Understanding the Science of Quitting Smoking: Why is it So Hard?

This year there are currently 1.3 billion tobacco users worldwide.

It's common knowledge that smoking is unhealthy to both smokers and non-smokers - the latter of which could inhale secondhand smoke. Because smoking is a public health concern, there's been an increase in smoke-free laws to protect people's health and encourage cessation.

Despite these laws, statistics on tobacco usage by WHO show that only 4% of users who attempt to quit smoking will succeed without cessation support. Even with intervention, the chances of quitting only doubles, and is far from certain. The threat of a relapse is always on the horizon as well, and recent research has found that about 85% of ex-smokers will return to smoking within a year.

Why is it so hard to quit? Here's a look at the science behind smoking addiction.

Chemical Effects

First, we need to understand how smoking addiction affects the brain. Cigarettes contain about 600 ingredients, and when burned create more than 7,000 chemicals. The primary ingredient is tobacco and the smoke produced has been proven to include formaldehyde, lead, ammonia, hydrogen cyanide, arsenic, and nicotine among many others.

Nicotine is the key variable causing addiction. An article on nicotine buzz by Prilla discusses how nicotine activates specific receptors found in our peripheral and central nervous systems. These are called nicotinic acetylcholine receptors. When nicotine binds with them, they release neurotransmitters that communicate with the body that there has been an increase of acetylcholine release norepinephrine.

This makes users feel alert and focused. When paired with the stimulated release of dopamine, a chemical involved in pleasure, users become dependent on this release and start craving for the same hit. That is why cessation alternatives like vapes and nicotine pouches are careful to include smaller amounts of nicotine.

Smaller amounts lead to steady weaning by slowly decreasing the brain's dependency on nicotine. However, we previously noted in Vaping Around the World, many countries still ban e-cigarettes due to smoking hazards and health risks. For that reason, users hoping to quit for good may look into non-smoking alternatives like the nicotine gum or the spit-free nicotine pouch.

Social Pressures

While the chemical effects of smoking explain part of the problem, understanding society's impact on smokers is equally crucial.

The Campaign for Tobacco-Free Kids denounces tobacco ads targeting teenagers, as research has found that many teens associate cigarettes with popularity, sophistication, or attractiveness due to these "social" ads. Peer pressure plays a huge role: 88.2% of adolescents have tried a tobacco product when their friends did, and social smoking has also become a recreational or leisure activity.

This shouldn't be surprising when we assess how secondhand smoke contains nicotine as well. 1 in 5 nicotinic acetylcholine receptors (nAChRs) in the brain become occupied by nicotine after only 1 hour of exposure to secondhand smoke. This means that even one smoker's habit can have far-reaching effects.

Cornell University economist Robert Frank explains this "behavioral contagion", and how it is often the situation, not the individual's attitude, that influences decision-making. Attitudes are as communicable as viruses. In this case, the smoking epidemic is a social problem that requires legislative measures and efforts from every stakeholder to successfully vanquish.

It is extremely difficult to quit smoking on your own, unless society acknowledges these externalities and harnesses behavioral contagion and chemical responses as playing equal roles in smoking addiction. Only when these are acknowledged will cessation become an easier collective experience.

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