Barriers to Quitting

Smokers tend to begin using tobacco products before they leave school, with 90% of addicts commencing in regular tobacco use before their 19th birthday. They are less concerned about health risks than older nicotine users and quickly become addicted to nicotine.

Why do people start smoking?

There are three separate factors to consider when assessing the likelihood of an individual to start smoking; environmental factors, socio-demographic factors and individual factors.

Environmental

Parental, sibling and peer smokers can increase pro smoking ideology.

Socio-demographic

Lower socio-economic background individuals and those from ethnic minority backgrounds are more likely to smoke.

Individual

Low self-esteem, poor school/work performance, perception of smoking as ‘cool’ and a history of previous ‘risky’ habits (for example underage alcohol consumption, unprotected sex) are directly linked to starting smoking.

The rate at which individuals become daily smokers almost matches the quit rate, which means smoking prevalence is only declining very slowly.

 

Why is smoking addictive?

Nicotine is a natural ingredient within tobacco leaves, meaning it is present in cigarette tobacco and smokeless (oral) tobacco. Inhaling during the act of smoking a cigarette distils nicotine from the tobacco leaves.

Smokers will regulate the draw and inhalation they take of a cigarette, titrating their nicotine dose to their perceived physical need.

Nicotine is transported into the lungs on tar droplets. When these droplets reach the alveoli of the lungs the nicotine is rapidly absorbed into the blood stream.

Once within the bloodstream, the nicotine travels to the brain where it can bind to nicotinic cholinergic receptors on neurons. This facilitates the entry of calcium into the neuron upon which it has bound.

It is this movement of calcium into the neuron which facilitates neurotransmitter release.

The most important neurotransmitter released by nicotine in the causing dependence is dopamine. It is this neurotransmitter that gives the sensation of a pleasurable experience and is associated with reward motivated behaviour.

Increased availability of dopamine in the brain is synonymous with drugs of abuse. Addictive substances, such as cocaine and MDMA, release dopamine which is strongly associated with their addictive characteristics.

Stimulating acetylcholine receptors in the brain is also associated with release of acetylcholine, noradrenaline, adrenaline and serotonin. This cocktail of neurotransmitters results in the user feeling more alert and more focussed alongside modulating their mood.

The comforts of continued nicotine use are outweighed by the discomforts of quitting. Indeed, withdrawal symptoms are often cited as a reason to maintain, and relapse to, cigarette use.

The neurotransmitters released and increased availability of nicotine within the brain of a smoker results in neuroadaptation occurring.

Withdrawal symptoms typically include irritability, restlessness, depression, anxiety, issues with personal relationships, decreased concentration, increased hunger and eating and insomnia.

The most cited reason reported by smokers for continuing smoking is the perceived effect on stress levels. This is difficult to quantify; however, smokers have self-reported lower anxiety when smoking compared to when not smoking.

Peak withdrawal occurs 1-2 days’ post cessation. Interestingly, smoking cessation has been shown to ultimately improve happiness and reduce stress levels in the long term.

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Photos
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