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General Medical Questions
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Question : I've been sober for a few years and I'm ready to stop smoking. But people tell me it's harder than quitting alcohol. Why? Is there anything I can do to make it easier?
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The Trusted Source
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Howard LeWine, M.D.

Michael Craig Miller, M.D Michael Craig Miller, M.D., is Senior Editor of Mental Health Publishing at Harvard Health Publications. He is an assistant professor of psychiatry at Harvard Medical School. Dr. Miller is in clinical practice at Beth Israel Deaconess Medical Center, where he has been on staff for more than 25 years.

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August 22, 2011
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A:

First, congratulations on staying sober. That should give you confidence that you'll succeed at putting smoking behind you too.

Many people do report that quitting smoking is harder than quitting alcohol. There are a few reasons. But there's one big one that every smoker feels: it's hard to bear withdrawal symptoms when relief is always a few seconds away.

When you take a puff, your lungs absorb the nicotine almost instantly. Nicotine helps release adrenaline, which has a quick stimulating effect. It also triggers the release of dopamine — the chemical messenger at work in the brain's reward system. On top of that, other chemicals in tobacco smoke may slow or stop the breakdown of dopamine in the brain, which further intensifies the effect.

At 10 puffs per cigarette, a 2-pack-per-day smoker gets 400 daily doses. Even with smoking restrictions in public places, it is still easier to smoke — and function — through the day than it is to drink. And the habit can start early in life — since cigarettes are easier for teens to get than alcohol. Since habits "stick" from repetition and reinforcement over time, it makes sense that smoking is one of the toughest habits to break.

But quitting can be easier with treatments like these:

  • Behavioral and cognitive techniques. These aim to change the stimulus and response patterns that reinforce the habit.
  • Relaxation and distraction techniques. These help you bear the withdrawal symptoms.
  • Supportive psychotherapy. This helps you deal with the emotional ups and downs of quitting.

You can also take medications to help you quit. Nicotine replacement therapy now comes in many forms: gum, patches, lozenges, nasal spray and as an inhaler. Two non-nicotine pills are also available. One is varenicline (Chantix). It mimics the effects of nicotine, cutting down craving and withdrawal symptoms. It also blocks part of nicotine's effect, causing a smoker to get less of a reward. The other is bupropion (Wellbutrin, Zyban). It's a prescription antidepressant that helps lower the desire to smoke by triggering some of the same receptors as nicotine.

The toughest period is the first days and weeks. People who make it to three months seem to have the most success. This may be because you start to feel healthier. The biggest motivator of all — and you may have felt this when you quit alcohol — is the good feeling you get when you invest in your good health.

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