Because loneliness chooses it, it will make you more lonely

This is the 3871th article of Da Yi Xiao Hu

Friends who smoke often tell me that they smoke to get rid of loneliness and escape solitude. Some even say that they smoke to relieve loneliness. Is this really the case?

Today I will tell you a story.

Last month, Xiao Wang’s wife came to my smoking cessation clinic again. This time she came alone. She told me that Xiao Wang had relapsed. If I remember correctly, this is his third relapse. But the first two times, the couple came to my clinic together, and they had a good chat. I prescribed smoking cessation medicine, and he continued to quit smoking for more than half a year. This time, Xiao Wang’s wife came alone, and I felt very strange. Why didn’t your Xiao Wang come? His wife sighed and said that it turned out that Xiao Wang was sent by his unit to a mountainous area in the inland to do a project. There were few people there, and he stayed alone for nearly two months. He felt lonely and bored, so he started smoking again. This time he came back and increased his daily cigarette intake to two packs of cigarettes a day. So he thought of coming to the smoking cessation clinic to get some medicine.

To be honest, I don't approve of this kind of family members dispensing medicine on behalf of others. Especially for patients who have relapsed many times, I must have a good chat with him and find out the reasons for relapse before I can prescribe the right medicine. I asked: "Why didn't your Xiao Wang come to the clinic?" His wife said: "This time Xiao Wang became a little strange after returning home. He didn't leave the community for two weeks. Every day at home, he just slept, smoked and watched TV. He was not even interested in his favorite spicy crayfish." I asked casually: "Did he encounter any unpleasant things, at work, at home?" His wife replied: "No, the unit also gave Xiao Wang a big reward because he went to the mainland to work in difficult conditions." At this point, I suddenly remembered a case of a heavy smoker with depression that I had seen before. I reminded his wife: "This time, quitting smoking needs to be temporarily delayed. Can you take him to the psychologist's clinic for consultation? Watching TV and smoking every day for two weeks always seems a bit wrong."

Last week, Xiao Wang and his wife came to my clinic again. It turned out that he had actually been to the psychological counseling clinic for treatment and was diagnosed with mild depression. The doctor analyzed that it might be related to his work environment in the past two months and also related to his smoking. The psychologist also strongly recommended that he quit smoking. Xiao Wang's relapse after quitting smoking several times might also be related to his mild depression. It seems that both smoking and depression need to be treated.

Smoking not only cannot relieve loneliness, but may even aggravate loneliness, depression, and anxiety. After smoking, the nicotine in tobacco enters the brain through the lungs, acts on the nicotine receptors in the brain, and then produces dopamine, which can bring transient excitement and pleasure to the brain. However, when this part of dopamine is exhausted, a low mood will appear. At this time, it is often necessary to smoke more tobacco and ingest more nicotine to maintain the release of dopamine. At the same time, it will lead to a state of more depression. Once you fall into such a vicious cycle, it will lead to the emergence of depression and anxiety. After the brain is stimulated by nicotine, some irreversible changes will also occur. An interesting study found that smokers have lower brain activation when watching pictures of delicious food than non-smokers. Studies have found that smokers are more likely to suffer from depression and anxiety among patients with acute myocardial infarction. There is evidence that nicotine exposure during adolescence may have adverse effects on the brain: the limbic system that controls cognition, emotion, and reward gradually matures during adolescence and is particularly susceptible to the long-term effects of nicotine. Abnormal activation of nicotinic acetylcholine receptors during adolescence can cause persistent changes in neuronal signaling. Multiple animal experiments have shown that chronic nicotine exposure during adolescence leads to long-term deficits in learning and cognitive processes, such as decreased attention and memory, and increased impulsivity and anxiety.

A recent 12-year follow-up study of more than 9,000 people published in The Lancet found that smoking leads to more severe social isolation and stronger loneliness than non-smokers. "Smokers" communicate less with their families and participate less in social activities, and the older they smoke, the more serious this situation becomes. Tobacco dependence and negative emotions such as depression are mutually causal, creating a vicious cycle. In fact, in addition to the mental factors such as depression and anxiety caused by smoking itself, passive smoking can also have an impact. Many studies have shown that pregnant women who are passively smoked are more likely to experience mental states such as anxiety and depression.

There is an old Chinese saying that drinking to drown your sorrows only makes you more sorrowful. In fact, smoking to relieve loneliness will only make you more lonely. The correct way is to quit smoking as soon as possible, participate in more social activities, or even consult a psychologist.

References

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2 Goriounova NA, Mansvelder HD. Short‑and long‑term consequences of nicotine exposure during adolescence for prefrontal cortex neuronal network function[J]. Cold Spring Harb Perspect Med, 2012, 2(12)

3 England LJ, Aagaard K, Bloch M, et al. Developmental toxicity of nicotine: A transdisciplinary synthesis and implications for emerging tobacco products[J]. Neurosci Biobehav Rev, 2017, 72: 176‑189

4 Cao Miao, Zhang Haiyong, Xiao Shuqin. Comparison of anxiety and depression levels between smoking and non-smoking patients with acute myocardial infarction during hospitalization[J]. Chinese Journal of Modern Nursing, 2011, 17(25): 2992-2994. DOI: 10.3760/cma.j.issn.1674-2907.2011.25.005

5 Rubinstein ML, Luks TL, Moscicki AB, Smoking-cue induced brain activation in adolescent light smokers. J Adolesc Health, 2011,48(1): 7-12.

6 Philip KEJ, Bu F, Polkey MI, et al. Relationship of smoking with current and future social isolation and loneliness: 12-year follow-up of older adults in England[J]. The Lancet Regional Health-Europe, 2022, 14: 100302.

Author: Shanghai Fengxian District Central Hospital

Liu HongweiChief Physician