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Nicotine is a drug found naturally in tobacco. It is as addictive as heroin or cocaine. Over time, a person becomes physically and emotionally addicted to (dependent on) nicotine. Studies have shown that smokers must deal with both the physical and psychological (mental) dependence to quit and stay quit.
When you inhale smoke, nicotine is carried deep into your lungs. There it is quickly absorbed into the bloodstream and carried throughout your body. Nicotine affects many parts of the body, including your heart and blood vessels, your hormones, the way your body uses food (your metabolism), and your brain. Nicotine can be found in breast milk and even in mucus from the cervix of a female smoker. During pregnancy, nicotine freely crosses the placenta and has been found in amniotic fluid and the umbilical cord blood of newborn infants.
Different factors affect how long it takes the body to remove nicotine and its by-products. In most cases, regular smokers will still have nicotine or its by-products, such as cotinine, in their bodies for about 3 to 4 days after stopping.
Nicotine causes pleasant feelings that make the smoker want to smoke more. It also acts as a kind of depressant by interfering with the flow of information between nerve cells. Smokers tend to increase the number of cigarettes they smoke as the nervous system adapts to nicotine. This, in turn, increases the amount of nicotine in the smoker's blood. In fact, nicotine inhaled in cigarette smoke reaches the brain faster than drugs that enter the body through a vein (intravenously or IV).
After a while, the smoker develops a tolerance to the drug. Tolerance means that it takes more nicotine to get the same effect that the smoker used to get from smaller amounts. This leads to an increase in smoking over time. The smoker reaches a certain nicotine level and then keeps smoking to maintain this level of nicotine.
When smokers try to cut back or quit, the lack of nicotine leads to withdrawal symptoms. Withdrawal is both physical and mental. Physically, the body reacts to the absence of nicotine. Mentally, the smoker is faced with giving up a habit, which calls for a major change in behavior. Both the physical and mental factors must be addressed for the quitting process to work.
Those who have smoked regularly for a few weeks or longer, and suddenly stop using tobacco or greatly reduce the amount smoked, will have withdrawal symptoms. Symptoms usually start within a few hours of the last cigarette and peak about 2 to 3 days later when most of the nicotine and its by-products are out of the body. Withdrawal symptoms can last for a few days to up to several weeks. They will get better every day that you stay smoke-free.
Withdrawal symptoms can include any of the following:
These symptoms can lead the smoker to start smoking cigarettes again to boost blood levels of nicotine back to a level where there are no symptoms. (For information on coping with withdrawal, see the section, "How to quit.")
Smoking also makes your body get rid of some drugs faster than usual. When you quit smoking, it may change the way your body handles medicines. Ask your doctor if any medicines you take regularly need to be checked or changed after you quit.
Why should I quit?
Health concerns usually top the list of reasons people give for quitting smoking. This is a very real concern: Half of all smokers who keep smoking will end up dying from a smoking-related illness. In the U.S. alone, smoking is responsible for nearly 1 in 5 deaths, and about 8.6 million people suffer from smoking-related lung and heart diseases.
Nearly everyone knows that smoking can cause lung cancer, but few people realize it is also a risk factor for many other kinds of cancer too, including cancer of the mouth, voice box (larynx), throat (pharynx), esophagus, bladder, kidney, pancreas, cervix, stomach, and some leukemias.
Pneumonia is included in the list of diseases known to be caused by smoking. Smoking also increases your risk of getting lung diseases like emphysema and chronic bronchitis. These diseases are grouped together under the term COPD (chronic obstructive pulmonary disease). COPD causes on-going (chronic) illness and disability and worsens over time -- sometimes becoming fatal. Emphysema and chronic bronchitis can be found in people as young as 40, but are usually found later in life, when the symptoms get much worse. Long-term smokers have the highest risk of developing severe COPD.
Smokers are twice as likely to die from heart attacks as are non-smokers. And smoking is a major risk factor for peripheral vascular disease, a narrowing of the blood vessels that carry blood to the leg and arm muscles. Smoking also affects the walls of the vessels that carry blood to the brain (carotid arteries), which can cause strokes. Men who smoke are more likely to develop erectile dysfunction (impotence) because of blood vessel disease.
Smoking causes an increased risk of macular degeneration, one of the most common causes of blindness in older people. It also causes premature wrinkling of the skin, bad breath, gum and tooth problems, bad smelling clothes and hair, yellow fingernails.
Women have some unique risks linked to smoking. Women over 35 who smoke and use birth control pills have a higher risk of heart attack, stroke, and blood clots of the legs. Women who smoke are more likely to miscarry (lose the baby) or have a lower birth-weight baby. And low birth-weight babies are more likely to die or have learning and physical problems.
Based on data collected in the late 1990s, the U.S. Centers for Disease
Control and Prevention (CDC) estimated that adult male smokers lost an average of 13.2 years of life and female smokers lost 14.5 years of life because of smoking. And given the diseases that smoking can cause, it can steal your quality of life long before you die. Smoking-related illness can limit your activities by making it harder to breathe, get around, work, or play.
Why quit now?
No matter how old you are or how long you've smoked, quitting can help you live longer and be healthier. People who stop smoking before age 50 cut their risk of dying in the next 15 years in half compared with those who keep smoking. Ex-smokers enjoy a higher quality of life with fewer illnesses from cold and flu viruses, better self-reported health, and reduced rates of bronchitis and pneumonia.
For decades the Surgeon General has reported the health risks linked to smoking. In 1990, the Surgeon General concluded:
When smokers quit -- What are the benefits over time?
20 minutes after quitting: Your heart rate and blood pressure drop.
(Mahmud A, Feely J. Effect of Smoking on Arterial Stiffness and Pulse Pressure Amplification. Hypertension. 2003;41:183.)
12 hours after quitting: The carbon monoxide level in your blood drops to normal.
(U.S. Surgeon General's Report, 1988, p. 202)
2 weeks to 3 months after quitting: Your circulation improves and your lung function increases.
(U.S. Surgeon General's Report, 1990, pp. 193, 194, 196, 285, 323)
1 to 9 months after quitting: Coughing and shortness of breath decrease; cilia (tiny hair-like structures that move mucus out of the lungs) regain normal function in the lungs, increasing the ability to handle mucus, clean the lungs, and reduce the risk of infection.
(U.S. Surgeon General's Report, 1990, pp. 285-287, 304)
1 year after quitting: The excess risk of coronary heart disease is half that of a smoker's.
(U.S. Surgeon General's Report, 1990, p. vi)
5 years after quitting: Your stroke risk is reduced to that of a non-smoker 5 to 15 years after quitting.
(U.S. Surgeon General's Report, 1990, p. vi)
10 years after quitting: The lung cancer death rate is about half that of a person who continues smoking. The risk of cancer of the mouth, throat, esophagus, bladder, cervix, and pancreas decrease, too.
(U.S. Surgeon General's Report, 1990, pp. vi, 131, 148, 152, 155, 164, 166)
15 years after quitting: The risk of coronary heart disease is the same as a non-smoker's.
(U.S. Surgeon General's Report, 1990, p. vi)
Kicking the tobacco habit offers some benefits that you'll notice right away and some that will develop over time. These rewards can improve your day-to-day life a great deal:
The prospect of better health is a major reason for quitting, but there are other reasons, too. Smoking is expensive. It isn't hard to figure out how much you spend on smoking: multiply how much money you spend on tobacco every day by 365 (days per year). The amount may surprise you. Now multiply that by the number of years you have been using tobacco and that amount will probably shock you.
Multiply the cost per year by 10 (for the next 10 years) and ask yourself what you would rather do with that much money.
And this doesn't include other possible costs, such as higher costs for health and life insurance, and likely health care costs due to tobacco related problems.
Smoking is less socially acceptable now than ever.
Today, almost all workplaces have some type of smoking rules. Some employers even prefer to hire non-smokers. Studies show smoking employees cost businesses more because they are out sick more. Employees who are ill more often than others can raise an employer's need for costly short-term replacement workers. They can increase insurance costs both for other employees and for the employer, who often pays part of the workers' insurance premiums. Smokers in a building also can increase the maintenance costs of keeping odors down, since residue from cigarette smoke clings to carpets, drapes, and other fabrics.
Landlords may choose not to rent to smokers since maintenance costs and insurance rates may rise when smokers live in buildings.
Friends may ask you not to smoke in their homes or cars. Public buildings, concerts, and even sporting events are largely smoke-free. And more and more communities are restricting smoking in all public places, including restaurants and bars. Like it or not, finding a place to smoke can be a hassle.
Smokers may also find their prospects for dating or romantic involvement, including marriage, are largely limited to other smokers, who make up less than 21% of the adult population.
Smoking not only harms your health but it hurts the health of those around you. Exposure to secondhand smoke (also called environmental tobacco smoke or passive smoking) includes exhaled smoke as well as smoke from burning cigarettes.
Studies have shown that secondhand smoke causes thousands of deaths each year from lung cancer and heart disease in healthy non-smokers.
If a mother smokes, there is a higher risk of her baby developing asthma in childhood, especially if she smoked while she was pregnant. Smoking is also linked to sudden infant death syndrome (SIDS) and low-birth weight infants. Babies and children raised in a household where there is smoking have more ear infections, colds, bronchitis, and other lung and breathing problems than children in non-smoking families. Secondhand smoke can also cause eye irritation, headaches, nausea, and dizziness.
If you have children, you probably want to set a good example for them. When asked, nearly all smokers say they don't want their children to smoke. But children whose parents smoke are more likely to start smoking themselves. You can become a good role model for them by quitting now.
How do I know if I'm a light, average, or heavy smoker?
Some NRT products make their recommendations based on what kind of smoker you are. But there is no formal category in any textbook or a group that defines a light, average, or heavy smoker. In general, a light smoker is someone who smokes less than 10 cigarettes per day. Someone who smokes a pack a day or more is a heavy smoker. An average smoker falls in between.
Sometimes a doctor will use the term pack year to describe how long and how much a person has smoked. A pack year is defined as the number of packs of cigarettes a person has smoked every day multiplied by the number of years he or she has smoked. Since 1 pack is 20 cigarettes, a person who has smoked 20 cigarettes a day for a year is considered to have smoked 1 pack year. Someone who has smoked 30 cigarettes a day (1½ packs) for 3 years has smoked 4.5 pack years (1½ x 3), and so on. This is just another way to figure out how high your risk of smoking-related disease might be.