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Treat Smokers with Compassion – Why Quit Smoking is so tough

Treat Smokers with Compassion – Why Quit Smoking is so tough

Written by: Andrew da Roza, Addictions Therapist

To non-smokers and those who have an occasional cigarette at a party or outside a bar, it is baffling why smokers just can’t simply quit. What’s the big deal?

If you think this, then the conclusion may be: “well they just don’t want to quit”; or “they are uneducated, and don’t know how much damage they’re doing to themselves and those around them”; “they have no conscience” or “they have no self-control”. 

The problem with these conclusions is that the scientific evidence doesn’t support them. 

70% to 80% of smokers want to quit – and many of them desperately want to quit – and most smokers fail.  

A majority have tried to quit multiple times – and about 40% are still drawn to smoking -even after losing fingers and toes to gangrene, or lungs to cancer and COPD, as a result of smoking. Many suffer heart attacks, mouth, throat and colon cancer, or labour under serious diabetes problems; some even lose their close relationships with their families. 

They wish that if only they could quit, their lives would be so much better – yet they continue to smoke. 

So, there is more to the compulsion to smoking than meets the eye. 

Perhaps kindness and compassion for smokers may be a more rational reaction – than dismissal, frustration, irritation, anger or contempt?    

There are very good reasons why the chemicals in cigarette smoke are so compelling – and it’s to do with our brains and our bodies. It’s not a mystery.  

Although nicotine in the smoke is a comparatively benign substance, and it doesn’t cause the damaging effects of the other harmful substances in the smoke – it is highly addictive. It is the nicotine that causes the addiction – but it is the tar and other substances that cause the damage. 

In addition to nicotine, there is another substance, in smoke, that creates a potentially “pleasant” psychoactive effect.  It is a monoamine oxidase inhibitor – which results in chemicals in the brain staying longer in the space between neurons and firing those neurons.

And the effect the smoker feels? Well, there can be numerous combinations of “positive” effects. 

Those smokers who feel down, moody and unmotivated, may feel a pleasant “lift” or “boost”. Anxious, fearful and nervous smokers, may feel calmer, and more able to think straight. Smokers who are tired, sleepy or lethargic, may be able to focus, concentrate and pull themselves out of their procrastination.  

Smoking helps some people become more energetic, have better reactions times and become more effective or efficient. Smoking enables people who are mentally tired with work or constant rumination, to feel like they are taking a break and “relaxing” from their thoughts. They can just let their minds gently wonder. They may even feel that after their “reverie” with a cigarette, they have managed to solve a problem that they have been grappling with.

Some people use smoking as a bonding experience. Ironically, all the community stigma that surrounds smokers makes some feel like a “band of brothers and sisters”, as they stand outside in smoking areas or in smoking rooms. It enables instant connection and the sense of “belonging”.

In short, the effects of smoking depend on how you are feeling in the moment. 

Insidiously, mental illness and other addictions result in many becoming vulnerable to smoking – either to cope with: their illness; the difficult side effects of their medication; and the social stigma against mental illness addiction that so oppresses and shames them. 

By way of examples, ADHD, schizophrenia, bipolar disorder, anxiety and major depressive disorders, and personality disorders, can all result in life-long suffering – that smoking may appear to “take the edge off”.  

There is now persuasive research that some people are more genetically susceptible to being addicted to cigarette smoke. They may get more of a “buzz” from it, they may be more tolerant to its side effects, the effects may wear off faster, and they may feel the withdrawal effects (when not smoking) more keenly. They may have more trouble starting to quit – and staying quit. 

There are many other vulnerability factors as well: adverse childhood events (which afflicts 2 out of every 3 Singaporeans); traumas; family and peer modelling; rebelliousness, isolation and loneliness, financial distress, problems in relationships and at work; and many more factors, may all conspire to lead smokers to smoke daily. 

Once they smoke enough cigarettes for long enough – the brain changes, it becomes “hijacked” by the smoke.  

Smokers experience brain changes as: 

  • Tolerance – the need for more smoking, more often, to get the same effect;
  • Withdrawals – 45 minutes to two hours after smoking, they may feel the exact opposite of what they felt when they smoked – and therefore need a cigarette to feel “normal”;
  • Impulsiveness – in the moment (of smoking), they forget about the harms of tobacco and their resolves to quit, and habitually light up;
  • Smoking triggers – smoking cues are everywhere – and they trigger the urges and cravings – and once these build up, they become overwhelming;
  • Stress – their stress response slowly but inexorably ratchets upwards, daily – so that even things that used to be experienced as minor, now elicit strong and intolerable emotions. If health, relationships, jobs and self-image are all on the line because of smoking – the stress can be intense. 

Luckily – there is a solution. Smokers now have access to psychotherapy, nicotine replacement therapy, quit smoking medication, and any number of other tools to help them on their quit journey. In other countries, new nicotine delivery technologies like e-cigarettes and heat-not-burn are being improved and refined – and they are much safer than smoking. 

Smokers deserve our respect and compassion in their struggle with cigarettes. And they don’t have to do it alone. So that the help-seeking and quit smoking load can be lightened. 

You can also hear more from Andrew at the 7th Asia-Pacific Behavioural & Addictions Conference (APBAM2020: Forum 1 – “Tobacco Harm Reduction: Myths & Realities).

 


 

What if I am addicted to more than one thing? I can’t stop them all at once!

What if I am addicted to more than one thing? I can’t stop them all at once!

Promises Healthcare Singapore addiction
It is common to have more than one addiction. Many compulsive drinkers tend to be heavy smokers and coffee drinkers. Compulsive drinkers may also drink to bolster their courage that allow them to be the “life of the party” where they can be hooked into engaging in risky sexual behaviours and onto paid sex as well.

Drug users often abuse a variety of drugs. This may include alcohol, cigarettes or drugs. The use of drugs produces a pleasurable effect and when coupled with other substances or behaviours (e.g Sex, Gambling) – it creates a stronger pleasurable effect in which experts believe affect the reward centers in the brain. Casinos have long figured out that offering alcohol (officially) and paid sex (unofficially) is good for enhancing and maintaining gambling behaviour. This creates a destructive pattern that results in a downward spiral where one’s finances begin to dry up. Relationships begin to fracture and life descends into chaos.

If this is becoming a pattern in your life, professional addictions counseling can offer recovery solutions that are effective for individuals who are using multiple substances and behaviors. These solutions to addictions can work together and support each other. Break the vicious cycle today and live free from addictions.

At Promises Healthcare, we are committed to helping you through your journey to recovery. Discover a new life, away from addiction and find renewed hope. Please contact our clinic or inquiries and consultations.

Written by: Andrew da Roza, Therapist, Promises Healthcare Pte Ltd

Addiction – How to deal with triggers, urges, and cravings

Addiction – How to deal with triggers, urges, and cravings

Promises Healthcare Singapore

If you have compelling, irresistible cravings to drink, smoke, use drugs and gamble, which leads to behaviors that is destructive to yourself and others, you can seek help from a professional counselor for addiction treatment.

They can offer you tools and techniques to deal with urges and cravings. One powerful practice that has been shown by several studies to reduce urges and cravings is mindfulness. Mindfulness allows you to control your cravings by noticing in the moment what is arising in your thoughts, emotions and body. By being in the moment with your cravings and not being subsumed by them or reacting to them, the craving will fade away. Do you have difficulties in controlling your urges and cravings? Do you feel that you have no control over your life and that the cravings are controlling you?

At Promises, we have skilled, compassionate counsellors that can help you overcome your cravings through the practice of mindfulness and various techniques. At Promises Healthcare, we are committed to helping you through your journey to recovery.

Discover a new life, away from addiction and find renewed hope. Please contact our clinic for inquiries and consultations.

Written by: Andrew da Roza, Therapist and sex addiction specialist, Promises Healthcare