Nicotine, dependence and cravings

Nicotine is a stimulant drug – from the lungs it reaches the brain in about seven seconds. Most people assume that when they smoke they become addicted to nicotine, but there is now some scientific evidence that suggests nicotine is not as addictive as we used to believe. Researchers now think there is something about the act or habit of smoking that people get addicted to and that nicotine is the ‘vehicle’ that creates that addiction. Nicotine, therefore, is not the ‘primary’ addiction. However, there is evidence that nicotine replacement therapy works for some people, as it can help reduce the urge to smoke.

Professor Aveyard explains why some people become addicted to smoking.

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People we talked with thought trying to stop smoking had caused them a wide range of responses including getting ‘snappy’ and irritable, feeling physically unwell, being unable to concentrate or sleep, experiencing a tightening in their chest or stomach, having the ‘shivers’ and feeling depressed or hungry. A couple of people even felt that stopping smoking suddenly precipitated a panic attack. However some people who stopped smoking suddenly had no problems or only felt as if they had a ‘cold’ for a few days.

Judith thinks it’s a fallacy that nicotine is a relaxant. She used to plan carefully when to have her cigarettes but now realises she mainly smoked out of boredom or habit.

Age at interview 36

Gender Female

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Sarah tried to quit smoking whilst dealing with an eating disorder. She had a panic attack and then worried how she would cope without cigarettes.

Age at interview 33

Gender Female

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Rukmini didn’t find it hard to give up smoking. She had no withdrawal symptoms.

Age at interview 35

Gender Female

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Miles had a non-smoking girlfriend and knew he had to stop smoking, but he still had the odd one.

Age at interview 48

Gender Male

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Some people found it hard when they couldn’t smoke for some hours, for example in a meeting, in daytime during Ramadan or on a flight. Some got into a ‘mild panic’ when they ran out of cigarettes.

Munir wondered how much he really needed a cigarette, since he could go for 18 hours without smoking during Ramadan.

Age at interview 54

Gender Male

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Keith thought he had been addicted to nicotine but thought it ‘curious’ that during long days at work he forgot about smoking. Sue had realised she was not addicted when her GP pointed out that ‘If you’re only having one in the morning… why don’t you just pack it up?’ He said, ‘That’s ridiculous. You’re not addicted.’ Sue says that he was the first person who actually told her that the desire for cigarettes was in her head.

Professor Aveyard talks about how behavioural prompts (cues) affect when and where people like to smoke and how changing your routines can help you to give up smoking.

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John remembered a long train journey to Scotland that stopped once and all the smokers got off to smoke. He says ‘And even then I was starting to think this is a bit daft. Because you know, you’ve managed an hour and a half, you can manage another hour and a half. But you just felt it was you, you were a smoker, therefore that’s what you had to do. The whys didn’t make much sense’. Andy felt that it was ‘pathetic’ he was ‘enslaved to a little white stick’ and Peter said that it had become ‘associated with many other things that were… positive and enjoyable’.

Sometimes the fear of craving for a cigarette was worse than the craving itself: Roger said that he would prepare for times when tobacconists would be closed over Christmas holidays by buying in many packets of tobacco. Judith would smoke several cigarettes in quick succession if she knew she would not be able to smoke later, but wondered how much she needed them.

Even when Cassie was in hospital with a collapsed lung, she got her friend to push her outside for a cigarette.

Age at interview 22

Gender Female

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Sue found it strange that the smoking ban meant that smoking was always on her mind because she had to plan cigarette breaks throughout the day.

Age at interview 57

Gender Female

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Many people had thought hard about their desire to smoke when they were considering giving up smoking; some were convinced that they had been addicted to nicotine while others felt it was more a social habit, or a combination of the two. Some people felt they must have a physical addiction to nicotine because when they tried ‘light’ cigarettes they would just smoke twice as many.

People spoke about the ‘illogical’ nature of their desire for cigarettes, and how it was so powerful that despite the obvious risks of smoking they still continued. Haseen thought that he could resist almost all other temptations but still found it very difficult not to smoke. Sarah talked about the ‘function’ of her smoking, in that it gave her some sort of support with her eating disorder. Others talked about the role smoking had in reducing or controlling stress. Caroline said that even though she adored her children and they wanted her to quit, she still felt she had to smoke.

Abdul was a chain smoker he started to hate smoking and felt that he had to demonise smoking in order to quit.

Age at interview 37

Gender Male

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Raf felt on edge without a cigarette and had a constant urge to smoke. This may be why he smoked for so long.

Age at interview 40

Gender Male

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Gareth is puzzled that he and his siblings have all stopped smoking but have all started again.

Age at interview 58

Gender Male

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Some people thought only in retrospect they felt they had been addicted to nicotine. People spoke about having ingrained habits such as a ‘hand to mouth’ action; constantly thinking about smoking; collecting smoking paraphernalia such as tobacco tins, papers, ashtrays and lighters. Carol described herself as having an ‘addictive personality’, and talked about swapping ‘one addiction for another’ in the sense that she now puts food in her mouth rather than cigarettes.

Tom’s desire to smoke seemed to be prompted by certain situations, such as coming out of the cinema.

Although some people could manage to smoke less, cutting down or smoking light cigarettes were often not regarded as ways to decrease addiction to smoking.

Also see ‘Effects of not smoking‘ and ‘Cutting down’ unsuccessful attempts and trying again‘.

Smoking: memories and experiences

After getting over the unpleasantness of the first few attempts, most people had begun to enjoy smoking. They often had good memories and associations with...