Are You Gonna Smoke Your Lungs Out?

Cold turkey

That’s the way most of the Minnesotans I spoke with quit smoking. The odds they beat are impressive. According to the National Institute on Drug Abuse, only about 6 percent of 35 million smokers who try to quit each year actually succeed, and it takes people multiple tries. The ex-smokers I spoke with say the key to quitting was reaching a state of readiness. Let’s take a look at the allure of nicotine and the success stories from ex-smokers who’ve tried everything in the book.

A Poison

Nicotine is a nitrogen-based compound found in plants in the nightshade family, like tomatoes and tobacco. In high doses, nicotine is a poison. It’s a common ingredient in pesticides. And nicotine is complicit in the diseases associated with smoking that kill half a million Americans a year. Nicotine constricts arteries and reduces blood flow to the legs and feet, contributing to heart disease and stroke. It also promotes the growth of cancer cells. In other words, many of the other 4,000 chemicals in cigarette tar cause cancer, but nicotine lights the fuse.

A Feel-Good Drug

As smokers know, none of that information is enough to make them kick the habit. Cigarettes deliver about 1 to 2 milligrams of nicotine per cigarette. Within seconds, nicotine binds with receptors in the brain that stimulate memory, recall, and reaction time as well as the release of dopamine, making smokers feel more alert, energized, and euphoric. Nicotine also sparks a rush of adrenaline, which increases heart rates, breathing rates, and blood pressure. It releases glucose and suppresses insulin, which decreases appetite. These acute effects dissipate within minutes, causing smokers to light up again to avoid nicotine withdrawal. Without nicotine, smokers become anxious, irritable, and hungry. In short, nicotine, like any addictive drug, messes up smokers’ normal neural pathways, making it really aggravating to give up.

A Weaning Device

Nicotine-replacement products like gum (Nicorette), skin patches (NicoDerm CQ), or inhalers (Nicotrol) aim to give smokers the nicotine their bodies crave—with one key difference. None of them delivers the drug with the same intense, satisfying wallop that a cigarette does—the nicotine seeps in more slowly. (The exception is nicotine nasal spray, which works as fast as a cigarette.) The idea is to keep smokers’ bodies happy while they learn to give up all the social situations and routines they associate with lighting up.

“People oftentimes underestimate the physical addiction piece,” says Dana Brandenburg, a psychologist with the University of Minnesota’s Department of Family Medicine, who has set up two Minneapolis-area clinics to serve smoking-cessation clients, especially those without insurance. Studies have shown that nicotine replacements double the success rate for quitters. But Brandenburg says that personal support is just as powerful: “Studies show that if a health provider asks people if they smoke and lets them know quitting is important, [it can] double their success.”