When I work with a private treatment centre, we can usually wean people off anything, with one notable exception: nicotine. If somebody is determined to smoke it’s impossible to make him or her quit, even though we may be able to help them abstain from almost anything else.
The hold that nicotine has over those of us with an addictive nature is so powerful that most addiction centres don’t even bother to attempt to tackle it if there are other addictive issues going on at the same time.
When patients are admitted to an addiction ward at hospitals they find themselves in a very strict regime. Their phones are confiscated, they’re not allowed books or television in their rooms, and their diet is strictly controlled. The reason for all this is that therapists need to tackle the emotions that lie beneath an addict’s behaviour. Things like phones and excessive TV watching are a distraction that gets in the way of this process, which is why they’re banned.
Yet, despite the austerity of the regime, patients can continue to smoke (although obviously it’s frowned upon for medical reasons). They’re allowed to carry on smoking because if any treatment centre tried to force them to quit, the establishment would be empty within a week.
I know this from past experience because a clinic I worked in many years ago tried to do exactly that. When the boss of the centre attempted to ban patients (and staff) from smoking, everybody responded by threatening to walk out. It created an enormous amount of disruption, even though it was a very well-run institution.
So the treatment centre in question compromised by painting lots of little yellow ‘smoking’ circles in the car park. Patients were banned from smoking unless they stood in the centre of one of these circles (which were just about big enough for one person and were located ten metres apart). The idea was to prevent smokers from enjoying themselves by chatting to each other while they had a cigarette.
It didn’t make any difference. Even though it was January and freezing cold at the time, people were still quite happy to stand outside in a windswept car park, as long as they got their hit of nicotine!
Go to any place where recovering alcoholics are congregating, and you’ll see dozens of people outside, all smoking heavily. These are often people who’ve had the courage and tenacity to overcome major alcohol addictions, yet they remain powerless to stop themselves from ruining their health by consuming tobacco.
The reason for this is that nicotine addiction works in two distinct ways – and one of them is particularly relevant for those with wider issues surrounding addictive behaviour. Most people are aware that smoking creates a physical dependency. We become hooked on cigarettes as our bodies become used to the nicotine, and we physically crave more of it if we try to stop. However, most of these symptoms pass within three or four days, and certainly within a week or two when we stop. But nicotine also creates a psychological dependency, due to the very powerful effect that it has on our emotions.
This is true of all forms of addiction, but with nicotine the psychological effect is extremely powerful. It may surprise you to learn that I consider nicotine to have a much greater effect on our emotions than alcohol does. Nicotine acts as both a stimulant and a relaxant. As a therapist I know that nicotine pacifies our emotions (even if it stimulates our thoughts). As we have already seen, people who have an addictive nature are very sensitive to emotional stress, so the pacifying effect of nicotine is very seductive (even if people don’t fully realize how it works).
Everyone understands that cigarettes are addictive in a physical sense: but we’re far less aware of the characteristics of nicotine as a mood-altering drug. Of course, cigarettes don’t make you slur or fall over as you stagger down the street, like you do when you’re drunk or stoned (on the contrary, many people claim nicotine helps them to concentrate). And for this reason, the popular perception of nicotine is that it’s not a particularly heavy drug.
In my opinion this is a misconception, because the emotional hold that nicotine has over some people is almost unbreakable.
Booze and drugs have a very overt effect on our mental state: they make us drunk or high. Cigarettes don’t create the same peaks and troughs, but their overall long-term effect on deadening down our emotions is actually much stronger.
I know countless recovering drug abusers, alcoholics, sex addicts, gamblers, anorexics and overeaters who’ve all overcome severe problems with addiction, yet they continue to smoke. This is despite them being almost evangelical about the fact they’re clean with regard to other forms of addiction.
When people quit alcohol or drugs, they not only often continue to smoke, but their habit actually increases. Part of the problem revolves around the rituals attached to smoking. If suddenly you find yourself with lots of empty time then it’s natural to search out something to do with your hands. Meanwhile, widespread bans on smoking in many public places have resulted in smokers congregating outside pubs or offices to chat, and this form of social interaction has become part of the ritual.
In my case, when I was a heavy smoker there were several ‘triggers’ that always led to me sparking up in a ritualistic way. If the phone rang, I would automatically light a cigarette. If somebody came to see me, the first thing I did was sit down with them and light up. These triggers can take lots of different forms. A friend told me that whenever his boss spoke to him, he would go straight outside afterwards and have a smoke!
When I quit booze I went from being a 20 a day smoker to consuming 60 a day. In this instance, I was using cigarettes as an emotional crutch to prop me up because I missed the effects that alcohol had previously had on my feelings. The moment the alcohol stopped working for me as a drug of choice – because I didn’t have it – I looked for something else and nicotine was it.
I realized just how far nicotine had got me addicted when I was going out to play pool one day. I had my jacket on and I was anxiously patting my pockets because I was worried I’d forget my cigarettes. I had a full packet opened and another packet that was opened and half-full, and two cigarette lighters (in case one ran out of gas). This was all very well, but I was only going out for an hour! That’s how hooked I was – and I realized that the hold cigarettes had over me was every bit as strong as the effects of the booze.
When I did eventually quit smoking, I went through a truly awful time. I had two beautiful Labrador dogs back then, and I can remember one particular day when I took them for a walk down by the river. I was in the process of giving up smoking and I felt very low.
The sun was sparkling on the water and the wind was gently whispering through the trees, and it should have been a perfect moment to enjoy, but all I could think about was how miserable I felt. I was virtually praying for God to take me off the Earth. The reason I felt that was because giving up smoking had brought up lots of feelings that I’d been numbing through nicotine.
Some people find it easier to quit smoking than others. This is partly due to physical factors, and partly due to the fact that some of us just find it almost impossible to break addiction.
But emotionally, if like me you have an addictive nature, you’re still likely to find it very tough. A lot of people find they put on weight when they quit. This was something that I experienced, because suddenly there was a void in me where the nicotine had been. I reacted by stuffing myself with sugar!
I also tried substituting expensive Havana cigars for all those cigarettes (based on the logic that I’d only smoke one per day), but within a few days I was smoking four or five Havanas in an afternoon and I’d have soon been bankrupt.
If ever there was a case of moving the deckchairs around on the Titanic this was it. All I was doing was swapping one addiction for another. I eventually stuck to sugar, but I was just replacing the mood-altering effects of tobacco with refined carbohydrates. I suddenly found myself eating about six Snickers bars a day. Instead of using my hands to light up, every time I experienced a trigger I was stuffing my face with chocolate. I’m a bit more controlled these days, but even now I’m partial to the odd pudding.
In any hospital waiting room you can usually spot the smokers from ten miles away. They’re emaciated and coughing; they’re flushed, they’re often skinny and they generally look dreadful. It’s terrifying that people can do that to themselves. We all know that tobacco causes lung cancer, but there are a whole raft of additional ways in which cigarettes can ravage our bodies. Smoking causes medical problems that many people are completely unaware of.
For instance, one of the serious effects is something called peripheral neuropathy, in which a combination of smoking and drinking causes damage to your nerve endings at your extremities. It can lead to terrible numbness in your hands and feet. Victims can become susceptible to gangrene and can end up being forced to have a limb amputated.
So smoking doesn’t just cause diseased lungs. That’s only part of it: there’s an endless list of other ailments, like high blood pressure, heart disease and stroke. You don’t have to be a doctor to spot a heavy smoker: it’s normally written on the person’s face. Long-term smokers have what I call ‘an expensive face’. They look wrinkled and tired, as if they’ve been in a battle to survive drudgery all their life. I don’t mean this in a derogatory way – I’m the first to admit that I’ve an expensive face of my own! The crow’s feet around my eyes are the legacy of the 60 a day I was smoking while I was playing pool.
It’s impossible to estimate the total cost to the UK’s National Health Service of treating smoking-related conditions, but it’s clearly a gargantuan figure. As I mentioned earlier, according to ASH, there are around 100,000 deaths a year from smoking, but as we have seen that’s just one part of the story. What seems certain to me is that if the NHS were to provide genuine help for those who wish to quit, it would almost certainly be self-funding.
By this I mean that the cost of the treatment would be far outweighed by the cost saving from not having to treat so many smokers. Unfortunately, prescribing people nicotine patches if they’ve an addictive nature is unlikely to work. The answer instead lies in tackling the root cause of why some people are so sensitive to emotional distress.
Many ex-smokers also find themselves drinking more caffeine when they give up cigarettes. While I’m not suggesting for one moment that caffeine is a dangerous drug, it’s helpful to be aware that it is a mood-altering substance. People often consume things like coffee or sugary treats without really thinking about why they do it.
Ask someone why they eat puddings and they’ll probably just say: ‘I don’t know – I just like them!’ What they’re unlikely to say is: ‘I like the effect they have on my brain chemistry, because it gives me a little buzz and improves my emotional state!’
In the case of caffeine, the effect it has on us is that of a stimulant. When we drink coffee, or other drinks that are rich in caffeine, it alters the way we feel. Most of us experience a little lift and without realizing it, we’re briefly invigorated. Mostly this effect is harmless, but it’s worth being aware that too much caffeine can have an adverse effect on your health.
If you think you’re drinking too much caffeine there’s a simple way to find out: just give it up for a day. If you find yourself with a fiendish headache it’s probably a sign of physical withdrawal.
According to the Mayo Clinic in America, caffeine can cause a sudden spike in blood pressure. Some doctors also believe it can lead to hypertension (high blood pressure), and there’s also a suggestion that it can block a hormone that helps to keep the arteries free-flowing.
Most people agree that if they drink too much coffee it can make them feel a little bit wired, or even jittery. I’m not arguing that we should all quit coffee, but clearly, if you find yourself suddenly guzzling gallons of it as a result of ‘moving the deckchairs around’ while battling another addiction, then you might want to cut down a little.