Smoking – why quitting is so hard, and what to do about it

Anyone who’s tried to quit smoking knows willpower often just isn’t enough. We asked addiction specialist Professor Andrew Lawrence why it’s so tough – and what can help.

Yvette Chegwidden
April 2017

Nicotine is addictive because it increases levels of the chemical dopamine, which activates the brain’s pleasure centre, or what are known as reward pathways. Research has shown dopamine is one factor in excessive wanting or craving drugs.

Professor Lawrence heads the Florey Institute’s Addiction Neuroscience Laboratory. He says a large part of the problem is that nicotine addiction is also linked to the part of the brain that reacts to cues.

“In the case of smoking, people tend to associate nicotine with a certain event – such as sitting in your car stuck in traffic or after a meal. Once you do this behaviour two or three times, you go through what’s called an ‘associative process’. In the future, when you get stuck in traffic that becomes the cue to have a cigarette. Just as if you have one after a meal.

“The cues that drive drug use are very powerful,” he adds. “Driven by many different cues smokers may make lots of different associations with events or situations, and the brain becomes very sensitive to these.

“It also activates the parts of the brain involved in decision making and when those parts become active, it drives you to have a cigarette.”

The addictive brain

Professor Lawrence says the part of the brain associated with addiction is one of the last to develop. “A lot of problems with addiction tend to emerge during adolescence,” he says, “which is a period of maturation of the nervous system.”

“When you throw drugs such as nicotine on top of a brain that’s still maturing it can have a worse effect than when that system is fully refined. In general, people who develop drug problems as adolescents tend to have worse addictions that can be harder to treat.”

Help for quitting

If you want to quit smoking, Professor Lawrence suggests making an appointment with your GP. “If you have a real problem and you find you’re not getting the right help, perhaps ask for a referral to an addiction medicine specialist. The QUIT organisation is also a great place to start,” he advises.

The key to avoiding a relapse, in Professor Lawrence’s experience, “is to break the importance of those trigger cues so they no longer mean it’s time to have a cigarette. This could be going through a process of cue exposure therapy with the aim of reducing the association between the cue and drug use.”

He also says many people find nicotine replacement therapy, such as patches, strips or gum, helpful. “It’s the equivalent of a methadone program for smokers. It means you’re getting your nicotine in a different way. You can then slowly wean off cigarettes.”

It’s important not beat yourself up if your first or latest attempt is unsuccessful. “Just keep trying,” Professor Lawrence says.

“One of the definitions of addiction is that it’s a chronic relapse disorder. People start and stop all the time. Don’t view a relapse as a failure. Just see it as an opportunity to stop again. It’s not failure. It’s just a temporary setback. Continue to seek help.”

Smoking rates in Australia

Tobacco kills approximately 6 million people globally per year, or roughly half of its users. In Australia smoking rates are declining steadily, and have halved since 1980.

The introduction of tax increases in 2010, smoke free public areas, and plain packaging featuring disturbing imagery in 2012, appear to be chipping away at smoking rates.

Australian Bureau of Statics figures reveal a drop in the number of Australian smokers from 22.4% of adults smoking daily in 2001 to 14.5% in 2014/2015.