With all the latest research and statistics bombarding Americans today
about the consequences and deadly risks of smoking, why do they still
have such a difficult time trying to "shake the habit" (of smoking),
biologically, psychologically, and from a social standpoint?

Hi! Thanks for the question.

I have found the following articles, with reference to some studies
and observations, explaining why some people have difficulties in
quitting smoking.

BIOLOGICAL:

?The important reason with nicotine is that the drug helps the user
maintain his or her daily routine, especially at work. We have some
telling information about smoking in the workplace. In the early
1970s, British researchers T.W. Meade and N.J. Wald asked some 3,600
workers to detail when they actually smoked cigarettes from the time
they awoke until they went to bed.?

?Electroencephalograph studies show that nicotine generally arouses
human beings. Give a subject a dose of nicotine and his brainwave
activity will increase in frequency, a sign of increased arousal.
However, we also have some evidence that nicotine sedates or depresses
smokers, depending on the dosage and environment.?

?Smoking ? Why Is It So Hard to Quit??
http://www.acsh.org/publications/priorities/0401/hardtoquit.html


?Nicotine is in all tobacco products. It makes you feel calm and
satisfied. At the same time, you feel more alert and focused. The more
you smoke, the more nicotine you need to feel good. Soon, you don't
feel "normal" without nicotine. It takes time to break free from
nicotine addiction. It may take more than one try to quit for good.?

?Online Guide to Quitting?
http://www.smokefree.gov/guide/why_so_hard.html 


?A UC Irvine College of Medicine study reveals for the first time the
underlying brain mechanisms that link personality traits to nicotine
addiction.?

?It has been long established that hostile personality traits are
related to cigarette dependency and smoking cessation difficulties.
Now UCI researchers have found that in people who have aggressive
personalities nicotine triggers significant brain activity in the
areas that help control social response, thinking and planning. In
turn, non-hostile people showed no brain activity increases at all to
nicotine. These findings suggest that some people are born with a
predisposition to cigarette addiction and helps explain why quitting
for some is practically impossible.?

?The fact that non-smokers in the high-hostility group showed a
significant metabolic response to nicotine provides the first
biological evidence that people with high-hostility personalities are
likely to become dependent on cigarettes because of their brains?
strong response to nicotine, said Potkin. ?In turn, this might also
help explain why other people have no compelling drive to smoke or can
quit smoking with relative ease,? he added.?

?UCI study reveals why some people may be 'born to smoke'?
http://today.uci.edu/news/release_detail.asp?key=1095 


-----------------------------------
SOCIAL:

?Among male participants, those from ?broken homes? were less likely
to have quit, as were those who had been offered cigarettes in high
school. High school girls who?d been offered cigarettes did not show
the same predisposition to still be smokers years later, even though
they were more likely than boys to receive offers of cigarettes. The
researchers also noted that this sex difference did not appear to be
due to male smokers being more heavily addicted than female smokers.?

??Ruling out these alternative explanations suggests that there are
implicit or explicit social pressures involved in being offered a
cigarette, even during the period of emerging adulthood,? the authors
note, ?and that male smokers have more difficulty resisting these
pressures.??

?Both male and female students who earned lower grades in high school
were less likely to have quit. Females were less likely to have quit
if they?d believed in high school that they couldn?t resist the
temptation to smoke.?

?PEER PRESSURE MATTERS IN YOUNG ADULTS? SMOKING DECISIONS?
http://www.hbns.org/newsrelease/adolescentsmokers9-3-02.cfm 


?Another important factor (which health professionals frequently
ignore) affecting motivation to quit is the smoker's perception of the
benefits of continued smoking. Teenage smokers report that smoking
fits in with a rebellious image, helps them to establish and maintain
friendships, and helps them to look more, grown up. These might be
called the social benefits of smoking to young people.?

?These perceived beneficial effects reported by young people are very
similar to those most frequently reported by adult smokers. Certainly,
the effect which smokers most consistently say they smoke for is an
alleviation of an unpleasant mood state (e.g. making them feel less
tense, irritable or miserable). The smoker's motivation is there fore
likely to be affected by strongly how strongly they believe that
smoking provides these kinds of beneficial psychological effects,
balanced against the perceived disadvantages of smoking.?

?The Psychology of Tobacco Addiction:  Why it is difficult to stop smoking?
http://www.islamset.com/healnews/smoking/INGCAT/Jonathan.html
?Yet another type of barrier to quitting is the social environment.
Smokers often live or socialize with other smokers, reinforcing
smoking as a normative behavior. The survey revealed that current
smokers were twice as likely as never smokers to have people who are
close to them who also smoke. Among all adult Minnesotans, just 30
percent of never smokers said they had a spouse or close friend who
was a current smoker, while 60 percent of current smokers said this.?

?Quitting Smoking Nicotine Addiction in Minnesota?
http://www.health.state.mn.us/divs/hpcd/tpc/quittingsmoking.pdf


------------------------------
PSYCHOLOGICAL:

?High self-esteem participants who had relapsed by the six- month
follow-up reported a significant drop in risk perception at that time
and this drop remained significant at the 12-month follow-up. In
addition, these same individuals were less likely to commit to making
another attempt to quit smoking. "People with high self-esteem have
difficulty admitting that their behavior has been unhealthy and/or
unwise, and sometimes that difficulty can have a negative effect on
their health," says psychologist Frederick Gibbons, Ph.D., and lead
author of the study.?

?PSYCHOLOGICAL RESEARCH OFFERS REASONS FOR SMOKING BEHAVIOR:
CRAVING CIGARETTES NOT NECESSARILY ASSOCIATED WITH ABSTINENCE, HIGH
SELF-ESTEEM IMPEDES EFFORT TO QUIT?
http://www.selfhelpmagazine.com/articles/atd/reasons.html


?Current smokers cited a complex set of barriers to their ability to
quit. Two-thirds of current smokers (67%) listed physical cravings or
feelings of withdrawal as a barrier, more than any other reason. Many
smokers also identified social and psychological barriers, including
losing a way to handle stress in their lives (55%), risk of gaining
weight (32%), and concern about interference with social or work
relationships (19%).?

?Some groups experienced certain barriers more frequently. A far
greater percentage of women (48%) than men (17%) cited the risk of
gaining weight. Concern about the loss of cigarettes as a way to
handle stress was listed as a barrier by 65 percent of women and 46
percent of men. A greater percentage of women (22%) than men (16%)
identified the possible risk of interference with social or work
relationships as a barrier to quitting.?

?Quitting Smoking Nicotine Addiction in Minnesota?
http://www.health.state.mn.us/divs/hpcd/tpc/quittingsmoking.pdf


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Google Answers Researcher

Good enough for me! Thanks a lot. I have to research this for a paper,
and this is an ideal way to get started. I didn't want to be swamped
with information because I have to do the research myself, but this is
just enough information to get a general feel for the issue.

Here are some great articles to start you off:

ABC of smoking cessation
Why people smoke
Martin J Jarvis
http://bmj.bmjjournals.com/cgi/reprint/328/7434/277

ABC of smoking cessation
The problem of tobacco smoking
Richard Edwards
http://bmj.bmjjournals.com/cgi/reprint/328/7433/217

A brief review of adolescents and tobacco: what we know and don't know.
Am J Med Sci. 2003 Oct;326(4):235-7. 
Risk factors concerning the onset of teen smoking and progression to
regular use are complex and are best conceptualized from an
interactional perspective. Peer factors have been shown to be a strong
predictor of initiation of smoking and influencing the transition to
regular use. Peer group norms governing connectedness to school (low
connectedness), substance use (alcohol in particular), and deviance
all seem to affect teen smoking. At-risk teens tend to select
particular peer groups that reinforce substance use and deviance, thus
suggesting a bidirectional relationship concerning peer factors
related to teen smoking.

Family factors are also predictive of teen smoking. Parental and
sibling smoking, family conflict, and family communication concerning
the consequences of tobacco use all have been found to be related to
either initiation of use, progression to regular use, or both.

Finally, intrapersonal variables such as sex, ethnicity, depression,
and other substance use play an important role as risk factors for
tobacco use. White teens have almost triple the smoking rate of black
teens and have higher rates of smoking than other minority groups. 
Although male and female teens smoke at approximately the same rates,
girls are much more susceptible to maternal smoking than are boys,
suggesting the possibility of sex differences concerning social
influences of smoking.

Understanding the complex interaction between these aforementioned
multiple domains of influence is important in designing effective
prevention programs and treatment approaches.


The Genetics of Smoking Related Behavior: A Brief Review.
Am J Med Sci. 2003 Oct;326(4):168-173.
Based on the results from genome-wide linkage and association analyses
on different subject populations, 15 loci located on 8 chromosomes
were reported
to harbor susceptibility genes for nicotine and other substances of
abuse. It is expected that a newly completed human genome sequence, as
well as advances in genomic technologies such as genotyping and array
analysis, will greatly enhance progress toward the identification of
genes associated with smoking behavior.


Hope that helps.

-d

"Emotional Addiction to Tobacco" 
by Renée Miereanu, Clinical Hypnotherapist
http://www.smokingends.com/addiction.html

For me, the most difficult thing about giving up cigarettes was that
my many years of smoking had formed a myriad of mental associations
between everyday actions and smoking a cigarette. Every time I talked
on the telephone I lit a cigarette. Every time I used my computer I
had a smoke-a-thon. I had a wake-up dig before breakfast. I had a
nitey-nite cig before falling asleep. I smoked while driving my car. I
smoked before sex. I smoked after sex. (Never during sex, though.)

When I quit, cold turkey, I got these constant reminders all day long.
Each occasion that used to be done with a cigarette as accompaniment
now seemed to demand that I tithe to the Nicotine God. Beating the
physical addiction was easy. Getting rid of the associative "kindling"
that triggers the desire for a cigarette has been, for me, impossible.

I have not smoked a cigarette since October 1989. Not a day goes by
without my wanting to smoke. I seldom go more than an hour or so
without having to push aside the desire for a cigarette.

It is said that drug addicts have monkeys on their backs. My monkey
has been starving for more than 14 years now, but he doesn't die. He
just stays hungry, because I won't feed him.

rod84.....

As a smoker for more than 35 yrs now, I have tried several times to
quit. The withdrawals I sufferred can only be described as a
nightmare. I was physically sick to my stomach, shaking and my nerves
were taut. I have since done some research on nicotine withdrawal, and
from all that I have gathered, some say that nicotine withdrawal can
be as severe as heroin withdrawal.
I agree with that and can't help but wonder that, since the government
has all these warnings on the danger of smoking and has basically
forced smokers outside and into "less than desirable" groups, why have
they not built rehab centres for smokers to withdraw. I bet if I was
in a secure facility with counsellors, doctors and close one on one
counselling, I could quit....Everyone makes it sound so easy when, in
reality, it is the same as going through a major drug withdrawal. And
I agree with pink, the many people I have talked to who quit, say the
urge to smoke never ever leaves.

My experience is a lot like PinkFreud's:  the strong associations with
certain activities, the unending nicotine craving.  In fact--wow, we
both quit in the same month!  I still stand downwind of a smoker now
and then, just to inhale a little.  I would pay $100 for a cigarette
any day (well, for $100, make that *two* cigarettes), if I could just
stop there, but I couldn't.

I don't have an hourly thought of smoking, but I do think of it every
day and still sometimes dream of it.  I have heard that recovering
alcoholics and drug addicts say cigarette smoking is the hardest
addiction to break, and I believe it.

I've thought a lot about it, and I have identified a few other things
that made quitting so hard.  One is that there's no obvious payoff. 
If you quit overeating, you lose weight.  If you quit drinking, you
stop being drunk.  If you quit smoking, all you get is an unquenchable
desire that won't quit.  Maybe some disease that you're going to get
later in life anyway won't be so bad--maybe it kills you in five years
instead of in six months--and maybe you don't get that one disease and
instead survive to die of something better, but how could you ever
tell?  It's hard even to feel virtuous when you haven't really done
something good, just stopped doing something bad.  In my case I didn't
even get to have the ashtrays go away or lose the smoky smell in my
hair and clothes and the revolting brownish coating on all surfaces in
the house because my husband remains a heavy smoker to this day.  So
there was no apparent payoff at all, just something going on
constantly under my nose that reminds me of what I can't have.

Here's a second reason:  I simply enjoyed it.  I enjoyed smoking--but
I never wanted to *be* a smoker.  It's just plain hard to give up
something you enjoy, especially for a reason that offers as little
satisfaction as "it's bad for you."  Then, of course, I gained weight,
about 40 lb., and even now I'm still heavier than I was before.  (A
helpful friend told me she had decided, "It's easier to lose weight
than cancer," and that was one of the things that got me through
quitting.  I went through an awful lot of pretzels and chewed the heck
out of my pencils for months afterward.)

And a third:  it's a useful device.  In addition to all those
associations that PinkFreud mentioned, it's also great for such things
as (a) stalling so you can think before you speak, (b) breaking social
ice by offering or accepting a cig or a light, (c) making an excuse to
get up and move around, (d) underscoring your remarks or expressing
yourself silently with a gesture or a puff of smoke--the angry
stubbing out of a butt, the long, leisurely, contemplative exhalation
versus the short, noisy, impatient burst, the seductive application of
cigarette to lips without breaking eye contact--all those exquisitely
communicative behaviors that are virtually impossible to duplicate
with a spoon or a soda straw or a Pilot V-ball pen.  And just think of
the ways a lighter or a match can be used as a prop.  Man, I miss the
drama as much as anything.

Not to mention the fact that starting was an act of sheer teenage
rebellion amidst the turbulent sixties, and I still (unfortunately)
like the idea of getting away with things I'm not supposed to do.

Now, I will tell you how I quit one last and final time and made it
stick.  When I had made up my mind for real, for good, I began a
quitting journal.  I smoked my way through my very last pack, counting
down, making every drag memorable and deep.  And while I did that, I
wrote down all my thoughts:  the fear, the anxiety, the dread, the
ambivalence, the resolve, the trauma of having my babysitter bum my
third-to-last smoke when I was down to counting the minutes I had left
(no, of course I didn't tell her), the last stub-out, and then--the
joneses.  I wrote down the white-knuckle days, hours, and minutes, the
cravings, the mood, the irritability, the compulsive munchies, all of
it.

And every time I felt like starting again, I reread that journal and
asked myself, "Do I want to go through that again?"

There was never any doubt about the answer.

Apteryx

I almost forgot:  AND (e) making the bus/subway/trolley come.

I realize that this is a "late" posting - way after the original
question was posed, but I would like to comment.  I searched the
Google database for reasons that people become addicted because my
husband definitely falls into that category.  Now, I just feel pity
for him after reading some of the comments.

A good friend died a couple of years ago.  A longtime smoker, he
suffered years with emphysema and eventually ended up in an oxygen
tank.  At a body weight of 60 pounds, he continued to smoke in the
oxygen tank and lost his life in a hospice, leaving his wife with
$100,000.00 in debt.

Yes, some people do really have difficulty, but others do not.  My
husband's sister was read the Riot Act by her physician when she was
diagnosed with rheumatoid arthritis and a failed thyroid gland.  So,
she got nicotine patches and, apparently, they were effective.  At
least, that is what she says.

Incidentally, I did get a good laugh from Pinkfreud's comments. 
Having had a few questions answered by her in the past, I felt a
kinship with her and her observations about triggering events and
environments.  I personally know that is true and that the brain is
WAY more powerful than we think.  The tail definitely wags the dog. 
But, I'm not sure that lugging around an oxygen tank is quite as
romantic as the before and after cig.