Quitting is possible

Putting out the last cigarette is not easy because this is a persistent and tenacious addiction, but with the right motivation and support, anyone can succeed.

Smoking is one of the main risk factors favouring the development of cancer. There is a large body of scientific evidence that demonstrates its link to cancer, heart attacks, emphysema, and lots of other diseases and conditions. The negative effects of cigarettes affect many aspects of daily life, and each smoker needs to find their own personal motivation and solutions in order to quit. Here are a number of good reasons to break the habit.

Some numbers linked to smoking, and the impact of the pandemic.

According to data from the World Health Organisation (WHO), tobacco is responsible for more deaths worldwide than alcohol, AIDS, drugs, traffic accidents, homicide and suicide combined. It is estimated that every year smoking kills about 8 million people around the world (7 million due to direct consumption, the rest by passive smoking). In Italy, 93,000 deaths every year are estimated to be attributable to smoking, and more than a quarter of the victims are aged between 35 and 65.

Based on data from the Istituto Superiore di Sanità (ISS) referring to 2023, there are 10.5 million smokers in Italy, more than 20 percent of the population over 15 years of age.

The results of a recent study by Eva Negri and Carlo La Vecchia, supported by the Italian AIRC Foundation for Cancer Research, showed that deaths from lung cancer continue to rise in the European Union among women, in contrast to the data regarding men. According to the survey, the principal cause is smoking. The increase in mortality is mainly observed in women over 65, who grew up at a time when smoking was more prevalent among girls.

The pandemic probably also had a significant impact on the increase in the number of smokers observed in recent years. Tobacco consumption had been steadily declining since the early 2000s but this was reversed in 2022, with a 2.2 percent increase in the number of smokers, both men and women. Notably, among young people the use of e-cigarettes increased by 0.7 percent and consumption of heated tobacco products tripled.

Why quit?

There are many good reasons to stop smoking: each smoker needs to find the most compelling ones based on their individual circumstances.

For the sake of our health

Without doubt, the most important reason to quit is for the smoker’s own health. According to the WHO, cigarette smoking is the leading cause of preventable death in our society. It is responsible for the majority of lung, throat and oral cancer cases, and also increases the risk of cancer of the breast, bladder, bowel, and other organs.

Smoking facilitates the onset of cancer in several ways: it stimulates the formation of genetic mutations, which can alter cells in various ways and in so doing cause their transformation and the spread of cancer. It also impairs the immune system, blocking its ability to fight neoplastic growth, and causes chronic inflammation which in turn encourages the development of tumours.

In many other organs, smoking is harmful because it damages the blood vessels directly, favouring the atherosclerosis process, which can lead to heart attacks or strokes. Atherosclerosis can also impair the blood supply to the limbs or to the corpora cavernosa, which are the sponge-like regions of the penis that dilate to cause erections.

In the lungs, as well as encouraging the formation of tumours, smoking changes the way the cilia move, these hair-like structures line and protect the airways, keeping them clean. Smoking also causes damage to the alveolar walls where the exchange between oxygen and carbon dioxide takes place. This is why it is also the main cause of emphysema.

The health risks from smoking are therefore not limited to cancer. Smoking favours the onset of heart disease and damages the blood vessels and lungs: these conditions not only potentially reduce life expectancy but also impair the quality of life and can lead to severe disability.

For the health of everyone around us

When a person smokes, anyone near them inhales around 4,500 chemicals, more than 60 of which are carcinogenic. One of these is benzene, which causes leukaemia. The effects of the combination of these substances means people regularly exposed to passive smoking have a higher-than-average risk of developing cancer and heart disease. According to the WHO, 1.2 million deaths worldwide are attributable to passive smoking each year. What’s more, it is estimated that non-smokers that live or work alongside a smoker who lights up without stepping away are 25 percent more likely to get lung cancer or heart disease than those who are not exposed to second-hand smoke.

The threat to young children is even greater: children exposed to second-hand smoke run a higher risk than their peers of getting bronchitis, pneumonia, asthma attacks, ear infections, and meningitis. They are also more likely to become smokers themselves, exposing them to all the health risks already described. Last but not least, passive smoking greatly increases the danger of cot death for infants.

To save money

Calculating an average of 15 cigarettes per day and approximately EUR 5 per packet, this means spending about EUR 106 per month, meaning almost EUR 1,250 in a year. In addition, the direct costs of healthcare spending on tobacco-related illness are considerable. In 2012, the WHO estimated a total cost of USD 422 billion, which corresponds to approximately 5.7 percent of global health expenditure.

To beat addiction

Addiction to nicotine is caused by interference with the reward pathways of the brain that regulate feelings of pleasure. The release of dopamine, the neurotransmitter that produces these feelings, is affected by addiction to tobacco, in the same way as alcohol and drugs. These substances interrupt normal processes of dopamine release and create a need to continue taking them to keep getting the same sensations and avoid cravings. Continuously activating dopamine production changes sensitivity to these substances, leading to dependency and addiction.

Nicotine also increases attention levels, reduces the appetite, and provokes a sense of anxiety or irritability. Studies with laboratory animals show that these behavioural changes contribute to addiction. This can result in a vicious circle, in which it is very hard to quit, despite being aware of the risks.

To improve our looks

Heavy smokers can be spotted by their appearance: discoloured teeth, bad breath, fingers and nails stained by nicotine, older-looking skin, excessive facial hair growth. Quitting smoking leads to improvements inside and out!

For the environment

All stages of cigarette production and consumption have an impact on the environment. Tobacco farming causes five percent of global deforestation, worse still, it often takes place in areas at risk of desertification, such as South-East Asia or Latin America. Approximately 3.7 litres of water are used to produce one single cigarette, while the entire supply chain consumes 22 billion tonnes of water each year. Overall, the tobacco manufacturing industry, including transport, distribution, and production of cigarette packs, produces 80 million tonnes of CO2 emissions. The damage caused also involves waste production and disposal, from the paper used for cigarette packs to the plastic wrapping and discarded butts. The latter pose a direct threat to the environment because they are not biodegradable and release microplastics.

According to the 2022 WHO World No Tobacco Day report, each year the tobacco industry and cigarette consumption produce the following effects:

  • the deforestation of an area equivalent to almost half the entire land area of Cabo Verde;
  • the emptying of 15 million Olympic swimming pools;
  • the creation of packaging waste weighing the same as 9433 freight trains;
  • CO2 emissions equivalent to that of three million transatlantic flights.

Quitting smoking contributes to everyone’s health, both directly by reducing the risks of developing smoking-related diseases in smokers and bystanders, and indirectly by protecting the environment.

How to quit smoking

Data from the Italian National Institute of Statistics (ISTAT) show that 90 percent of smokers quit without needing help, on average they are successful after six attempts. This means that it is possible to quit, but it’s important not to be afraid to fail and try again. The probability of success increases according to the amount of support received. Smokers should not be afraid to ask for help and use the support tools available.

Available tools

There is no one right way to quit smoking that is always effective, it is a strictly personal process. There are numerous approaches that can help, including psychological ones such as hypnosis, auriculotherapy, acupuncture, for example. The only scientifically validated method, however, combines pharmacological and psychological support and is offered by specialised centres in many countries.

Nicotine replacement therapy

Trying the break the habit means dealing with the psychological dependence on the pleasure of smoking and the gestures involved, but physical dependence also needs to be processed, this is often overlooked but it is actually a major hurdle. This is because the body has got used to the effects of nicotine, and a lack of it causes withdrawal symptoms to varying degrees, depending on the type of smoker and the quantities smoked. One of the recommended methods of quitting is to gradually reduce nicotine intake while compensating by means of nicotine replacement therapy, which gradually reduces the dose consumed. There are patches, chewing gum, lozenges, oral sprays, and inhalers on the market with different doses of nicotine.

However this therapy is administered, all replacement products control the physical discomfort caused by the lack of nicotine, increasing the likelihood of success for those who have decided to quit smoking. These products can be bought in pharmacies without a prescription, they are even safe during pregnancy under medical supervision. The important thing is to respect the established doses and timing, using them for at least 2-3 months and reducing the dosage generally by a third every month.

Other medicines

In some cases, in addition to recommending psychological and behavioural support, doctors may prescribe specific medication to help overcome the most difficult stage of giving up cigarettes. The most widely used drugs are cytisine and bupropion, both of which require a doctor’s prescription. Cytisine is a partial nicotine receptor agonist that relieves the urge to smoke and reduces the pleasure derived from it; it can be obtained in pharmacies as a galenic preparation. Bupropion is a drug that stimulates dopamine, thus reducing the craving for nicotine. Although experts recommend them to improve the chances of success, unfortunately, in Italy, these drugs as well as and nicotine replacement therapies are not provided free of charge by the National Health Service. Patients therefore have to cover the cost, which per day coincides more or less with the price of a packet of cigarettes.

What happens after quitting?

Breaking the habit of smoking has a series of consequences that can be noticed in the first few days. The beneficial effects last for a long time and strengthen the determination to persist; the possible negative consequences, on the other hand, are mostly transitory and can easily be alleviated.

Pleasant effects

Immediate and long-lasting consequences:

After 20 minutes, blood pressure and heart rate return to normal.

After 12 hours, carbon monoxide levels in the blood drop, while oxygen levels normalise.

After 24 hours, the lungs begin to cleanse themselves of mucus and deposits from smoking.

After 2 days, the body has cleared itself of nicotine and the sense of taste and smell begin to recover.

After 3 days, breathing begins to improve, and energy is regained.

After 2-12 weeks, blood circulation improves.

After 3-9 months the improvement in breathing becomes more pronounced, coughing and wheezing decrease.

After 1 year, the cardiovascular risk is half that of people who carry on smoking.

After 15 years, the risk of lung cancer in many cases has decreased to the level of people who have never smoked, or at least halved (depending on many factors, including the number of cigarettes smoked and the number years with the habit).

Less pleasant effects

Withdrawal symptoms

Quitting is not easy, and the lack of nicotine is felt acutely during the first few days. In addition to cravings, i.e., the strong desire to smoke, it is quite normal to feel restless, irritable, fed up, or tired. It may also be difficult to sleep and concentrate.

At this stage, in addition to the support provided by nicotine replacement products or medication prescribed by a doctor, it is important to focus on the benefits and the reasons that led to the decision to give up smoking. It is also helpful to engage in leisure activities as a distraction, preferably outdoors and with other people.

Weight gain

Some people put on a bit of weight when they quit smoking, not usually very much though. This is due to compensatory behaviour that creates an urge to eat gratifying food, and in the first few days this can be quite powerful and hard to control. It is called a food craving and is often caused by the feelings of stress or despondency induced by nicotine addiction. Satisfying this urge brings an instant feeling of pleasure, but the craving may recur in the short term, leading to overeating and weight gain. These cravings tend to subside after the first few weeks, but taking the specific medication for nicotine addiction helps to curb these tendencies. At this stage, it is important to remember that the benefits of giving up smoking are always greater than the risks associated with gaining a bit of weight. It is a good idea to be proactive and avoid shifting the desire for gratification from cigarettes to food; one way is to opt for low-calorie foods, for example fruit and vegetables, another is to take up a form of physical exercise, something enjoyable, boosting the benefits of quitting smoking.

This information does not substitute professional medical advice or consultations with healthcare professionals.