Why is it so hard to stop smoking?

Nick Hopkinson, our medical director, explains what makes stopping smoking so difficult and why NHS support is the best way to quit.

hand breaking cigarette

Why do people smoke?

Most people who smoke started when they were children. They tried their first cigarettes because it seemed cool, peer pressure or because their parents smoked, so it seemed normal. Once people start smoking it’s hard to stop because nicotine is so addictive. Half of the people who try one cigarette will go on to become regular smokers. Some people can quit just by deciding to stop, but for many others it isn’t that easy.

Why do some people find it harder than others to quit?

Tobacco smoke contains over 5,000 chemicals, including nicotine. Nicotine is highly addictive, and smokers will develop a level of physical dependence to their use of tobacco. Nicotine is thought to be as addictive as heroin and cocaine.

The tobacco industry has designed and modified cigarettes, adding additional chemicals, to make them as addictive as possible. Nicotine is a stimulant and can provide temporary relief from feelings of anxiety and depression. 

However, in between cigarettes the levels of nicotine in the brain drops, raising stress levels and creating the need to smoke. The perceived calming effect from lighting the next cigarette generally reinforces the habit, making it hard to stop.

Some people who smoke also have a greater physical dependence on tobacco than others. This may be because they smoke more cigarettes or have smoked for a long time. Those people will experience more extreme withdrawal symptoms when they try to quit.

Because of this physical addiction, some people may find it takes a long time to stop for good. But the good news is the NHS have designed services to provide support to help people quit.

Getting help isn’t failing

Some people believe the best way to quit smoking is to do so without any support, also known as going cold turkey. 

But only about 1% of all people who try to quit without any support will be successful. The rest will go back to smoking. 

This is because quitting smoking is, quite simply, incredibly difficult. One of the most sensible things to do is get help from the NHS by people who are trained to give it. 

What are the best ways to stop smoking?

Specialist services help people in various ways, such as thinking about what didn’t work well in previous attempts and working with the smoker to identify what to try next. Details of stop smoking services can be found on the NHS Smokefree site.

Medication, such as Champix, is available on prescription. Advisors will also give coaching and support, making replacement products (such as nicotine patches and gum) much more effective. They can also give advice on e-cigarettes and how they can be incredibly effective in stopping smoking.

Whatever you chose, the odds of quitting are made far better by going to a stop smoking service. Getting help isn’t failing – it’s one of the best things you can do for your health.

Why does the NHS provide support for smokers?

Having access to the most effective methods of quitting means smokers are more likely to be successful, quit earlier and save further damage to their health. By providing these services, the NHS saves far greater costs later down the line.

Prevention is better than cure. Helping people to quit smoking is much better value than treating the complications that occur in people who continue to smoke.

Stop smoking services are very cost effective. The amount spent on running the services is much smaller than the benefits they have. In fact, stop smoking services save money because they cost less to the NHS than doing nothing about smoking.

If you can stop smoking, you’ll live longer and feel better. It doesn’t matter how old you are or how long you have smoked for. For more advice on how to stop smoking, take a look at our information online. 

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Dr Nick Hopkinson, medical director at the British Lung Foundation.

Dr Nicholas Hopkinson

Nick is our medical director, reader in respiratory medicine at Imperial College and consultant physician at Royal Brompton Hospital.

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30 September 2019