Stop me if you’ve heard this one before: Smoking is bad for you.

For more than 55 years, we’ve known that tobacco is bad for our health — so bad that it kills us. Each year, more than 440,000 people die in our country because of tobacco use, and more than 5,000 of them are Minnesotans.

The community, the government and nonprofit groups have been educating the American people about tobacco’s dangers for decades, and it’s hard to find someone who hasn’t been touched personally by the deadly diseases it causes.

And yet, despite better education on the subject, improved methods for helping people quit and policies banning smoking in public places, tobacco remains the single largest, preventable cause of death in the U.S. About one in five Minnesotans still smoke.

Why? Because nicotine, the drug in tobacco that causes addiction, is that powerful.

How does nicotine work?

What kind of effect does nicotine have on a person? Well, let’s look at a typical smoker.

Sarah puffs on her cigarette 10 times during the five minutes that it takes her to smoke it. When she smokes a cigarette, she receives 1 to 2 milligrams of nicotine, which rapidly enters her bloodstream.

When the nicotine hits Sarah’s brain, it signals her adrenal glands to release epinephrine, or adrenaline. The rush of adrenaline stimulates her body to quickly release glucose and increase her blood pressure, breathing and heart rate. Because nicotine also suppresses the insulin output from Sarah’s pancreas, her blood sugar level is slightly higher than usual.

But that’s not what keeps Sarah coming back for more. Sarah smokes cigarettes because nicotine makes her feel good. How does it do this? By lifting the lid on a natural chemical, called dopamine, in Sarah’s brain.

Nicotine literally changes the chemical makeup of your brain so that you want more and more of it.Dopamine causes a person to feel pleasure — some natural stimuli that prompt its release are food and sex. Nicotine increases the level of this key brain chemical, just as other often-abused drugs do, producing the pleasing sensation Sarah craves. (Some smokers describe this feeling as a “buzz.”)

Cigarette smoking is a very effective means of delivering nicotine in Sarah’s system. It quickly pumps the drug into her brain — levels peak within 10 seconds of inhalation. But the acute effects of nicotine and the good feeling start to dissipate in a few minutes. Why?

Nicotine literally changes the chemical makeup of your brain so that you want more and more of it.

What does this mean for Sarah? In order to keep feeling good and to avoid the unpleasantness of withdrawal, she must keep smoking — more and more, in fact. If Sarah goes a couple of hours without nicotine, she feels lousy. She finds that she’s irritable. She craves a cigarette and can’t think as clearly or stay focused on anything else.

Before long, Sarah, who started out having a couple of “social” smokes with friends, finds herself having two cigarettes a day (and not always socially).

Soon there isn’t enough —  because smoking two cigarettes a day makes her want to smoke five, and smoking five makes her want to smoke ten. Now Sarah is smoking 30 cigarettes each day, giving her brain up to 300 daily “hits” of nicotine, and always wanting more.

She has become convinced that she needs to smoke to be comfortable, and, in a way, she’s right: after all, her brain has been trained — and is still being trained — to crave more and more nicotine.

The hidden cost

Nicotine is what makes tobacco addictive to the majority of users, but that might not be so bad if that were all it contained. Cigarette smoke contains many other dangerous chemicals, including tar and carbon monoxide. According to the former U.S. Surgeon General C. Everett Koop, at least 19 of them are known to cause cancer.

When Sarah smokes a cigarette, the nicotine immediately causes her blood pressure and heart rate to rise and her arteries to narrow. Meanwhile, carbon monoxide in the smoke reduces the amount of oxygen her blood can carry. So, as the nicotine creates a demand for more oxygen, the carbon monoxide decreases the amount that can be supplied. And that’s just the short-term effect.

Over time, smoking increases the risk of her arteries hardening. Dangerous chemicals damage the inner walls of the arteries, resulting in fatty buildups that cause the vessels to narrow and harden. Because smoking also increases Sarah’s chances of blood clots, she is now more likely to have a heart attack.

Smoking puts Sarah at advanced risk for lung cancer; emphysema, heart and respiratory disease and many other ailments. The more she smokes, the more she wants to smoke, and every cigarette puts her at even greater risk.

Sarah is aware of the way that her smoking influences her behavior; she is even aware of the harms it may someday cause her.

The National Institute on Drug Abuse noted that “addiction is characterized by compulsive drug seeking and use, even in the face of negative health consequences. It is well documented that most smokers identify tobacco use as harmful and express a desire to reduce or stop using it, and nearly 35 million of them want to quit each year. Unfortunately, only about 6 percent of people who try to quit are successful for more than a month.”

Still Sarah finds it too difficult to quit on her own.

Hopeful signs – quitting smoking

There are some hopeful signs. The fact that most smokers realize the dangers of smoking — and that most of them want to quit — is an extremely positive thing in itself.

Today, our understanding of addiction and nicotine is better than it used to be, and that means our methods for helping break the addiction are better, too.

Medications have been developed and are readily available. Nicotine replacement therapies, such as nicotine gum and the patch, relieve withdrawal symptoms. Although they supply users with nicotine, these products do not produce as potent physiological effects – nor do they create the same pleasurable sensations that a cigarette does. They also do not contain the cancer-causing toxins of cigarettes. All nicotine replacement products — gum, patch, lozenge, spray and inhaler — appear to be effective, and most are available over the counter.

In addition, there are prescription drugs that can help, such as bupropion (marketed as Zyban), which is in the antidepressant class of drugs. A new drug, varenicline tartrate (Chantix), recently received Federal Drug Administration approval. This medication may help people quit by easing withdrawal symptoms and blocking effects of nicotine.

Research studies have been conducted, and the results show that such aids are effective, particularly when combined with behavioral therapy.

Quitting smoking has immediate health benefits. Within 24 hours of quitting, your blood pressure and risk of heart attack decrease. Over time, your risks for stroke, lung cancer and coronary heart disease lessen.

But when you first stop the flow of nicotine, you’re likely to feel irritable, impatient, hostile, anxious, depressed, unfocused, restless and hungry. The withdrawal symptoms hurt enough that nicotine addiction has long been rated one of the hardest addictions to break.

And so, despite the clear benefits of quitting, for about 18 percent of Minnesota’s adults, some 666,000 residents, quitting smoking remains a wish or a dream. The simple fact is, most people need at least a little help. Although some people are able to quit without assistance, it has been proven that medications and help in changing behaviors increase your chances of success.

In Minnesota, there are numerous resources for quitting help. Whichever way you choose to quit, you will take four steps:

1. Decide to quit
2. Set a date and pick a plan
3. Survive withdrawal
4. Stay tobacco-free

Use your loved ones for motivation, but remember: It’s your decision and your responsibility.Decide to quit: You’re on your own for this step. Only you can decide to quit. And, you can only quit for yourself. However, others may want you to quit, and you may want to quit for your spouse, your children, your grandchildren or your friends. But, ultimately, you have to decide to quit for you.

You should recognize that by not smoking you won’t have to worry about inadvertently promoting smoking to your children and grandchildren. And, as a nonsmoker, you will be protecting those you love from the dangers of your secondhand smoke.

So, use your loved ones for motivation, but remember: It’s your decision and your responsibility.

Set a date: Get started by choosing a specific day within the next month as your “Quit Day.” Set the date soon so that you can ride a bit on your energy from making the decision to quit, but do give yourself time to really prepare to succeed. Some people use a special day, like a birthday or holiday. No matter how you choose the day, make sure that you circle it on your calendar and engrave it in your mind: That’s the day you quit. Shore up your support by telling friends and relatives who will be helpful and encouraging. Ask them, and be specific, for what you need from them leading up to your quit date and on that day.

Pick a plan: Planning and commitment, not luck, will make you successful. Check with your employer, insurance or health care provider. You may have resources for quitting through those channels. Those of us who help people quit smoking use what we call The Five A’s:

1. Ask — Do you smoke?
2. Advise — Quitting is the most important thing you can do for your health.
3. Assess — Do you want to quit this month?
4. Assist — Prepare for your quit date.
5. Arrange — Schedule your first follow-up session one week after the quit date.

Consider using the nicotine patch, gum or lozenge, joining a class or support group, or using self-help books and pamphlets. Consult with your health care provider to help you determine the most appropriate course for you. This may include a prescription drug. Prayer and meditation, which are important in 12-Step recovery programs, can also be helpful in quitting smoking. Most likely, you will use several of these options.

Survive withdrawal: The good news is that nicotine replacement can ease many of the physical symptoms of withdrawal. The bad news is that the mental symptoms are often tougher to shake off. Many smokers miss the ritual and physical sensations of lighting and smoking cigarettes.

That’s where some outside assistance can really help. Talking with someone who understands the ups and downs of quitting can help you:

• Identify the events, places and people that trigger an urge to smoke.
• Discuss tactics to avoid or defuse those triggers.
• Recognize and refute rationalizations that may sabotage your attempt.
• Practice strategies to deal with your cravings, from rehashing your reasons to quit to taking five deep breaths.
• And, of course, celebrate your successes.

Stay tobacco-free: Once you get over the initial withdrawal period, you’ll find yourself in what we call the “maintenance” phase. Now’s the time to reconnect with your non-smoking friends and stick to smoke-free places. You may experience a strong desire to smoke months or even years after you’ve quit. Stress is often cited as the culprit for resuming smoking. There’s no escaping stress for anyone. You can’t choose to be “stress-free,” but you can choose to be “tobacco-free.” Physical activity is one good stress-reducer. Relaxing hobbies are another.

Quitting smoking is a challenge, but nationwide and here in Minnesota, more people have quit than are still smoking.

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Ann Wendling, M.D., M.P.H., was the Director of Intervention Programs at the Minnesota Partnership for Action Against Tobacco (now ClearWay Minnesota)

Last Updated on January 4, 2022