How does the human body get addicted to cigarettes?

Only 3-5% of people who quit smoking can go a long time without cigarettes. We talk about the formation of addiction, the process of withdrawal and ways to alleviate it.

How the addiction is formed

According to WHO statistics, more than 8 million people die every year from the consequences of tobacco use. More than 7 million of them are tobacco users and former users, another 1,2 million are non-smokers exposed to second-hand smoke, the so-called “passive smokers”.

As of July 2022, 33% of the adult population smoke in our country, VTsIOM reports. Over the past five years, the proportion of smokers has not changed much.

At the same time, our country began to perceive smoking cessation rather as a necessary measure. In 2017, 22% of respondents said that they only needed a strong desire to do this, and 11% cited health problems. In 2022, these arguments are given with the same frequency – 16% each.

However, quitting smoking is not an easy task, as nicotine and cigarettes are highly addictive. When smoke is inhaled, nicotine enters the bloodstream and reaches the brain, says Aleksey Aleksandrov, narcologist-psychiatrist, chief physician of the Psychiatry-Narcology Clinical Center (Minsk). In the brain, nicotine acts on various receptors. The most important of them in the process of addiction formation are dopamine ones. “It is through the dopamine system that the mechanism for reinforcing and repeating behavior that brings pleasant or strong experiences is realized,” the expert explains.

Several factors contribute to the development of cigarette addiction:

• the smoking process itself (behavioral component);
• repeated exposure to nicotine contained in the smoke of a burning cigarette (biological component);
• situations and people with whom they smoke (social component);
• moods and expectations (emotional component).

“The chronic effects of nicotine on the brain alone, without taking into account the behavioral and social components, cannot explain why addiction is formed and maintained, and also why there are breakdowns after quitting smoking,” Alexandrov notes.

Can you quit cigarettes on your own?

In 90% of cases, long-term smoking forms an addiction to nicotine, doctors warn. Moreover, the withdrawal syndrome manifests itself within three to four hours after smoking cessation and reaches a peak within 24–48 hours. The following symptoms are observed: desire to smoke, weakness, irritability, anxiety, insomnia. After two to three weeks, the severity of symptoms decreases, experts say.

Continued smoking is caused by addiction to nicotine, so it is understandable why quitting on your own is so ineffective – over a long period of time, only 3-5% of smokers succeed in this, adds Alexey Alexandrov.

According to the expert, physical addiction to nicotine is a mental disorder (with refusal, emotions change, sleep is disturbed) and behavior (a person cannot quit smoking immediately, even when the health consequences are obvious and significant).

Therefore, addiction is quite difficult to overcome on your own, without auxiliary means. Alexandrov divides such funds into three groups:

“Overcoming addiction to nicotine with a pronounced physical component, as a rule, requires the prescription of drugs from the first two groups. And in a number of countries, regulators and public health experts are considering the third group of aids as an alternative to the first two,” says Alexey Alexandrov.

“Switching to non-smoking tobacco or nicotine products allows a comparable majority of smokers, compared to those who are just trying to quit without aids, to completely abandon tobacco,” says Aleksandrov. He cites Sweden and the consumption of tobacco snus as an example.

In Sweden, replacing cigarettes with snus has led to a reduction in cancer cases, especially in men. In 2020, the incidence of lung cancer in men in Sweden was estimated at 17,2 cases per 100 thousand people compared to 35,2 cases per 100 thousand people in the UK, throat cancer – 3,9 versus 4,1 cases per 100 thousand people, respectively.

At the same time, nicotine replacement therapy (it includes auxiliary agents of the second and third groups) has a downside. Nicotine packs and chewing gums are indeed considered one of the safest ways to deliver nicotine to the body, Dr. Konstantinos Farsalinos, a senior researcher at the University of Patras and the School of Public Health at the University of West Attica (Greece), said during the First Eurasian Nicotine Forum.

However, smokers usually do not like them very much, the level of acceptance of this product is not very high, the expert points out. As a result, such a safe way of delivering nicotine to the body may not have a serious impact on improving public health. “But if a person moves from traditional cigarettes to less dangerous products, it is important that he likes their taste. So he can gradually quit smoking, ”says Farsalinos.

How does the body wean itself from cigarettes?

Narcologist-psychiatrist Alexei Alexandrov divides the process of weaning from cigarettes into several stages:

“The physical component of the addiction, or nicotine hunger itself, resolves either with medication or with the use of alternative nicotine within a few weeks. And the craving for smoking can return even after years, so breakdowns should be treated as part of the process of overcoming addiction, ”emphasizes Alexandrov.

How to reduce the risk of relapse

The main factor in the first stage of the withdrawal process, Alexandrov calls the regular satisfaction of nicotine hunger with the help of alternatives to cigarettes. This is necessary so that the craving for smoking does not lead to breakdowns.

Tobacco heating systems and e-cigarettes can facilitate the first step (immediate cessation of cigarettes, which is accompanied by strong cravings) of the process, the expert adds.

According to him, switching to new products and changing the habitual style of smoking can reduce the risk of relapse in typical situations. And episodic recourse, for example, to vaping (without regular vaping), rather than cigarettes, could prevent a return to constant smoking, Aleksandrov believes.

Combustion vs heating

Tobacco heating systems and e-cigarettes are considered a less harmful way to deliver nicotine to the body because they do not burn tobacco. After ignition, the temperature in different parts of a conventional cigarette can reach 900 ° C, and carcinogens enter the smoker’s lungs. A study by a group of British scientists published in the peer-reviewed medical publication The Journal of Internal and Emergency Medicine found a significant reduction in health risks among those who completely switched from cigarettes to tobacco heating systems. For example, there is a decrease in the biomarker of lung cancer risk and the number of leukocytes, an inflammatory marker that indicates the risk of cardiovascular disease. As the scientists note, soon after the full transition to tobacco heating systems, this and other biomarkers were at the level of people who completely quit smoking.

“The short-term health effects of e-cigarettes are determined by the components of the aerosol or the way you vape. When using tobacco heating agents, the content of toxic products, including specific tobacco carcinogens and carbon monoxide, according to studies, is several times less than in cigarettes. However, such products in any case pose certain health risks as they contain both these harmful substances and nicotine, ”Alexandrov points out.