No joking on smoking: My top ten tips for giving up smoking this Stoptober

Although most of my academic research is on behavioural addiction, I have published quite a few papers on more traditional addictions such as alcohol addiction and nicotine addiction (see ‘Further reading’ below). In 2012, I had to watch my mother fight a losing battle with smoking-related lung cancer and chronic obstructive pulmonary disease. She died in September 2012 aged 66 years, and had chain-smoked most of her adult life. This followed the death of my father who also died of smoking-related heart disease, aged just 54.

In my previous blog I looked at ways to reduce alcohol intake as part of the ‘Go Sober For October‘ campaign. In today’s blog I provide my advice for giving up smoking as part of the annual ‘Stoptober’ campaign. In the UK smoking accounts for approximately one in four cancer deaths, and as I said, it’s something I’ve witnessed first-hand. I’m sure most people reading this are aware of the addictive nature of nicotine. As soon as nicotine is ingested via cigarettes, it can pass from lungs to brain within ten seconds and stimulates the release of the neurotransmitter dopamine. The release of dopamine into the body provides reinforcing mood modifying effects. Despite nicotine being a stimulant, many people use cigarettes for both tranquillising and euphoric effects.

Most authorities accept that nicotine is one of the most addictive drugs on the planet and that smokers can become hooked quickly. One of the reasons my own parents were never able to give up was because of the prolonged withdrawal effects they experienced whenever they went more than a few hours without smoking. This would lead to intense cravings for a cigarette. Watching both my parents’ die of smoking-related diseases is enough incentive for me to never smoke a cigarette. Hopefully, others can find the incentives they need to help them give up permanently. Here are my top ten tips to help you (or someone you know and love) stop smoking:

• (1) Develop the motivation to stop smoking: Many smokers say they would like to stop but don’t really want to. When you take stock, make sure you are clear as to why you want to give up. It may be to save money, to improve your health, to prevent yourself getting a smoking-related disease, or to protect your family from passive smoking. (It could of course be all of the above). Really wanting to give up is the best predictor of successful smoking cessation.
• (2) Get all the emotional support you can: Another good predictor of whether someone will overcome their addiction to nicotine is having a good support network. You need people around you that will support your efforts to quit. Tell as many people that you know that you are trying to quit. It could be the difference between stopping and starting again.
• (3) Avoid ‘cold turkey’: Although some people can stop through willpower alone, most people will need to reduce their nicotine intake slowly. The best way of doing this is to replace cigarettes with a safe form of nicotine such as those available from the pharmacy, or on prescription from the doctor.
• (4) Get support from a professional: Even if you are using a safe form of nicotine from your pharmacist or doctor, cutting out cigarettes completely can be hard. Getting support from a trained NHS stop smoking adviser can double your chances of stopping smoking. To find your nearest free NHS stop smoking service (in the UK call 0300 123 1044) or visit the Smokefree website.
• (5) Use non-nicotine cigarette shaped substitutes: Smoking is also a habitual behaviour where the feel of it in your hands may be as important as the nicotine it contains. The use of plastic cigarettes or e-cigarettes will help with the habitual behaviour associated with smoking but contain none of the addictive nicotine.
• (6) Use relaxation techniques: When cravings strike, use relaxation exercises to help overcome the negative feelings. At the very least take deep breaths. There are dozens of relaxation exercises online. Practice makes perfect.
• (7) Treat yourself: One of the immediate benefits of stopping smoking will be the amount of money you save. At the start of the cessation process, treat yourself to rewards with the money you save.
• (8) Focus on the positive: Giving up smoking is one of the hardest things that anyone can do. Write down lists of all the positive things that will be gained by stopping smoking. Constantly remind yourself of what the long-term advantages will be that will outweigh the short-term benefits of smoking a cigarette. In short, focus on the gains of stopping rather than what you will miss about cigarettes.
• (9) Know the triggers for your smoking: Knowing the situations in which you tend to smoke can help in overcoming the urges. Lighting up a cigarette can sometimes be the result of a classically-conditioned response (e.g. having a cigarette after every meal). These often occur unconsciously so you need to break the automatic response and de-condition the smoking. You need to replace the unhealthy activity with a more positive one and re-condition your behaviour.
• (10) Fill the void: One of the most difficult things when cigarette craving and withdrawal symptoms strike is not having an activity to fill the void. Some things (like engaging in physical activity) may help you in forgetting about the urge to smoke. Plan out alternative activities and distraction tasks to help fill the hole when the urge to smoke strikes (e.g. chew gum, eat something healthy like a carrot stick, call a friend, occupy your hands, do a word puzzle, etc.). However, avoid filling the void with other potentially addictive substances (e.g. alcohol) or activities (e.g. gambling).

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Griffiths, M.D. (1994). An exploratory study of gambling cross addictions. Journal of Gambling Studies, 10, 371-384.

Griffiths, M.D. (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, 191-197.

Griffiths, M.D. (2012). First person: Highly-addictive drug killed both of my parents. Nottingham Post, October 1, p.13.

Griffiths, M.D., Parke, J. & Wood, R.T.A. (2002). Excessive gambling and substance abuse: Is there a relationship? Journal of Substance Use, 7, 187-190.

Griffiths, M.D., Wardle, J., Orford, J., Sproston, K. & Erens, B. (2010). Gambling, alcohol consumption, cigarette smoking and health: findings from the 2007 British Gambling Prevalence Survey. Addiction Research and Theory, 18, 208-223.

Griffiths, M.D., Wardle, J., Orford, J., Sproston, K. & Erens, B. (2011). Internet gambling, health. Smoking and alcohol use: Findings from the 2007 British Gambling Prevalence Survey. International Journal of Mental Health and Addiction, 9, 1-11.

Resnick, S. & Griffiths, M.D. (2010). Service quality in alcohol treatment: A qualitative study. International Journal of Mental Health and Addiction, 8, 453-470.

Resnick, S. & Griffiths, M.D. (2011). Service quality in alcohol treatment: A research note. International Journal of Health Care Quality Assurance, 24, 149-163.

Resnick, S. & Griffiths, M.D. (2012). Alcohol treatment: A qualitative comparison of public and private treatment centres. International Journal of Mental Health and Addiction, 10, 185-196.

Sussman, S., Lisha, N. & Griffiths, M.D. (2011). Prevalence of the addictions: A problem of the majority or the minority? Evaluation and the Health Professions, 34, 3-56.

Umeh, K. & Griffiths, M.D. (2001). Adolescent smoking: Behavioural risk factors and health beliefs. Education and Health, 19, 69-71.

What a drag: A brief look at cigarette smoking and nicotine dependence

Cigarette smoking among adults (i.e., those aged 18 years and over) has been a highly prevalent behaviour in Great Britain for decades but overall rates have significantly declined in recent times. Figures show that the highest recorded level of nicotine smoking among British males was in 1948 when four-fifths smoked (82%) although at that time only two-thirds smoked manufactured cigarettes (as the rest smoked pipes and/or cigars). The highest recorded level of nicotine smoking among British females was in the mid-1960s (45%) slightly higher than the prevalence rate of 41% in 1948.

A 2003 study by Dr. M. Jarvis in the journal Addiction reported that since 2000 the overall adult smoking rates in Great Britain had been declining by around 0.4% per year. More recently, the British prevalence rates of smoking remained constant at 21% between 2007 and 2009 (according to a 2013 report by Action on Smoking and Health [ASH]). According to the 2013 Office for National Statistics report, the most recent prevalence rate is 20% (21% of men and 19% of women). This equates to around 10 million British adult cigarette smokers. Smoking prevalence rates are highest in young adults. More specifically, in the 20-24 year age group, the prevalence rate of nicotine smoking is 30% in males and 28% in females. Only 1% of children are nicotine smokers at the age of 11 years. By the age of 15 years, 11% of children are regular smokers. As the 2013 ASH report noted:

“Since the mid 1970s cigarette consumption has fallen among both men and women. The overall reported number of cigarettes smoked per male and female smoker has changed little since the mid 1980s, averaging 13 cigarettes per smoker per day. As in previous years, men smoked slightly more per day on average than women and there was an association between consumption and socio-economic group. In 2011, smokers in manual occupations smoked an average of 14 cigarettes a day compared with 11 a day for those in managerial or professional groups… In 2011, 63% of smokers said they would like to stop smoking altogether. Other ways of measuring dependence include how difficult people would find it to go for a whole day without smoking and how soon they smoke after waking… In 2011, 60% of smokers said they would find it hard to go for a whole day without smoking. Eighty-one per cent of heavier smokers (20 or more a day) said they would find it difficult, compared to 32% of those smoking fewer than 10 cigarettes per day”.

Like drug addictions more generally, nicotine addiction is a complex combination of influences including genetic, pharmacological, psychological, social and environmental factors. In 2010, the US Surgeon General asserted that “there is no established consensus on criteria for diagnosing nicotine addiction” but that there are a number of symptoms can be viewed as addiction indicators such as:

• Drug use that is highly controlled or compulsive with psychoactive effects
• Stereotypical patterns of use
• Continued use despite harmful effects
• Relapse following abstinence accompanied by recurrent cravings.

A 2000 report by the Royal College of Physicians also noted that nicotine fulfils criteria for defining an addiction and states that:

“It is reasonable to conclude that nicotine delivered through tobacco smoke should be regarded as an addictive drug, and tobacco use as the means of self-administration…Cigarettes are highly efficient nicotine delivery devices and are as addictive as drugs such as heroin or cocaine.”

One of the key characteristics of drug addiction or dependence on a substance is the degree of compulsion experienced by the user. Since 1992, the British General Lifestyle Survey (which typically surveys around 15,000 adults from over 9000 households annually) has asked three questions relevant to nicotine dependence and addiction. The first is whether the person would like to stop smoking, the second is whether person would find it easy or difficult not to smoke for a whole day, and the third is how soon after waking up they smoke their first cigarette. Since 1992, there has been almost no change in any of the three measures.

The latest 2013 survey reported that 63% of smokers said they would like to stop smoking altogether and 60% felt it would be difficult for them to go a day without smoking. Four-fifths (81%) of heavy smokers (i.e., those smoking 20 or more cigarettes a day) said they would find it difficult to give up smoking compared to one-third (32%) of lighter smokers (i.e., those smoking less than 10 cigarettes a day). The average number of cigarettes smoked per day is 13, and 14% smoke a cigarette within five minutes of getting up in the morning, a figure that rises to 35% among heavy smokers who smoke more than 20 cigarettes a day. Research consistently shows that approximately two-thirds of smokers want to quit the behaviour yet the majority are unable to do so, which is also suggestive of a genuine addiction. Those that do try to quit smoking typically experience a wide range of withdrawal symptoms including craving for nicotine, irritability, anxiety, difficulty concentrating, restlessness, sleep disturbances, decreased heart rate, and increased appetite or weight gain.

Outside of Great Britain, tobacco and other drug use prevalence have been examined extensively among youth and adults. For example, by the Monitoring the Future research group in the U.S. (http://monitoringthefuture.org). They reported that daily (20 or more days in last 30 days) cigarette smoking varied from 11.4% among 18 year olds to 17% among 50 year olds. One may infer that daily cigarette smoking is addictive use, though several studies measure tobacco (nicotine) addiction specifically. Tobacco addiction (dependence) among older teenagers has been found to vary between 6% and 8%. Studies have found a prevalence rates of between 1.7% to 9.6% for tobacco addiction among college students.

In a 2004 issue of the Archives of General Psychiatry, Dr. Jon Grant and colleagues found a prevalence of 12.8% for tobacco addiction among a U.S. national sample of adults. A few years later in a 2009 issue of the American Journal of Public Health, Dr. R.D. Goodwin and colleagues found a prevalence of 21.6% and 17.8% for tobacco addiction among a U.S. national sample of male and female adults, respectively. It appears that daily smoking demonstrates about the same level of prevalence as direct measures of dependence, particularly among adults.

In a 2011 study that I carried out with Dr. Steve Sussman and Nadra Lisha, we estimated that past year nicotine dependence prevalence in the general adult population of the U.S. as being approximately 15%. A different summary of research on the epidemiology of drug dependence has shown that of all people who initiate cigarette use, almost one-third become addicted smokers (32%), a figure that is much higher addiction rate than for users of heroin (23%), cocaine (17%), alcohol (15%) or cannabis (9%).

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Action on Smoking and Health (2012). Nicotine and addiction. London: Action on Smoking and Health.

Action on Smoking and Health (2013). Smoking statistics: Who smokes and how much. London: Action on Smoking and Health.

Benowitz, N. (2010). Nicotine addiction. New England Journal of Medicine, 362, 2295–2303,

Carpenter C.M., Wayne, G.F., & Connolly, G.N. (2007). The role of sensory perception in the development and targeting of tobacco products. Addiction, 102, 136-147.

Goodwin, R.D., Keyes, K.M., & Hasin, D.S. (2009). Changes in cigarette use and nicotine dependence in the United States: Evidence from the 2001-2002 wave of the National Epidemiologic Survey of Alcoholism and Related Conditions. American Journal of Public Health, 99, 1471-1477.

Grant, B.F., Hasin, D.S., Chou, P., Stinson, F.S., & Dawson, D.A. (2004a). Nicotine dependence and psychiatric disorders in the United States. Archives of General Psychiatry, 61, 1107-1115.

Information Centre for Health and Social Care (2011). Smoking drinking and drug use among young people in England in 2011. London: Information Centre for Health and Social Care.

Jarvis, M. (2003). Monitoring cigarette smoking prevalence in Britain in a timely fashion. Addiction, 98, 1569-1574.

Office for National Statistics (2012). The 2010 General Lifestyle Survey. London: Office for National Statistics.

Office for National Statistics (2013). The 2011 General Lifestyle Survey. London: Office for National Statistics.

Sussman, S., Lisha, N. & Griffiths, M.D. (2011). Prevalence of the addictions: A problem of the majority or the minority? Evaluation and the Health Professions, 34, 3-56.

Wald, N. & Nicolaides-Bouman, A. (1991). UK Smoking Statistics (2nd edition). Oxford: Oxford University Press.

Becoming less of a drag: The Stoptober campaign (revisited)

(The following blog is based on an article I published last year in the Nottingham Post on why I was actively supporting the Stoptober smoking campaign to get people to stop smoking for 28 days during October. I also published a blog last year outlining my 10 top tips for giving up smoking. Since that blog, my ten tips have been slightly changed and adapted in co-operation with the Department of Health running the Stoptober campaign. I make no apologies for repetition between today’s blog and that published last year, as my only aim is to help people give up smoking).

Although most of my academic research is on behavioural addiction, I have published quite a few papers on more traditional addictions such as alcohol and nicotine addiction (see ‘Further reading’ below). Last year I had to watch my mother fight a losing battle with smoking-related lung cancer and chronic obstructive pulmonary disease. She died in September 2012 aged 66 years, and had chain-smoked most of her adult life. This followed the death of my father who also died of smoking-related heart disease, aged just 54.

This October, the Department of Health (DoH) are re-launching the ‘Stoptober’ campaign for the second time, urging as many nicotine smokers as possible to give up smoking for 28 days from October 1. The DoH website claims that “people who stop smoking for 28 days are five times more likely to stay smoke free” compared to those that don’t give up for such a long period. Like last year, those that decide to try and stop for the month will be given a lot of encouragement during the campaign including access to the Smokefree Facebook page and the downloadable Stoptober app. People will also be sent daily emails providing additional encouragement.

In the UK smoking accounts for approximately one in four cancer deaths, and as I said, it’s something I’ve witnessed first-hand. I’m sure most people reading this are aware of the addictive nature of nicotine. As soon as nicotine is ingested via cigarettes, it can pass from lungs to brain within ten seconds and stimulates the release of the neurotransmitter dopamine. The release of dopamine into the body provides reinforcing mood modifying effects. Despite nicotine being a stimulant, many people use cigarettes for both tranquillising and euphoric effects. Most authorities accept that nicotine is one of the most addictive drugs on the planet and that smokers can become hooked quickly. One of the reasons my own parents were never able to give up was because of the prolonged withdrawal effects they experienced whenever they went more than a few hours without smoking. This would lead to intense cravings for a cigarette. Watching both my parents’ die of smoking-related diseases is enough incentive for me to never smoke a cigarette. Hopefully, others can find the incentives they need to help them give up permanently. Here are my top ten tips to help you (or someone you know and love) stop smoking:

• (1) Develop the motivation to stop smoking: Many smokers say they would like to stop but don’t really want to. When you take stock, make sure you are clear as to why you want to give up. It may be to save money, to improve your health, to prevent yourself getting a smoking-related disease, or to protect your family from passive smoking. (It could of course be all of the above). Really wanting to give up is the best predictor of successful smoking cessation.
• (2) Get all the emotional support you can: Another good predictor of whether someone will overcome their addiction to nicotine is having a good support network. You need people around you that will support your efforts to quit. Tell as many people that you know that you are trying to quit. It could be the difference between stopping and starting again.
• (3) Avoid ‘cold turkey’: Although some people can stop through willpower alone, most people will need to reduce their nicotine intake slowly. The best way of doing this is to replace cigarettes with a safe form of nicotine such as those available from the pharmacy, or on prescription from the doctor.
• (4) Get support from a professional: Even if you are using a safe form of nicotine from your pharmacist or doctor, cutting out cigarettes completely can be hard. Getting support from a trained NHS stop smoking adviser can double your chances of stopping smoking. To find your nearest free NHS stop smoking service (in the UK call 0800-1690169) or visit the smokefree website and click on the ‘ways to quit’ tab.
• (5) Use non-nicotine cigarette shaped substitutes: Smoking is also a habitual behaviour where the feel of it in your hands may be as important as the nicotine it contains. The use of plastic cigarettes or e-cigarettes will help with the habitual behaviour associated with smoking but contain none of the addictive nicotine.
• (6) Use relaxation techniques: When cravings strike, use relaxation exercises to help overcome the negative feelings. At the very least take deep breaths. There are dozens of relaxation exercises online. Practice makes perfect.
• (7) Treat yourself: One of the immediate benefits of stopping smoking will be the amount of money you save. At the start of the cessation process, treat yourself to rewards with the money you save.
• (8) Focus on the positive: Giving up smoking is one of the hardest things that anyone can do. Write down lists of all the positive things that will be gained by stopping smoking. Constantly remind yourself of what the long-term advantages will be that will outweigh the short-term benefits of smoking a cigarette. In short, focus on the gains of stopping rather than what you will miss about cigarettes.
• (9) Know the triggers for your smoking: Knowing the situations in which you tend to smoke can help in overcoming the urges. Lighting up a cigarette can sometimes be the result of a classically-conditioned response (e.g. having a cigarette after every meal). These often occur unconsciously so you need to break the automatic response and de-condition the smoking. You need to replace the unhealthy activity with a more positive one and re-condition your behaviour.
• (10) Fill the void: One of the most difficult things when cigarette craving and withdrawal symptoms strike is not having an activity to fill the void. Some things (like engaging in physical activity) may help you in forgetting about the urge to smoke. Plan out alternative activities and distraction tasks to help fill the hole when the urge to smoke strikes (e.g. chew gum, eat something healthy like a carrot stick, call a friend, occupy your hands, do a word puzzle, etc.). However, avoid filling the void with other potentially addictive substances (e.g. alcohol) or activities (e.g. gambling).

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Griffiths, M.D. (1994). An exploratory study of gambling cross addictions. Journal of Gambling Studies, 10, 371-384.

Griffiths, M.D.  (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, 191-197.

Griffiths, M.D. (2012). First person: Highly-addictive drug killed both of my parents. Nottingham Post, October 1, p.13.

Griffiths, M.D., Parke, J. & Wood, R.T.A. (2002). Excessive gambling and substance abuse: Is there a relationship? Journal of Substance Use, 7, 187-190.

Griffiths, M.D., Wardle, J., Orford, J., Sproston, K. & Erens, B. (2010). Gambling, alcohol consumption, cigarette smoking and health: findings from the 2007 British Gambling Prevalence Survey. Addiction Research and Theory, 18, 208-223.

Griffiths, M.D., Wardle, J., Orford, J., Sproston, K. & Erens, B. (2011). Internet gambling, health. Smoking and alcohol use: Findings from the 2007 British Gambling Prevalence Survey. International Journal of Mental Health and Addiction, 9, 1-11.

Resnick, S. & Griffiths, M.D. (2010). Service quality in alcohol treatment: A qualitative study. International Journal of Mental Health and Addiction, 8, 453-470.

Resnick, S. & Griffiths, M.D. (2011). Service quality in alcohol treatment: A research note. International Journal of Health Care Quality Assurance, 24, 149-163.

Resnick, S. & Griffiths, M.D. (2012). Alcohol treatment: A qualitative comparison of public and private treatment centres. International Journal of Mental Health and Addiction, 10, 185-196.

Sussman, S., Lisha, N. & Griffiths, M.D. (2011). Prevalence of the addictions: A problem of the majority or the minority? Evaluation and the Health Professions, 34, 3-56.

Umeh, K. & Griffiths, M.D. (2001). Adolescent smoking: Behavioural risk factors and health beliefs. Education and Health, 19, 69-71.