Quit Smoking for Life. Suzanne Schlosberg

hooked until you try to quit, only to find yourself overwhelmed by a craving; next thing you know, you’re fishing through the trash for a half-smoked butt. Or, like Burke, you may not realize it until you’re stranded in a smoke-free zone, feeling irritable and panicky. When reality does strike, you might feel the way she did: mystified that a measly cigarette can seize hold of you and frustrated that others can walk away from cigarettes when you can’t. “My mom quit cold turkey after smoking for 40 years,” says Burke. “Everyone knows someone like that, and it makes you feel awful that you can’t do it yourself.”

      If you’re struggling to quit, you shouldn’t feel embarrassed. It doesn’t mean you’re weak. It means you’re normal. For most smokers who want to quit — and 69 percent of all smokers do want to stop, according to the U.S. Centers for Disease Control² — beating cigarette addiction is hard. The tobacco industry has poured billions of dollars into making sure it’s hard. In this chapter we explain why quitting smoking is such a challenge and why determination alone is often not enough to counter the addictive pull of cigarettes.

      But don’t allow this to discourage you. Given the tools, anybody can quit. Everybody can quit. Christine Burke quit and, as you’ll read in later chapters, she transformed her life in ways she could never have imagined.

      For the moment, don’t worry about quitting. Now might be the right time for you, or it might not. We’ll explore your readiness in Chapter 3, Deciding to Quit. Instead, use what you learn in this chapter to better understand your addiction. That way, you’re better equipped to do battle.

      Burke’s low moment in the airport restroom marked a turning point. For the first time, she owned up to her destructive relationship with cigarettes. Upon arriving at the Salt Lake City airport, she got a second dose of reality. “When I walked off that plane, the first thing I wanted to do wasn’t hug my son but light a cigarette,” she recalls. “That’s what cigarette addiction does to you. In the back of my mind, I was thinking: This is not what I want for myself.”

The Addiction Triangle

      If you smoke daily, your body is almost certainly hooked on nicotine, and that’s no small predicament. Nicotine is so addictive that a quarter of teens, the age range when 90 percent of smokers begin the habit, start to lose control after smoking just three or four cigarettes; after smoking five packs, nearly 60 percent are dependent.³ Long-term use of nicotine can actually change the structure of your brain, and the longer you smoke, the more significant the changes. So even if nicotine were the sole basis for addiction, quitting would be a challenge. But nicotine dependence doesn’t fully explain why cigarettes are so tough to give up. There are two other reasons: 1) Smoking also is driven by habit — unconscious, repetitious behavior patterns — and 2.) It’s strongly influenced by an emotional connection to cigarettes.

      You take about ten puffs on each cigarette you smoke. If you smoke one pack a day, over a year you’ll take more than 70,000 puffs. Christine Burke smoked about 30 cigarettes a day for 37 years. That’s almost four million puffs. If you do anything four million times, especially something that triggers a jolt of pleasure, you’ve developed a deep-rooted behavior. Burke smoked within five minutes of waking each morning, a sure sign of nicotine dependence. But her smoking patterns were driven by something far more complicated than nicotine levels. Over time, like so many smokers, she had developed triggers throughout her day that prompted her to smoke. Every night, for instance, Burke capped her supper with a cigarette, even if she had stubbed one out right before eating. That cigarette wasn’t her nicotine-deprived brain cells talking. It was the result of decades of repeated and reinforced behavior that had turned smoking into a way of life.

      And her stress-fueled urge to smoke in the Atlanta airport? Sure, she craved a cigarette because her bloodstream was low on nicotine and because she habitually relied on smoking to relax. But Burke also pined for a cigarette because she’d come to consider cigarettes a dependable companion, always in her corner in good times and bad.

      Think of the three facets of cigarette addiction — the physical, the habitual, and the emotional — as the corners of a triangle. Your triangle may have somewhat different dimensions than the next smoker’s. For some folks, the physical nicotine dependence looms largest; withdrawal symptoms are a beast. Others are surprised to discover they weren’t heavily addicted to nicotine, yet they’re hit with an intense urge to smoke every time they drink coffee or pick up the phone. Answering the following questions will give you a picture of your own triangle of addiction. In the coming chapters you’ll learn strategies for dealing with the physical part, the habits, and the thoughts or feelings. You are more likely to succeed if your strategies are tailored to your particular challenges.

      Physical Addiction:

      How do you feel physically when you haven’t had a cigarette for a while?

      When are your cravings strongest?

      What do you do when you are somewhere you can’t smoke?

      Habits and Behavior:

      Is smoking so much a part of your daily routine that you can hardly imagine what you’d do if you weren’t smoking?

      Would your social life change if you quit smoking?

      Do you always smoke with alcohol or coffee?

      Thoughts & Feelings:

      Do you use a cigarette to deal with emotions such as stress, boredom, or anger?

      Is being a smoker part of the way you see yourself?

      Do you have fond associations with cigarettes and smoking, or think of cigarettes as your friend?

      Now, let’s take a closer look at each corner of the addiction triangle.

Your Brain on Nicotine

      When you take a puff on a cigarette, nicotine gets sucked into your lungs and then catches a ride, via your bloodstream, to your brain; there it triggers a release of extra dopamine, a brain chemical that makes you go, “Ahhhh.” This process takes all of ten seconds. That’s five seconds faster than it would take intravenously injected heroin to reach your brain. Thanks to this lightning-quick buzz, you develop a strong association between the act of smoking and the feeling of pleasure.

      But the party doesn’t last. Within minutes after you finish a cigarette, the nicotine level in your blood starts dropping, shutting off the dopamine release. When you’re addicted to nicotine — if your brain relies on the drug to keep you feeling “normal” — you start to feel restless or prickly after about an hour. You might also begin feeling low on energy or have trouble concentrating. Soon you’re thinking about your next cigarette.

      When you go to the movies, do you notice a small crowd storming the exit as the credits roll? Maybe you’re one of these folks, reaching into your coat pocket as you hit the lobby, pulling out the cigarette pack as you leave the theater, and then lighting up twenty feet from the building. This mad rush happens because two hours, the length of the average movie, is the point at which the typical nicotine-addicted brain starts shouting, “More. NOW!” The more addicted you are, the sooner your brain will make the demand.

      None of this is an accident. You might think of a cigarette as nothing more than tobacco and a fuzzy filter rolled up in paper. Not too state-of-the-art, right? In fact, tobacco companies have put an astonishing amount of engineering into making cigarettes maximally addictive. For example, cigarette tobacco is treated with ammonia to change the molecular structure of nicotine; as a result, it’s absorbed much more quickly than nicotine from untreated tobacco. Consider, too, the design of cigarette filters. Nicotine rides on small particles of tar, the stuff that turns the filter, and your lungs, brown; filters are devised to deliver tar particles that are precisely the right size to penetrate deeply into the lungs, optimizing the potential for addiction. Sophisticated filter technology also reduces throat-burning sensations. So as you take a drag, you’re less likely to think you’re doing any harm to yourself.

      If cigarettes are that addictive, why can some people smoke on occasion without developing a