There is a neural pathway in the brain called the ‘reward system’. This encourages certain forms of behaviour through a feeling of well-being, or even pleasure, when a life-sustaining need such as eating or drinking is satisfied. For example, drinking a glass of water at mealtimes is nice; however, nothing will give you more pleasure than drinking that glass of water if you are very thirsty, dehydrated or in a potentially life-threatening situation.
What happens inside the brain? When the neuroreceptors in the reward system receive a signal from a messenger (a neurotransmitter known as acetylcholine), informing them of a necessary form of behaviour, this leads to the release of a pleasure-inducing molecule called dopamine.
When you smoke, nicotine reaches the brain in less than 10 seconds and creates a genuine nicotine ‘fix’, causing an immediate sensation of pleasure because it resembles and takes the place of the neurotransmitter whose action it imitates (the acetylcholine). It deludes the smoker’s brain and is soon perceived as essential, as a vital requirement for bodily survival. Providing nicotine to the body triggers pleasure, whereas insufficient amounts or a complete lack causes unpleasant sensations that the smoker will try and avoid by smoking again.
But beware! The pleasurable sensation dulls over time; smokers must increase their consumption or take deeper drags on their cigarette in order to continue feeling the same pleasure. Moreover, as the amount of available nicotine increases, the neurons create more receptors to absorb it. When these receptors are no longer supplied with nicotine, which occurs very soon as the chemical quickly leaves the body, their ‘need’ is no longer satisfied and withdrawal symptoms appear, such as the craving to smoke, anxiety, irritability and hunger.
The Fagerström test is important in measuring cigarette dependence
The Fagerström test provides a clear picture of cigarette dependence. The result helps determine which treatment may be useful and facilitate the process to quit smoking. To complement the test and assess the evaluation, tobacco treatment specialists also check the way in which smokers inhale. Then, receptors need time (a few days to several months) before they cease to be avid for nicotine, which explains the duration of treatments.
For many smokers, smoking involves a series of actions repeated an incalculable number of times over months, or even years, that arise from ‘trigger situations’ causing the smoker to reach automatically for their cigarettes.
These ritual actions become necessary acquired reflexes
So smokers ‘learn’ to smoke. In certain areas of the brain, new neural pathways have been developed, which are the source of the conditioned reflexes responsible for the gesticulatory and psycho-behavioural aspect of cigarette dependence.
Apart from its addictive properties, nicotine acts on the areas of the brain that control mood. It can calm or excite, depending on the moment and the emotional state. For this reason, it is considered to be a ‘mood altering’ substance. It is easy to understand why, on a daily basis, smokers light up when they are feeling nervous or depressed (to find out more, consult the Smoking and psyche section.
In addition, nicotine is an anorectic (appetite suppressor) molecule. It acts on the areas of the brain that control satiety and dramatically reduces a smoker’s appetite (to find out more, consult the Smoking and weight gain section. For many smokers, women in particular, smoking helps them skip meals and thus lose weight.
Emotional attachment and addiction to cigarettes
Smoking entails repeating the behaviour that ‘binds’ smokers to their cigarette, many times per day and regardless of the reasons. Many smokers even describe their cigarettes as an ‘extension of themselves’.
This is a factor that smokers cannot disassociate from their self- image, it is a part of their identity. Smokers cannot visualize daily life without their cigarettes; together, they form a ‘whole’. The relationship is as intimate as the bond which unites a mother and baby while breast feeding. Cigarettes are often perceived as a transitional object that can be clung to like a child’s security blanket in times of stress, worry, anxiety or concern.
Imagining a complete break from cigarettes, identified rightly or wrongly by smokers as an object that provides pleasure, is probably the most difficult hurdle to overcome. This challenge must involve abnegation that can be compared to a sort of mourning. The route to cessation requires time, as the brain needs to reorganise and attain a point of ‘psychological maturity’ that will enable it to accept the idea of life without cigarettes!
It is likely that the need and desire to smoke would not be so powerful without this significant emotional aspect that ‘binds’ smokers to their cigarettes.
Nicotine is a molecule that is rapidly broken down by the body. Its concentration is reduced by half in two hours and within a few weeks, there is no longer any trace of the substance in the body. So then, are we no longer addicted? The answer is no. From a physiological point of view, nicotine receptors, which are small molecules found at the surface of a great number of nerve cells in some regions of the brain, regularly wait for nicotine in order to function (see the Physical addiction section).
In the absence of nicotine, withdrawal symptoms can be observed over several weeks. This is why people use nicotine replacement products that enable these receptors to be satisfied gently and ‘desensitised’ to the action of nicotine.
But be careful! The receptors are quickly reactivated as soon as smokers ‘take up’ again. In fact, in a mere seven seconds, nicotine from tobacco binds to the receptors and almost immediately ‘re-sensitises’ them!
Let’s not forget about behavioural dependence!
Besides the physical side of addiction that holds smokers prisoner, their mind unconsciously creates neural pathways that are activated automatically in the presence of any situation perceived as a ‘trigger situation’, making them want to put a cigarette between their lips. For these pathways to ‘open up’, they have to stop reinforcing these reflexes. No-one else can do this relearning for them, and they will only be successful if their will to free themselves of cigarette addiction is strong enough. Cognitive behavioural therapies (CBT) can help smokers to control and change their behaviour patterns.
Smokers must also come to terms with the idea of eventually being separated from their cigarettes, their life companions. And they should remember that, as former smokers, their mind will never regain the initial configuration of a non-smoker; they will forever carry the mark of their past addiction. Sometimes, just a few puffs is all it takes for the past servitude to take over again.