“I’m not addicted; smoking is just a habit. You see, when I wake up in the morning, if I don’t have a cigarette with my coffee, I feel like I can’t get anything done. I’ve started my day like this for so long that I can’t even imagine it any other way.” — You will often hear such explanations from those wishing to join a nicotine de-addiction program. This is hardly surprising, as the act of smoking becomes so intertwined with a smoker’s daily routine and is repeated so frequently that it is indeed perceived as a deeply ingrained habit.
Smoking with coffee, smoking during breaks, smoking after meals, smoking while meeting friends, with alcohol, while driving, and so on. Furthermore, throughout the past century, doctors also contributed to the perception of smoking primarily as a “bad habit.” True, there is a habitual component, as smokers have learned on a conditioned reflex level that smoking brings them a certain sense of satisfaction and/or relief. However, it must be noted that this feeling of relief primarily results from satisfying nicotine withdrawal (nicotine hunger).
The behavior of smoking is supported by our own reward system, which, upon nicotine entering the blood, releases dopamine—the hormone responsible for the sensation of pleasure—into the center of our nervous system: the brain. The brain remembers this and subsequently prompts us to repeat the smoking behavior.
The same hormone, dopamine, is also involved in the development of gambling addiction. Interestingly, in this case, addiction develops without the intake of any external psychoactive substance. For a person with a gambling addiction, the stimulus to play is a trigger or a situation (e.g., going to a casino with a friend), as well as their own hormones, which alter their mood and physical sensations, fostering a strong, often irresistible urge to play.
So, how does a habit differ from an addiction? Why do we find it difficult to establish so-called “healthy habits” (e.g., walking in the morning), while we repeat behaviors labeled as “bad habits” despite incurring significant financial loss (in gambling) or substantial health damage (with regular nicotine use)? In discussions on this topic, you will often hear the following argument: establishing healthy habits requires considerable effort, time, finances, and other resources, whereas maintaining an unhealthy habit is much easier; consequently, the desired benefit—albeit at the cost of certain risks or harm—is obtained more easily and quickly.
We will discuss the “desirable” effects of smoking further, but regarding the difference between habit and addiction: addiction is a more complex phenomenon than a habit, although it encompasses it. More than 40% of our daily behaviors have turned into habits—morning routines, eating patterns, work styles, communication with friends and family, minor purchases, etc. Frequently performed behaviors have the potential to become automated, where we follow a well-known path without thinking. This applies to beneficial habits, such as brushing teeth or regular exercise, as well as harmful behaviors, such as excessive procrastination. Changing well-learned habits is not easy, as human behavior models are imprinted in the brain’s neural connections. However, creating new neural connections is certainly possible with appropriate effort and the right strategy—especially when a person is highly motivated to change their behavioral pattern.
In the case of addiction, we are dealing with a more difficult situation because behavior is driven by biological factors—such as changes in brain function resulting from intoxication, hormonal imbalance, and pathological changes at the cellular or structural level—as well as psychological and social factors.
The neurobiology of addiction clearly explains the processes that form in the nervous system of a person dependent on a substance or behavior. According to neurobiology, addiction is a chronic disease of the human brain, during which this organ functions differently. The good news here is that the brain of a nicotine-dependent person restores its neurobiological processes more easily than in cases of addiction to other, more toxic psychoactive substances (e.g., alcohol). After passing the initial rehabilitation period—about three months after quitting smoking—the former smoker’s brain manages a beneficial transformation: the levels of “happiness hormones” become stable. Dopamine is no longer critically sought after because it is supplied to nerve cells steadily, without interruption, and in sufficient quantities. In smokers, however, dopamine absorption is disrupted due to the desensitization (decreased sensitivity) of receptors in neurons caused by nicotine use. As a result, the absorption of dopamine and other happiness hormones is problematic for smokers, leading to high levels of anxiety, depression, irritability, low mood, and a decreased ability to focus. Even the pleasure felt from smoking is mainly related to satisfying nicotine hunger.
Nicotine hunger, in turn, is caused by the obstruction of another neurotransmitter, acetylcholine, in the nervous system of the nicotine-dependent person. Nicotine essentially occupies acetylcholine receptors and, in a literal sense, makes the smoker’s nervous system dependent on it. When nicotine levels in a smoker’s blood drop, their nervous system struggles to function, which triggers the urge to smoke. Smoking another cigarette temporarily reduces this imbalance until the next smoke. Over time, more and more cigarettes are needed to satisfy nicotine hunger (for the nervous system to function more or less properly); however, at some point, the smoked cigarettes can no longer fully relieve the physiological discomfort. Such a smoker suffers doubly—they neither receive the “benefits” of smoking nor can they quit for fear of suffering even more. This typically happens after 10–15 years of smoking, when most smokers begin to think about quitting.
At this time, it is good for the smoker to know that the withdrawal syndrome developed after quitting smoking lasts only 5–7 days, while the urge to smoke will bother the former smoker only episodically during the first 3–4 weeks. To avoid these discomforts, a doctor may prescribe nicotine replacement therapy (NRT). During the first month of quitting, properly selected therapy increases the chances of success by 50%.
Unlike overcoming physiological dependence on nicotine, the process of overcoming psychological and social dependence is far more laborious: it must be checked whether the person has unhealed psychological trauma or unresolved life problems that encourage tobacco use; what their primary triggers are and how to deal with them; whether the person uses smoking as a coping strategy; whether there is a need to improve skills for dealing with stress or anger, and so on. Understanding the psychological and social aspects of addiction takes place within the framework of Cognitive Behavioral Therapy (CBT), during which, along with gaining insight, new behavioral models are selected and learned. This is when the most pressing question for smokers is answered: “If I don’t smoke, what should I do?”
Unlike addiction to other psychoactive substances (e.g., alcohol), in the case of nicotine addiction, it is not necessary to stop use before starting CBT. It is possible to continue smoking until the psychological and social parts of the addiction are addressed. Once the smoker is ready to smoke and extinguish the last cigarette in their life, the physiological part is then tackled with the help of nicotine replacement therapy.
The “Stop Smoking Program” at the Cognita Center is based on Cognitive Behavioral Psychotherapy. The program duration is 6 weeks, while the support period after quitting smoking lasts 3–6 months. Therapeutic sessions are held in a group psychotherapy format, involving 7–8 smokers and two facilitators (a psychologist and an addictologist). If anyone wishes to participate in the program, find us on Facebook at Cognita or on Instagram at cog_nita, write to us, and sign up for an initial consultation. The next group begins work on May 30th.
By the way, World No Tobacco Day is observed globally on May 31st. As a former smoker, I congratulate you in advance on this wonderful date and hope that many more people free from tobacco products will join the ranks of former smokers in Georgia soon.
Nino Bolkvadze Founder of Cognita Center, Addictologist
