An addiction is a health problem that usually appears as the result of a process, which may unfold more or less quickly over time. Typically, addiction develops over time, linking different kinds of use, rather than appearing suddenly.
Psychopathology and medical manuals classify it as a disease, although it is not only an effect on the body or the brain; it also has psychological and social causes and consequences. That’s why we say it is a biopsychosocial condition:
1. Biological
First, nicotine addiction—and the use of tobacco or other products that contain it—is a problem that affects the body and biology, because it has serious consequences for your health. For example, it predisposes you to respiratory and cardiovascular diseases, cancers, and many others.
Also, addiction is maintained and reinforced through what is known as the reward circuit. This structure is in your brain and is responsible for releasing the neurotransmitter dopamine so that you seek out stimuli and rewards in your environment that help you survive. In this way, this circuit helps guide the search to find and store food or to maintain sexual relationships.
In the evolution of the species, accumulating resources even when they were not necessary at that exact moment has been a very valuable strategy, since it was necessary to anticipate days or phases of food scarcity.
When tobacco addiction develops, this structure becomes altered, since it asks you to reward it with nicotine. In this way, it drives you to seek more and more of the substance, under the premise that if you accumulate something valuable, such as food, you will have a better chance of surviving. However, addiction disrupts this mechanism, which begins to activate so that you consume and accumulate nicotine in your body.
2. Psychological
Second, addiction has psychological roots and consequences. Many people describe feeling that their need to use is not so much physical as mental, because they notice that when they can’t access a cigarette (long trips, periods of illness, hospitalizations) they don’t feel as much of a need to smoke, but when that possibility becomes more feasible, cravings come on abruptly.
Thus, smoking is also a psychological experience and is built on the association of stimuli (you may crave it less on a plane; more on a patio), but also on more complex aspects such as a person’s identity: being open, interesting, adult, attractive, intellectual, daring, etc., or on the needs associated with use: rest, switching off, reward, rebellion, standing out, connecting with other people, etc.
It is very beneficial for you to be aware of the psychological implications of nicotine addiction because it places you as an active part of the change, allows you to ask yourself what your particular way of coping with the situation will be, and helps you feel that you have agency over your life.
If you view it only as a physical illness, you may tend to approach the change process as merely a passive patient. Although this is beginning to change, bodily illnesses are frequently treated without much need for patient involvement: people receive medication or undergo an intervention, but they don’t decide on or design the treatment.
If it is accepted that smoking also has a subjective basis—that is, the unique way each person has built and developed it, and the psychological aspects that accompany it—then the recovery process can also be guided by drawing on personal resources, gaining self-knowledge and self-efficacy. This personal process can help you answer for yourself why, when, and in what way you are going to begin abstinence.
In that sense, it is important that you can acknowledge to yourself the difficulty with nicotine and the resulting health problem it involves, and, on the other hand, that you can build your own motivation (not only your family’s or your doctors’) to quit. At the same time, doubts, moments of weakness, or ambivalence are normal and are allowed throughout the process.
3. Social
Lastly, smoking is also a social issue: it is a socially accepted behavior, promoted in advertising, social media, films, and other public spaces, and you may even feel that it gives you a good reputation, the feeling of being part of the community of smokers, and, moreover, it is a substance that is easy to access.
Smoking is a social epidemic because it has not been consumed in the same way in all cultures or in all historical periods. Just as there are areas of the world where use is decreasing, there are others where it is increasing, and this is not explained by many people starting or quitting smoking at the same time by chance, but because it is a social dynamic.
Although the social acceptance of smoking may contribute to continued use, abstinence can also be a social experience in which you receive support and external reinforcement, through a network that accompanies and sustains you.
That is why we recommend relying on your environment to make nicotine addiction a shared difficulty and abstinence a collaborative commitment. Shared problems are resolved sooner than hidden or secret problems. Later we will suggest at what point in the process you can involve the people around you.