Why is it so difficult to stop smoking?

Not so long ago, it was allowed to smoke cigarettes in any closed environment, even on planes. This is because, a few decades ago, little was said about the health risks of smoking, and the practice was even treated by advertising as something that transpired trust, something that only well-resolved and successful people did.

However, over time, the risks began to become increasingly clear, becoming a public health issue. As a result, cigarette brands are now required to include photos and information on health problems caused by cigarettes on their packaging. There is no lack of information when it comes to smoking, but this does not prevent more and more people from starting to smoke and not being able to stop.

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Smoking is an addiction, and it turns out to be a difficult mission to get out of the practice. So what happens to our body when we become addicted to cigarettes? Why is it so hard to stop? To better understand, Canaltech spoke with Karine Cunha, a psychiatrist at the Clínica Ella – Centro de Saúde Feminina and at the IPq-HCFMUSP (Institute of Psychiatry of the Faculty of Medicine of the University of São Paulo), and with some people who smoke, have already tried to quit and failed.

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Tolerance and abstinence

We asked Cunha why smoking is considered an addiction, and the psychiatrist said that every addictive substance, that is, it causes dependence, has two fundamental characteristics: tolerance and the withdrawal syndrome. The specialist explains that tolerance occurs when there is a reduction in the substance’s effect with its continued use. “So, as its effect decreases, the person starts using increasingly larger amounts. The person starts, for example, smoking a cigarette, two, and they lose the effect. To have more, the person starts smoking more . One pack, two packs”, he points out.

Withdrawal syndrome is a set of unpleasant symptoms suffered by the body when the substance is withdrawn, not consumed. “Our brain is used to that chemical,” says Karine. “And when you take this substance, the body misses it. It asks for consumption”. To alleviate this syndrome, then, the person ends up going back to consuming what is causing the addiction.

The psychiatrist also says that any addiction is difficult to let go of because it involves not only physical issues, but also psychological ones. In fact, many people end up smoking to try to combat symptoms of frustration or anxiety, for example, or even depression. “That one [fumar] it has become a habit and every habit is very difficult to give up. So, the person has to be very focused and determined to be able to give up any type of substance that causes dependence”, he comments.

The longer and the greater the amount a person smokes, the more difficult it will be to stop, as the doctor explains, especially when a certain substance begins to be consumed in adolescence. During this period, the brain is still in formation, so the substance ends up altering the organ’s development, chemistry, neurons and neurotransmitters. “So, when the onset is earlier, and the amount used is greater, it is much more difficult to abandon the addiction.

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Still on the effects of an addictive substance in the brain, the psychiatrist explains that the action takes place in the region called the brain reward system. “You consume the substance and then have a chemical release of neurotransmitters in this brain reward system, mainly dopamine and serotonin”, reveals the doctor. So, the person goes through a great feeling of pleasure and euphoria, leaving the brain used to feel all this and want more and more, causing the substance to be consumed in excess. This affects the behavior of the individual, who ends up using nicotine even though he knows how bad it is, even though he wants to stop. Cunha even says that he has seen several patients who have tried to quit smoking more than once in their lives.

Karine explains that the ingredients in cigarettes are what causes the most withdrawal symptoms, which appear from 24 hours after the last consumption, with a peak of one to four days. “So, if the person doesn’t smoke for 24 hours, he starts to have symptoms, which in the first four days come with a very high intensity, lasting about a month, or even longer. days, but the symptoms are very prominent” says the doctor. Among the main symptoms, which usually appear at the same time, are:

Depressive mood; Insomnia; Irritability; Anxiety; Difficulty concentrating; Restlessness; Increased appetite and weight gain.

Attempts

Canaltech talked to some people who have tried to quit smoking and haven’t been able to. The onset, motivations and symptoms are practically the same, which proves that quitting smoking is not an easy task and that there are many issues involved.

The beginning

Raul Barroso, 26, says he has smoked since he was 15 years old (11 in total) and that he started the practice through outside influence, as happens with many issues in adolescence. He says he wanted to impress a girl, but he never stopped. He’s already tried to quit two or three times, and the most recent was when he tried to change his life after bariatric surgery. “I simply put it in my head that I wanted to stop and followed up to treat my anxiety. It worked until I had surgery, as I had to stop taking anxiety medication and I started smoking again to control it,” he explains.

Flávio Faria, a 29-year-old publicist, says he started smoking even younger, at 12, and has already been addicted for 17 years. With a story a little different from Rui’s, he started to smoke not only because of the influence of friends at school, but also because of his family because he also lived with a smoker mother. He tried to stop three times, twice on his own and once on medical advice. “On two occasions I tried to stop just reducing the daily amount and in one with medical help who prescribed the patch and an anxiety medication,” he says.

We also talked to Jonathan Nunes, 26, who has also smoked since he was 12, totaling 14 years of smoking. He started smoking out of curiosity and has tried to quit countless times for financial reasons, the smell of cigarettes and mainly for health. The administrative assistant says he managed to stop for a year, but ended up coming back.

In the case of Felipe Soares, 29, smoking started when he was 19 years old, influenced by a cousin. “We went to a club every Friday and he always took a pink cigarette that had flavor, and when I drank I smoked it with him. Felipe has also tried to quit a few times, spending a maximum of four months without nicotine, motivated by the financial and health issue.

Feelings

Raul told us that, in fact, he considers himself a nicotine addict, and that when he stopped smoking he felt better and less tired, but at the same time stressed, impatient and always trying to do something to occupy his mind. “As much as they say it’s easy, at times when we don’t have access to cigarettes, anxiety attacks,” he says, revealing that smoking ends up being a refuge from daily stress, which has also been “discounted” in food. The young man reveals that after the surgery he started to monitor the health of his lungs and that he hopes to stop again. Another hurdle at the moment is the fact of being alone in the pandemic, which is the reality of many people.

Flávio told Canaltech that, when he stopped smoking, he didn’t miss it much in the first few days, which ended up changing drastically in the following days. “As time went on, I felt a little shaky and weak, with a lot of headaches,” points out the advertiser in relation to physical symptoms. Regarding psychological symptoms, once again anxiety, irritation and restlessness were the answers. He considers himself dependent, does not undergo medical follow-up and intends to try to stop the addiction again, saying that what prevents him is willpower, which is overshadowed by the knowledge of what the withdrawal symptoms are. Furthermore, Flávio says he knows that it is necessary to learn to control impulses.

Jonathan also said that when he stopped smoking he felt abstinence. “[Fiquei] well shaken, his nerves frayed, but he was getting smaller. But the desire never went away and it was always bothering him,” he commented. The young man considers himself a nicotine addict, does not have medical follow-up on his health and says that he always waits for a moment when he’s fine for another attempt. “It has to be a lot. psychologically, because it’s very easy to sabotage oneself,” he says.

Felipe says that if he doesn’t smoke for a single day, he already feels agitated and eats a lot of “junk”, besides being very anxious and waiting for something to happen. He has never had his lungs monitored and says he intends to try to break the addiction again. “I try practically every week, this year my record was three days,” he said, saying that the biggest obstacle ends up being himself, as he doesn’t feel well without cigarettes.

How, then, to abandon the addiction to cigarettes?

Karine Cunha says that trying to smoke without help is extremely difficult, and advises anyone who wants to stop smoking to look for a psychologist and a psychiatrist, as each of the professionals will act differently. “The psychiatrist is the professional specialized in any type of substance dependence, and there are medications that help a lot the person to interrupt consumption”, he explains. Regarding the psychologist, the professional says that there are two types of therapy: traditional psychotherapy, which helps people to know themselves, their positive and negative points, and cognitive-behavioral therapy, aimed at the person’s problem. “So, in the case of nicotine addiction, there are several structured sessions, when the psychologist discovers what the trigger is, that is, what makes the person seek cigarette consumption, and teaches the person to develop strategies to be able to stop the addiction “, exemplifies.

Image: Reproduction/Rawpixel

Cunha says that there are different treatments for tobacco dependence, each with a different mechanism of action. The psychiatrist brings as an example bupropion, which acts on the brain’s reward system, messing with neurotransmitters (dopamine, serotonin, norepinephrine), reducing the desire to smoke. It does, however, have two weeks to start taking effect. The doctor gives a tip to a person who has this medication prescribed and wants the treatment to be effective. “The ideal would be to start taking the medicine two to three weeks before the day chosen to stop smoking, so when that day arrives, she will already have reduced desire”, she says.

Another option mentioned by the doctor is the use of nicotine replacement patches, because when the entry of the substance into the body is interrupted, the person has withdrawal symptoms. The patch then replenishes the blood nicotine in the bloodstream, reducing abstinence. Effectiveness will depend, however, on the amount of cigarettes a person smokes. “If she smokes several cigarettes, we use the highest concentration, and we keep reducing the concentrations to zero”, he points out. Regarding gums and lozenges, Karine says that they help when the person feels the uncontrollable urge to smoke, releasing the nicotine absorbed by the mucosa of the mouth. Therefore, they also reduce withdrawal symptoms and cigarette cravings.

There is also an option called varenicline, which is very effective in fighting addiction but has many side effects. “Usually, we don’t start the treatment for him, but when the patient had several other attempts, with several other methods and it didn’t work, we used it. The medicine, alone, reduces the withdrawal symptoms and the urge to smoke”, he adds.

Finally, the psychiatrist says that to stop smoking you have to really want to, and then seek medical and psychological help for that. She reinforces that it is ideal that the person is at a good time in life to make it easier, avoiding doing it in times of stress, for example, in terms of relationship breakups, among other changes in life.

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