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  Have You Ever Wonder Why it is 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 is a drug found naturally in tobacco. The body becomes physically and psychologically dependent on nicotine. Studies have shown that smokers must overcome both of these to be successful at quitting and staying quit.
When smoke is inhaled, nicotine is carried deep into the lungs where it is absorbed quickly into the bloodstream and carried to the heart, brain, liver, and spleen. Nicotine affects many parts of the body, including the heart and blood vessels, the hormonal system, body metabolism, and the brain. Nicotine is found in breast milk and in cervix mucous secretions. Nicotine freely crosses the placenta and has been found in amniotic fluid and the umbilical cord blood of newborn infants. Nicotine is metabolized by the liver, lungs and a small amount is excreted by the kidneys. Nicotine is broken down into cotinine and nicotine-N'-oxide.
Although several different factors influence the rate of metabolism and excretion, measurements of nicotine or its metabolites will vary depending on the fluid being measured (blood, urine, or saliva). In general, a regular smoker will have nicotine or its metabolite (cotinine) present in the body for about 3 to 4 days. In studies measuring nicotine levels in urine, 72 hour urine collections yielded greater than 90% of cotinine in most subjects.
Nicotine produces pleasurable feelings that make the smoker want to smoke more and also acts as a depressant by interfering with the flow of information between nerve cells. As the nervous system adapts to nicotine, smokers tend to increase the number of cigarettes they smoke, and hence the amount of nicotine in their blood. After a while, the smoker develops a tolerance to the drug, which leads to an increase in smoking over time. Eventually, the smoker reaches a certain nicotine level and then smokes to maintain this level of nicotine.


Why Do a Lot of Smokers Fail to Quit Smoking?
About 25% of adults continue to smoke, about 70% of them want to quit. In one study, of the women smokers who said they wanted to stop smoking, 80% of them were unable to. Nicotine is a psychoactive drug, and some researchers feel it is as addictive as heroin; in fact, nicotine has actions similar to cocaine and heroin in the same area of the brain.
Depending on the amount taken in, nicotine can act as either a stimulant or a sedative. Most smokers have a special fondness for the first cigarette of the day because of the way brain cells respond to the day's first nicotine rush. Rat studies show that nicotine increases the activity of dopamine, a chemical in the brain that elicits pleasurable sensations -- a feeling similar to achieving a reward. The first nicotine intake of the day is particularly effective in enhancing the activity of dopamine-sensitive neurons. During the day, however, the nerve cells become desensitized to nicotine; smoking becomes less pleasurable and smokers may be likely to increase their intake to get their "reward". A smoker develops tolerance to these effects very quickly and requires increasingly higher levels of nicotine.
Withdrawal is a difficult process. Even after years of nonsmoking, about 20% of ex-smokers still have occasional cravings for cigarettes. A study in 1986 reported that 68% of all smokers wanted to quit, and in that year a third of them tried seriously, but only 6% of all smokers succeeded. People who keep trying, however, have a 50% chance of finally quitting, and in any case the attempts to quit are never a waste of time, since the amount of smoking is reduced during these periods.
Researchers have been trying to discover those conditions or sets of behaviors that can help predict why so many people fail to quit. From one study to the next, however, no consistent factors have emerged; these include gender, number of cigarettes smoked, levels of nicotine in the blood, length of time smoked, or the intensity or severity of withdrawal. A 1994 study, however, did find one consistent predictor for failure to quit: almost anyone who cheated during the first two weeks of withdrawal, even if they were wearing the patch, was smoking again in six months. On the other hand, nearly half of the people who didn't cheat during the first two weeks were still not smoking after sixth months.
A recent study indicates that smokers who quit and start again may damage their lungs even more severely than people who have not yet made an attempt to quit. Some experts suggest that those who relapse may have been at high risk for poor lung function in the first place or that those who start smoking again are more strongly addicted than other smokers and may inhale more deeply and hold the smoke in their lungs longer. The message here is not that quitting smoking is more dangerous than not quitting; the emphasis is on not starting again.

Copyright * 1998 Nidus Information Services, Inc. Well-Connected Report: Smoking. September 1998.

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