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Part of the difficulty of quitting stems from their chemical addiction to nicotine, a substance with potent neurochemical effects.
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Why don't smokers just quit? |
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Some smokers do not
yet want to quit. They may be unconcerned about the long-term health effects
of smoking. They may think that they will quit later, when they are in a
better position to do so. Over the years, however, they may become convinced
by public health campaigns that quitting would be worth the effort, so
health educators and fitness professionals should keep spreading the word. Nicotine and withdrawal |
The primary strength of cigarette addiction, however, lies in the chemical addiction to nicotine. The physical and psychological effects of nicotine are not totally understood, but scientists do know that it has powerful effects on many physiological systems, including the cardiovascular and respiratory systems. Nicotine also affects brain chemicals, called neurotransmitters, that are involved in a number of psychological functions, including regulation of mood.3
Like other strongly addictive drugs, nicotine causes changes in these
neuro-chemical pathways that lead to powerful cravings and other symptoms
when the drug is withdrawn. Withdrawal symptoms vary widely, but include
feelings of irritability, anger, anxiety, tension, difficulty concentrating,
restlessness, insomnia, excess hunger and drowsiness. People with especially
strong negative withdrawal symptoms often have a great deal of difficulty
kicking the habit.
Smoking and depression
Some research suggests an association between depression and smoking.
Researchers continue to explore this association. Are depressed people more
likely to smoke because they are looking for a way to relieve negative
feelings? Depression may prompt young people to begin smoking. Most smokers
begin smoking in adolescence, however, and peer group smoking is the
strongest predictor of smoking for that age group -- much stronger than
depression.4 Smoking may also increase risk of depression in some people,
although the mechanisms for this are not yet clear.
Does quitting smoking cause depression? Yes, but in a minority of people.
Most people who are at-risk for depression are smokers with a prior history
of at least one episode of major depression, and people addicted to alcohol
or other drugs.3 But depression can also develop in ex-smokers who have
never experienced depression or have never been addicted to other
substances.
Antidepressants to help quit
smoking
The smoking-depression link prompted researchers to investigate the use of
antidepressants in smoking cessation programs.5 Various studies have found
that when compared to receiving a placebo, people receiving antidepressants
have significantly higher success rates for quitting smoking. This holds
true even for people who are not depressed, which means that antidepressants
work not only by relieving depression in depressed people, but by other
mechanisms as well. In fact, in one study, recent ex-smokers receiving an
antidepressant reported fewer withdrawal symptoms than did subjects
receiving the placebo. Symptoms less prevalent in the antidepressant group
included anger, anxiety, irritability, tension, difficulty concentrating,
restlessness and insomnia.5
Exercise vs. antidepressants
Antidepressants work by helping ex-smokers feel better, which reduces their
need to "light up." Studies on cessation programs have found that smoking
relapse occurs primarily because ex-smokers feel a need to smoke to relieve
negative feelings, a phenomenon researchers call "negative affect reduction
smoking."
Many physicians now prescribe antidepressants for people who need help
quitting. It is important to note that antidepressants have drawbacks,
including their expense and side-effects. Some people who use
antidepressants remain on them for years and have difficulty withdrawing
from them. Of course, antidepressant dependency and side-effects probably
outweigh the negative health consequences of cigarette smoking.
Nevertheless, it makes sense to explore other options, such as exercise.
Regular physical activity can also help people quit.2 This is not surprising
considering the antidepressant/smoking research. After all, exercise has
effects similar to those of antidepressants. It reduces feelings of
depression and also lessens feelings of anxiety, irritability, anger and
tension. It improves sleep quality and mood. Regular physical activity may
also help prevent or reduce the weight gain that commonly occurs with
smoking cessation.
While exercise requires much more time and energy than taking pills,
physical activity has enormous health benefits without unwanted
side-effects. Encourage your clients and friends who smoke to give exercise
a try. FM
REFERENCES
1. Breslau, N., and E.O. Johnson. Predicting smoking cessation and major
depression in nicotine-dependent smokers. American Journal of Public Health
90 (7): 1122-1127, 2000.
2. Marcus, B.H., et al. The efficacy of exercise as an aid for smoking
cessation in women: A randomized controlled trial. Archives of Internal
Medicine 159 (11): 1229-1234, 1999.
3. Patten, C.A., J.E. Martin, M.G. Myers, et al. Effectiveness of cognitive-behavioral
therapy for smokers with histories of alcohol dependence and depression.
Journal of Studies on Alcohol 59 (3): 327-335, 1998.
4. Patton, G.C., J.B. Carlin, C. Coffey, et al. Depression, anxiety, and
smoking initiation: A prospective study over 3 years. American Journal of
Public Health 88 (10): 1518-1522, 1998.
5. Prochazka, A.V., M.J. Weaver, R.T. Keller, et al. A randomized trial of
nortriptyline for smoking cessation. Archives of Internal Medicine 158 (18):
2035-2039, 1998.
Barbara A. Brehm, Ed.D., is professor of exercise and sport studies at Smith
College, Northampton, Mass.
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