Smoking Addiction and a Quitting Plan
What Is Addiction?
Addiction is defined as an irresistible urge toward a particular person, object, or substance, combined with the persistence of that urge despite the social, legal, or relational problems it causes in a person's life. Addiction can involve substances such as alcohol, tobacco, cannabis, hallucinogens, heroin, and cocaine. This booklet focuses on tobacco addiction, and specifically on smoking, the most common way tobacco is used. When assessing a person's addiction process, two key definitions come up. These are:
Tolerance: The need for increasingly larger amounts of a substance to achieve the same effect.
Withdrawal: The discomfort a person feels when the substance is not taken.
Nicotine Addiction: Smoking
Nicotine, a harmful chemical found in tobacco products, is addictive. It is most commonly absorbed into the body by inhaling cigarette smoke. Nicotine has a stimulant effect on the body and influences dopamine release in the brain's reward system. When people use nicotine, their blood pressure and breathing rate increase. Nicotine users feel more alert and experience relaxation and pleasure.
Nicotine use causes an artificial increase in the number of nicotinic receptors in the brain, and the body becomes accustomed to operating with a certain level of nicotine present. In other words, people end up needing to smoke more cigarettes to get the same pleasure they once got from one. When they don't smoke, they end up smoking again just to fill the gap left by the nicotinic receptors that the body can no longer fill on its own. This is how nicotine addiction develops.
Smoking addiction is extremely common in our society and spans a wide age range. According to NIDA, people start using substances for a variety of reasons.
These are:
Feeling good: getting a sense of pleasure, feeling better
Relaxing, calming down: forgetting problems, feeling numb
Focusing: sharpening concentration
Curiosity or peer pressure: the idea that "just once won't hurt"
A quick look around us shows that many smokers want to quit. In a survey of smokers in the United States, it was found that in 2018, 55.1% of adult smokers (21.5 million people) had made an attempt to quit smoking. Based on this, and considering that there are also smokers who want to quit but haven't yet acted on it, we can say the proportion of people who want to quit is even higher.
Change: Taking Action
There is a distinction between those who act on the behavior and those who leave it as a mere wish. For a behavior change to occur, people need to complete the "Stages of Change" defined by Prochaska and DiClemente.
Precontemplation stage: In this stage, people may be aware that smoking has negative effects, but they have no awareness at all of the idea of quitting. They have no motivation to change their behavior.
Contemplation stage: People are aware of the advantages and disadvantages of smoking but are ambivalent about changing their behavior. If you think you're in the contemplation stage and are feeling uncertain, you can decide whether or not to keep smoking through an exercise where you write down and organize all your thoughts on the subject.
It's important to recognize that continuing to smoke is also a decision. You can prepare and fill out a table listing the advantages and disadvantages of quitting.
You can use the following questions while filling out the table:
What are the consequences of my behavior for me?
What are the consequences of my behavior for others?
What do I think and feel about myself?
What do others think and feel about me?
Preparation/Determination stage: People in this stage have decided to change and quit smoking and have started making plans toward recovery.
Action stage: After making their decision, people start taking active steps. They begin adopting new and different behaviors to help them quit smoking, though these behaviors are not yet consistent.
Maintenance stage: The person sustains their decision to quit smoking. They have begun adapting to the behavior change and to the new way of life.
Relapse stage: The stage in which people try a cigarette again or return to smoking. In this stage, people may start exhibiting their old behaviors again.
It's important to know that all of these stages are part of the addiction process. What matters is not getting stuck in the relapse stage and keeping up your motivation to change.
Action: Intervening in Addiction
The addiction process involves many dimensions.
Interventions for the physiological dimension of addiction: These can be grouped under a single heading, Nicotine Replacement Therapy (NRT). This method includes various medical options such as nicotine patches, nicotine gum, and nicotine pills (Champix/varenicline). The core mechanism here is to reduce the desire to use nicotine, withdrawal symptoms, and the pleasure derived from smoking.
Interventions for the psychological dimension of addiction: These involve learning and using relaxation exercises and other healthy alternatives to using smoking as a tool for problem-solving or emotional regulation. Work here focuses mainly on the Cognitive Behavioral Therapy model and Motivational Techniques to restructure the thoughts that maintain the smoking behavior.
Interventions for the behavioral dimension of addiction: These include breaking smoking routines, recognizing alternative ways to manage the urge to smoke, and adjustments that can be shaped around your daily routine.
My Smoking Cessation Plan
Alongside any medical support you receive, you can put together a personal 'Smoking Cessation Plan' to help you identify the adjustments you'll make in your life and to prepare in advance for the difficulties you may face during the quitting process. In this plan, which you can shape to fit yourself, you'll find the whole range of things worth thinking through and preparing for, along with interventions you can apply throughout the process.
Step 1: Set a Quit Date for Yourself.
Note: Setting a date within the next few weeks helps you feel ready for this process.
Make sure the day you choose is one when you don't feel uneasy or already anxious. For example, prefer a day when you feel more relaxed rather than a day when you have an important presentation.
The social support you receive during this important life change will help you. At this point, you can tell your loved ones and those close to you that you're planning to quit smoking and that you've set a date for it. The key thing to keep in mind here is to share this thought only with people who will be supportive of you no matter what.
Step 2: Clarify Your Reasons for Quitting.
Having clear reasons will help you stay motivated and stick to your decision, especially when cravings become intense or when you experience withdrawal symptoms. By glancing at this list once or a few times a week, you can remind yourself of the reasons you decided to quit. Below you'll find a sample list:
To live longer and healthier
To avoid economic harm
To take control of my life back
For my kids and family
To set a good example for those around me
To feel less bothered by the restrictions on where smoking is allowed
To look better and not have an unpleasant smell
To fully absorb your decision to quit and to help you pinpoint the reasons for quitting that suit you best, you can answer the following questions.
What is it that I don't like about smoking?
What have I missed out on in life because of smoking?
How does smoking affect my health?
What will get better in my life once I quit smoking?
Recognize Your Triggers.
Triggers are anything that causes your craving to smoke to arise. Being aware of what your triggers are helps you plan and prepare. The triggers that bring on the urge to smoke can be anything in your life. Categorizing them as emotional, day-to-day, and social helps you more easily choose the right way to cope. After you quit, stay away from your day-to-day and social triggers as much as possible. Afterward, you can apply different and healthy ways to deal with your triggers. You can try the suggestions below.
Emotional triggers: The feelings you experience can trigger your urge to smoke. For example, you might want to smoke for reasons like savoring a good moment or venting your anger. When you notice you're in an emotional state that brings on the urge to smoke;
You can talk about how you're feeling with someone you trust.
Close your eyes and take slow, deep breaths to slow down your mind and body.
If you get the urge to smoke during a pleasant moment, focus on continuing to enjoy that moment instead of giving in to the craving.
Incorporate exercise into your life to naturally strengthen your brain's reward system in a way that makes you feel good.
You can listen to relaxing music and do relaxation exercises.
Day-to-day triggers: Any activity in your life that you associate with the smoking behavior can become one of your day-to-day triggers. The key intervention here is to break the link between the activity you're doing/in and your urge to smoke. You can try the suggestions below for this.
Instead of your smoking habit, you can develop new behavior patterns to replace smoking, like chewing gum or eating candy (for example, having chocolate or drinking water after a meal or with coffee instead of a cigarette).
You've probably heard of people who describe smoking as a hand habit. If this pattern applies to you, you can find a different way to keep your hands occupied, like carrying a stress ball or marbles, or doing handicrafts.
If you're sitting, standing up and moving will shift your attention away from the urge to smoke that the behavior you were doing brought on (for example, taking a short walk during work/study breaks instead of smoking).
Change your behavior patterns. Brushing your teeth right after meals can replace the after-meal cigarette with a different behavior.
Social triggers: Since your social circle includes people who smoke, coping with this trigger depends on support from those around you. The suggestions below will help you cope with social triggers.
You can step away from friends and family members when they're smoking.
You can ask them not to smoke around you.
When possible, you can try to avoid entering places where smoking happens.
You can openly tell those around you that you've quit smoking and ask them to help you.
Things You Can Do to Cope With the Urge to Smoke
When the urge to smoke arises, shifting your attention away from that urge is important for being able to cope with the desire to smoke. The list below includes various ways that can help you cope in a healthy manner when the urge to smoke hits you. What matters here is that everyone's way of coping is different, and sometimes you'll need various combinations of these methods. It's important to keep trying until you find the coping method that works for you. When my urge to smoke hits;
I'll stop what I'm doing and turn to another task, giving it my full attention. For example, you can do distracting activities like making a to-do list, organizing the papers on your desk, straightening the pillows at home, or playing a game on your phone.
I'll get physically active. I'll exercise. For example: taking a short walk, going up and down stairs, walking to the store. Regular exercise is an effective way to cope with the urge to smoke, regulate your mood, and deal with withdrawal symptoms.
I'll go somewhere smoking isn't allowed. For example, staying in your own room instead of going near coworkers who smoke, sitting in the non-smoking section of a cafe, or going to the library or the movies — being in places where smoking isn't possible will keep you in a safe zone while your craving fades.
I'll drink water.
I'll do a breathing exercise. Taking 10 slow, deep breaths and focusing your attention on your breathing during that time, and if the craving is still strong, repeating another 10 deep breaths, can help you gain control over the physical symptoms of the urge.
I'll call someone who will support me in not smoking.
Important Note: The intense urge to smoke you feel after quitting is temporary, and how often this intense craving comes will decrease and eventually disappear over time. You can get through each wave of the urge to smoke using a different method each time.
Set Up Activities That Will Be Good for You. Quitting smoking isn't an easy process. In the period after you quit, you may find yourself dealing with negative states like low mood, insomnia, irritability, and tension. That's why, during the quitting process, celebrating even the smallest progress and rewarding yourself will help you stay committed to the process. Building a pool of fun, relaxing activities that make you feel good will help you feel a little better whenever you want to reward yourself or when you're facing tough situations or setbacks. Activities like listening to a song you love, calling someone you love and who supports you, playing with your pet, or going for a walk can help you build this pool of activities.
Coping With a Relapse
It's common for people who decide to quit smoking to occasionally slip into a relapse stage and start smoking again. After smoking again, what matters is not giving up on the quitting process with thoughts like "it's too late now" or "all my effort was wasted," but instead focusing on continuing the quitting behavior. If you've smoked or started smoking again at some point during your quitting process, reviewing the steps below will help you in your quitting journey.
You can reset your quit date. When setting this date, be careful not to overlook your needs.
Reread the notes you prepared about why you wanted to quit smoking. Review the times you didn't smoke and congratulate yourself for that stretch.
Think about what caused you to smoke again. Prepare in advance for how you might apply a different solution the next time you encounter a similar situation.
Did you know? Most smokers need several attempts before quitting for good. Think of setbacks as a way of learning what works for you and what doesn't, and use that knowledge in your next attempt to quit.
Prepare Yourself for Success.
Additional strategies that support the plan you've made will help maintain your motivation and commitment to the process. Below are additional strategies you can apply.
Consult a doctor about smoking cessation medications.
Throw away items like cigarettes, lighters, and ashtrays that you have at home or in your car.
Share the details of your plan with the people who will support you.
If you know someone who has quit smoking before and has stuck with that decision, ask them what worked and what strategies they used.
Save quit-smoking helpline numbers to your phone for support.
Get support from a professional who can help you throughout your smoking cessation process.
You can download the booklet version of this article from the link below.
Duygu Çankaya Çadırcıoğlu, Registered Psychotherapist
REFERENCES
Nicotine Replacement Therapy www.stopsmokinglondon.com
Tobacco Product Use and Cessation Indicators Among Adults — The United States, 2019.
Uzbay, T. (2009). Madde Bağımlılığının Tarihçesi, Tanımı, Genel Bilgiler Ve Bağımlılık Yapan Maddeler. http://www.eczaakademi.org/images/upld2/ecza_akademi/makale/20110325100354mad de_bagimliligi_tarihcesi.pdf adresinden erişildi.
Toker Uğurlu, T., Balcı Şengül, C. ve Şengül, C. (2012). Bağımlılık Psikofarmakolojisi. Psikiyatride Güncel Yaklaşımlar-Current Approaches in Psychiatry, 4(1), 37–50. doi:10.5455/cap.20120403
National Cancer Control Programme, Manual for Tobacco Cessation (2005). Directorate General of Health Services Ministry of Health and Family Welfare Government of India.
https://www.psychiatry.org/patients-families/addiction/what-is-addiction
