By Dr. Raju Hajela

Most people know about the harmful effects of smoking and the benefits of not smoking, yet that knowledge is usually not enough to motivate people to quit. Gruesome images and direct messages related to harm caused by cigarettes on packages of cigarettes have a limited impact on preventing smoking or helping people quit, largely because of Addiction, the perceived positives of smoking and the negatives of not smoking that every smoker has to go through to become smoke-free!

Nicotine is Highly Addictive
Inhaled tobacco smoke takes nicotine from the lungs into the bloodstream and up to the smoker’s brain within 7 seconds. Nicotine triggers a number of chemical reactions that interfere with feelings for the smoker (usually taking away negative feelings even though they may be perceived as pleasure). These sensations are short-lived, subsiding within minutes. As the nicotine level drops in the blood, smokers feel edgy and agitated — the start of nicotine withdrawal. So, in order to relieve the discomforts, smokers light up another cigarette… and then another… and another. And so it goes — the vicious physiological cycle of nicotine addiction. One cigarette is never enough, a fact that every smoker knows all too well.

Smokers are sometimes unaware of the Addiction as many continue to look smoking as just a bad habit. Reality of Addiction is much different.

Nicotine and Adrenaline
Nicotine, chemically being a stimulant, leads to the release of adrenaline, the “fight or flight” hormone. Physically, adrenaline increases a person’s heart rate, blood pressure and restricts blood flow to the heart muscle. When this occurs, the smoker experiences rapid, shallow breathing and the feeling of a racing heartbeat. Adrenaline also instructs the body to dump excess glucose into the bloodstream.

Nicotine and Insulin
Nicotine also inhibits the release of insulin from the pancreas, a hormone that is responsible for removing excess sugar from a person’s blood. This leaves the smoker in a slightly hyperglycemic condition, meaning he has more sugar in his blood than is normal. High blood sugar acts as an appetite suppressant, which may be why smokers think their cigarettes reduce hunger.

Nicotine and Dopamine
Nicotine activates the same reward pathways in the brain that other drugs of abuse such as cocaine or amphetamines, although to a lesser degree. They all increase the level of dopamine in the brain, a neurotransmitter that is responsible for feelings of pleasure and well-being. The acute effects of nicotine wear off within minutes, so people must continue dosing themselves frequently throughout the day to maintain the pleasurable effects of nicotine and to prevent withdrawal symptoms. Research has shown that children treated with stimulants for ADHD are more vulnerable to using tobacco and cocaine, as they get older, in addition to misusing their prescribed medications.

So, the perceived positives of tobacco in terms of pleasure, relaxation and concentration are all related to relief from the negatives of not smoking, which include physical withdrawal symptoms, dealing with the return of suppressed feelings and positive physical changes that may be perceived as negative, e.g. increased coughing as the cilia in the lungs regenerate and clear the accumulated debris from the lungs. The ‘pleasure’ associated with coffee and cigarettes or alcohol and cigarettes is actually a chemical balancing act that is also linked to a conditioned response as the body and brain actively try to compensate for the disruptive internal changes created by the external chemicals!

Dealing with Withdrawal, Feelings and the Recovering Body and Brain:
Physical withdrawal symptoms such as loss of concentration ability, irritability, fatigue etc.; and feelings of anxiety, depression, mental agitation are all temporary phenomenon that dissipate over time. They do contribute to craving, which in many ways can simply be called ‘looking for relief’, that is directly related to falling nicotine blood levels. However, as Addiction is a brain disease that affects not just the reward circuitry but also the memory, motivation and related circuitry, the withdrawal symptoms and feelings can be triggered by stress, environmental cues and other substances or behaviours that affect the same circuitry! Hence, it is extremely important for smokers to look at their personal vulnerabilities as they prepare to quit smoking, to develop strategies to deal with those challenges; and seek ongoing help through knowledgeable friends and/or professionals to support the recovery journey not just from smoking but also other aspects of Addiction that may be present or emerge.

Food Issues

As the taste buds regenerate upon quitting smoking, there is a tendency for people to eat more. This is compounded by the loss of nicotine affecting adrenaline, thus affecting metabolic rate; and the reward circuitry substitution for food when nicotine is no longer providing the dopamine release. Fears of weight gain or actual weight gain are strong de-motivators for many people to persist with becoming smoke-free.

Breathing Issues
The cilia in lungs that are damaged by long-term exposure to smoke start to regenerate once the damage is not occurring during a smoker’s quit attempt. This can be perceived as irritability in air passages and increase in productive cough as the lungs begin to clear away the accumulated debris. This may also compromise breathing at times despite the net positive benefits of not having carbon monoxide interfere with carrying oxygen through the bloodstream and the removal of more than 4,000 toxic chemicals that cause lung damage.

Brain Issues

Last but perhaps most importantly, it is essential to recognize that the internal argument – Do I smoke? or Don’t I smoke? – is futile! The brain does not distinguish between do or don’t, hence, the message ‘Don’t Smoke’ is interpreted as ‘Smoke’! Even when someone does not smoke for some period of time due to strong determination, this approach is hard to sustain. In contrast, internal and external dialogue that reinforces being smoke-free, enjoying a tobacco-free life and enhancing health, even though there may temporary challenges along the way, is the key to success and well-being!

So, if you are a smoker, get to know the facts and yourself, to embark on the positive journey of being smoke-free for life!!