Tobacco smoking has been around for thousands of years and, before its dangers were known about, doctors often recommended it to patients to help clear their lungs (this was in the good old days when doctors used to smoke their pipes while doing their rounds in hospitals).
Now we know there is no question smoking is bad for you. There is a whole list of diseases associated with smoking: the top three are lung cancer, chronic lung disease and heart disease, but less talked about are mouth cancer, hair loss, infertility, and impotence.
The good news is fewer people are smoking. Through public health policies (tax on cigarettes, advertising and banning smoking indoors), rates of smoking are down, with most recent estimates in the UK at 15% of the population in 2017.
But plenty of people still smoke. If it is so bad for you (and we know it’s so bad for us), why is it so hard to stop?
It’s important to remember that nicotine, the addictive substance in cigarettes, triggers the production of dopamine in the brain, which plays a key role in addiction in humans. Without going into too much detail, nicotine is one of the most addictive substances known to man, and is thought to be as addictive as some class A drugs.
While nicotine keeps us hooked, it’s the tar (and other chemicals) in cigarettes that is thought to cause cancer: it damages our DNA, as well as clogging up important blood vessels, which can lead to heart attacks and strokes.
Patients who come to their GP for help to quit are in no doubt their daily habit is a potentially deadly one. They often want to stop because they dislike the habit and can feel the toll on their breathing and lungs.
How do I give up?
The first thing is to recognise that smoking is not just about the nicotine. Think of it like a cluster of habits rather than a single one. This is definitely a factor that makes it more difficult to quit. Some patients tell me that smoking structures their day and even gives it a certain meaning. If you’re a smoker, think about when you smoke and why. Do you smoke first thing in the morning, with your first cup of coffee? After meals? Or when you can’t stare at your screen for another minute and need a break, perhaps when something/someone stresses you out? Apart from this, smokers also enjoy the other components of smoking, including holding cigarettes, inhaling and the taste. Cigarettes become companions in our daily routines. We think they help us cope.
There are a number of available approaches to giving up, but the multi-faceted aspect of cigarette addiction means that often the best ones focus on behavioural change. These include smoking cessation groups, hypnotherapy, traditional therapy, and text message advice. This is in addition to nicotine-therapy, particularly in the beginning of the process. Your GP can offer lots of support and provide you with resources. There are other ancillary methods with reported success, including creating a support group for yourself of friends and family members. Alternatively, calculate how much money you will save from not smoking and put that money aside each day. Then dedicate it to a special gift or project for yourself.
Be kind
Perhaps the most important thing to remember when quitting cigarettes is to be patient and kind with yourself. As with any lifestyle change, it’s going to take time, and there will be ups and downs. Most people who quit try more than once before they are finally able to stop for good. Excessively high expectations can lead to disappointment.
Should I vape instead?
There has been a huge rise in e-cigarette and vape use because of the misconception that it is a better alternative to "traditional smoking". Recent data has shown the dramatic rise in vaping by young people, driven by the belief that it is less harmful than smoking cigarettes, the fact its much cheaper, and the use of cannabinoid (both CBD and THC) products in e-cigarettes.
However, recent reports in the US have shown the damage that vaping can cause including deaths, after nearly 100 cases of hospitalisation due to severe lung disease and 500 cases of lung damage across the country. This has led to California becoming the first state in the US to issue a firm public health warning to stop vaping and a ban on the sale of e-cigarettes in San Francisco. While vaping is a relatively new phenomenon, it is still harmful to the body, particularly the lungs, and the long-term effects remain unknown.
Smoking is still bad and attempts to give up should focus on both the physical and mental elements of it. Switching to vaping may be slightly better for a current smoker but be aware it has its own health risks and pitfalls. If you want to give up, there are a number of resources available, including talking to your GP, support groups and online services