Why is smoking addictive?
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 are when you start 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.
Nicotine withdrawal
Withdrawal symptoms are the physical and psychological effects that 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/or 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 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 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.
The stress myth
Many smokers believe that smoking reduces stress, but the NHS says this isn't true. When a smoker doesn't smoke in a while, the craving they experience can lead them to feel irritable and stressed. Naturally, when they have a cigarette, this feeling is temporarily eased. The stress they feel is caused by the act of smoking, and by quitting smoking, they can actually reduce stress and anxiety levels.
Physical effects of smoking
According to the NHS, smoking increases the chance of 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.
- 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 impotence 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 many conditions, including asthma, Crohn's disease and multiple sclerosis. It can also increase the risk of developing conditions such as osteoporosis, dementia, pulmonary fibrosis and gum disease.
Interested in what you have to gain when giving up? Here are 10 benefits of quitting smoking.
The link between smoking and mental health
Nicotine stimulates our dopamine production, the feel-good hormone. Because of this interaction with our brain chemistry, smoking can have a big impact on our mental health. Smoking can be correlated with the following mental health conditions:
- depression
- bipolar disorder
- ADHD
- schizophrenia
- post-traumatic stress disorder
Read more about the studies exploring the link between smoking and these conditions at Action on Smoking and Health.
Whether or not it's smoking that leads to mental health issues or the other way around is still being researched. Generally, though, those living with a mental health condition can find themselves more heavily addicted to smoking and therefore find it more difficult to quit.
Over time, smoking slows down our ability to produce dopamine, making smoking one of the only ways to get it. When mental health conditions that rely on dopamine are at play, it's easy to see why smoking becomes an obstacle to getting better but it is also difficult to stop.
How quitting smoking improves mental health
When you quit smoking, your dopamine function can return to normal, meaning you no longer rely on cigarettes to feel good. Several studies show that those who quit smoking experience improvement in anxiety and depression scores, including this 2023 study. There is even evidence to suggest that quitting smoking is as effective as antidepressants in improving mood.
The ups and downs of stress levels you may have experienced when smoking and craving cigarettes also level out, helping you feel more able to handle stress. Your physical health should also improve, helping to generally improve the quality of your life.
Of course, there's also the sense of accomplishment that comes with stopping smoking. Knowing you've taken control of your health and are making positive changes can help to boost your mood.
Stopping smoking: What help is available?
Around 70% of smokers say they want to quit, but going cold turkey doesn't always work. Instead, planning to quit and getting support along the way can improve your chances of success.
Stopping smoking can be done in a variety of ways including:
- nicotine replacement therapy (NRT)
- prescription medications
- NHS stop-smoking services
- quit smoking helplines
- talking therapies
Telling those around you that you plan to quit and having their support can be imperative. They can encourage you, help you avoid craving triggers and celebrate your wins with you. Self-care along the journey can help too, ensuring you're managing stress, eating a balanced diet and moving your body where possible.
Coping with cravings
You may find it easier to quit smoking if you are in control of your cravings. 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 happens 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.
What talking therapies help you stop smoking?
Working with a professional like a counsellor can offer invaluable support. If you find you're using cigarettes to help you feel calmer or better, talk therapy can help you identify healthier ways to do this. Here are some therapies to explore:
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 and better cope with stress. The most common type of behavioural therapy is CBT and a 2025 study found those trying to quit smoking are twice as likely to quit when having CBT.
Group behavioural therapy
Group behavioural therapy makes use of the group dynamic to help change unhealthy behaviours. 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 and quit helplines are accessible, affordable and can also be anonymous. It's becoming easier than ever due to the increase in video conferencing software available.
What should I be looking for in a counsellor or therapist?
There are currently no laws in place stating 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.
Start your stop smoking journey today and use our site to find the right counsellor for you.
