Published: Jan. 3, 2006
Updated: Mar. 24, 2010
By Angela Spivey
What are cigarette smokers hooked on? You know the answer. Even tobacco companies concede that a cigarette is basically a delivery system for an addictive drug: nicotine.
But to a smoker, a cigarette is much more than that. A smoker craves not only nicotine, but all the tiny things he or she has unconsciously learned to associate with it -- the feel of a lighter in a pocket, the smell of burning tobacco, the sensation of smoke in the throat.
“A smoker who has smoked a pack a day for twenty years has inhaled a cigarette over a million times,” says Robert Shipley, PhD, former director of the Duke Center for Nicotine and Smoking Cessation Research. “Each time, they have associated that inhaling of a cigarette with something pleasurable.”
Research shows that those associations are so strong that the cigarette’s power lies just as much in its sensory effects as in the nicotine, says Jed Rose, PhD, the center's current director.
Understanding the intricacies of addiction to cigarettes is key to helping smokers kick the habit -- a goal that has proved frustratingly elusive for both the health care community and smokers themselves.
Most current smoking-cessation methods are only moderately helpful, with overall quit rates 25 percent or less after one year, Rose says.
The mainstay of smoking-cessation treatment is nicotine replacement therapy (NRT), which can help relieve some of the irritability, hunger, and other withdrawal symptoms that smokers feel in the first weeks of quitting.
Patients who use NRT are more successful than those who don’t. Initial quit rates on NRT are about 25 percent -- without, 5 to 10 percent.
Recent research conducted by Rose, a co-inventor of the nicotine patch, suggests a simple way to modify NRT to dramatically increase those success rates. The modification helps NRT not only relieve withdrawal, but actually weaken smokers’ dependence on the cigarette itself.
In one study, Rose had a group of smokers start using a nicotine patch on their target quit date, just as the labeling directs. Another group began the patch early -- two weeks before they stopped smoking. Those who used the patch while still smoking were twice as successful at quitting.
Why? Using NRT and cigarettes at the same time appears to “devalue the experience of smoking,” Rose says.
If the physical need for nicotine is met by the patch, but the person still smokes, then each time he lights up, the cigarette itself provides less of a reward.
Gradually, the smoker’s body and brain learn not to associate cigarettes with pleasure. The cigarette loses some of its power.
Once smokers are ready to quit, they are more successful if they have strategies for handling cravings.
Arming smokers with a plan is a major part of the QuitSmart smoking cessation program, developed by Duke’s Robert Shipley.
In one study, 66 percent of smokers using QuitSmart were still smoke-free at six months, versus just 16 to 30 percent in four comparison treatments.
The program uses multiple methods: gradually switching to low-nicotine cigarettes before the quit date, various forms of NRT, hypnosis, and behavioral treatment such as encouraging smokers to reward themselves.
“Smokers spend a lot of their life in the actual smoking ritual. Now they have time on their hands,” Shipley says. “We want them to use that time not to clean the cupboard, but to do something to feel good -- take a walk, a bubble bath -- so they don’t feel deprived, which could lead them back to cigarettes.”
These approaches tackle not just the physical addiction to nicotine, but the smoker’s emotional dependence on the whole habit.
Shipley says that, for most smokers, giving up cigarettes is like giving up a good friend.
“If a smoker is lonely, they smoke. If they’re bored, they smoke,” he says. “While you and I can see it as a false friend, to a smoker, day by day, hour by hour, it’s been a very good friend to them.”
If you’re ready to quit, try these strategies to help yourself succeed.