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Smoking, an Illness and Not Just a Habit

Written by
Dr. Bharat Udey
and medically reviewed by Dr. Sneha Kannan

Published on Jul 09, 2015 and last reviewed on Mar 25, 2019   -  3 min read



Apart from physical hazards, smoking causes behavioral problems in the form of dependence syndrome, characterized by progressively increasing the amount of smoke, intense craving and withdrawal symptoms in the absence of smoke. Though can be quit on its own, it also requires specific treatment for complete cure.

Smoking, an Illness and Not Just a Habit

Smoking is one of the common modes of substance use. Usually, people smoke cigarettes, pipes, bidis, chillums, hookahs. A common ingredient of smoke is tobacco, derived from dried leaves of the tobacco plant. Tobacco consists of an alkaloid known as nicotine, which is water soluble and is a psychoactive substance.

How Does One Get Addicted to Nicotine?

  • On average, one cigarette consists of 1-1.5 mg of nicotine.
  • Once started to smoke, nicotine reaches the brain within 15 seconds.
  • In brain nicotine primarily acts on alpha nicotinic receptors, distributed in different areas of the brain, predominantly in the frontal cortex, where it acts to enhance concentration.
  • Besides frontal cortex nicotine also acts on nucleus accumbens, where it produces its craving causing effect just like other psychoactive substances, hence lead to dopamine surge leading to increased pleasure with smoking and hence cause dependence in long term use.

Withdrawal Effects:

  • Usually, people begin smoking too early in their life (by the age of 14-15 years).
  • In the beginning, they smoke 1-2 puffs which can lead to pleasure sensations.
  • But gradually the amount needs to be increased to seek the same pleasure. This is called tolerance, one of the features of dependence.
  • With long term use, the brain cannot bear the mere absence of nicotine.
  • Hence with the lack of nicotine, a person starts developing withdrawal effects in the form of irritability, headaches, restlessness, difficulty to concentrate.
  • They also develop specific behaviors reflecting the need for a smoke, urge to smoke in public places, to smoke with tea/coffee.
  • They will not be able to enjoy until they get a chance to smoke and would remain preoccupied most of the time in regard to seek out for a smoke.

There are a few criteria by which a person can be diagnosed with tobacco dependence. One such commonly used criteria is Modified Fagerstrom test, used by clinicians regularly.

Once diagnosed with dependence, the next question which arises is how to treat it. Currently, there are many modes to treat tobacco dependence. It is commonly divided into two broad categories, pharmacological and non-pharmacological.

Pharmacological Mode Includes Drugs:

  • Nicotine Replacement Therapy ( NRT): Nicotine replacement therapy, provides nicotine substitute for smoke and can be given under supervision and the dose can be regulated and gradually tapered. The dose of nicotine replacement therapy is determined by the number of smokes required per day by a person. The average duration of treatment is ten weeks. NRT can be given in the form of gums, lozenges, patches, and nasal sprays.
  • Bupropion: It is a noradrenergic dopamine reuptake inhibitor antidepressant, which acts by increasing the level of dopamine. It increases the dopamine level in nucleus accumbens, hence reduces the pleasure produced by tobacco smoke. Hence reduces the craving for a smoke.
  • Varenicline: It is an alpha 4 beta 2 receptor partial agonist, hence acts on alpha receptor and reduces the craving of smoke. It is thus used for treating smoke dependence.
  • Clonidine, Tricyclic antidepressants can also be used for the treatment of tobacco dependence.

Non-pharmacological Treatment:

  • Delay the urge to smoke.
  • Discuss about the smoke and quit the habit.
  • Deep breathing exercises should be practiced.
  • Drink plenty of fluid.
  • Distract yourself from the thoughts regarding smoke.

Also, motivation assessment is also important and should be carried out alongside the treatment, because if the motivation level is low, the risk of relapses is high. Hence, the person should be motivated enough to quit smoking, and his/her motivation should always be increased by the therapist with every session to increase the success of treatment. To enhance motivation, motivational enhancement therapy can be used as well.

In the end, though smoking is easy to start, it is difficult to quit. But if one is motivated enough, it can be stopped, and the abstinence can be maintained as well.

Would you like to quit smoking? Consult a psychologist counsellor online for help -->


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Last reviewed at:
25 Mar 2019  -  3 min read




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