Feature Article

Nicotine dependence: why is it so hard to quit?

Colin P Mendelsohn



Most smokers repeatedly fail to quit because they are addicted to nicotine and have lost control of their smoking behaviour. This article examines why it is so hard to break the habit long term and suggests strategies GPs can use to optimise their interventions. Smokers need to be re-engaged and assisted through repeated attempts to quit over the long term.

Key Points

  • Nicotine dependence is a substance abuse disorder involving compulsive drug use in spite of known health risks.
  • Most smokers continue to smoke because they are addicted to nicotine. Today’s smokers may be more addicted than in the past.
  • The psychoactive effect of nicotine is mediated by activation of the powerful reward pathway in the brain and the release of dopamine.
  • Other mechanisms underlying nicotine addiction are environmental cues, nicotine cravings and withdrawal symptoms.
  • Successful treatment is based on optimising pharmacotherapy and behavioural strategies to counter smoking cues.