Why Quitting Smoking is So Hard

It’s often said that cigarette smoking is one of the hardest habits to break. Quitting, for lack of a better way of putting it, is a “Pain in the butt.” So, why is it so hard anyway? Here’s all you need to know.

What is in cigarettes?

Nicotine is an alkaloid liquid found in plants like tobacco. It turns brown when exposed to air. It smells like tobacco. Cigarette smoke containing nicotine enters your airways, travels through your air passages, and comes into contact with blood vessels. It then enters your arterial blood and binds to white blood cells. It is then delivered to nearly all cells in your body. It also is capable of crossing the blood/brain barrier, something very few substances are capable of doing. So, within seconds, it enters your brain. There it binds to nicotine cholinergic receptors. This causes calcium to enter neurons and neurotransmitters to exit neurons.^1-3 

Another common neurotransmitter released is dopamine.  Neurotransmitters are chemicals that transfer nerve impulses from your brain to the rest of your body. The most significant in our case is dopamine. This hormone produces the pleasurable feeling you experience after inhaling cigarette smoke. Other chemicals in cigarette smoke may enhance the effect of nicotine on the brain, thereby enhancing the production of dopamine.^1-3,5

Tolerance and withdrawal

Over time, a tolerance to nicotine develops. When this happens, more nicotine cholinergic receptors in the brain are created. When nicotine binds to them, they release more dopamine, which increases the feeling of pleasure. Over time, these receptors become desensitized to the effects of nicotine. In other words, they become tolerant to nicotine. This is what some experts believe causes people who smoke to smoke more. So, while you might start out smoking 1-2 cigarettes a day, this increases, perhaps, to 1-2 packs per day after several years.^{1, 6}

Abstinence creates withdrawal symptoms. Nicotine cholinergic receptors get used to nicotine being there; they expect it to keep coming in. When they receive no nicotine, they do not release enough dopamine, which means you experience withdrawal symptoms. Smoking that next cigarette releases more nicotine into your system, and this triggers the release of more dopamine. You once again feel pleasure. 

Smoking a “typical” number of cigarettes in a day “maintains near-complete saturation” of these receptors. Essentially, when you get to this point, you are basically smoking to prevent withdrawal. Your reward now becomes the feel and taste of the smoke in your mouth, the smell of it in the air. ^3,6 

So, you decide to quit smoking.

Of the 45 million Americans who smoked cigarettes in 2010, 70% said they wanted to quit. Of that 45 million, 40% did quit for at least one day. Of those who quit, 80% returned to smoking within one month. Why? Because, when these nicotine cholinergic receptors don’t receive any nicotine, this instigates a series of chemical reactions that trigger irritation, restlessness, craving tobacco, difficulty concentrating, anxiety, stress, and depression. ^2,3 These negative feelings are hard to overcome. This is why it’s so much easier just to smoke another cigarette than to go without.

It might be harder to quit smoking than drinking. You might think this is a crazy statement, but it’s what studies show. In fact, studies show that quitting smoking might be just as hard as quitting heroin, cocaine, and amphetamines. ^2,3This is why nicotine is now listed as a “dependence-producing drug.” Nicotine, therefore, is a positive reinforcer. Inhaling it into your system causes a euphoric effect. It makes you happy, content, relaxed.¹This is why people keep smoking even when they know the risks. This is why many smokers keep smoking even after a diagnosis of a smoking related disease, such as COPD. 

They are highly addictive

It is highly addictive. There is both a physical addiction and psychological addiction.

1. Physical addiction. This is where your body gets used to a drug you voluntarily put into your body, which in this case is nicotine. Not putting it into your body causes withdrawal symptoms. This is due to changes (as described above) in your body due to chronic exposure to the drug. It gets to the point where, if you don't have another cigarette, you literally crave one; you seek one.   
2. Psychological addiction. This is the habit associated with smoking. For instance, you are in the habit of waking up, sitting at your kitchen table, having a cup of coffee, and smoking a cigarette. This brings you pleasure. The nucleus accumbens is a part of your brain that controls pleasure. When you do something that brings you pleasure, like smoking cigarettes, this part of the brain wants you to repeat that something.⁸

You can break the habit

So, in order to quit, not only do you have to break the physical addiction, you also have to break the psychological addiction. The combination of these is what makes cigarette smoking a pain in the butt to quit.^{1, 8-9}

But it can be done. 

When you succeed at quitting, the number of nicotine cholinergic receptors gradually declines, and your body gradually increases production of dopamine to normal levels. So, it may take a while, but withdrawal symptoms will eventually subside.⁶ The benefits of quitting are well worth it. If you smoke and want to quit, the best place to start is by talking with your doctor.