Analyzing Addiction

Most smokers want to know why they smoke. No one starts smoking wanting to become addicted, and most new tobacco users think it won’t happen to them. But for those who continue to smoke after those first early packs, addiction powerfully contributes to why they keep smoking.

Experts don’t have a universally agreed upon definition of addiction. That’s because it’s a complex concept that defies easy explanations. Nevertheless, most people have notions as to what they think it is. And perhaps you’ll find it helpful if we describe our way of looking at the phenomenon.

An addiction involves powerful feelings that come about from ingesting certain types of drugs or substances. The hallmark of an addiction is using a substance chronically despite harmful effects on a person’s life now and in the future. Using addictive substances generally feels good, and bad feelings abate for a while. Unfortunately, negative feelings return, and the craving for positive feelings increases, culminating in a vicious cycle of addiction.

Tolerance is another important aspect of addiction. Tolerance occurs when a substance is used over and over again, and it begins have a reduced impact. More is, therefore, needed to get the same effects. Tolerance develops quickly for most regular smokers — 1 or 2 cigarettes a day quickly turns into 10, 20, or more. Of course, at some point, smokers usually reach a stable level of intake (after all, there are only so many hours in a day!).

There are many myths and misconceptions about what an addiction is and isn’t. The following points explain some of these myths:

• Myth: Addiction is unfixable. Actually, considerable data suggests that many people ultimately are able to break their addiction, whether it’s tobacco, drugs, or alcohol.
• Myth: All addicts must reach rock bottom before they can break their addiction. Rock bottom is hard to define — it varies from person to person. However, lots of people stop using addictive substances well before hitting anything like a true rock bottom.
• Myth: Willpower is all you need. Psychologists don’t even fully agree on what exactly willpower is. If you think of yourself as lacking something fundamentally necessary, such as willpower, you’ll never succeed. If you want to quit, it’s worth taking a shot, no matter how much willpower you think you do or don’t have.
• Myth: Addicts are weak people. People become addicted for a variety of reasons as we explain in the following sections on biological, psychological, and social factors. Being strong or weak has nothing to do with it.
• Myth: Addiction is simply a choice. Sure, there’s an aspect of choice involved with starting to smoke. However, most addicts would truly not choose to be addicted.
• Myth: I could never become addicted. Thinking like that could make you more vulnerable to becoming addicted. No one is immune.
• Myth: Addicts always suffer considerably when they try to quit. Surprisingly, there are a few, lucky people who manage to quit a substance like cigarettes without struggle. But for most people, the more they develop a plan and garner support and help from others, the easier they’ll find quitting.
• Myth: After you’re detoxed, you’re done with your addiction. Your system clears itself of nicotine in a few days, but cravings are another matter. Those may continue for weeks, months, or sometimes forever (though almost always they lessen over time).
• Myth: Taking medication to help with addiction is cheating by substituting one drug for another: Medications used to treat addiction, are always safer than the original substance. Even nicotine replacement therapy avoids tars and toxic chemicals that come from burning cigarettes. Furthermore, most people use these medications as a bridge to quit entirely at some point. Does it help to call it cheating? No.
• Myth: Addicts are bad people. We can’t deny that those who are addicted to almost anything are often shamed and stigmatized by others. But so-called addicts are people just like everyone else. They start out using substances as recreation, response to pressure, or a variety of other reasons. What they don’t do is start out with the intention of becoming addicted.

When we use the term addiction, we’re referring only to the response people have to certain substances such as opioids, alcohol, and nicotine. This approach avoids applying the term addiction to behavioral issues such as aberrant sexuality, Internet addiction, and kleptomania, which may actually belong in another category of mental dysfunction that lies beyond the scope of this article.

To further understand addiction to tobacco, it’s important to appreciate how an addictive substance affects the body. In addition, it’s useful to recognize that addiction interacts with powerful feelings and emotions. Finally, addiction affects relationships while relationships simultaneously impact addiction. In other words, addiction is driven by biological, psychological, and social forces as explained in the following sections.

Biology of addiction

Imagine taking a drag on a cigarette. Smoke pours into your lungs while dumping a stew of chemicals into your bloodstream. These chemicals quickly breach the blood–brain barrier and deliver a jolt to the brain, most of which comes from nicotine. It takes less than ten seconds to go from drawing in that first puff of smoke to the brain starting to respond.

Nicotine stimulates the effects of dopamine, a brain chemical that increases feelings of pleasure. Dopamine levels also rise after ingesting cocaine, eating a favorite food, and having sex; in other words, stuff that feels good.

Nicotine also increases adrenaline, a neurochemical that stimulates the body to increase blood pressure, increase heart rate, and restrict blood flow to the heart. Adrenaline prepares the body for threat — the well-known fight-or-flight syndrome that prepares you to either stand and fight or flee from danger. It also increases focus and causes calories to burn at a faster rate.

In addition, nicotine causes the body to dump more glucose (blood sugar) into the blood stream. Normally, when blood sugar rises, insulin is secreted, which enables blood sugar levels to come back to normal. However, nicotine inhibits that process, which leads to higher levels of blood sugar and decreased appetite.

So, in ten seconds or less, nicotine delivers pleasurable feelings, increases focus, decreases appetite, and increases energy. What could possibly go wrong?

Well, within a few minutes, nicotine levels begin to decline rapidly. Lower nicotine levels elicit feelings of reduced pleasure, increased nervousness and anxiety, diminished energy, a lack of focus, and the emergence of cravings. That’s why most long-term smokers report immediate decreases of anxiety and a sense of great relief when they light the next cigarette. No wonder, the pattern continues throughout the day.

But oddly, not through the night. Very few smokers wake up every hour to have another cigarette. And most smokers manage to get through work, movies, and airplane flights without intense distress. So, something more than mere biology must be contributing to the addiction of smoking.

Some experts contend that any addiction is a disease of the brain. Although biological factors clearly form part of the picture, that’s not the whole story. Thinking of smoking as a disease minimizes the importance of psychological and social contributors to the problem.

Psychological factors of addiction

We now turn to psychology to further clarify smoking addiction. People struggle with how to explain why they do things that they know are not in their best interests — smokers are no exception. The following three sections explain. First, a popular metaphor reveals how the mind works. Next, we show you how distorted thinking contributes to difficulty quitting smoking. Finally, we help you see how common associations become triggers for turning to tobacco.

Discovering elephants and their riders

Think of yourself as having two minds. The first you can think of as your elephant mind, and the second, as the elephant rider part of your mind. To a casual observer, the rider is in charge. The rider directs the elephant to go right, and the elephant usually obeys. However, if a hungry elephant spots its favorite meal on the left (consisting of luscious tree bark dripping with sap), who do you think will win?

Think of addiction as the elephant part of your mind, commanded by intense feelings of pleasure, pain, and/or fear. Yet the elephant isn’t that smart and mostly responds to what’s right in front of its trunk. The elephant does a poor job of forecasting the future or learning from the past. Immediate pleasures, temptations, and fears dominate the elephant’s decisions.

By contrast, the rider “knows” exactly what to do and is controlled by logic, reasoning, and critical thinking. The rider is no match for the brute strength of the elephant. The elephant part of the mind wants what it wants when it wants it. And the elephant truly does not like to feel one bit of discomfort.

So, how do the elephant and the rider parts of your mind dictate whether you’ll smoke? The elephant just wants to have fun. It can’t process and reason about long-term threats to health such as lung and cardiovascular diseases. The rider knows better but can’t seem to control the elephant. The rider tries reasoning, bribes, and persuasion, but the elephant feels bad when it doesn’t smoke and feels better when it does. It’s that simple.

Your rider mind can slowly but surely train the elephant to obey commands more often, but the training involves considerable skill, persistence, and patience. See Parts 4 and 5 for ideas about how to gain greater control over your elephant mind.

If you’re trying to quit smoking or vaping and you experience a relapse, remember that you’re dealing with a very, very large elephant. It takes time to train the elephant. Be patient with your elephant, and yourself!

Adding up addictive thoughts

From a psychological standpoint, one of the most problematic factors driving both addiction and emotional distress can be found in the realm of distorted thinking. Distorted thinking causes you to make unwarranted assumptions and inaccurately portrays reality, usually in negative ways. Such thinking can be seen in these examples related to smoking:

• “I smoke because I’m so nervous. If I quit, I’d be a wreck and never be able to do my job. I’d get fired, for sure.”
• “I’ll probably gain a hundred pounds if I quit smoking.”
• If I want another cigarette this badly, I must need it.”
• “I smoked when I shouldn’t have today. Might as well give up.”
• “My grandfather smoked two packs a day and died in his sleep at 92. It worked for him; it should work for me.”
• “Just because countless others have learned to quit smoking, doesn’t mean I can do it.”
• “I can’t function without a cigarette.”
• “I’ve tried to quit before and failed, so I might as well give up and enjoy smoking.”

These thoughts all contain distortions of reality. And they wreak havoc on people’s attempts to quit. They sabotage quitting efforts by making mountains out of mole hills, ignoring positive evidence, increasing feelings of helplessness, and decreasing confidence. Not exactly a recipe for success.

Behavioral associations turn into smoking triggers

Do you remember getting thoroughly sick to your stomach after eating something? If so, you probably felt queasy or disgusted when you next encountered that food. Maybe you avoided that food for years or never ate it again. That’s because your mind connected the food with getting sick. The food became a potent trigger for nausea. However, that food might be both tasty and nutritious. You might spend a lifetime not eating a perfectly good, healthy food because of one association.

Associations are also formed to protect us. For example, when you smell badly spoiled food, you probably also feel nauseous. That’s a good thing, because the feelings prevent you from eating food that might make you sick.

On the other hand, the smell of freshly baked peanut butter cookies might take you back to a pleasant childhood memory. And if it doesn’t lead to binge-eating peanut butter cookies, that’s great. The brain tries to connect experiences that way so that it knows how to make you feel good and avoid feeling bad. And that can be a good or a bad thing.

With addictions, these brain connections or associations can work against you. They make you anticipate something very pleasant (we’re talking tobacco here) when thinking about or encountering certain settings, people, activities, or events. Associations can also bring on unpleasant emotions that make you want to smoke in order to feel better. These associations become triggers for smoking. Here’s a list of particularly common triggers that push many smokers to smoke.

• The first cup of coffee in the morning
• The sound and smell of someone opening a fresh pack of cigarettes
• Coffee after dinner
• Boredom
• Driving to work
• After lunch
• Eating out
• Driving in traffic
• Before a job interview
• After a job interview
• Break time at work
• Having a drink
• After sex
• Playing cards
• Getting in trouble
• After an argument
• At a party
• Talking on the phone
• With certain friends

Good grief. What’s a smoker to do? Avoid everything in life? No. But you can see how powerful associations can lead you straight to the next cigarette. Whether it’s to feel good or avoid feeling bad, the influence can be hard to escape.

Social contributors to addiction

Kids who hang out with smokers are more likely to smoke. Research suggests that adolescents are influenced to smoke by their friends or family who smoke, including parents, siblings, and extended family. That influence happens for three reasons:

• Modeling: Modeling is referred to as observational learning or imitation. People readily pick up on behaviors demonstrated by important people they relate with. See the nearby sidebar, “Monkey see, monkey do,” for an example.
• Predisposition: Secondhand smoke from household members may create a biological predisposition for acquiring an addiction to nicotine. Animal studies support that connection. See the nearby sidebar, “Secondhand smoke: Priming kids to smoke,” for an example.
• Peer pressure: Peers not only model smoking behavior, but also sometimes exert pressure on their friends to do the same. The pressured friends cave in so that they can fit in better and be liked. Adolescents are particularly vulnerable to peer pressure. See the nearby sidebar, “All the cool kids are doing it . . . ,” for an example.

The degree to which these influences impact any give person varies greatly. And for some people, all three influences come into play. The following three stories illustrate how modeling, addiction vulnerability due to secondhand smoke, and peer pressure lead to trouble.

If you’re a smoker, try to remember your earliest cigarettes. Ask yourself if modeling, secondhand smoke, or peer pressure may have played a role in your becoming hooked on cigarettes.

According to the U.S. Surgeon General, the younger you start, the more likely you are to become addicted. Out of every four high school smokers, three will become adult smokers. Sadly, out of those three, only one will quit and another will die early from the health consequences of smoking.

On the other hand, not every person with biological, psychological, and social risk factors becomes addicted to tobacco or nicotine. See the nearby sidebar, “The exception to the rule,” for an example.

Assess your tobacco addiction

It’s easy to deny the idea that you’re addicted or teetering on the edge of addiction to something like cigarettes. If you deny it, you’re likely to fool yourself into minimizing the damage it’s causing in your life. We have a quiz for you that may help you decide if your smoking really is a problematic addiction.

How bad is your addiction or how hooked are you? Ponder the following list of questions (our dirty dozen) to help you know.

• Do you smoke every day?
• Do you smoke to feel better?
• Do you have physical withdrawal symptoms such as agitation, restlessness, and increased appetite when you’re not smoking?
• Do you have emotional symptoms of withdrawal such as depressed mood, anxiety, lack of concentration, or stress when you’re not smoking?
• Would you buy cigarettes even if you couldn’t afford them?
• Do you avoid places that don’t allow smoking?
• Have you tried and failed to quit smoking numerous times?
• Do you have health problems from smoking?
• Do you crave a cigarette immediately after waking up in the morning?
• Do you plan for your next cigarette?
• Do you sometimes smoke instead of doing something else you need or want to do?
• Do you continue to smoke even though you know you’re harming others (your kids, spouse, or friends) through secondhand smoke?
• Do you worry when you’re about to run out of cigarettes?

There is no specific cutoff score for this quiz. But obviously, the more questions that apply to you, the more you’re hooked. Even answering yes to two or three of these questions suggests you have significant trouble with smoking. At the end of the day, it doesn’t matter to what extent your addiction is based on biological, psychological, or social factors. Either way, smoking kills, and it’s tough to quit.

The power of smoking addiction can’t be overstated. Ask any hospital nurse about patients’ desperate attempts to smoke while hospitalized. You’re likely to hear stories of people suffering from end-stage lung cancer still craving the very thing that’s killing them. One nurse we spoke to remembered a lung cancer patient, too weak to walk, who wanted to be wheeled outside to smoke. When the nurse turned down the request, the patient called 911 to report that he was being abused by the uncaring staff. After the patient’s third phone call to the police, an officer was dispatched to the hospital. Upon hearing his complaint, the officer was less than sympathetic to the patient. No charges were filed. To be clear, we have no intent to disparage this patient. Consider the anguish he must have been feeling over his overwhelming compulsion to smoke. Under such circumstances, all reasoning and common sense are drowned by the intense cravings for a cigarette.