Why You Smoke
Why You Smoke
Linda Hyder Ferry (Associate Professor, Preventive Medicine and Family Medicine, Loma Linda University School of Medicine) gives expert video advice on: Why is it so hard to quit smoking?; What is 'nicotine'?; How does nicotine affect the body? and more...
Why is it so hard to quit smoking?
Smoking is a very complex human behavior. It involves a variety of aspects that trap some people much more one way than another. For example, some people; just the rituals and routines of using a cigar, a pipe, a cigarette, becomes very familiar to them. And they have a hard time breaking that. Other than habit, there is psychological dependence, the meaning you get out of it, and how it makes you feel, and what you associate with smoking. "Oh, I use a cigarette to relax.". And that's hard to change that part of the human behavior. But the real reason people can not quit smoking, when they make up their mind to stop, is because of the brain chemistry that makes you feel good when you smoke and within hours of not having a cigarette the brain chemistry changes, creating withdrawal symptoms that make someone feel miserable. Irritable, they have cravings, they're hungry, and they're fidgety. And all of those symptoms are very unpleasant for a smoker. Going on two weeks, for some people six weeks, before they really feel like they're free from that cycle of brain chemistry.
What is 'nicotine'?
Nicotine is a water soluble chemical, grown in the leaves of tobacco plants and several other plants of the same family. It is actually designed to be an insecticide, so that when some insect comes to eat the plant, they get poisoned. Now tobacco plants are genetically engineered, and farmed and grown, to have a very high content of nicotine. When nicotine in a tobacco leaf is smoked and inhaled into the lungs, five to ten seconds later it gets through the lungs into the blood, and up the arteries of the neck into the brain.
How does nicotine affect the body?
Once someone inhales cigarettes into the lungs, it gets picked up from the capillaries, absorbed into the blood, goes right up the arteries to the head and releases in the brain chemicals that create a sense of pleasure, relaxation, and stimulation. A smoker knows just how to smoke enough nicotine by the length of time they hold it into their lungs and how frequently they puff on the cigarette to create a level of nicotine that feels comfortable and good to them, creating the sensations of nicotine dependence. Every person uses nicotine differently to create that effect.
How does nicotine affect the brain?
Nicotine is absorbed in three ways, either through the mouth with people who puff on a cigar, on a pipe, people who chew, or in the nasal mucosa or through a cigarette inhaled into the lungs. That nicotine travelling to the brain affects a specific part of the brain to create a release of chemicals that feel good. There are four or five specific areas that nicotine works on, but I would like to just focus on two that have to do with nicotine addiction. The first one is the release of nicotine in a place of the brain called the reward center. That releases a chemical called dopamine that feels great when you smoke a cigarette. It makes someone associate whatever that behavior was with "That feels great, let's do that again". In other words, laughter, running, exercise, eating food, drinking water, smoking a cigarette, or sexual release. All of those release that chemical called dopamine that human beings associate with a state of feeling good. The difference is that nicotine's affect on this reward center is almost instantaneous. Six to seven seconds after a puff of cigarette, that smoke delivers enough nicotine to create a high that no other normal physiologic experience can mimic. Nicotine stimulation from a cigarette puffed into the lungs is the most intense pleasure other than chemicals such as crack cocaine or amphetamines in releasing dopamine into the human brain to make people get the sensation that they want.
Why do I crave cigarettes?
Someone who has been smoking for a significant period of time, meaning months to a year, has set up pathways in their brain where nicotine releases chemicals that feel great, and then those chemicals drop and you don't feel so good. So you smoke again and you get another high and then another drop. That pattern of nicotine highs and then withdrawal, create the sensation that smokers begin to associate with "I'm afraid I'm addicted". That pathway has a physiologic mechanism that will call for nicotine again.
Is smoking a habit or an addiction?
Taking tobacco in any form, whether it is chewed, smoked, inhaled in the mouth and puffed out like a cigar or a cigarette, can be a habit for a short period of time. A habit is something you do repetitively, and automatically. Once you have crossed the line and you are now set into the pattern of highs from your nicotine dependence and then lows, this then becomes an automatic part of your brain function and you are addicted to nicotine. You know you are addicted is that you physiologically get those symptoms. Nicotine is the most addicting substance that a human brain comes in contact with on a milligram per milligram basis then any other chemical, meaning it takes very little nicotine to the human brain to set up the addiction cycle.
Why is smoking called an addiction?
Many people think everyone is an addicted to something. Actually, addiction has a very specific definition. Addiction means that you use a behavior or a substance that creates a sensation in a human being that has to be increased over time to maintain that addiction. Someone doesn't smoke one cigarette and get addicted. Someone can smoke a cigarette and feel high, that feels great, and want to repeat that. But you're not yet addicted, you're experimenting with something. The second part is that once you set the cycle in your brain, you have a definition called withdrawal. You'll have withdrawal from any true addictive disorder. You can have withdrawal from chemical dependency. You can have withdrawal from alcohol. You can have withdrawal syndromes from marijuana. You can have withdrawal syndromes from sexual addictions. It requires both increased tolerance to the behavior or this chemistry that you're using, and once you stop the behavior or the chemistry a pattern of withdrawal which is specific for that addiction. So, why is nicotine the agent that people say smoking is an addiction versus a habit? It's because nicotine absolutely fits that pattern of definition for addictions that the American Society of Addiction Medicine uses as a consistent definition, to say “this behavior or this pattern of behaviors and withdrawal symptoms” is tolerance plus withdrawal equals addiction.
What are the most common reasons people smoke?
If you look at the age at which Americans, and people in the western culture begin to smoke, often it's between 12 and 15 years of age. Now the reason why adolescents smoke is very different from the reason why adults continue to smoke. Adolescents smoke for peer pressure. Adolescents smoke just to experiment. Adolescents smoke to rebel. Adolescents smoke to just fit in with a certain crowd. They smoke to be sophisticated. They smoke because they want to look grown up like an adult. But, once the adolescent crosses a line and has been using tobacco on a regular, daily basis for a period of time, they move over into the next stage. That's where they actually use the substance long enough to develop patterns in their brain to be addicted. Ten percent of adults who use tobacco, can lay tobacco down and not miss it at all, and have no withdrawal symptoms. But 90% of human beings who encounter tobacco on a regular basis become addicted to it. So when you say to someone, "Why do you smoke? What do you like about it?" Most of the time they say, "I like the way it makes me feel." I like it because it helps me relax. I like it because it helps me when I'm at work to be calm, and to be able to focus on my work and stay stimulated. When I'm not smoking, I just feel distracted. I like cigarettes because of the way it makes me feel in my throat. When in reality that's just an association with how it's feeling in your brain. Most people say, "I smoke because I like the way it feels." The other half of the smokers say, "I smoke because I have to. I smoke because I'm used to it. I smoke because it's a habit." They think, but when in reality it's a habit that has turned into a controlling addiction. They really don't have the choice to smoke anymore.
Does smoking really help you relax?
Taking deep breaths and exhaling, or performing yoga can help you relax. If you are a smoker and need to smoke to relax, try these techniques!
If smoking is so dangerous, then why is it legal?
In the United States, we need to remember that tobacco was our cash crop as a beginning nation. The tobacco industry forming around that, primarily in the South-East, worked with our legislators to protect tobacco, especially at the point where the Food and Drug administration legislation went through - tobacco was excluded as not a drug and not a food. So therefore it has been totally outside of the realm of control by appropriate health authorities through all these years. It is legal because it has assumed a role as a product that someone uses just because they like it, because it's a habit, something you can quit anytime you want. The tobacco industry specifically denied for decades that it created addiction even though their own research showed unequivocally that it was an addictive substance.
Why do I crave a cigarette every time I go to a bar?
Craving for a cigarette actually has two or three origins. One is the craving that is associated with chemistry: a chemical reminder that occurs every so often in a smoker where they start searching for their cigarette and their lighter because their brain says, "My nicotine levels are low." But when you go into an environment where you always do this ritually and where it calls for smoking socially - with other people or because of the activities that you engage in - you do that out of habit. So there is a ritual and a routine and an environmental cue to smoke, such as in a bar. But there's another reason in addition to chemistry and the environment, and that is that alcohol decreases your decision-making process about smoking. Alcohol is associated with a cigarette by habit, but alcohol itself and the way it affects the brain makes you want to have nicotine in association with that.