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Tobacco Cessation: Roadblocks to Quitting

May 31^st is the World Health Organization's World No Tobacco Day. This annual event seeks to remind the world that tobacco use is one of today's biggest public health issues and a leading cause of chronic illness and death. Globally, 1 in 5 adults or approximately 1.2 billion people are tobacco smokers. In addition, over 300 million people use smokeless tobacco and 35 million use electronic cigarettes. Every year, approximately half of all tobacco users think about or attempt to quit, but quitting can be challenging, and it often takes numerous attempts for a quit to last. Some of the common challenges or roadblocks to quitting are managing stress, dealing with nicotine withdrawal, weight gain, fear of failure, and lack of support and access to health care and tobacco-cessation products.

Many tobacco users cite stress relief as a major reason for continuing their habit. They feel that smoking, chewing, or vaping relaxes and calms them and are afraid of how they will manage stress without tobacco. It may seem that tobacco use is relaxing, but the opposite is actually true. Nicotine, the addictive substance in tobacco, is a stimulant that releases adrenalin and other chemicals that increase your heart rate and raise your blood pressure. A regular user will experience mini withdrawals throughout the day as the nicotine leaves their system, making them feel anxious and on edge. Using tobacco gives your body the nicotine it craves and calms those withdrawal symptoms, but this ultimately creates a vicious cycle that reinforces the addiction. Smoking may temporarily relieve your withdrawal symptoms, but it does nothing to solve your problems or actually get rid of the stress in your life. It can cause additional stress for users worried about health effects and judgment from others. Finding healthier ways to manage stress and increase positive coping skills is a major factor in any successful quit attempt.

Another roadblock to quitting is experiencing withdrawal symptoms, urges, and cravings. When you smoke, chew, or vape, the nicotine in the tobacco binds to receptors in your brain and releases neurotransmitters. As your habit continues and your tolerance to nicotine builds, the receptors in your brain become desensitized and start to increase. Over time a tobacco user has many more receptors than a non-tobacco user, and it takes more and more nicotine for the same release of neurotransmitters to occur and for the tobacco user to just feel normal. When you attempt to quit, your brain needs time to adapt to the loss of the nicotine. Withdrawal symptoms, such as anxiety, depression, irritability, headaches, insomnia, dizziness, mental fog, cough, and increased appetite, may occur. Severe withdrawal lasts approximately two to three weeks, but it can take as long as three months for the receptors in your brain to return to a normal nonsmoking level, and certain neurotransmitters can take up to 12 months to return to normal levels.

The longer a person uses tobacco, the more it becomes an unconscious act tied to triggers and cues. When a smoker attempts to quit, these triggers create urges. Urges can arise many years after quitting. The critical period for urges is the first 3 to 12 months. During this time, the brain learns new, nonaddictive pathways as the quitter does not respond to urges and avoids tobacco use.

It can be very hard to quit while experiencing withdrawal symptoms and fighting urges and cravings. There are tobacco-cessation products that can help alleviate withdrawal symptoms and make it easier for users to concentrate on the behavior changes that are needed to be successful. Medications are designed to increase neurotransmitter levels and alleviate the symptoms of withdrawal, and these are helpful for that time period when relearning and developing new pathways is taking place.

An additional challenge is that many tobacco users are concerned about gaining weight when they quit. Since being overweight and/or obese also poses health risks, this is a real concern for many tobacco users and is not without merit. When you use tobacco, the nicotine in the tobacco binds with the receptors in your brain and releases certain neurotransmitters or chemicals that act as appetite suppressants and reduce your hunger. When you quit, your appetite will increase for a while. A lot of people also find that they eat to fill the time when they used to be smoking, chewing, or vaping. Unfortunately, you might crave more carbs and sweets during withdrawal. Most people gain about 5 to 10 pounds as they try to quit tobacco use. Encouraging other nonfood-related ways to fill their time, such as exercise and hobbies, and healthier, lower-calorie food options, can be ways to manage weight gain.

Many people are reluctant to attempt to quit for fear of failure. They may have tried to quit before and been unsuccessful. They may feel bad about not being able to quit and blame themselves, feeling that they are lazy or just lack the motivation or willpower to make a change. They may be afraid of letting other people know they are trying to quit only to let them down. Everyone has a story about someone they know who one day just decided to quit using tobacco and was able to do it "cold turkey," or without any behavioral help or use of tobacco-cessation medication. Some of these stories are true, but many are myths. Users who attempt to quit on their own are often unsuccessful. Many tobacco users think about quitting and attempt to quit each year. Studies show that without cessation support, only four percent of these attempts will succeed. Nicotine is an addictive substance that causes a real chemical change in your brain, and willpower or self-determination is often not enough to be able to quit. In fact, studies show motivation or desire to quit does not always equate to success in quitting. What does work is educating users on the science behind the addiction and offering behavioral support coupled with tobacco-cessation medication. These supports and interventions can more than double a tobacco user's chance of quitting.

One final challenge to quitting and to tobacco-cessation awareness, in general, is that globally, tobacco users often come from lower socioeconomic groups and face a lack of access to health care and tobacco-cessation products. Studies show that, globally, few people understand the specific health risks of tobacco use. Increasing global awareness of the dangers of tobacco use, providing health care professionals with the training and knowledge on how to support people to quit, as well as making tobacco-cessation medications readily available can all make a difference.

References

Australian Tobacco Harm Reduction Association. (n.d.). Barriers to quitting. Retrieved October 14, 2021, from https://www.athra.org.au/barriers-to-quitting

Besaratinia, A. & Tommasi, S. (2019, November 15). Vaping: A growing global health concern. EClinicalMedicine, The Lancet, 17, 100208. doi: 10.1016/j.eclinm.2019.10.019

Ritchie, H. & Roser, M. (Revised 2019, November). Our world in data. Retrieved October 14, 2021, from https://ourworldindata.org/smoking

Twyman, L., Bonevski, B., Paul, C., & Bryant, J. (2014, December 22). Perceived barriers to smoking cessation in selected vulnerable groups: A systematic review of the qualitative and quantitative literature. British Medical Journal (BMJ) Open, 4(12), e006414. doi: 10.1136/bmjopen-2014-006414

Villanti, A.C., Bover Manderski, M.T., Gundersen, D.A., Steinberg, M.B., & Delnevo, C.D. (2016, April). Reasons to quit and barriers to quitting smoking in US young adults. Family Practice, 33(2), 133–139. doi: 10.1093/fampra/cmv103

World Health Organization (WHO). (2020, May 27). Tobacco. Retrieved October 14, 2021, from https://www.who.int/news-room/fact-sheets/detail/tobacco