ar from cigarettes," says Fiore.
The news, however, isn't all bad. For the last 20 years, the proportion of Americans who smoke has dropped continuously, for the first time in our history. In America today, there are nearly 45 million ex-smokers, about as many as are still puffing away.
These quitters, perhaps surprisingly, are for the most part the same folk who tried and failed before. The average person who successfully gives up smoking does so after five or six futile attempts, says Fiore. "It appears that many smokers need to go through a process of quitting and relapsing a number of times before he or she can learn enough skills or maintain enough control to overcome this addiction."
Never underestimate the power of your enemy. Although nicotine may not give the taste of Nirvana that more notorious drugs do, its effects on the nervous system are profound and hard to resist. It increases levels of acetylcholine and norepinephrine, brain chemicals that regulate mood, attention, and memory. It also appears to stimulate the release of dopamine in the reward center of the brain, as opiates, cocaine, and alcohol do.
Addiction research has clearly established that drugs with a rapid onset—that hit the brain quickly—have the most potent psychological impact and are the most addictive. "With cigarettes, the smoker gets virtually immediate onset," says Jack Henningfield, Ph.D., chief of clinical pharmacology research for the National Institute on Drug Abuse. "The cigarette is the crack cocaine of nicotine delivery."
Physiologically, smoking a drug, be it cocaine or nicotine, is the next best thing to injecting it. In fact, it's pretty much the same thing, says Henningfield. "Whether you inhale a drug in 15 seconds, which is pretty slow for an average smoker, or inject it in 15 seconds, the effects are identical in key respects," he says. The blood extracts nicotine from inhaled air just as efficiently as oxygen, and delivers it, within seconds, to the brain.
The cigarette also gives the smoker "something remarkable: the ability to get precise, fingertip dose control," says Henningfield. Achieving just the right blood level is a key to virtually all drug-induced gratification, and the seasoned smoker does this adeptly, by adjusting how rapidly and deeply he or she puffs. "If you get the dose just right after going without cigarettes for an hour or two, there's nothing like it," he says.
The impetus to smoke is indeed, as the tobacco companies put it, for pleasure. "But there's no evidence that smoke in the mouth provides much pleasure," says Henningfield. "We do know that nicotine in the brain does."
For many, nicotine not only gives pleasure, it eases pain. Evidence has mounted that a substantial number of smokers use cigarettes to regulate emotional states, particularly to reduce negative affect like anxiety, sadness, or boredom.
"People expect that having a cigarette will reduce bad feelings," says Thomas Brandon, Ph.D., assistant professor of psychology at the State University of New York at Binghamton. His research found this, in fact, to be one of the principal motivations for daily smokers.
Negative affect runs the gamut from the transitory down times we all have several times a day, to clinical depression. Smokers are about twice as likely to be depressed as nonsmokers, and people with a history of major depression are nearly 50 percent more likely than others to also have a history of smoking, according to Brandon.
Sadly, but not surprisingly, depression appears to cut your chance of quitting by as much as one-half, and the same apparently applies, to a lesser extent, to people who just have symptoms of depression.
According to Alexander Glassman, M.D., professor of psychiatry at the Columbia University College of Physicians and Surgeons, the act of quitting can trigger severe depression in some people. In one study, nine smokers in a group of 300 in a cessation program became so depressed—two were frankly suicidal—that the researchers advised them to give up the effort and try again later. All but one had a history 