Whether you’ve picked up smoking or vaping because of stress, peer pressure, or even curiosity, deciding to quit is an arduous journey. Studies suggest that only 3-5% of all smokers can stop and sustain going cold turkey, which reaffirms that the quit journey isn’t as straightforward as it seems. 

There are many reasons the quit journey can be so emotionally, mentally, and physically demanding. We’ll discuss what makes it hard and how to find the right support to help you through the peaks and valleys that come with it.

Nicotine Dependency

The World Health Organization’s Tobacco Trends reports that one in five‌ adults are still addicted to tobacco.

According to Truth Initiative’s article, Tobacco is a social justice issue: Mental health, “People with mental health conditions—depression, anxiety and ADHD, for example—or substance use disorders make up 25 percent of the population, but they account for 40 percent of all cigarettes smoked in the U.S..”

That means that, “One in three adults with mental illness smoke compared to 1 in 5 adults without mental illness.”

How do I know I’m dependent on nicotine?

The Mayo Clinic characterizes nicotine dependence as using, without having the will to stop. “Nicotine is the chemical in smoked tobacco that causes the urge to smoke,” the article explains. “The chemical brings on pleasant feelings, but these effects are short-lived. So you have another cigarette, cigar or pipe bowl.”

The more tobacco you use, the more nicotine you consume, and that “high” becomes satisfying to both the body and the mind. If you are dependent, you will probably experience withdrawal symptoms when attempting to stop.

How to Evaluate If your Nicotine Dependent

Mayo Clinic’s article, Nicotine Dependence, describes symptoms of nicotine dependence as the following:

1. You can't stop smoking. You've made one or more serious attempts to stop without long-term success.
2. You smoke within 30 minutes of waking up. The sooner you start smoking after waking and the more cigarettes you smoke during the day, the more dependent on nicotine you are.
3. You have nicotine withdrawal symptoms when you try to stop. Your attempts at stopping have caused physical and mood-related symptoms. Withdrawal symptoms can include strong cravings, anxiety, irritable mood, restlessness, trouble focusing or sleeping, depression, frustration, anger, increased hunger, and constipation.
4. You keep smoking despite health conditions. Even though you've developed health conditions linked to smoking, you haven't been able to stop.
5. You give up social activities. You may stop going to smoke-free restaurants or stop socializing with family or friends because you can't smoke in these situations.

Why Quitting Feels Difficult

While mental health challenges like stress, anxiety, and depression can be the reason someone starts to smoke/vape, they can also be a major reason it’s hard to quit.

“Many treatment centers do not offer smoking cessation services, and the tobacco industry has also supported efforts to block smoking restrictions at mental health facilities,” the Truth Initiative's article explains. “A journal article on tobacco use and schizophrenia found that Big Tobacco “hired legal counsel to monitor research on hospital smoking restrictions."

The tobacco industry’s aggressive marketing tactics unfortunately cater to two surprising populations: youth and those managing chronic mental health issues.

"Williams stated that tobacco is the number one cause of death in this population," in the article "Tobacco is a social justice issue: Mental health." He continued, "There is significant evidence that people can quit smoking, leading to improved mental health outcomes and longer, better lives."

Our page, Tobacco & Nicotine says common triggers to include:

• Stress
• Drinking coffee or alcohol
• Driving
• Social situations
• After meals
• Seeing others smoke or vape

Withdrawal symptoms may include:

• Strong cravings
• Irritability
• Increase anxiety/stress
• Difficulty concentrating
• Restlessness
• Trouble sleeping
• Increased appetite

Methods for Emotional Regulation Without Nicotine

Use breathing techniques
Try box breathing, belly breathing, or simple deep breaths through the diaphragm.

To learn these techniques, read Healthline’s article, 10 Breathing Exercises to Try When You’re Feeling Stressed.

Get in tune with your body
Sometimes an overlooked indicator of stress is tension in the body. Find some quiet time to sit and scan your body and identify where you’re feeling stress. Take steps to release the muscles using tools like breathing, a warm bath, or massage.

Try using visualizations and affirmations
Anxiety can often trick the brain into thinking it’s in danger. These intrusive thoughts can lead to a sense of panic, causing the body to ask for nicotine to help regulate. Instead, try using meditative visualizations of a safe space, and use affirmations like, “I am safe, and I can handle this without substances.”

Find a healthy distraction
One of the best ways to fight the urge to smoke is to keep busy. Work with your hands, like gardening, cooking, or playing sports. Be intentional about scheduling outings or quality time with friends and family (the ones who support your quit journey).

Get exercise & maintain a balanced diet
Smokefree’s article, Coping With Stress Without Smoking states that “Being active sends out natural chemicals that help your mood and reduce your stress. Sometimes a short walk is all it takes to relieve stress.”

Fueling your body to support daily movement will keep those ‘feel good’ hormones going.

Surrender to the process
Be patient with yourself during this process. We already know that quitting all at once is very difficult to maintain, so don’t put pressure on yourself. Having hard days, relapsing, and trying more than once doesn’t mean you’re failing, it's part of the process. Accepting the ebb and flow of quitting removes the stigma!

Resources

Quitting tobacco is a process, and you don't have to do it alone. Successful quitting often combines:

1. A personalized quit plan
2. Behavioral counseling or coaching
3. FDA-approved quit medications
4. Support from family and friends
5. Follow-up with a healthcare professional
6. If one approach doesn't work, don't give up. Many people make several quit attempts before quitting successfully.

Talk to your healthcare professional about treatment options, medications, and counseling.

Free quit support is available through the New Hampshire Quitline by calling 1-800-QUIT-NOW or visiting QuitNowNH.org.

Remember, you can quit. While those with mental health challenges are vulnerable to a longer quit journey, it’s not impossible - and the evidence explored here tells you that not only can you quit, your mental health can improve when you do.

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