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Every January, countless people resolve to improve their lives. Recently the most popular New Year’s resolutions included getting fit, losing weight, saving money, and spending more time with family, according to the Nielsen data company.

Smokers often pledge to quit, but in 2016 quitting was the 10th most difficult resolution to keep, says Britain’s Royal Society for Public Health, after goals like drinking less and reducing social media usage. Of Brits who had determined to quit smoking, 41% stayed on track for one month, compared to 13% who made it through the entire year.

Grim But Preventable Health Risks
People who resolve to quit smoking have compelling reasons to do so: smoking leads to a host of health problems including cardiovascular disease, high blood pressure, diabetes, emphysema, bronchitis, sexual dysfunction, and infertility, to name just a few. The American Cancer Society (ACS) reports that smoking increases the risk for cancer in the mouth, throat, esophagus, kidney, cervix, liver, bladder, pancreas, stomach, colon, and most notably lung – the second most common cancer in men and women, and the leading cause of cancer death.    

In 1966, the United States became the first country to require warning labels on cigarette packs and by 1990 had banned smoking on all domestic airline flights. The following decades saw smoking ban-ned in office buildings, restaurants, and other public spaces, and many states raised their cigarette-buying age to between 18 and 21. (Both Evanston and Chicago require cigarette buyers to be 21.)

In the past 50 years, the number of adult smokers in America dropped from 42% to around 15% – currently about 36 million people. Even as smoking has declined, illnesses related to smoking and second-hand smoke caused more than 480,000 deaths in 2016 – about one of every five – according to the Centers for Disease Control (CDC). Of those, 158,000 people died from lung cancer – more deaths than from colon, breast, and prostate cancers combined. The CDC calls tobacco smoking the leading cause of preventable disease and death in the United States.

Nicotine’s Heady Siren Call
Amidst the warnings, statistics, and health hazards, the question of why people continue to smoke remains. The answer, in a word, is nicotine, which occurs naturally in tobacco and triggers feel-good chemicals in smokers. Almost 30 years ago, the Surgeon General’s report on the Health Consequences of Smoking concluded that nicotine causes addiction and compared tobacco’s addictive processes to those of heroin and cocaine.

“Like all addictive drugs, nicotine works by stimulating the release of chemical messengers in the brain,” says Daniel J. Fridberg, Ph.D., a clinical psychologist and assistant professor in the Department of Psychiatry and Behavioral Neuroscience at the University of Chicago. When smokers inhale, they experience a pleasurable rush of dopamine and norepinephrine, explains Dr. Fridberg, who is co-director of the university’s Tobacco Cessation Program. Smokers’ brains adjust to the nicotine-induced pleasure, which motivates them to continue but also causes withdrawal symptoms when they are not smoking. “At this point,” he says, “many smokers will smoke simply to remove the unpleasant withdrawal feelings.” And the cycle of addiction begins.

Industrial-Strength Smoke
Tobacco companies add up to 600 ingredients to cigarettes, according to the American Lung Association (ALA), and once lit they generate more than 7,000 chemicals including acetone, arsenic, butane, carbon monoxide, formaldehyde, lead, methanol, tar, and nicotine. At least 70 cigarette chemicals cause cancer, although nicotine has so far proven not to be carcinogenic. Smoking cessation aids such as patches and gum often contain nicotine, to wean smokers off the addiction gradually and ease unpleasant withdrawal symptoms.

Psychological Addiction
Many patients in the University of Chicago’s Tobacco Cessation Program report that their addiction to cigarettes is as much psychological as it is physical, says Dr. Fridberg. They smoke not necessarily for enjoyment but out of habit – to relieve stress, when socializing with other smokers, or after a meal.

“In our clinic, we educate our patients about the psychology of addiction,” says Dr. Fridberg, “and why continuing to smoke can often increase, not decrease, stress due to continued or worsened health problems, financial costs, and so forth.” Managing that aspect is important for those who want to quit.

For almost 40 years, the ACS has encouraged smokers to quit on the third Thursday of each November during their Great American Smokeout. On whatever day smokers designate as their Quit Day, the ACS recommends the following:

• Do not smoke – not even one puff.

• Keep active – try walking, short bursts of exercise, or other activities and hobbies.

• Drink lots of water and juices.

• Start using a nicotine replacement, if desired.

• Attend a stop-smoking class or follow a self-help plan.

• Avoid situations where the urge to smoke is strong.

• Avoid people who are smoking.

• Drink less alcohol or avoid it completely.

• Try an alternate routine – use a different route to go to work, drink tea instead of coffee, eat breakfast in a different place, or eat different foods.

Quitting: There’s an App for That
Dozens of smartphone and tablet apps provide quit smoking assistance, often at no charge. The National Cancer Institute (NCI) designed their app QuitStart mainly for teens who want to quit, but adults can use it along with a QuitGuide app that tracks moods and cigarette cravings, and monitors progress toward achieving smoke-free milestones. Smokers can sign up for NCI’s SmokefreeTXT, a text messaging service that provides encouragement and advice to people trying to quit.

The American Cancer Society offers a free Quit For Life app, which sends out daily tips and motivation reminders and calculates cost savings from not buying cigarettes. Freedom From Smoking Plus is the American Lung Association’s interactive online smoking cessation program, accessible from laptops, tablets, and smart phones.

Relapses and Rewards
The ACS notes that quitting can take several tries; if a smoking relapse occurs, determine what did and did not work to help strengthen future attempts. The ALA suggests acknowledging each quit-smoking milestone with a reward such as a long walk, leisurely swim, or bike ride to celebrate improved health. Use money normally spent on tobacco for concert tickets, a nice restaurant meal, new fitness or hobby supplies, or even a vacation. Rewards do not have to be expensive, and small boosts every now and then can keep that New Year’s resolve strong.

Tips for Kicking the Habit

Quitting presents a challenge for smokers, even those who are motivated. The CDC reports that 7 out of 10 smokers want to quit and offers the following tips for developing a plan to kick the habit:• Pick a quit date within two weeks, which allows time to create a quit smoking plan.• Let loved ones know, so they can provide support.• List reasons for quitting and review the list every day.• Remove smoking reminders including all cigarettes, lighters, matches, ashtrays, and anything that smells of cigarette smoke.• Identify smoking triggers to avoid, such as foods and social situations.• Make a list of support resources – a doctor or counselor, stop-smoking websites, friends and family – and keep it handy.