Nicotine Addiction

Introduction

Nicotine, the substance obtained from the tobacco plant, is the active ingredient in cigarettes, smoking pipes, chewing tobacco and cigars. It’s a stimulant which is, for many, the underlying reason promoting ongoing use and addiction in many individuals desperate to quit smoking. In fact, many find it so hard to quit nicotine that they continue to smoke cigarettes, even though it’s widely known to be harmful for the body.

Nicotine, however, is not just a substance found in tobacco. For many, it’s a chemical that drives a variety of bodily processes with astounding impacts on the ability to refrain from smoking, all while reducing the chances of ever kicking this negative habit.

Today, those mechanisms will be delved into; the effects of nicotine on the body will be discussed and explored and, the reasons nicotine is so addictive will finally be understood.

But, first…

...a brief history

The use of nicotine is believed to have been a habit of many a man, and has been shown to have been in practice since as early as 5000 BC.

The Ancient Greeks used it in healing rituals, the early North Americans for religious purposes, the later European settlers as a gesture of goodwill. Today, it’s a habit, a social crutch… a drug. Today, nearly a billion people across the globe smoke tobacco, which is believed to be driven solely by nicotine [1].

But why so? What exactly is it about nicotine that keeps people going back; many times, even when they’re desperate to quit. In answering that question, it’s necessary to know what effects nicotine has on the body.

Section 1: Insights into nicotine

How nicotine affects the body

At its very core, nicotine has what is called a parasympathomimetic action.

It acts on the nervous system, promoting a response when it binds to the specific receptors it targets [2]. These receptors, which allow the nicotine compound to lock onto them, then send messages to the brain. In mere seconds from the time of initial consumption, the nicotine spreads through the body via the bloodstream. The target organ, however, isn’t the lungs, the kidneys or even the stomach. It’s the brain.

Once nicotine crosses the barrier into the brain, it promotes a number of precise reactions… Ones that are related to addiction.

Nicotine and its addictive properties

Those who use nicotine, do so for many different reasons: stress relief, focus [3], social pressures or simply because they enjoy the habit. Perhaps the most compelling reason, however, is the effect it has on the primary reward and reinforcement centres of the brain

Nicotine does something so incredible to the brain; an action that compels the ‘seeking out’ behavior [4] for the next ‘fix’.

For a better understanding of why some find it so hard to commit to smoking their last cigarette, or using other nicotine-containing products for the last time, it would be necessary to understand the hormonal triggers that arise after nicotine consumption. The hormones released as a result of nicotine use are predominantly known as ‘feel-good’ hormones.

The first being dopamine. It’s the natural chemical the body releases in response to sa positive stimulus, like praise or reward.

Nicotine use is highly associated with a dopamine-reward mechanism [5]. It’s a learned behavior that associates the use of the chemical with positive emotions. This positive outcome is motivation to continue taking part in the habit and it becomes a behaviour; a reward-seeking, incentive-driven behaviour.

The very first trigger for this habits is said to be stimulated by the receipt of a reward [6]; in this case, the habits refers to smoking cigarettes. The reward may have been a teenager being acknowledged by a group of peers upon smoking their first cigarette. Or possibly the positivity that came with a break from a stressful situation at work. It could have even been the reward of fitting into a certain culture that was associated with the habit, for example, comparison to glamorous movie stars, handsome cowboys, or upper class businessmen who were the face of smoking advertisements.

Whatever the trigger, good or bad, it was likely linked to some form of reward.

Continuation of the reward the began acting as a predictive cue for further reward; this prediction of reward is the second step following behavior-reward learning [7], [8]. Once predictive behavior is set in motion, the knowledge that a reward is likely to come is sufficient to initiate the reward-seeking behavior. It is also believed that this reward-related behavior is as a result of nicotine’s specific effect on dopamine release. There appears to be an increase in the duration of dopamine release under the influence of nicotine, which makes the feeling of reward all the more intense [9].

Another effect dopamine has is its influence on emotional and working  memory, habit forming and executive function. Emotional memory is the recall of an emotion felt during the act of a particular experience while working memory is the ability to make immediate conscious decisions based on the information that is part of short-term memory. Habit forming is the act of performing a task in an automatic fashion, a form of subconscious action, while executive function is the ability to get things done; to manage time and to pay attention [10]. There is, however, more to true addictive behavior.

Addiction is more than just reward-seeking

A reward-based learning process is not the only system involved in behavioral actions. There’s also a punishment-based learning that takes place in learned behaviors [11]. When considering a reward, one also learns that when the behavior is not initiated there is likely some form of punishment to follow, albeit an emotional punishment. It’s the balance of reward and punishment that prompt actions that are conducive to sustaining life, and also of the process of addiction [12].

Addiction is a modification of these learning circuits. And it’s why tobacco use is the leading cause of preventable death, which results in the loss of over 7 million lives across the globe, every year (6 million from direct use, and 1 million from exposure to secondhand smoke) [13].

Nicotine, while blamed for addiction, is not the only factor involved in the addiction process. There are environmental stimuli and sensory experiences that play a role.

The Pavlovian experiment provides a valid explanation of these cues.

Stimulating the idea of a reward

During the experiment Pavlov, a scientist, wanted to show that a response could be elicited upon a certain stimulus, even if that stimulus was not directly related to a response. Using his dog, he showed that simply ringing a bell would not cause a dog to salivate. He hypothesised, however, that he would be able to condition the animal to produce this response (salivation).

For a number of days, he would ring a bell, and then feed his dog. He would continue to do so until he observed that the dog would expect food when the bell was rung. Once it was evident that the dog associated the ringing of the bell with food, Pavlov begun ringing the bell but would not bring the dog any food. With this, he proved his theory. The dog would salivate in spite of no food.

It’s the Pavlovian theory of stimulus-outcome and stimulus-reward-outcome that can be associated with nicotine addiction. It’s that act of lighting a cigarette, for example, followed by a feeling of relief, relaxation, calm and control, and being more alert that creates the desire to do it again. Continuing with this stimulus-outcome action, a stimulus-reward-outcome reaction can be elicited. The mere thought of a cigarette, the smell of tobacco or even a stress response can promotes the reward-seeking behaviour and this trigger the need for that outcome [14], which is nicotine use.

Tied together, these dopamine-influenced brain and behavior pathways are what keep many people going back to nicotine; locked in that behavior, even though there is awareness of the fact that the behavior is harmful.

Continuing to smoke despite the knowledge of its risk

This association between continuing a habit despite it being harmful, according to scientific reports where researchers have explored the behaviors in smokers, is said to do with a risk-reward system. Firstly, it appears that those who go on to smoke have a higher tendency to seek out behaviors that have immediate reward, or satisfactory outcomes. It may be the reason for an increase in the incidence of making risky decisions - even making bad choices - to get that quick, and subjective high-level reward [15].

In a study, conducted back in 1999, the conclusion was that smokers know about the risks involved in their behavior [16]. A follow up study, performed in 2000, showed that although smokers appear to be aware that there are risks involved in smoking, the brain fails to interpret these risks correctly [17].

The evidence for this misinterpretation is cleared when looking at younger people who smoke. From around the ages of 14 to 20, there’s a form of denial of the risks involved in smoking; not when they first start the habit and, not well into the first few years after that, it seems. In fact, it appears that this denial stems from what is called an accumulation of risk. “One cigarette won’t harm me, and neither will two. But maybe 300,000 will?”

The brain appears to block perception of the harm that once cigarette can have and, during the moment, blocks the thought that by continuing to smoke a pack a day, after 40 years this can add up to around 300,000 cigarettes having been smoked. Denial or not, smokers and non, it has been proven that, eventually, this habit will become harmful.

Yet people keep doing it.

Questions arise as to why. Is it a case of being unable to say no, or the intent on seeking rewards? The answer may lie in whether smoking is a physical dependence or an addiction; or both.

Smoking can become an addiction or be a physical dependence

There’s an essential difference between addiction and physical dependencies.

When it comes to nicotine and the habits that have formed around it, like smoking cigarettes, both terms are appropriate to use. Delving into the meaning of each may give a clue as to why.

Addiction is a behaviour that is created due to chemical changes in the brain. These chemicals cause a behaviour to continue, even if there is an awareness around the fact that it may be harmful – to oneself or to others.

It may cause irrational behaviour and result in poor decision-making when the substance to which there is an addiction no longer has an effect on the body. While addiction is often associated with elicit or pharmacological drugs, there is an aspect of addiction in nicotine use; it’s when there’s an associated inability to stop using the substance or quit the habit despite knowing it’s potential to cause harm.

Dependence typically precedes addiction, which is true of substance abuse. With nicotine use, dependence may be observed parallel to addiction; an explanation that becomes clear when there is a clear understanding of what dependence is.

Dependence can be broken down into two further categories: mental and physical dependence.

Mental or psychological dependence is associated with emotion. The emotion associated with the behaviour is triggered by how a person feels about the habit. For example, the second someone wakes up, they think about a cigarette, or they associate having a cigarette with drinking coffee, it may even be connected to a specific environment or place…

Psychological dependence becomes clearer during times of withdrawal. When going without, the consequences can be emotional. When nicotine use has been avoided for a certain time, emotions like moodiness, anxiety, depression or irritability may result.

Physical dependence is the manifestation of physical symptoms when no longer taking part in the behaviour. For example, feeling shaky, tired, or ill when nicotine has not been consumed for any time period.

It become clear now that nicotine as a substance, a chemical, has a powerful influence on behaviour, and there is little to question as to whether it also has mentally and physically effect. It is this combination of effects of nicotine that allows both addiction and physical dependence to be used interchangeably when referring to nicotine habits.  

In summary, nicotine addiction is used to describe the chronic, relapsing behavior associated with the compulsive seeking out of products containing nicotine, and the associated symptoms of withdrawal that include anxiety, mood swings, irritability, dysphoria and other negative emotional effects when there is no longer access to nicotine [18] [19].

Despite the nature of these symptoms, it is not guaranteed that a person hoping to stop their use of nicotine products will develop them.

Who is more likely to develop an addiction? Do they have certain personality traits?

One of the most startling statistics surrounding nicotine use are those obtained in relation to depression. It has been reported that the smoking portion of this population is twice that of the non-depressed population [20]. In research conducted in as early as 1990 [21], scientists explored the link between depression and smoking, finding that a history of major depression was one of the greatest risks for quitting failure, where removal of tobacco products exacerbated the symptoms of low mood [22].

It is a complex topic, and one over which researchers are still debating the defining criteria, though there is consensus amongst the health community that there are stages in which addiction progresses [23], namely:

• The initiation phase, where use of the addictive substance begins
• A maintenance phase, where use continues
• Loss of control over intake
• Compulsive intake and seeking behaviours
• High rate of relapse during avoidance or relapse

Interestingly, when it comes to withdrawal and relapse, studies show that there are more people that do not develop an addiction to nicotine, and they are able to quit without the negative consequences [24].

What does play a role in their development, appears to be a level of vulnerability; a factor that has a significant level of genetic influence [25]. This genetic influence will be discussed in greater detail in a later section, the question as to whether specific personality traits play a role in whether one is more likely to become addicted, needs addressing.  

One of the first traits associated with nicotine use and addiction appears to be impulsivity and novelty-seeking behaviour which, although complex in nature, are largely inherited. Impulsivity can be defined as behaviour that includes a low level of planning, which may be inappropriate for the situation, and which includes risk taking actions without adequate consideration of the potential consequences [26]. Without generalising, studies have show tobacco users to possess this personality trait [27].

Emotions also play a part in this personality trait, where cravings tie in to the subsequent behavior. Similar to food cravings, it’s difficult to move past the craving, once the need or desire has been fixated upon, and which typically goes beyond the reward-seeking intent associated with a surge of nicotine. Impulsivity also has to do with the ability to control a response to a certain behavior, whether that impulse to ‘have it right now’ or not can - or cannot - be controlled.

One of the traits associated with this aspect of impulsive behavior is called ‘delay discounting’. It’s described as the value placed on a reward, where impulse is measured in length of time it takes to receive the reward. In tobacco use, for example, delay discounting is higher. The longer one waits to satisfy the impulse, the less value there is placed on it. That means, impulsivity has a big role in the maintenance of the behavior; if impulse is no longer a factor, there is greater chance of reducing the behavior with increased time that passes between the stimulus and the receipt of the reward [28].

Another personality trait is novelty or sensation-seeking behavior in the risk of tobacco use and addiction. This, too, is a heritable tendency. It’s a trait that predicts how a person will need to seek out sensational, intense or more complex and emotional experiences  to satisfy their desires. This trait, according to research done way back in the 70s and 80s, is one of the most important factors to consider when addressing addiction [29] [30] . It is highly associated with reduced ability to stop smoking, and is one of the main problems associated with the continuing of the habit having attempted to quit [31].

It can thus be concluded that personality traits do play a role in addiction, but what of addictive personalities?

Addictive personalities don’t exist

Those who do become dependent or ‘addicted’ to smoking – and other behaviors for that matter – may often joke that they have an addictive personality; particularly when they aren’t able to stop.

Scientists, cannot otherwise pinpoint universal character traits that are common to all of those who are addicted to one substance or another [32], a statement confirmed by experts at the Center for Neurobehavioral Research on Addiction at the University of Texas Health Science Center at Houston. Looking at personality traits of smokers, they can’t be categorized; some are bold, others shy. Some have a certain degree of control over their addiction, others don’t. Some are honest, others aren’t. There is no clear personality associated with addiction.

Despite the stigma associated with addiction, many don’t fit into the mould of the typical personality disorder associated with lying, stealing, having no conscience and being manipulative or antisocial. Research shows that only a mere 18% of all addicts display these traits!

What is possible - and plausible - when it comes to addiction and personality traits may have to do with the following influencers:

Genes: Evidence in children born to addicted parents that have subsequently been adopted by non-addicted parents, show that only half of them go on to be addicts themselves. This research shows that genes have around a 50% chance of being involved in the formation of addictive behaviours [33].

It is, however, important to remember that genes do not dictate action. The process of free choice also needs to be taken into consideration along with the factors that include availability of an addictive – or potentially addictive – substance and whether someone would indeed choose to use it.

Some bodies of evidence suggest that vulnerability, which is a heritable trait, is associated with the genetic risk of addiction [34]. As discussed above, the personality profiles of impulsiveness and novelty-seeking behavior that has been linked with tobacco addiction, is part of genetic vulnerability [35] [36]. However, there are also environmental and psychological factors associated with addiction and vulnerability, for that matter.

Environment: The role that the environment an individual is exposed to is becoming increasingly implicated in the use of tobacco and nicotine addiction. This includes social influences on vulnerability.

The human brain is very susceptible to effects of the environment. Insight into adolescents and peer pressure may provide a clue. Many people were first exposed to the habit when they were compelled to do so during social interactions with peers at a young age. It was the environment that offered them the opportunity to take part in the behavior, essentially setting a platform for which an addiction could manifest [37].

Psychological: As mentioned above, while it has been difficult to pinpoint the exact relationship between the two, research has shown that there is a higher prevalence of smoking in the population that are living with psychological pathologies, like depression, for example. Studies have proven that there are overlaps in the brain pathways associated with addictive behaviour as well as cognitive and emotional function [38].

Experts have attempted to study the more intricate details of these connections, but a strategy that will show whether psychological pathologies came before smoking or, whether smoking lead to these psychological disorders has proved elusive. In any event, the numerous studies that have been conducted show that both genetics and the environment may play a role in the psychological aspect of addiction [39].

Experts also believe that there is another side to addiction that compels the practice despite a person being in a state of reduced health, where the use of a substance is a form of self-medication, and it has been particularly well-studied in psychological disorders.  

The theory of self-administration in the cause of addiction

There is a theory that has been presented which addresses the reason nicotine use in underlying medical problems may be warranted, or include positive outcomes; in particular, the research refers to psychological disorders.

The hypothesis has been tested in schizophrenia, for example. In one study, researchers induced rats with schizophrenia and then offered some of these rats nicotine and, others, salt water. As observed, rats who used nicotine appeared to display enhanced cognitive abilities and reduced symptoms of schizophrenia compared to those which consumed only salt water. According to scientists, the conclusion of this study supports the self-medication hypothesis of nicotine use in this particular psychiatric disorder [40].

In another, similar study, researchers once again examined two groups of rats, providing one group with nicotine and the other with salt water - this time, however, the rats were not schizophrenic. During administration of the selected substance, researchers performed a series of cognitive tests on the rats and, once again, found that rats who were using nicotine performed better than those without. Additionally, when the rats were made to stop using nicotine, their results declined to become similar to the salt water group. This group of researchers provided insight into the use of nicotine as a ‘once-off’ enhancement aid. The history of nicotine use doesn’t appear to have as great a role in its ability to enhance performance, when removed, however, the results are clear: abilities decline [41].

In addition to the potential mental impacts, the theory of nicotine self-administration has potentially serious implications, particularly with attempts of discontinuation.

Researchers have observed that nicotine self-administration may rise significantly after a period of cessation or deprivation, where the negative effects associated with cessation have a powerful effect on the brain system [42]. It’s likely that the stress of deprivation on the brain systems is enough to provoke an increase in the reward-seeking pathways, almost as if to say, “don’t make me go through that again.”

Section 2: Nicotine withdrawal

Withdrawal symptoms, a negative consequence of quitting

With the knowledge of how nicotine, using tobacco products and smoking affects the brain, an understanding of the process of withdrawal can begin to form. It is clear from the addiction section that reward-seeking behavior has a major role to play in the continuation of the behavior and also a significant impact on the ability to stop it.

In addition, it is believed that further impact on the brain and its chemical messengers are at play where a negative feedback system provokes consequences when there is a sudden loss of activity stimulating the reward system. For so long, these rewards have been firing off every time there is an influx of nicotine. Then, once this stimulus stops, it stresses the brain [43].

Looking at the process of withdrawal, it’s important to consider how positive and negative reinforcement work, of which positive reinforcement [44] has already been addressed (when the idea of smoking comes to mind, followed by the action of smoking, it triggers the positive reinforcement system).

Negative reinforcement works a bit differently.

When the trigger to smoke arises, and there is a hesitancy to satisfy the craving, the intensity to follow through with the action increases exponentially. When all of the negative emotions associated with withdrawal intensify, and the symptoms of withdrawal begin to occur parallel to this, it’s associated with negative reinforcement and many people give in and reach for that familiar cigarette instead of experiencing these consequences.

However, if one was to hold out and allow these symptoms to manifest and then pass, quitting may be successful; but how long should one expect them to last, and what does going through withdrawal really entail?

Withdrawal: what to expect

Here are some of the common symptoms of withdrawal:

• Depression, anxiety and irritability

Once nicotine consumption ceases, the emotional symptoms associated with withdrawal include feeling depressed, less euphoric, irritable, anxious and frustrated, as well as having a heightened reaction to environmental stimuli that may affect concentration. Physical symptoms also develop. The heart slows down, the stomach may become upset and other cravings may develop (for example, for specific foods).

When abstinence continues, so do the above symptoms, but there may be others that develop, like sleep disturbances and an increased susceptibility to the stress response.

• Sleep disturbances

Unfortunately, sleep is a major factor to consider when quitting [45]. Without a regular nicotine influx, the risk of anxiety and irritability is already heightened. Add to that a lack of sleep and the body begins to lose the ability to cope. Studies have found that those who are going through nicotine withdrawals have increased risk of waking during the night [46], which may affect how many hours of good quality sleep is achieved within the recommended 7-9 hours.

• Weight gain

When the use of tobacco products stops, there are a significant number of health benefits. However, there is one serious risk: weight gain [47] [48]. A large body of evidence supports the fact that body weight increases in a number of people when they quit smoking [49]. Not only is this a fear that may prevent people from quitting, it’s something that can cause them to be more prone to relapse [50].

Withdrawal symptoms do, however, go away...

How long does withdrawal last?

While the first symptoms of withdrawal appear relatively soon after one quits using nicotine [51], some symptoms can last for years. Weight gain, for example, has been followed up in those who stopped using tobacco products 8 years later, with subjects showing consistent increases in body mass over that time.

Fortunately, research has shown that a multitude of the other negative symptoms don’t last as long. It appears that across the board, experts believe that the symptoms - like anxiety, irritability and heightened awareness of environmental stimulus - that show up a few hours after withdrawal sets in, can begin to dissipate within two weeks of the final exposure to nicotine.

These symptoms differ for everyone, and a number of factors need to be considered when trying to determine the severity of withdrawal in each individual.

Withdrawal, it’s severity and length of duration depends on a number of factors

While there has been plenty said about the dopamine pathway and dependence/addiction to nicotine, there are other factors that come into play during abstinence. These factors include a person’s gender, environmental factors, genetics, and a variety of other brain and body chemicals.

It’s this complex system that dictates whether someone will have withdrawal symptoms when they stop using nicotine, what the severity of those are and why it can be a unique experience for every individual. These, however, are some of the factors that have been studied:

• Gender differences and environmental factors

In general, studies show that men may be more at risk of adverse withdrawal symptoms compared to women, particularly when they perceive their environment to be one that has heightened levels of stress.

As demonstrated in another study on rats - which have been proven to provide effective correlations in humans - rats, which had more enriching environments, showed reduced levels of stress markers - like  cortisol production - during periods of withdrawal. Although environmental stress proved to be a significant factor dictating the experience of withdrawal, gender also played a role. Female rats, with the same exposure to these enriching environments, were observed to experience even further reductions in stress markers related to withdrawal compared to their male counterparts [52].

• Genetics and biochemicals

Genetic makeup also dictates how a person will respond to abstinence from nicotine.

A factor that has been studied in this regard is a receptor pathway that responds to the chemical acetylcholine (ACh), which has numerous functions within the brain. When nicotine addiction and withdrawal is observed, it appears that specific genes are responsible for the way in which ACh affects the receptors in the brain [53]. In some people, genetics dictate that ACh has a greater influence on the brain during tobacco use than in others, which means for those who do, the stress on the brain is increased [54] when nicotine is removed or reduced [55] and it supports the theory that ACh is associated with nicotine use reinforcement [56].

• Duration of tobacco use

In 1989, a study was done to predict whether an individual would be more likely to relapse when they had been smoking for a significant period of time versus one who hasn’t. Interestingly, the conclusion of the study showed that withdrawal symptoms have a far greater influence on restarting than duration of the habit [57].

It appears that each individual, and the elements that make up their body, are the greatest predictor of, not only whether there’s a risk of addiction but, whether they’re able to take the steps required to quit, be subjected to severe withdrawal symptoms, be able to abstain indefinitely or relapse...

Section 3: Nicotine addiction therapy

Fortunately, the support when it comes to a person’s efforts to quit smoking is readily available, it’s effective and it promotes successful cessation [58]. Below are five of the most well-known products available on the market that are frequently used as for smoking cessation attempts. Details regarding their pros and cons are included, as these may aid in the selection of a suitable method that takes into account an individual’s lifestyle and habits [59]:

1. Gum:

Pros

• It replaces the need for the oral fixation associated with various types of tobacco products.
• It might assist with food intake and reduce the risk of weight gain as gum is chewed instead of eating snacks.
• The dose can be managed according to the symptoms of withdrawal an individual person experiences.
• It can be used with other products being used to assist cessation.

Cons

• Gum needs to be chewed frequently and this may reduce compliance.
• If a person has difficulties with their oral health or teeth, chewing continuously may be problematic.
• Chewing technique needs to be taken into consideration for effectiveness.
• It may not always be acceptable – or desirable – for someone to chew as often as required.
• The jaw muscles may begin to tire and hurt.

2. Lozenges:

Pros

• As with gum, it’s a replacement for the oral fixation of tobacco products.
• It may distract from wanting to eat and thus reduce the risk of weight gain.
• The dose can be individualised based on the requirements and need of each person.
• It is safe to use with other cessation products.

Cons

• Dosing may need to be frequent, and this may affect an individual’s level of compliance.
• There may be associated digestive issues like nausea, heartburn or hiccups.

3. Transdermal patches:

Pros

• A person doesn’t have to think about the patch once applied to the skin every day and so compliance is better.
• Others don’t need to be aware of it being in use as a cessation aid.
• There is constant nicotine delivery over a 24-hour period.
• It’s safe to use in conjunction with other cessation assistance products.

Cons

• When used alone, there are limited options when it comes to dose management and so withdrawal symptoms may still appear if the dose is too little for the specific requirements of the individual.
• Is a person has a skin condition, this method is not advised.

4. Nasal spray:

Pros

• Dose is managed by the individual.
• It can be used in conjunction with other products.

Cons

• Frequency of desired dose can reduce compliance.
• Some people may not enjoy the nasal therapy as it may cause irritation and sniffing.
• If a person has an airway irritation or nasal disorder this method is not suited for nicotine delivery.

5. Oral inhaler:

Pros

• Easy to use substitute for other tobacco products.
• Effectively manages withdrawal symptoms.
• Can be an effective replacement for the hand-to-mouth habit involved in smoking.
• Other products can be safely used at the same time.

Cons

• It’s necessary to use the inhaler frequently to manage symptoms.
• There may be device malfunctions in colder weather.

Other therapies include:

1. Chronic medication – this medication is prescribed by a doctor and is administered daily to assist with cessation of nicotine use [60].
2. Meditation – mindfulness has been determined to be an important consideration [61] when it comes to tobacco cessation, as studies reveal that those who practice mindfulness may be more likely to abstain from smoking compared to those who don’t take part in the practice [62].
3. Exercise – the evidence to suggest that exercise improves abstinence from using tobacco products is mixed, however, it has been suggested that exercise [63] [64] can aid in smoking cessation in the long term [65].

In conclusion

There are many reasons to quit smoking. Some personal, some for health reasons and others as a simple means to change towards more positive habits.

Before the process of cessation begins, it’s essential to discover what the body is really going through, why the addictive habits were formed in the first place, why there is reduced capacity in some individuals to remain cigarette-free, as well as the consequences of cessation - both good and bad.

Once a clear picture of the reasons underlying addiction has been painted, individuals may use this to determine the need for smoking cessation support products or therapies, understand why previous efforts have been difficult and, begin to adjust their approach to addiction in a way that’s personalized for their habits, lifestyle and body. This understanding and personalization is the key to maximizing the ability to successfully break the habit.

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