The psychology of tobacco addiction: Why it is difficult to stop smoking

The two main factors determining whether or not a smoker will stop smoking are: motivation to quit and level of addiction to tobacco. Motivation is determined by a variety of influences, including (i) awareness of smoking-related health risks to the self and others; (ii) the financial cost of tobacco; and (iii) other social pressures to stop (e.g. workplace smoking bans) or continue smoking (e.g. advertising). However, even among people with a very high desire to stop smoking, most smokers find it very difficult to quit. For example, among smokers who make a determined self-quit attempt (i.e. those who try to stop on their own without any extra assistance) only between 2 and 5% succeed in remaining abstinent for 1 yr. Addiction to tobacco is determined by an interaction of pharmacological and psychological factors. One of the main problems for those trying to quit is the nicotine withdrawal syndrome. This consists of bad mood (irritability, restlessness, depression and anxiety), sleep disturbance, poor concentration, hunger (and associated weight gain) and a strong craving for tobacco. These symptoms typically begin within a few hours of quitting, peak in the first 48 h and most return to normal within 1 month. However, the majority of people who try to quit will relapse within the first month owing to the combined difficulties of giving up a strong habit (70,000 puffs a year for a pack-a-day smoker) while experiencing tobacco withdrawal symptoms. The first step in helping people to stop smoking (at both an individual and a national level) is to boost their motivation to quit. However, in countries where the majority of smokers already have strong motivation to quit (as measured in surveys), it is necessary to provide some practical help to increase the chance of success. This help can take many forms, including mass social support events (e.g. Quit and Win), telephone help-lines, smokers' clinics and the provision of nicotine replacement therapy.