What is tobacco addiction?
Nicotine is a powerful drug. It is as addictive as heroin or cocaine (Royal College of Physicians, 2000).
(a) The trouble with cutting down
The cycle of nicotine addiction continues when a smoker cuts down. The smoker will still experience withdrawal symptoms. Smokers may smoke fewer cigarettes but will inhale more deeply and more often to achieve the desired nicotine hit (known as compensatory smoking). Most people find that they quickly return to their usual level of consumption after trying to cut down, because the brain continues to crave the usual dose of nicotine.
(b) Common misconceptions
Stress and smoking
When the next cigarette is smoked, nicotine levels rise again and the symptoms of withdrawal are temporarily relieved. Smokers therefore smoke their next cigarette to relieve the withdrawal from their previous cigarette. In this way the cycle of addiction continues.
Why do some people find it difficult to quit smoking?
The cycle of nicotine addiction can be broken. Nicotine leaves the body 48 hours after the last cigarette, and cravings gradually become less frequent and less intense during the first three weeks of quitting. However, this is only conquering the physiological addiction.
Smokers will have varied reasons for continuing to smoke and this will affect their readiness to quit. These reasons may be categorised into three groups (Royal College of Physicians, 2000), all of which can overlap and reinforce one another.
Stop Smoking Wales delivers an intensive behavioural support programme (SSW Flowchart) to smokers motivated to quit which addresses all three areas. The behavioural support programme helps clients to put in place coping strategies to increase their chances of success in abstinence.
The Fagerström test for nicotine dependence (FTND) (Heatherton et al., 1991) is conducted with all clients. This provides a quantitative measure and is the most widely used smoking cessation tool. An in-depth assessment of the clients smoking history is also taken at the assessment session of the behavioural support programme. Information on Nicotine Replacement Therapy (NRT), bupropion and varenicline is provided. Stop Smoking Wales do not prescribe or supply stop smoking aids, however they will give the client a letter to take to a prescriber (GP or Pharmacist) requesting pharmacotherapy to support their quit attempt.
Breaking old habits can be the most challenging. The treatment sessions aim to share experiences among clients to increase knowledge of practical ways to minimise exposure to situations that are associated with smoking.
Helping the client to understand their relationship with smoking and whether they are dependent on tobacco psychologically is an important aspect of the programme. Common misconceptions around stress relieving proprieties of smoking are discussed as well as planning alternative coping strategies to help the client once the quit attempt has been made.