Failure to Quit:

Biological, psychological, behavioral, and cultural factors all play a role in nicotine addiction, making smoking one of the hardest addictions to beat. About half of people who quit return to smoking. Even after years of not smoking, some ex-smokers still have occasional cravings for cigarettes.

Some experts suggest that, in addition to depression, there are three major areas responsible for the inability to quit:

• Mental performance. Nicotine improves concentration and thinking. Quitting smoking temporarily impairs one's mental performance.
• Stress. Although smoking many not reduce stress, stopping certainly increases it.
• Weight gain. Quitting smoking can cause you to gain weight. Studies are mixed on whether weight gain is permanent in most smokers or not. Certainly, it is a major factor in relapse. [See "Weight Gain" section in this report.]

How well a person does in the first 2 weeks of smoking cessation is critical to their success. Smokers should not be shy about seeking all the help they can during this period. Although withdrawal symptoms can be intense, treatments are available to reduce them.

Attempts to quit are never a waste of time, since the amount of smoking is reduced during these periods. People who keep trying still have a 50 - 50 chance of finally quitting.

Individual Risk Factors for Failure

Researchers have been trying to discover individual risk factors or sets of behaviors that can help predict why specific people fail to quit. Some factors include:

• Being female
• Being a heavy smoker
• Inhaling deeply
• Being a long-term smoker
• Having severe withdrawal symptoms

Among many studies, however, only one found a single consistent factor for failure to quit: Cheating during the first 2 weeks of withdrawal, even with the patch, nearly guarantees that a person will smoke again in 6 months.

Women and Smoking

Studies show that women have a harder time trying to quit smoking and have less success with abstinence programs than men. There are many proposed reasons for this:

• Nicotine has different effects on mood in women compared to men. Women who quit may have greater anxiety and stress than men who quit.
• Women are not as physically dependent on nicotine as men, but they are more addicted to the actual behavior of smoking, which is the more powerful deterrent to quitting. This may be the reason why nicotine replacement, which only reduces cravings, tends not to be as effective in women.
• Women may fear weight gain after quitting more than men.
• Certain phases in the menstrual cycle may reduce the response to drugs that are used to help women quit smoking.
• Men may be less supportive than women in helping their partners quit.
• Women trying to quit may miss the feeling of control associated with smoking more than men.

On the positive side, evidence suggests that when women quit, their lung function seems to improve more rapidly than in men who quit.