Source: jwomwen.blogspot.com
Stopping smoking is the single most important thing most smokers can do to protect their health, and the earlier they do the better. Most smokers recognise this and express a desire to stop and try to stop, often repeatedly but many do not succeed in their first attempt.
Smokers may or may not have sought help to quit, have tried nicotine replacement to help them stop or had tried to cut down with the intention to stop smoking. However, only a minority of them are ready to stop right away or are willing to seek professional help to quit smoking.
Smokers’ behaviours are constantly driven by the balance between their urges to smoke and desires to stop which are active at those precise moments. Their responses involve starting, stopping or changing reactions to cues in the environment (for example, the need to smoke upon seeing someone else smoking) and react to the strongest of one or more competing forces present at that moment.
For example, if a smoker experiences powerful urges to smoke, a small trigger (e.g. the smell of a cigarette smoke) may act as a reminder and influence his decision to continue smoking and may put quitting on hold. However, if conflict arises, and a smoker experiences a strong desire not to smoke (e.g. having smoking related health symptoms such as bad cough) which increases tension due to smoking, this may influence the smoker not to smoke even when was offered a cigarette.
As each day comes, we never stop evaluating and making value judgements in our behaviours. Likewise, smokers have the ability to form beliefs about their smoking habits, which forms the basis of why they need to smoke. For example, just believing smoking is enjoyable generates satisfaction and influences the decision to continue smoking.
As everybody else, in their life, smokers usually have many competing priorities which require them to make decisions and act on it. Smokers like others have the capacity to ‘plan’ ahead for future actions and develop an intention to undertake them. Thus, plans influence smokers’ daily activities. The level of commitment to a plan set by a smoker is important for his action. When smokers face competing demands or opportunities that are not time-critical, the decision to either quit smoking or to continue depends on the greatest immediate priority at that particular moment. Whatever action is taken by the smokers depends on the strength of wants or needs for cigarettes, which might cause conflict when the decision is made.
Each of us possesses instincts, habits and emotions which shape the way we plan ahead and make future decisions. Coupled with the powerful influence of our own social worlds, we each have an individual sense of identity which acts as a source of self-control.
Self-control is a cornerstone of behaviour change. Smokers need to practice self-control all the time if they want to quit smoking. The moment-to-moment wants and needs to quit smoking arising from that self-control must be strong enough to overcome the external and uncontrollable impulses, wants and needs to smoke. The exercise of self-control is effortful: it requires and uses up mental energy and this challenge makes quitting smoking difficult.
It is commonly known that quitting smoking is difficult and most smokers make many attempts before it can be successful. Cigarette which contains nicotine and is harmful for health causes addiction due to the binding of nicotine to receptors in the ventral tegmental area of the brain resulting in pleasant sensation because of dopamine release. This makes the act of smoking enjoyable and makes smokers want to smoke. It appears that the sensations of smoke in the throat are closely paired in time with the nicotine reward. Nicotine can act as ‘pleasure amplifier’ and make mildly pleasurable stimuli more rewarding. Thus the sweet smell of tobacco, the aesthetics of the cigarette packs and even other activities associated with smoking for example smoking after meals or to socialise become more pleasant with nicotine present in the brain. This in turn can make smoking more rewarding and lead smokers to wanting to smoke.
Dr. Wee Lei Hum is an Associate Professor at the Faculty of Health Sciences, Universiti Kebangsaan Malaysia. Her most recent role prior to joining UKM was Senior Principal Assistant Director at the Institute of Health Behavioural Research. Dr. Wee is also a member of the NARCC.
[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.]
References:
- West, R. (2006). Theory of addiction: Blackwell Publishing, UK.