Your Health  -   A to Z of Common Medical Conditions

Nicotine Addiction

Description -  Cigarette smoking is the largest, avoidable cause of death, often at a tragically young age, in the developed world. It is involved in chronic lung disease, a number of malignancies -including lung cancer- and arterial disease, particularly heart attack and stroke. It can make the risk from other conditions, such as diabetes and blood pressure, much worse. 50 years ago it was very uncommon to meet a doctor who didn't smoke, now it is equally uncommon to meet one who does. Why do so many people who know the risks continue to smoke? It is not just because it is perceived as pleasant and "sociable". It is mainly because nicotine is one of the most addictive substances known, comparing with cocaine and heroine. Withdrawal from nicotine, the effects of giving up smoking, takes two forms. There is an immediate feeling of withdrawal - acute desire for a smoke, irritability, poor concentration, headache, constipation and indigestion in some - and a subtle much longer-term effect. Many people who have succeeded in getting over the short-term acute withdrawal, which may last several weeks, find, over the following months, that there is a feeling of life incompleteness. It is a feeling of "I shall never really be happy, or enjoy anything to the full again, without a cigarette." This is not always understood by non-smokers who counsel smokers on breaking the habit. All people who do such counselling should, ideally, be smokers who have given up successfully. This feeling of incompleteness can last a year, sometimes two, and is always there ready to prompt the ex-smoker, at any moment of stress, to re-start the habit. And re-starting with  "just one" cigarette is the equivalent of the alcoholic-in-remission's "just one drink". Another factor with giving up smoking is that one appears to be equally addicted to 5 cigarettes a day as to 25. So cutting down is not an option. On the credit side, apart from the health expectation advantages, many people when the give up smoking feel very well and energised, less tired for no particular reason.

Management - Giving up smoking is a painful process. This must not be concealed from intended habit-breakers. Some medications such as nicotine chewing gum, patches, sprays etc. do help reduce the craving but are only part of the answer and will not satisfy the deep psychological effects. Acupuncture or hypnosis may help. There are many tips on giving up, many are personal and individual, and will not work on all. Many people, for example, against standard advice, carry a packet of cigarettes around with them at all times. This can act as a kind of security and makes it so easy to cheat one is reluctant to do so. The best time to give up, if the opportunity arises, is during an acute illness such as influenza. The first cravings are unnoticed as the person feels so unwell anyway and on recovery a jump-start has been given to stopping the habit. In the early stages, situations where one would ordinarily enjoy a smoke - morning coffee, the pub, long telephone calls - should be avoided. The smoker should be advises to save up all the money that would have been spent on tobacco, put it in a jar every day, and spend it, not on household essentials, but on a treat or luxury, as a reward. Friends should be told of the decision. A particular friend may help one keep to it, a thankless job usually as most nicotine addicts find any criticism of their habit, or smoking generally, as obtrusive  "It's my life". Excessive weight gain should be avoided, some is inevitable, but an infinitely smaller threat to a healthy life than smoking.

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