“Quitting smoking is hard.” This is what we’re all told. And yet, we also seem to have an uncle Bob who managed to quit successfully by going cold turkey and never looked back, even if he smoked a carton a week beforehand. Everyone else is led to believe that their willpower is at fault.
If you’ve tried to quit and failed, you should know that you’re not alone
Success rates for smoking cessation are abysmal: recent estimates say that only 7% of people successfully quit by “going cold turkey” on a given cessation attempt. Even with nicotine replacements, such as gum and patches, the success rate only rises to about 25%. Addiction is certainly powerful, but not that powerful: 10% of heroin addicts quit on their own, and only about 50% relapse, compared with the almost 90% of smokers that relapse. Even with cocaine, which has a reputation for being nearly impossible to quit, users are able to successfully quit – without relapse – about 25% of the time, roughly the same as nicotine. No, something more than addiction must be to blame here.
As it turns out, nicotine is a very effective treatment for a number of conditions. A battery of studies have been conducted over the past two decades or so, which all come to essentially the same conclusion: when you separate nicotine from tobacco and the dangerous delivery methods (smoking, smokeless, and e-cigs,) then nicotine isn’t that bad. It’s effective, cheap, and has fewer side effects than most prescribed drugs. Perhaps the problem, then, isn’t with addiction or even with nicotine, but instead, it’s that quitters are often quite literally going off their medication without replacing it with something else. The following are four conditions which research has shown that nicotine successfully helps manage.
A study at Duke University in 2006 found compelling evidence that nicotine substantially improved the symptoms of depression in non-smokers. Other studies since have come to the same conclusion. Nicotine stimulates certain neurotransmitters, like serotonin, dopamine, and norepinephrine. These carry messages between nerve cells in the brain, and depression has been linked to an imbalance of these neurotransmitters.
Things to look out for: Depression is not necessarily feeling “sad.” It can present as excessive crying or anger, or as apathy and numbness. If you find that your nicotine withdrawal symptoms go beyond irritability and inability to focus, and instead manifest as hopelessness, changes in sleep, or changes in appetite, then it might be worth considering depression as an underlying cause.
Who to see: A primary care physician or psychiatrist
At higher doses, nicotine functions as a pseudo-stimulant by regulating neurotransmitters such as norepinephrine and dopamine. Additionally, even in those who are neurotypical, nicotine serves can be a performance enhancer. For those with ADD or ADHD, the effects of nicotine can be enough to replace prescription drugs and are often cheaper, albeit much more dangerous.
Things to look out for: Low concentration is nearly a given when you quit smoking, as is jitteriness. In the short-term, you should ask yourself: how extreme are the effects of withdrawal on concentration, hyperactivity, and motivation? All three of those are affected by attention-deficit disorders, and if the above symptoms become so severe as to affect functioning, then ADD or ADHD may be to blame. Also, caffeine may make you sleepy or feel calm, instead of hyping you up. If you’re a woman, your PMS may come with not only pain, bloating, fatigue, and irritability, but also with hyperactivity, frustration, and the inability to concentrate.
Who to see: Primary care physician or psychiatrist. If you’re at school, then often counseling services can provide tests to help you get a diagnosis.
Cigarettes have been repeatedly connected with increases in chronic pain with certain conditions. However, when you separate nicotine from tobacco, things change drastically: in some cases, nicotine has even been found to reduce pain considerably, especially as it pertains to nerve disorders. Studies have also found that nicotine may help with some painful stomach disorders, such as ulcerative colitis and perhaps even irritable bowel syndrome.
What to look for: Pain. When you quit, it’s not uncommon to come down with “quitter’s flu,” which is a collection of withdrawal symptoms that mimic the flu. However, the primary withdrawal symptom should not be a pain. If it is, then it might be worth considering that an underlying pain disorder might be the root of your problem
Who to see: Primary care physician or rheumatologist.
Other Neurological and Psychiatric Disorders
Strange as it sounds, a battery of studies over the past two decades have shown a great deal of promise in using potentially using nicotine for various brain-related disorders. Notably, clinical trials have treated schizophrenia, Parkinson’s, and Alzheimer’s with nicotine. While it did not completely treat all symptoms, in all three cases, symptoms improved with the use of nicotine.
What to look for: Symptoms related to these conditions, which could range from psychiatric symptoms such as delusions and hallucinations (for schizophrenia) to problems with memory and executive function (Alzheimer’s) to issues with muscle and coordination (Parkinson’s.) Basically, if weird things start happening when you quit smoking, you might want to see a doctor.
Who to see: A primary care physician would likely be the first choice, but more than likely you would also need to see a specialist as well.
Of course, we’re not encouraging people to go out and start smoking; cigarettes are still very dangerous. However, if you have one of the above conditions, then the problem may not be will-power or addiction, but instead, it may be medical. If that’s the case, then quitting before addressing the underlying problem is probably unreasonable and likely impossible. So, if you suspect that you may have one of these conditions, why not it get it checked out before attempting to quit again?