Smoking and Nicotine

For many people, smoking starts with a cigarette with friends in adolescence, or a shisha session at a café that seems innocent, then years later turns into the first thing the person does on waking and the last thing before sleep. Smoking is not just a bad habit that a firm decision is enough to drop; in most cases it is a real dependence on nicotine, fed by daily habits and situations linked to it. This page explains the forms of smoking common in Egypt, why quitting is hard, what happens to the body, and which methods have proven effective for stopping, then guides you to a separate article on each aspect.

What is smoking?

Smoking is inhaling the smoke or vapor produced by burning or heating tobacco, or using tobacco in other ways such as chewing and sniffing it through the nose. The substance that makes a person return to it again and again is nicotine, a stimulant that reaches the brain within seconds of inhaling and stimulates the release of dopamine in reward circuits, giving a quick feeling of relief and focus. But the greatest harm does not come from nicotine alone, but from thousands of other substances in the smoke, including tar, carbon monoxide and known carcinogens.

The World Health Organization considers tobacco one of the biggest public health threats in the world, causing the deaths of more than eight million people a year, including more than a million people who never smoked but were exposed to passive smoking.

Common forms of smoking

Smoking is no longer limited to the traditional cigarette, and each form has its own myths that make people underestimate it:

• Cigarettes: the most widespread form, and the most studied in terms of harms.
• Shisha: many think the water purifies the smoke, but in fact a single long session may expose the smoker to far more smoke and carbon monoxide than one cigarette. We detail this in the article The harms of shisha.
• E-cigarettes and vapes: they usually contain nicotine, cause the same dependence, and their long-term effects are still under study. See the article E-cigarettes.
• Smokeless tobacco: such as toombak, which is placed in the mouth, and snuff, which is sniffed through the nose; both deliver nicotine and harm the mouth or nose.

Why is it hard to quit smoking?

Many smokers fail in their first attempts, and this does not mean weak willpower. The difficulty comes from three overlapping sources:

1. Physical dependence: the brain adapts to the presence of nicotine, and when it is absent withdrawal symptoms appear, such as irritability, anxiety, difficulty concentrating, urgent cravings, increased appetite and disturbed sleep. These symptoms usually peak in the first days and then ease gradually over weeks.
2. Habit tied to situations: a cigarette with coffee, after eating, on a break and under stress. Each of these situations becomes a trigger that automatically calls up the craving.
3. The psychological role: many use the cigarette to calm tension, fill emptiness or feel a sense of belonging, so they fear losing this tool without an alternative.

We explain the addictive side in detail, including the signs of dependence and withdrawal symptoms, in the article Nicotine addiction.

What does smoking do to the body?

There is hardly an organ in the body untouched by smoking. It is a major cause of lung cancer and cancers of the mouth, larynx, esophagus and bladder, raises the risk of heart attacks and strokes, and leads to chronic obstructive pulmonary disease, which makes breathing a daily burden. It also affects fertility in men and women, harms pregnancy and the fetus, slows wound healing, and affects the teeth, gums and skin.

The harm is not limited to the smoker; passive smoking exposes children to asthma attacks and ear and chest infections, and raises the risk of heart disease in adults around them. You can find the details, and how to protect your home and car, in the article The harms of passive smoking.

Smoking and mental health

Many smokers believe the cigarette calms their nerves, but a large part of this calm is simply a temporary silencing of the withdrawal symptoms that began since the last cigarette. Studies indicate that anxiety and stress usually decrease after getting past the first weeks of quitting, not the opposite. The rate of smoking is also much higher among people with depression, anxiety, schizophrenia and addiction to other substances, so they need a quit plan in which the psychiatrist takes part, because stopping may affect mood and the blood level of some psychiatric medicines.

Ways to quit smoking

The best results come from combining behavioral support with medication when the person needs it, not from relying on willpower alone. The most important elements of the plan:

• Setting a quit day and preparing for it by getting rid of cigarettes and lighters and telling those close to you.
• Knowing the triggers and setting an alternative for each, such as walking after eating or changing where you drink coffee.
• Nicotine replacement such as patches and nicotine gum, which ease withdrawal and double the chances of success; the doctor or pharmacist determines their type and duration.
• Prescription medicines that reduce cravings; the doctor decides how suitable they are for each person after reviewing their health and medicines.
• Psychological support, individual or group, especially for those who have tried to quit many times or have an accompanying mental disorder.

You can find a practical plan from the day of the decision to the third month in the article Quitting smoking.

What happens after quitting?

The body begins to recover quickly: the level of carbon monoxide in the blood falls within about a day, breathing and circulation improve within weeks to months, and the risk of heart disease falls gradually with every year without smoking. Many people ask how long nicotine stays in the body, especially before medical tests, which we explain in the article How long nicotine stays in the body.

Common myths about smoking

Myth: shisha is lighter than cigarettes because the water filters the smoke. The truth is that water does not remove carcinogens or carbon monoxide, and the length of the session makes the amount inhaled large.

Myth: cutting down to a few cigarettes a day is enough. The truth is that even light smoking clearly raises the risk of heart disease, and that the safe goal is stopping completely.

Myth: quitting after many years is useless. The truth is that the body benefits from stopping at any age, and that the benefit begins from the first days.

How does the doctor determine the degree of nicotine dependence?

The doctor does not settle for the number of cigarettes, but asks about signs that reveal the strength of dependence: when you smoke your first cigarette after waking, whether you find it hard to abstain in places where smoking is forbidden, whether you smoke when you are ill and confined to bed, and which cigarette is harder for you to give up than the others. Someone who smokes in the first minutes after waking usually has stronger physical dependence, and usually needs medication support along with behavioral support. The doctor also pays attention to accompanying illnesses, the medicines the patient takes, and previous quit attempts and the reasons for relapse in them, because these details are what determine the most suitable plan.

The family’s role: support instead of surveillance

The family can help a great deal, on condition that its role is support, not pursuit. Make the home and car smoke-free spaces for everyone, and avoid commenting on every cigarette or constantly reminding about the harms, because this creates more stubbornness than decisions. And when the person decides to quit, patience with their irritability in the first weeks, joining them for walks or an alternative activity, and celebrating every week that passes without smoking all make a real difference. If they relapse, don’t treat it as a final failure; most people who quit successfully needed more than one attempt.

Start here: steps you can take today

1. Write your personal reasons for quitting on a piece of paper and keep it with you.
2. Watch yourself for a few days and record when you smoke and why, so you know your triggers.
3. Choose a quit day within the next two weeks, and tell someone you trust about it.
4. Get rid of cigarettes, lighters and shisha tobacco before that day.
5. Prepare an alternative for each trigger: water, a short walk, chewing ordinary gum or a phone call.
6. Talk with a doctor or pharmacist about nicotine replacement or the medicines suitable for you before quit day.

The smoking and nicotine guide: each aspect in its own article

We have devoted a separate article to each question that concerns the smoker and their family:

• Nicotine addiction: symptoms, withdrawal, harms and ways to quit.
• Quitting smoking: a practical plan from the day of the decision to the third month.
• The harms of shisha: the myths of water and tobacco molasses, and carbon monoxide.
• E-cigarettes: nicotine, the harms and whether they help with quitting.
• The harms of passive smoking: on children and pregnancy, and how to protect your home.
• Toombak: what it is, its harms to the mouth and the risk of cancer.
• Treatment of toombak addiction: mouth examination and medication and behavioral support.
• The harms of snuff: nicotine, the nose and what is scientifically proven.
• Nicotine gum: how it works, how to use it and who it doesn’t suit.
• How long nicotine stays in the body: in blood, urine, saliva and hair.

When does it become an emergency?

Most quitting symptoms are unpleasant but not dangerous, but on the other hand there are signs that cannot wait, whether in the smoker or in a child who has got hold of nicotine products.

When should you seek help?

If you have tried to quit more than once and gone back, or withdrawal symptoms are beyond your ability, or you smoke alongside using other substances or with a mental disorder, specialist help raises your chances of success considerably. At Riviera Life, addiction and psychiatry consultants put together a quit plan that suits your situation, and the first consultation is free and confidential via +201507999722.