, and about 8.6 million people suffer from smoking-related lung and heart diseases.
Cancer
Nearly everyone knows that smoking can cause lung cancer, but few people realize it is also linked to a higher risk for many other kinds of cancer too, including cancer of the mouth, nose, sinuses, lip, voice box (larynx), throat (pharynx), esophagus, bladder, kidney, pancreas, ovary, cervix, stomach, colon, rectum, and acute myeloid leukemia.
Lung diseases
Smoking greatly increases your risk of getting long-term lung diseases like emphysema and chronic bronchitis. These diseases make it harder to breathe, and are grouped together under the name chronic obstructive pulmonary disease (COPD). COPD causes chronic illness and disability, and gets worse over time — sometimes becoming fatal. Emphysema and chronic bronchitis can be found in people as young as 40, but are usually found later in life, when the symptoms become much worse. Long-term smokers have the highest risk of developing severe COPD. Pneumonia is also included in the list of diseases caused or made worse by smoking.
Heart attacks, strokes, and blood vessel diseases
Smokers are twice as likely to die from heart attacks as non-smokers. Smoking is a major risk factor for peripheral vascular disease, a narrowing of the blood vessels that carry blood to the leg and arm muscles. Smoking also affects the walls of the vessels that carry blood to the brain (carotid arteries), which can cause strokes. Smoking can cause abdominal aortic aneurysm, in which the layered walls of the body’s main artery (the aorta) weaken and separate, often causing sudden death. And men who smoke are more likely to develop erectile dysfunction (impotence) because of blood vessel disease.
Blindness and other problems
Smoking increases the risk of macular degeneration, one of the most common causes of blindness in older people. It promotes cataracts, which cloud the lens of the eye. It also causes premature wrinkling of the skin, bad breath, gum disease, tooth loss, bad-smelling clothes and hair, and yellow teeth and fingernails.
Special risks to women and babies
Women have some unique risks linked to smoking. Women over 35 who smoke and use birth control pills have a higher risk of heart attack, stroke, and blood clots in the legs. Women who smoke are more likely to miscarry (lose the baby) or have a lower birth-weight baby. Low birth-weight babies are more likely to die or have learning and physical problems.
Years of life lost due to smoking
Based on data collected in the late 1990s, the US Centers for Disease Control and Prevention (CDC) estimated that adult male smokers lost an average of 13.2 years of life and female smokers lost 14.5 years of life because of smoking.
Each year, smoking causes early deaths of about 443,000 people in the United States. And given the diseases that smoking can cause, it can steal your quality of life long before you die. Smoking-related illness can limit your activities by making it harder to breathe, get around, work, or play.
Why quit now?
No matter how old you are or how long you’ve smoked, quitting can help you live longer and be healthier. People who stop smoking before age 50 cut their risk of dying in the next 15 years in half compared with those who keep smoking. Ex-smokers enjoy a higher quality of life. They have fewer illnesses like colds and the flu, lower rates of bronchitis and pneumonia, and feel healthier than people who still smoke.
For decades the Surgeon General has reported the health risks linked to smoking. In 1990, the Surgeon General concluded:
Quitting smoking has major and immediate health benefits for men and women of all ages. These benefits apply to people who already have smoking-related diseases and those who don’t.
Ex-smokers live longer than people who keep smoking.
Quitting smoking lowers the risk of lung cancer, other cancers, heart attack, stroke, and chronic lung disease.
Women who stop smoking before pregnancy or during the first 3 to 4 months of pregnancy reduce their risk of having a low birth-weight baby to that of women who never smoked.
The health benefits of quitting smoking are far greater than any risks from the small weight gain (usually less than 10 pounds) or any emotional or psychological problems that may follow quitting.