Nicotine
is the focus of this section. Smoking is the primary method of ingesting nicotine,
but dipping, or using nicotine gum and inhalers also get the job done. Any of these
may be substituted for the words smoking or cigarettes throughout the text.
Nicotine dependence is common, although dependence rates are higher
among females than males (31.6% vs. 27.4%), and higher among whites (31.3%) than blacks
(25%) or Hispanics (27.6%)1.
A Difficult and
Important Passage
The
vast majority of quit attempts fail!
Underestimating the nature of the challenge produces a recursive chain
[whirlpool] that pulls one toward relapse. Unrealistically
high expectations concerning one's mental control abilities or
underestimating the task difficulty may not only produce complacency, but
cause one to become excessively self-critical following mere cognitive
slips, let alone behavioral ones. This distress, or even panic, further
depletes cognitive resources, increasing the likelihood of a full blown
relapse5a.
 The
PIG says, "If people had an
appreciation of the nature of this task, they would focus less on their
own shortcomings, and more on the procedural details required to achieve the goal. When expectation is unrealistic, then failure is
inevitable."
Relief of Stress
One of the draws of smoking is that it is relaxing and helps the smoker
cope with stress. Smokers feel more relaxed when smoking than when not, and both
adult and adolescent smokers report that lighting up helps them cope with the stressors of
everyday life. But nicotine is a cholinergic agonist with stimulant rather than
sedative properties. Quizzically, users report report that smoking reduces
their stress.
Consider the itch, how pleasurable to scratch it. But the
pleasure is limited, and too much scratching hurts and can do damage. The curse of
the itch: as soon as you stop scratching, it begins to return - often with greater
strength. So it is with nicotine use - a self-generating behavior chain
maintained by a process akin to scratching an itch.
Most smokers have become dependent on nicotine, and need it to
maintain normal moods. They often suffer from unpleasant feelings of
irritability and tension between cigarettes, when plasma nicotine levels are
falling. This is why smoking is most pleasurable after an extended period of
abstinence - such as the first cigarette of day.
The idea that smoking helps one cope with stress is an illusion.
Smoking produces a short-term reduction of stress because it removes the
stress caused by withdrawal symptoms - scratching the itch.
Like athlete's foot, it may feel good to scratch, but it detracts from the quality
of life. Below are research finding that support the notion that the apparent mood
benefits of smoking only reflect relief of withdrawal symptoms:2
-
Smokers' stress level is similar to nonsmokers' stress only when
they have just smoked. Smokers' stress levels become worse than nonsmokers' during periods
of nicotine abstinence.
-
When nicotine deprived and non-deprived smokers were allowed to
smoke a cigarette, mood improvement only occurred in deprived subjects, who were, due to
withdrawal effects, already suffering from poor mood. When non deprived smokers had a
cigarette, their self-rated stress levels were hardly affected by smoking. Rather
they remained at normal levels - similar to those of nonsmokers.
-
Cohen and Lictenstein3 report that smokers who attempted
but failed to quit, reported unchanging levels of high stress over the 6 months they were
monitored. In contrast those who completely abstained for the 6 months reported a steady
decline of stress over time. The authors note that successful and unsuccessful quitters
reported similar stress levels at baseline, so it was not just the less stressed smokers
who managed to quit.
-
West and Hajek4 found that quitting resulted in
significantly lower state anxiety scores. They conclude: "Giving up
smoking is quite rapidly followed by a reduction of anxiety that may reflect
removal of an anxiolytic agent, nicotine."
-
When tobacco naive subjects are first administered nicotine, they
report feelings of anxiety and tension rather than relaxation.
-
When adolescents take up occasional smoking, they become more
rather than less stressed, and their stress levels increase as they become regular smokers.
-
When adults quit smoking they become less stressed rather than more
stressed.
-
There is no evidence that smokers suffer without nicotine, other
than during the initial brief period after quitting.5
The
importance of successfully completing this passage cannot
be overestimated: One of every two smokers dies from smoking!
Nicotine Replacement Therapy:
Nicotine replacement reduces the biological craving caused by
abstinence. However, much of the subjective craving experienced during quit attempts
is attributable to environmental factors - smoking related triggers that are not dampened
by nicotine patch or gum.6 Indeed, the impact of nicotine replacement on
craving is modest.7
Nicotine replacement therapy does more harm than good if you are not
strongly addicted to nicotine. However, if the answer to both of these
questions is, "Yes" nicotine replacement therapy may help. . . a little.
-
Do you have your first cigarette within 5 minutes of awakening?
-
Is the cigarette you would miss the most the first one of the day?
Whether or not you are strongly addicted, overcoming this beast is a
difficult task - one worthy of your respect. This web site contains information the
will help the intelligent layperson achieve a good outcome.
Suggested starting points:
Comments from a
Psychologist:
Quitting smoking
is tough. Even professional treatment is less than completely effective.
Most studies report a success rate - still not smoking one year after treatment - of
between 11% and 50%, with most reporting about a 20% success rate. Here are
some tips to increase your chances for successful outcome:
- Each journey is different, and
so there are no formulas or methods that are effective for everyone.
- Because you
have consumed nicotine so many times in so many situations - a regular smoker gets
about 60,000 hits each year - smoking
has become an autonomous habit.
Changing such a habit is not as simple as it seems - Please visit The OPEN Path for one solution.
- It is essential that abstinence is total! Success requires that you be
incorruptible - no exceptions, no matter what the circumstance. The odds are better
than 5 to 1 that if you have a single lapse you will ultimately relapse. Please
visit The Impeccable Path for the recommended solution
for nicotine dependence [this path is not necessarily recommended for other addictions].
- Escape from nicotine
dependence is difficult because it does not seem like a "big deal" at the
crucial moment. Like the first bribe accepted by a politician, the first lapse may
seem innocent, but it is almost certain to corrupt your future. The illusion that the first lapse is "no big deal" is
responsible for most failures.
- Most people believe that quitting
smoking is easier than it really is. For example, despite the prevailing view that smoking is
addictive, 60% of adolescent and 48% of adult smokers believe that they
“could smoke for a few years and then quit” if
they decided to.8
Footnotes
1. NIDA Notes, 16, 9, 2001
2. This review is based on a paper by Andy Parrott: American
Psyhol., 1999, 54, 817-820.
3. Cohen, S & Lictenstein, E, Health Psychol, 1990, 9,
466-478
4. West, R & Hajek, P, Amer J of Psychiatry, 1997, 154,1589-1592
5. Hughes, J. JCCP, 1992, 60, 689-697
5a. Polivy and
Herman. If at First You Don’t Succeed False Hopes of Self-Change. 2002 American Psychologist, 57, 677-689
6. Tiffany, S. etal. JCCP, 2000, 68, 233-240.
7. Jorenby, D. etal. Psychopharmacology, 1996, 128,
130-138
8. Arnett, J. J. Optimistic bias in
adolescent and adult smokers and nonsmokers. Addictive Behaviors, 2000, 25, 625–632.
9. Zagona, S. V.,
& Zurcher, L. A. (1965). An analysis of some psychosocial variables
associated with smoking behavior in a college sample. Psychological
Reports, 17, 967–978.
10. Milam, J. E., Sussman,
S., Ritt-Olson, A., & Dent, C. W. (2000). Perceived
invulnerability and cigarette smoking among adolescents. Addictive Behaviors, 25, 71–80.
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Giving
up smoking is easy, I've done it hundreds of times.
- Mark Twain
...You can fool some of the people all of the
time...
- Abraham Lincoln
No man is free who cannot command himself.
- Pythagoras
I went to a bookstore and asked the saleswoman,
"Where's the
self-help section?" She said if she told me, it would defeat the
purpose.
- Steve Wright |
