How to quit smoking scientifically and effectively?

Many people think that quitting smoking is too difficult, and we often see netizens discussing how to quit smoking scientifically and effectively. Today, let’s talk about quitting smoking.

01. How to determine whether you are addicted to smoking?

Whenever I see the issue of smoking cessation, I think of the official document “China Clinical Smoking Cessation Guidelines” [1]. This is an authoritative smoking cessation guide issued by the National Health Commission (formerly known as the National Health and Family Planning Commission), the highest medical and health institution in my country. It is a professional smoking cessation intervention guide developed through the joint efforts of many top institutions, including the World Health Organization Collaborating Center for Tobacco or Health, the National Center for Disease Control and Prevention Tobacco Control Office, and the Chinese Association for Tobacco Control Hospital Tobacco Control Professional Committee.

Many people may be put off when they see that this is written as a clinical guideline, thinking that it is a doctor's business, which is definitely professional, but obscure and difficult to understand. However, as someone who has read the report, I would like to make it clear that this report is written in a very popular way and can be understood without a biomedical background. For example, the figure below is a self-test form for tobacco dependence, which is used to determine the physical and psychological dependence of smokers on tobacco.

(Tobacco Withdrawal Symptoms and Scale [1])

The content is very simple and does not require professional operation. You can evaluate yourself by referring to the table above. As long as you have experienced the above symptoms three times in the past year, you can be judged as tobacco dependent.

Of course, the above description may make people think that they may also show the above symptoms even if they do not smoke, such as increased appetite and inattention. In this case, the following tobacco dependence assessment scale is more direct.

(Tobacco Dependence Assessment Scale [1])

According to this table, you can directly judge whether you are addicted to tobacco and the degree of your tobacco dependence based on your smoking habits. Pay special attention to the first cigarette in the morning. The reason for this is that after a night's sleep, it is equivalent to a long-term withdrawal. If you want to smoke in the morning, it means that your tobacco dependence is particularly high. On the contrary, if you can smoke or not after waking up in the morning, it means that the degree of dependence is low.

02. What is withdrawal?

Having read this far, I believe you have already noticed a very important word here: withdrawal, because it is often followed by a word called withdrawal symptoms. Withdrawal symptoms are a psychological phenomenon, which mainly refers to the strong discomfort or even the opposite of the drug effect after stopping the use of drugs [2]. Of course, this situation is not only applicable to drugs, but also to some of our daily foods such as alcohol, tobacco, and even behaviors such as playing games. It is a result of "addiction". However, withdrawal reaction is not a purely psychological phenomenon, but a phenomenon closely related to physiology. For tobacco, withdrawal reaction also exists, and the main factor behind it is nicotine.

This simple molecule is one of the main components of tobacco. In fact, nicotine itself is nicotine, and all nightshade plants, including tobacco, have nicotine. This substance is actually toxic. The secretion of nicotine can be used for sterilization and immunity, etc., which can help tobacco resist the harm of nature and allow itself to survive better. However, tobacco may not have thought that it would be used by humans for smoking, and the result is that nicotine has entered the human body.

After nicotine enters the human body, it is transported to the central nervous system and then encounters a key substance, the acetylcholine receptor. This substance is the binding partner of the neurotransmitter acetylcholine and is used to transmit nerve signals. For example, in our neural reward center, the binding of acetylcholine causes the release of dopamine, which makes people excited. Then the receptor is released, dopamine is reduced, and the excitement is restored [3].

(Diagram of nicotine producing excitement)

But the emergence of nicotine changed this situation. Nicotine is a competitor of acetylcholine and it can also compete for acetylcholine receptors. In this case, in order to cope with the lack of acetylcholine receptors in the body, more acetylcholine receptors are generated. As a result, when smoking, nicotine will continue to bind to acetylcholine receptors, thus producing continuous excitement in the brain. Once you give up smoking, the excess acetylcholine receptors will remain vacant, resulting in a strong desire for tobacco, which is the withdrawal reaction mentioned above.

(Nicotine Addiction)

It can be seen that nicotine is the core factor of withdrawal reaction, and the current clinical smoking cessation strategies are mainly targeted at nicotine.

03. How to quit smoking scientifically?

How to quit smoking scientifically? In this "Chinese Clinical Smoking Cessation Guidelines", a total of 3 drugs are recommended, which are also the drugs currently approved by my country's CFDA, namely:

1. Nicotine patches and nicotine chewing gum (over-the-counter drugs);

2. Bupropion hydrochloride sustained-release tablets (prescription drug);

3. Varenicline (prescription drug).

These three drugs are actually divided into two types.

The first type: replacement therapy - nicotine patches, nicotine chewing gum

This method of quitting smoking is actually a gradual relief process. Taking into account the strong reactions of tobacco addicts, a gradual reduction in dosage is used to achieve the goal of reducing addiction.

Since nicotine products contain nicotine, they can supplement the nicotine needs of smokers to satisfy those acetylcholine receptors, acting as a transition and buffer, so smokers will not have a strong withdrawal reaction, which is better than relying on willpower alone to resist. After all, change is difficult for everyone, especially when it involves the central nervous system's need for nicotine, which helps to get through the torment of the stage. But at the same time, the nicotine content is low and will not exceed the nicotine content of tobacco itself, so it is relatively safe and belongs to non-prescription OTC drugs.

The second type: direct blocking - bupropion hydrochloride sustained-release tablets, varenicline

For patients with severe smoking addiction, neurological drugs may be used. The two prescription drugs recommended by the "Chinese Clinical Smoking Cessation Guidelines" are both psychotropic drugs that act directly on the nervous system. Bupropion hydrochloride sustained-release tablets are well-known antidepressants, and varenicline acts on the acetylcholine receptors mentioned above and is a partial agonist of the nicotinic acetylcholine receptor α4β2.

The above two substances have strong psychoactive effects and many toxic side effects. They can cause depression and other mental disorders, and may even lead to suicide [4]. This is also an important factor in the strict control of such psychotropic drugs in many countries. my country has classified them as prescription drugs, which must be diagnosed in a hospital, prescribed by a doctor, and used under the supervision of a doctor.

The above are all drugs mentioned in the official guidelines. They are also official drugs that have been studied and approved by multiple departments. They have undergone many studies and are therefore relatively safe choices in all current channels.

In general, smoking addiction can be quit, and countless people have demonstrated this, so everyone must have confidence. Of course, quitting smoking is painful, not only because it is a test of willpower, but also because of the physiological barrier of acetylcholine receptor binding in our brain, which can be said to be even more difficult. This is also the fundamental factor of withdrawal reaction. Be determined, strengthen your will, and use smoking cessation auxiliary drugs to alleviate withdrawal symptoms, and strive to successfully quit smoking as soon as possible.

Finally, I would like to repeat one sentence to all non-smokers: Smoking is harmful to your health!

1National Health and Family Planning Commission of the People's Republic of China, Chinese Clinical Smoking Cessation Guidelines (2015 edition).

2 Hughes, John R., and Dorothy Hatsukami. "Signs and symptoms of tobacco withdrawal." Archives of general psychiatry 43.3 (1986): 289-294.

3 Benowitz, Neal L. "Nicotine addiction." New England Journal of Medicine 362.24 (2010): 2295-2303.

4 Varenicline: suicidal thoughts and behaviour. London: MHRA;2008