Smoking

Written by Emily Whitton
Emily Whitton
Counselling Directory Content Team

Reviewed by Kaye Bewley
Last updated 11th July 2023 | Next update due 10th July 2026

Smoking is one of the greatest causes of illness and premature death in the UK. It can create a number of problems, not only for the smoker but also for the people around them.

Second-hand smoke or passive smoking often leads to ill health in adults and can also harm young children and babies, increasing their risk of intense coughing, wheezing, and asthmatic symptoms. Here, we'll explore what it means to be addicted to smoking and how counselling/therapy can help you stop. 

What is smoking addiction?

Addiction refers to the emotional dependence on a substance or activity. Nicotine is the addictive substance found in tobacco, a plant that is used in products such as cigarettes, cigars and most e-cigarettes. Anybody who smokes can become addicted to nicotine, but generally, the younger you were when you started to smoke, the more likely you are to develop an addiction.

In this video, therapeutic counsellor Rachel Matthews explains why we can become addicted to smoking and how counselling can support those wanting to stop. 

When absorbed into the bloodstream, nicotine quickly reaches the brain, where pleasant, feel-good feelings are released by a chemical called dopamine. When taken in small amounts, nicotine can boost mood and create an adrenaline rush, making the person want more. As the nicotine wears off, it can make people irritable and cause unpleasant feelings, so the person may feel a need to smoke again.

Over time, withdrawal symptoms from not smoking get worse, so the person can become addicted to offset this - often increasing the amount of tobacco to get the same effect.


Why do people smoke?

For quite some time, a major effort has been underway to curb the world’s smoking habit. Laws are in place to prohibit smoking in certain areas, taxes on tobacco products continue to skyrocket and research highlighting the link between smoking and serious health issues continues to grow. So why might some people still smoke?

  • Boredom: Boredom can trigger a wide range of behaviours and habits, including smoking. The amount of excitement and novelty we require differs for each individual, which relates to how easily a person becomes bored.
  • Imitating parents: The habits of parents can influence their children. Research suggests a child is four times more likely to take up smoking if both parents smoke.
  • Self-expression: Smoking can start off as a form of self-expression and then develop into a habit. You might start smoking to stand out from the crowd but, the longer you continue, the easier it is to become addicted.
  • Social acceptance: Social acceptance is a key factor in why people start smoking from a young age. If you are the only non-smoker among your friends, it can be hard to resist as you feel the pressure to join in. Because of this, most people typically start smoking as teenagers.
  • Stress: Most adults quote stress as one of the main reasons they started or continue to smoke.

Effects of smoking

According to the NHS, smoking increases the chance of you developing more than 50 serious health conditions, such as:

  • Heart disease: Around one in six people develop heart disease due to smoking. It has been proven to be one of the biggest killers in the UK. 
  • Chronic obstructive pulmonary disease (COPD): Approximately 30,000 people in the UK die each year from COPD. Around nine in 10 of these deaths are linked to smoking. This disease causes people to be extremely ill for several years before they pass away.
  • Lung cancer: In the UK, around 35,000 people die from lung cancer every year. Smoking causes seven out of 10 of these deaths.
  • Other cancers: Smokers also develop other cancers including cancer of the throat, mouth, larynx, nose, oesophagus, kidney, blood (leukaemia), and bladder.
  • Sexual problems: Smoking can lead to impotency and other sexual problems in middle life.
  • Fertility: Long-term smoking harms fertility in both males and females.
  • Circulation: Smoking increases the risk of hardening of the arteries, which is also known as atheroma. Atheroma is one of the primary causes of strokes and heart disease.
  • Rheumatoid arthritis: Smoking increases the risk of developing rheumatoid arthritis, which causes inflammation of the joints.
  • Premature ageing: Smokers often develop more lines on their faces as the skin begins to dry, which can make them appear older than they actually are.
  • Menopause: Women who smoke start menopause an average of two years before a non-smoker.

Smoking can also worsen the symptoms of the following conditions: asthma, chest infections, tuberculosis, chronic rhinitis, diabetic retinopathy, Crohn's disease and multiple sclerosis. It can also increase the risk of developing: osteoporosis, dementia, pulmonary fibrosis, optic neuropathy, psoriasis, gum disease and tooth loss.

Therapists who can help you stop smoking

Quitting smoking

In July 2007, smoking was banned in the workplace and enclosed public spaces. This law is part of the Health Act 2006, which was established to introduce smoke-free environments for the benefit of all. With research showing that smoking accounts for more than one-third of respiratory deaths and around one-quarter of cancer deaths, the aim of this law is to benefit the life of the smoker and their colleagues in the workplace, with the goal of stopping smoking altogether.

It can be difficult to stop smoking, but the benefits are numerous. After one month of giving up, your skin will seem clearer, after three to nine months your breathing will have improved and after one year the risk of a heart attack or heart disease will have fallen dramatically.

The NHS and other organisations have promoted quit-smoking campaigns such as ‘Stoptober’ and ‘Go Smokefree’ to aid smokers in their fight to stop smoking. Other types of therapy, including counselling, have also proven successful when it comes to helping a smoker understand the effects of smoking on themselves, their family and their friends with the ultimate goal of stopping for good.

We often associate smoking with physical side effects, however, stopping smoking also has social, financial and emotional benefits.

Nicotine withdrawal 

Withdrawal symptoms are the physical and psychological effects you may experience during periods without nicotine. The more regularly you've been smoking, the more likely you are to experience withdrawal symptoms. These include dizziness, low mood or depression, irritability, anxiety and headaches.

Whilst withdrawal isn't dangerous, the effects can be unpleasant. They can last up to a few weeks but will get better each day you remain tobacco-free. Nicotine withdrawal is why many people find it so hard to quit smoking. 


Why should you stop smoking?

Stopping smoking can make a big difference to your overall health. The sooner you give up, the better you will feel. Even if you're not ready to stop in one go, reducing the amount you smoke will still be beneficial.

If you have been smoking since you were a young adult and stop before the age of 35, your life expectancy is only marginally less than a non-smoker. If you were to stop before you hit 50, the chance of you developing a smoking-related disease is halved.

  • Reduced risk of heart attacks and lung cancer: After one year of being smoke-free, the risk of having a heart attack decreases to half that of a smoker. After 10 years, the risk of lung cancer also decreases to half that of a smoker. After 15 years, the risk of having a heart attack falls to the same level as a non-smoker.
  • Helps to stop premature ageing: When you stop smoking, your facial ageing slows which delays the development of wrinkles. Ex-smokers also benefit from fresher breath, and whiter teeth, and are less likely to develop gum disease and lose their teeth prematurely.
  • Increased lung capacity: Within nine months of stopping smoking, you gain 10% of your lung capacity back. This may not necessarily be noticeable until you take part in an intensive sport or you go for a run.
  • Reduced stress levels: There is a common misconception that smoking decreases stress. The truth is, it only decreases stress when smoking a cigarette and for a short time afterwards. Between cigarettes, stress can actually be heightened due to cravings for the next fix. Removing this craving from your daily life helps to reduce stress, as you will no longer need to rely on smoking for instant relief.
  • Improved taste and smell: Another change many smokers will notice when they quit is a heightened sense of taste and smell. Around 4,000 chemical compounds in cigarettes dull your sense of taste, which will gradually return when you give up.
  • Stronger defence against cold and flu: After two weeks you will feel more energised as your circulation improves. It will be easier to fight off colds and flu, you will feel less tired and will even be less likely to suffer from headaches.
  • Improving the lives of others: As well as improving your own life, smoking cessation improves the lives of the people you live with. Children who live with smokers are three times more likely to develop lung cancer later in life, in comparison to children who live with non-smokers. So when you stop, the chances of the people you live with getting lung cancer and other smoking-related diseases dramatically drop.
  • The financial impact: If you smoke 20 cigarettes a day, you could save in excess of £2,000 a year when you give up.
  • The emotional impact: The emotional impact of smoking is often overlooked. There is always that constant nagging feeling that you need to stop, either from within or from increasing pressure from society.

A non-smoker may think that it's an easy habit to kick. The reality however is very different and many smokers find it incredibly difficult and often need support.


Stopping smoking: What help is available?

Around 70% of smokers say they want to quit. Stopping smoking can be done in a variety of ways including individual behavioural counselling, group behavioural therapy, telephone counselling and quit helplines.

Behavioural therapy

Behavioural therapy is based on the way you behave and/or the way you think. The objective of these therapies is to positively change your behaviours and thoughts to overcome problems. The most common type of behavioural therapy is CBT

Group behavioural therapy

Group behavioural therapy makes use of the group dynamic to change the way in which you behave. Having therapy in this way gives you the support of a group who have similar concerns to you.

Telephone counselling and quit helplines

Telephone counselling is accessible, affordable and can also be anonymous. It's becoming much more popular due to the increase in video conferencing software available on the Internet. One of the most important aspects that will help you succeed is support from others (both professional and personal).


What should I be looking for in a counsellor or therapist?

There are currently no laws in place stipulating what training and qualifications a counsellor must have in order to treat an addiction to smoking. However, the National Institute for Health and Care Excellence (NICE) has developed a set of guidelines that provide advice about the recommended treatments.

Overall, NICE say those keen to quit smoking should be referred to an evidence-based cessation service to help them stop smoking. Those who have been referred should be offered behavioural support together with drug treatment.

With regard to behavioural treatment, NICE recommends individual counselling or group behavioural sessions. Alternatively, telephone counselling and quit helplines have also proved effective.

Read the full NICE guidelines:

Tobacco: preventing uptake, promoting quitting and treating dependence.

There are several accredited courses, qualifications and workshops available to counsellors that can improve their knowledge of a particular area, so for peace of mind, you may wish to check to see if they have had further training in smoking cessation.


Coping with your cravings

You may find it easier to quit smoking if you are in control of your cravings. Research suggests that using sheer willpower alone might be too much of a task for some, so using a mixture of behavioural therapy and stop-smoking medicines is often recommended to help you.

A craving occurs when your body misses the regular hit of nicotine. Common cravings you might experience include:

  • The constant feeling in the back of your mind that you need a cigarette. This will decrease after the first few months of quitting.
  • Sudden urge that you need to smoke. These can be triggered by a cue. For example, if you always have a cigarette after dinner, as soon as you finish dinner you will get a craving. Other examples could be when you're stressed, angry or sad and you use a cigarette to relieve the stress of the situation.

You can tackle your cravings using nicotine replacement therapy (NRT), prescribed stop-smoking medicine and behavioural changes.

Nicotine replacement therapy: NRT satisfies nicotine cravings without the side effects you get from smoking a cigarette. This won’t give you the quick hit a cigarette does, but it can soothe these feelings you are having.

Stop smoking medicine: Prescription tablets are available that work on your brain to reduce cravings rather than replacing the nicotine in your system. Ask your doctor or stop-smoking counsellor to advise you on what medicines are available.

Behavioural changes: Smoking cessation behavioural changes aim to help you quit smoking for good, with the help of NRT and/or stop-smoking medicines.


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