People who haven’t “been there” can find it hard to understand why anyone would relapse, once a smoker gives up tobacco and gets past the withdrawal phase. If the abstinence symptoms are history, why is it so hard? The answer can be explained partly by a description of how nicotine works. Nicotine is a reinforcing substance, which means that using it results in sensations and conditions that are perceived as positive by the tobacco user. It can help a smoker regulate his or her mood. It can help curb appetite and can help keep body weight at least a few pounds lower. It can heighten thinking and reasoning skills, although not dramatically. Some people find that nicotine enhances memory, eases anxiety and tension, makes sensory experiences feel more intense, and makes pain easier to bear. Not all nicotine users report all these occurrences.
Since these effects are pleasurable, they are reinforcing. This means that they become psychologically and mentally linked to the act and circumstances of smoking. These linkages of what psychologists call stimulus and response operate on the same principles that led Pavlov’s dogs to salivate when they heard sounds associated with being fed. They are the same processes that start your mouth watering when you see a picture of your favorite chocolate. A sequence of behavioral psychologists, including B. F. Skinner and Albert Bandura, have described these phenomena well and expanded on their meaning in our social lives. If anything in psychology has been demonstrated to the point where theory has become doctrine, it is these principles.
When we use tobacco in any setting at all, what we perceive as the positive effects of using the substance reinforces our use of it. Just as we shape a child’s behavior with reinforcement (“That’s a magnificent mud pie, and thank you for not bringing it in the house”) we also shape our own tobacco-using behavior by our very use of tobacco. In a laboratory, a researcher can teach a pigeon to peck in a certain spot on a cage wall by reinforcing the bird’s behavior with food as it pecks closer and closer to the designated spot. An animal trainer can teach a cat to dance, can teach an elephant to stand on two legs, or can train a dog to jump through hoops, by using the same principles of reinforcement. We likewise train ourselves to reach certain emotional and mental states through the reinforcing use of tobacco. This results in a different, and perhaps more pernicious, form of dependence than what we would commonly call “addiction” to nicotine. We learn not only to depend on nicotine, but also to look to tobacco for its reinforcing effects.
The effects of reinforcement are multifaceted. When we smoke in a social setting, we are not only continuing our dependence on nicotine and experiencing tobacco and nicotine’s many physiological properties, but we also are linking the experience of smoking to the setting. Tobacco use becomes tied to chatting with friends, sharing conversation, flirting, solidifying relationships, or whatever else. We engage in much more than just a physically reinforced action; we also reinforce our smoking or other tobacco use with the effects of the setting in which we use tobacco.
In addition, repeated exposure to nicotine leads to a physical dependence, such that the nicotine-dependent person requires nicotine to avoid experiencing adverse effects. A dependent smoker who does not get the dose of nicotine that the body expects and needs will begin experiencing withdrawal symptoms. The symptoms vary considerably between individuals, but they generally involve some constellation of the following effects:
• Difficulty concentrating
• Racing heart
• Nicotine craving
• Insomnia or other sleep disturbance
• Digestive disturbances
Not every nicotine-dependent person will get all the symptoms, or will get them all at once. The symptoms may change throughout the course of withdrawal. A nicotine-dependent person using nicotine replacement (e.g., the patch or the gum) to help quit using tobacco may experience symptoms to a lesser degree, but may still experience them somewhat. Some clinicians have reported success with enhanced doses of nicotine replacement, through application of multiple patches or combinations of gum and patch. A smoker in withdrawal will begin to feel the symptoms fading within minutes after he or she uses nicotine. This is evident from subjective self-reports as well as from computerized testing administered to smokers deprived of nicotine.
Not only will the nicotine-deprived smoker undergo withdrawal symptoms during abstinence, but he or she will also notice the absence of nicotine’s purportedly enhancing qualities. For instance, the mind may feel dulled because of the effects of withdrawal, but also because of the absence of the nicotine that provided the mild enhancement. In addition, the lack of nicotine may affect how medications and other substances are taken into the body, perhaps resulting in symptoms secondary to withdrawal but noxious nonetheless.
source:Dying to Quit by Janet Brigham
Dr. Gnap is a family practice physician and behavioral medicine specialist in suburban Chicago. Dr. Gnap developed the Inner Control™ Program in 1970 and has worked with thousands of people to improve and correct medical, emotional, behavioral and learning problems including performance. He started the Inner Control program because so many patients asked, “what more can be done along with traditional treatment methods?”