Cigarette smoking is one of the most dangerous yet common addictions known to man. As science unravels the mechanisms behind nicotine addiction and its toxic and detrimental effects, more and more people are trying to quit. But is it that easy? What makes someone be able t-o quit cigarettes while another struggles to stop?
From a neurological point of view, it’s simple: when you smoke a cigarette, nicotine is rapidly absorbed into your bloodstream, reaching your brain in mere seconds. Your nervous system responds by releasing a neurotransmitter: Dopamine. Its role in triggering and maintaining motivation has already been well established (1).
A tolerance is gradually built with each new cigarette you inhale and the urge to smoke becomes a craving, leading to the addictive state as we know it. That causes severe withdrawal symptoms upon smoking cessation, such as irritability due to an increasing frustration, restlessness and a heightened anxiety, which make it all the more difficult to quit smoking and prevent possible relapses (2).
This scientific approach depicts nicotine as the main culprit behind tobacco dependence. However, studies have showed that it’s only partially true. The other side of the coin is the emotional factor that people face on a daily basis.
Many studies on animal models of addiction confirmed this fact. For example, when lab rats or mice are housed in an enriched environment (toys, wheels, larger cages etc.), they disregard the drugs offered even though they’re “addicted” to those substances (3). This suggests that environmental and emotional factors may influence nicotine addiction by amplifying or decreasing the effect of tobacco and its dependence.
Later, it was demonstrated that the frequency of tobacco use in people with psychiatric disorders is considerably higher than in the general population and inversely, smokers are more susceptible to develop psychiatric disorders than non-smokers (4 and 5).
These deficits in emotion regulation could vary from a mood swings, affective lability and social anxiety to serious disorders like schizophrenia, or depression (4, 6, 7, 8 and 9). Usually, the relapse trigger is emotional in smokers who have attempted to quit.
Therefore, these individuals often struggle to quit and report more withdrawal symptoms than smokers without a psychiatric disorder (10). Smokers tend to turn to cigarettes when faced with a tough situation. So, it is highly advised to avoid any negative situations as it may interfere with the motivation to quit (11).
Food for thought: A better understanding of emotional fluctuations may lead to upgraded therapies preventing relapses following smoking cessation (12).
Nadia, Consultant, Leyton France
- Hongbin Y., de Jong J.W, Tak YE, Peck J, Bateup H.S, Lammel S (2018) Nucleus Accumbens Subnuclei regulate motivated behavior via Direct Inhibition and Disinhibition of VTA Dopamine Subpopulations, Neuron, 97: 434-449.
- Colling S.E, Witkiewitz K, Kirouac M, Marlatt G.A (2015) Preventing Relapse Following Smoking Cessation, Curr Cardiovasc Risk Rep, 4: 421-428.
- Green TA, Cain ME, Thompson M, Bardo MT (2003) Environmental enrichment decreases nicotine-induced hyperactivity in rats, Psychopharmacology (Berl), 3: 235-241
- Hu Y, Fang Z, Yang Y, Rohlsen-Neal D, Cheng F, Wang J (2018) Analyzing the genes related to nicotine addiction or schizophrenia via a pathway and network based approach, Sci Rep, 13;8(1):2894.
5. Kauffman B.Y, Farris S.G, Alfano C.A, Zvolensky M.J (2017) Emotion dysregulation explains the relation between insomnia symptoms and negative reinforcement smoking cognitions among daily smokers, Addictive Behaviors, 72:33-40.
- Guillot C.R., Leventhal A.M., Raines A.M., Zvolensky M.J., Schmidt N.B. (2017) Anxiety Sensitivity Facets in Relation to Tobacco use, Abstinence-Related Problems, and cognitions in Treatment-Seeking Smokers, Addict. Behav. 56:30-35.
- Watson N.L, DeMarree K.G, Cohen L.M, Cigarette craving and stressful social interactions: the roles of state and trait social anxiety and smoking to cope, Drug Alcohol and Dependence, in pres
- Šagud M, Vuksan-Ćusa B, Jakšić N, Mihaljević-Peleš A, Živković M, Vlatković S, Prgić T, Marčinko D, Wang W (2018) Nicotine dependence in Croatian male inpatients with schizophrenia, BMC Psychiatry, 18 (1) : 18.
- Aldi G.A, Bertoli G., Ferraro F., Pezzuto A ., Cosci F. (2018) Effectiveness of pharmacological or psychological interventions for smoking cessation in smokers with major depression or depressive symptoms: A systematic review of the literature, Substance Abuse, in press (online 13/02/2018)
- Piper ME, Cook JW, Schlam TR, Jorenby DE, Baker TB (2011) Anxiety diagnoses in smokers seeking cessation treatment: relations with tobacco dependence, withdrawal, outcome and response to treatment, Addiction, 106: 418–27.
- Fillo J., Alfano C.A., Paulus D.J, Smits A.J, Davis M.L, Rosenfield D., Marcus B.H, Church T.S, Powers M.B, Otto M.W, Baird S.O, Zvolensky M.J (2016) Emotion dysregulation explains relations between sleep disturbance and smoking quit-related cognition and behavior, Addictive Behaviors, 57: 6-12.
- MacIntyre J.M, Ruscio A., Brede E., Waters A.J. (2018) Emotion Dysregulation and negative affect: Laboratory and EMA investigations in smokers, Addictive Behaviors Reports, in press (Online 07/01/2018)