Cigarette smoking is highly addictive—and it’s responsible for more than 480,000 deaths in the United States each year, including 41,000 from second-hand smoke, according to the CDC. That makes tobacco the single largest preventable cause of death and disease in the U.S. Worldwide, about 7 million deaths each year are due to tobacco use.
Smoking is associated with cancer, heart disease, stroke, gum disease, asthma and other chronic lung conditions, and Type-2 diabetes. About 14 percent of U.S. adults smoked cigarettes in 2017, according to the CDC, and it was recently estimated that nearly 7 in 10 wanted to stop smoking.
People with depression, anxiety, and other forms of mental illness are much more likely to smoke than the general population. While smoking may be used, in part, as a coping behavior, it is not a valid treatment for any mental health condition.
For more on causes, symptoms, and treatments of nicotine addiction, see our Diagnosis Dictionary.
An addiction to nicotine, also known as nicotine dependence or tobacco dependence, often begins in the teen years. Most people who smoke have friends or family members who also smoke. The younger a person is when he or she starts to smoke, the higher the risk of becoming addicted to nicotine, a drug found in tobacco.
In the short term, nicotine may distract from unpleasant feelings. Once smokers become dependent on nicotine, however, they experience physical and mental withdrawal symptoms that last for days or weeks, making it very difficult to quit. Many people who are addicted to nicotine continue to smoke even though they know it's bad for their health.
Although we are decades past the promotion of cigarettes as a personality enhancer or a weight loss aid, some young people are still beginning to smoke cigarettes. Research suggests that college students who smoke are more likely to believe the behavior provides emotional benefits and enhanced body image than non-smokers, perhaps driven by media portrayals of young, sexy women who smoke. They also tend to underestimate the harms of smoking. Both reasons may help fuel the decision to begin smoking or prevent them from trying to quit.
Nicotine is so addictive due to its chemical effects on the brain, but it may also be hard to give up from a social perspective. Around one-third of all cigarettes are smoked in social situations, research suggests, and many smokers are more likely to smoke when they see others smoke; they report that socializing is a key reason for smoking.
Perhaps most interestingly, nicotine may also help boost someone’s social skills. In a recent study, participants described themselves as being friendlier, more extroverted, and less socially anxious after ingesting nicotine, and nicotine use improved awareness of social and facial cues compared to participants who had abstained from nicotine for the past day or longer. The social function of smoking may help explain why it’s so addicting, and why it’s so hard to quit.
Nicotine is what makes cigarettes so addicting. Nicotine acts on acetylcholine receptors in the brain, which help to control attention and memory. Nicotine also boosts levels of the neurotransmitter dopamine and the hormone adrenaline. Eventually the brain becomes accustomed to these changes, so when people attempt to stop smoking, they can experience symptoms of withdrawal such as cravings, headaches, dizziness, anxiety, and irritability.
People with mental health conditions have unusually high smoking rates. Smoking can seem to boost mental health in the short term, temporarily stabilizing mood, but it can be harmful in the long term by exacerbating stress, anxiety, and depression. Research suggests that anxiety and depression improves among people who quit smoking, and people report greater life satisfaction and an increase in positive feelings. So, not only does quitting support physical health, but it can boost mental health as well.
Quitting smoking at any age can improve a person’s health, and the earlier a person quits, the better. A variety of methods can help a person break the habit, ranging from cigarette substitutes to supportive therapy.
Nicotine gum, lozenges, or patches are among the FDA-approved nicotine replacement products that people who cease smoking can use to manage withdrawal symptoms after they quit. Combining such methods with behavioral treatments, which help people prepare to quit and to cope effectively with cravings and withdrawal, can make long-term cessation even more likely. These may include the consultation of self-help materials, brief counseling with a healthcare professional, group sessions with others who are quitting, or forms of psychotherapy such as cognitive behavioral therapy.
Some medications, including bupropion and varenicline, can be prescribed to help increase the chances of continued abstinence, though the risk of side effects such as anxiety and depression should be taken into account.
Developing a plan with treatment and support will be most important, and you can do that by consulting with a doctor, therapist, or resources such as the Quit Now helpline. On your own, make quitting smoking your number one priority. Set a date to quit. Throw out all cigarettes and related items and avoid spending time with other smokers. Change your routine to minimize triggers for smoking. For example, create a new morning routine of drinking tea when you wake up. Remind yourself of all of the reasons you are quitting, and celebrate moments of victory along the way.
Mindfulness can be an effective approach to stop smoking. Mindfulness involves learning how to pay careful attention to thoughts and behaviors rather than trying to suppress them. In a smoking cessation context, mindfulness can help people interrupt the cycle of craving nicotine and smoking as a result. Smokers become more aware of why they smoke, what behaviors can substitute for cigarettes, and how unpleasant they may find the taste or smell when they pay attention. In addition to mindfulness, some individuals have found success with natural remedies such as acupuncture and even hypnosis.
Researchers and healthcare providers are constantly looking for innovative and effective ways to help people quit smoking. One of those ideas, paying smokers to quit, seems to be successful, according to a large review study. Financial incentives varied from cash, to vouchers for goods, to self-deposits, meaning the participants paid themselves to quit, and the dollar amount ranged from $45 to $700. No matter the amount, those who received rewards were significantly more likely to have stopped smoking than those who received no payment. Those people were also less likely to start smoking again after the incentive program was complete.
Successful policies must target a difficult problem: The reward of smoking is immediate but the harm is delayed. Reminding people of disease or even death in the future aren’t always strong enough to overcome the instant gratification of satisfying a nicotine craving. Imposing taxes on cigarettes (an immediate punishment) or printing graphic images of disease on the boxes (an immediate unpleasant feeling when looking at the box) may have a better chance of helping people quit smoking. On an individual level, people can put this principle into practice by devising consequences that their loved ones can help enforce. For example, if the person trying to quit smokes a cigarette, he or she must do the dishes that night.
Help and encouragement can go a long way. To provide support, begin by researching the process of quitting to understand it and assure the loved one that their pain is temporary. High stress can increase the chances of smoking again, especially at the beginning, so try to relieve that stress by cooking dinner or running a few errands, for instance. Refrain from smoking or talking about smoking around the person, and avoid guilting or shaming them. Focus on the positive and celebrate small victories. Lastly, it’s important to acknowledge that relapses are common; people often relapse a few times before quitting successfully.
Some smokers use e-cigarettes or “vapes” as a substitute for regular cigarettes and other smoked tobacco products. E-cigarettes still contain nicotine, which can stunt the growth of a developing adolescent brain. E-cigarette aerosol contains fewer chemicals than the 7,000 found in regular cigarette smoke, but it is potentially harmful nonetheless.
Vaping devices contain chemicals such as diacetyl—a flavorant linked to lung disease—harmful organic compounds, fine particles that can be inhaled, and metals like nickel, tin, and lead. They come in a range of shapes and sizes, but all include a battery, a place to hold the liquid being vaped, and some kind of heating component. While typically used with nicotine, they can also deliver marijuana or other drugs.
Vaping devices are considered unsafe for teens and pregnant women.
For more, see Vaping.
E-cigarettes are not approved by the FDA as a smoking cessation aid, unlike treatments such as nicotine replacement therapy or the medications Chantix or Zyban. However, research suggests that vaping may be more effective than nicotine replacement therapy; a randomized controlled trial found that one year after treatment, almost twice as many individuals who received e-cigarettes and behavioral support were smoke-free, as compared to individuals who received nicotine replacement therapy and behavioral support. Afterward, though, people continued to use e-cigarettes for much longer than they used nicotine replacement therapy.
Vaping has been linked to a respiratory illness that scientists dubbed EVALI or E-cigarette or Vaping Product Use-Associated Lung Injury. Instances of the disease began to emerge in 2019; around 2,800 have been hospitalized and around 70 have passed away, according to the CDC. Scientists believe that EVALI is likely caused by people vaping THC (the compound in marijuana that produces the feeling of being high) in poor-quality products.
Although EVALI should be taken very seriously, it’s important to state that it is extremely rare, because about 40 million people globally use e-cigarettes.