[Reading Health] New Year's Quit Smoking Resolution, Difficult with Willpower Alone

[Asia Economy Reporter Choi Dae-yeol] If you have decided to quit smoking in the new year, now is the toughest time. Everyone knows smoking is harmful, but quitting is difficult because of nicotine. When a regular smoker stops, withdrawal symptoms begin within 12 hours, triggering cravings along with discomfort, anxiety, depression, irritability, decreased concentration, and increased appetite. Withdrawal symptoms peak around 2 to 3 days after quitting and last for about three weeks.

Nicotine addiction results from a complex interplay of neurobiological factors, such as certain genetic predispositions, as well as psychological, cultural, social, and economic environmental factors. When smoking, nicotine reaches the brain in as little as 10 seconds, typically around 20 seconds. It stimulates dopamine release through nicotinic acetylcholine receptors, activating the brain's reward circuit, which makes smokers feel good. Prolonged heavy smoking can lead to tolerance, reducing responsiveness to smoking.

In the medical field, this nicotine addiction is referred to as craving. Like withdrawal symptoms, it arises from the body's recognition that nicotine is no longer present. If someone has smoked for a certain period and then quits, strong 'episodic cravings' are likely to occur. Cravings increase in specific situations such as after meals or bowel movements and decrease when those situations pass. These cravings can persist for years after quitting, increasing the risk of relapse.

6-Month Quit Success Rate: 'Willpower' Is Lowest,
Higher with Medication and Nicotine Replacement Therapy

According to clinical guidelines established by the U.S. health authorities for treating tobacco dependence, the success rate for quitting smoking for more than six months is lowest when relying solely on willpower, at only 4%. Receiving advice from a doctor slightly increases the success rate (6-12%), and using medication improves it further. Nicotine replacement therapies such as gum, patches, and inhalers have a success rate of 17%, while medication achieves about 19-26%. Since reducing nicotine dependence is challenging, these methods help by gradually replacing cigarettes with alternative means, eventually diminishing cravings and distancing smokers from cigarettes.

The first nicotine replacement developed was in gum form. In Korea, the product Nicorette, sold as an over-the-counter medicine, was developed in 1967. It was initially created to address withdrawal symptoms in the Swedish Navy, where smoking was banned on submarines, and was released as gum in 1978. Smokers can choose nicotine gum based on their smoking amount and nicotine content. The gum is slowly chewed and then held in the mouth for a while, allowing nicotine to be absorbed through the mucous membranes.

It is best not to chew the gum for more than 30 minutes. Drinking coffee or carbonated beverages before chewing can reduce absorption, so it is advisable to avoid them. Chewing multiple pieces at once may cause nausea and other unpleasant symptoms. The recommended daily amount is 8-12 pieces, and no more than 15 pieces should be chewed per day.

Quitting smoking using nicotine gum typically takes about three months. During this period, the amount used should be gradually reduced. According to the U.S. Food and Drug Administration, it is recommended to chew one piece every 1-2 hours up to 6 weeks after quitting, every 2-4 hours during weeks 7-9, and every 4-8 hours during weeks 10-12. If there is a risk of relapse after three months, use can continue up to six months. If cravings remain difficult to control afterward, consulting a specialist to find a suitable quitting method is advisable.

Combining Medication and Support Increases Quitting Effectiveness

Since smoking is caused by nicotine addiction in the brain, pharmacotherapy targeting the brain is helpful. Effective treatments include bupropion, an antidepressant, and varenicline. Varenicline, an active ingredient in specialized smoking cessation medications, increases dopamine release, improving mood without nicotine supplementation, thereby reducing both cravings and withdrawal symptoms simultaneously.

If you decide to quit smoking, it is best to start by setting a short-term goal to reduce psychological burden. Informing family, coworkers, and others around you is also a good strategy. Keeping a smoking diary to track when and with whom you smoked and when cravings are strongest helps reduce risk factors, as recommended by experts. Surveys show that smokers’ cravings increase after consuming spicy foods, so improving diet and lifestyle habits in advance also enhances the chances of successful quitting.

※ Source: Professor Choi Cheon-woong, Department of Pulmonology, Kangdong Kyunghee University Hospital, and Johnson & Johnson Korea

This content was produced with the assistance of AI translation services.