Skip to Accessibility Tools Skip to Content Skip to Footer
Why Quitting Smoking is So Hard.

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.

It all begins by voluntarily inhaling on a cigarette.

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

Over time, a tolerance to nicotine developsWhen 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. 

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

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.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. Orleans, Tracy P, editor, “Nicotine Addiction: Principles And Management,” 1993, New York, Oxford University Press, pages 24-41
  2.   Blakeslee, Sandra, “Nicotine: Harder to kick than… heroin,” New York Times, 1987, March 29,, accessed 8/20/17  Benowitz, et al., “Nicotine addiction.” New England Journal of Medicine, 2010,, accessed 8/20/17  “Nicotine Addiction and you Health,”,, accessed 8/20/17  “Cigarettes and other tobacco products,” National Institute of Drug Abuse, 2017, March,, accessed 8/20/17  Bishop, Shawn, "Smokers' Brains Change In Response to High Levels of Nicotine," Mayo Clinic, 2012, May 24,  Weinberger, et al., “The impact of cigarette smoking on stimulant addiction,” American Journal of Drug and Alcohol Abuse, 2009,,, accessed 8/20/17   "Physical vs Mental Addictions: What's the Difference,",, accessed 8/23/17   "Understanding Smoking," Respiratory Health Association,, accessed 8/23/17


  • voni7
    4 months ago

    I have sever COPD and I am still smoking. I am so ashamed of myself for still smoking, yet I cannot seem to muster up the power to quit. I have all the help, patches, gum, lozenges, prescription pills, and an E cig, and yet I just want to smoke more! I know this is killing me. I am not trying to sound morbid, but I just feel so crappy about myself. I quit drinking over 4 years ago. I am 67 and it is getting harder and harder to do anything I love doing, like my gardening and social things with friends. It seems like I have all the tools to quit, yet something in me refuses to use them. My husband has been so patient and tolerant of me, he quit about 6 years ago. I feel like I am just doomed to dye from this and am trying my hardest to kill myself. I know this sounds fatalistic and I have seen counselors and talked about these things for several years. Just wanted to share this, not that it will help anyone, just to let you know that even if you know your dying, smoking is hard to quit and I hate it. Thanks for listening to my rant. I hope I have not offended anyone. That certainly is not my intention. Sometimes it helps to just get it all out there in black and white so I can see the truth in front of me.

  • Baron
    1 year ago

    The above piece is very informative and well put together. However as an ex smoker I feel there is always something missing from ‘quit smoking’ advice. That is, no-one and nothing is going to give up smoking for you. Not a drug, not a pyschological mantra or even a placebo like an e-cigarette. You have to WANT TO give up smoking before quitting. I chose to go cold turkey after 50 years of smoking 1 ounce of tobacco a day, equivalent to around 3-4 packs. Because I had decided I really wanted to quit, I found it stupidly easy and perhaps only ‘uncomfortable’ for only a couple of weeks. After all, nicotine leaves your system after only about 3 days. What was harder to break, was the ‘habit’ which is touched on in this article, which involves the mechanical routines of smoking and the social aspect. However, if you really want to give up smoking, this is the very first step you have to take. If you enter a ‘quit’ strategy half heartedly, you will surely fail. Courage my friends, you can (and should) do it! Greetings from the UK.

  • nj6133
    2 years ago

    It wasn’t easy to quit and I had been trying for sooo long. One day I could not breath so off to the hospital I went. That night 9/2003 I did quit while laying in that hospital bed, feeling my lungs moving-railing they call it I think-they were moving as if I was breathing heavy but there was not a normal breath of air going in. Scared made me quit, I was done after way to many years of being a smoker. When I got home from the hospital after 6 days, opened my front door and smelled what almost killed me, that awful odor was what reinforced my decision. Every Sept I celebrate my quitting. I have COPD but I am alive and walk 4 or more miles a day, 5 days a week because now I can!
    What is bad for us is usually not what we want to give up but do it while you can!

  • Leon Lebowitz, BA, RRT moderator
    2 years ago

    Hi nj6133 and thanks for sharing your experiences with being hospitalized, quitting smoking and living with COPD. It’s good to hear how well you’re doing now after all you’ve been through. Keep up the good work!
    All the best,
    Leon (site moderator)

  • rickpaul
    2 years ago

    quit by chewing tobacco,it may not be much better i n` know, but at least `its `not goin thu my lungs……….rick

  • Lyn Harper, RRT moderator
    2 years ago


    Good for you for quitting! Sometimes it a step by step progression; you’ve made it this far, hopefully you can take the next step as well. Have you tried nicotine replacement therapy? It may take a combination of therapies – it often does.

    I wish you the very best!

    Lyn (moderator)

  • Poll