Patient. Is it true that when someone starts smoking as a teenager it is more difficult to stop?
Medical. Yes, it's true.

P. Why?
M.Because during adolescence, the stimulation of the reward and pleasure centers by nicotine-induced dopamine meets and becomes firmly "married" with very strong emotional states, unique because they are just emerging in an individual's life. They are characteristic of the emotional developmental stage of that stage of life.
A very difficult association is created between smoking and the social successes believed, wrongly, to be due to that behaviour. The young man remains convinced that the positive and rewarding things he has achieved are only due to his appearing on the social scene as a smoker.
In other words, the belief that smoking makes one appear more interesting and attractive, without knowing the reason—namely, the gratifying, artificial, and therefore "fake" chemical/pharmacological effect of nicotine—causes young people to cling to the behavior they've experienced as successful in life and in relationships, and won't let go, especially out of fear of later finding themselves without Dumbo's "magic feather." And let's not forget that once addiction has set in, breaking away is even more difficult, indeed unthinkable, due to the suffering caused by withdrawal.

P. But not all teenagers will need to use Dumbo's "magic feather" to find their serenity and balance. There will also be a social factor, of belonging to particularly disadvantaged social groups and with little culture and poor ability to develop rational solutions to the various problems of insertion into society typical of adolescence. Why does one necessarily have to choose to smoke to feel accepted by the community in which he lives?
M.Certainly, situations of strong psychological distress, easily more accentuated during the almost always difficult social integration of adolescence, can be conditions that favor the fall into the "trap" of smoking, always ready and tense in the territories thanks to the tolerated and supported presence legally by the institutions of the tobacco industry.
There is a nice little story that helps describe this condition.
A beautiful caterpillar had fallen from the deck of a ship, at night, during a storm, and was floundering on the surface of the water trying to stay afloat so as not to drown.
When the sea calmed down and the moon rose, he suddenly saw a large cylinder floating near him, an excrement that had come out of the ship's exhaust.
Despite the stench and disgust it made him, he thought that at least he could use it as a lifeboat, and he got on it, finally being able to relax and unwind without worrying anymore.
When it became light, with the sun shining warmly in the blue sky, it transformed into a chrysalis, and around midday it emerged from its shell in the form of a beautiful butterfly with large, colorful wings.
At that point he would have been ready to abandon that stinking lifeboat and fly free in search of land or another ship, but he decided to stay and live on the excrement, to which he felt deeply bound by a debt of gratitude, because that he had saved his life.
This is what happens to those who, in critical moments of their life, establish a relationship of dependence, and cling to cigarettes, alcohol, gambling, or any other entity, stinky and disgusting, but capable of making them survive.

P. Various images and writings are printed on cigarette packets that warn smokers of health risks, but exactly what are all these diseases caused by smoking?
M. According to the World Health Organization (WHO), smoking is responsible for approximately 8 million premature deaths each year, of which approximately 7 million are attributable to direct smoking and approximately 1 million to passive smoking.
The incidence percentages of smoking diseases, divided into tumors, respiratory system diseases, cardiovascular diseases, others, are as follows:

• Cancers: Smoking is responsible for approximately 22% of all cancers, including 70% of lung cancers, 22% of laryngeal cancers, 17% of mouth cancers, 13% of pharynx cancers, and 9% of bladder tumors. However, there is no certainty that there is an organ spared from falling prey to a tumor following contact with approximately 70 carcinogenic substances, components of smoking, together with approximately seven thousand others, therefore other organs can be targeted for tumors from smoking .
• Respiratory diseases: Smoking is responsible for approximately 75% of all deaths from chronic respiratory diseases, including chronic obstructive pulmonary disease (COPD), emphysema and asthma.
• Cardiovascular diseases: Smoking is responsible for approximately 25% of all deaths from cardiovascular diseases, including myocardial infarction, stroke and hypertension.

It is important to note that these are general data only and that incidence rates may vary depending on factors such as age, gender, family history and other health conditions.

P. You see, doctor, I have sometimes thought that if they no longer sold cigarettes, I would surely be able to free myself from smoking, willy-nilly. But tell me, how do you explain that there are smokers who reach considerable ages, ninety-year-olds, even centenarians, and do not have any tobacco-related disease?
M. It's possible that some smokers can reach considerable age without suffering or showing any harm from smoking, but this is due to a combination of genetic factors, lifestyle factors, and the amount and duration of smoking. In any case, research tells us that out of three smokers, two suffer harm, even fatal, while one remains unharmed. Therefore, we can conclude that smoking is like playing Russian roulette: a revolver with a cylinder equipped with three chambers, with two bullets inserted and one empty chamber; you rotate the cylinder and aim it at your head. Who can be sure that they'll get the chamber without a bullet? It's not worth foolishly enjoying yourself by tempting fate to irreversibly jeopardize your health and life.

P. In the media, journalists often call the habit of smoking a "vice" when they talk about cigarettes. What's the difference between a vice and an addiction?
M. Il vice it is only a repeated behavior that can be stopped without suffering on the part of a subject.

La dependence is a medical condition characterized by an unstoppable compulsion to consume a substance or practice a behavior, despite negative consequences. Addiction is characterized by three main symptoms:

• Tolerance: the need to consume more and more of the substance or practice the behavior more and more to achieve the same effect.
• Abstinence: Negative physical and psychological symptoms that occur when you stop using the substance or practicing the behavior.
• Loss of control: the person is unable to control their use of the substance or the practice of the behavior.

In the case of smoking, it is primarily an addiction to nicotine. The nicotine it is a psychoactive substance that has stimulating and relaxing effects. It can cause addiction even at low doses.
People who smoke often start doing so out of curiosity or imitation. However, once you become addicted to the nicotine, it's very difficult to stop.
There are three things that represent the concept well dependence:

• the barb of a fishing hook, a kind of tailstock at the top of the tip of the hook, which prevents the hook from coming out of the tissues in which it is stuck,
• the pot, a type of net, always used in fishing, which is easy to enter but from which one cannot exit, due to the geometry of the net.
• the idea of ​​a dress that, when worn, becomes one with the skin and becomes impossible to remove, because it would cause unspeakable suffering by tearing the skin.

P. If smoking is so harmful to human health, then why does the state still allow cigarettes to be sold?
M. It's a more than fair question: a first grade child can ask it. Unfortunately, the tobacco industry has a strong influence on politicians, so it is able to convince them not to pass laws against it, such as outdoor smoking bans in public places. Furthermore, it is now known that there is not even an economic advantage: the State collects around 14 billion euros every year from the sale of cigarettes, but has to spend 26 on the diagnostics and treatment of smoking diseases. When the State has politicians impervious to the siren song of the tobacco industry, then we will have laws that will convince that industry to remove its tents from our country.

P. I've heard of smoking cessation centers. What are they?
M. They are structures, public or private, where a smoker can find therapeutic help to free himself from his addiction nicotine.
Let's take some considerations into account.

1. The anti-smoking center is addressed to a smoker who has come to a strong awareness that he needs to stop smoking, and who is unable to do it on his own.
2. Generally they are free as services, at least the public and private ones managed by NGOs.
3. Drug therapies are paid, because they are not reimbursed by the NHS, and they do not even have a low cost. Therefore, quitting smoking with drugs costs money.
4. Despite their name, anti-smoking centers are not able to eliminate smoking in a society that continues to sell cigarettes and leaves the promotion of smoking among young people free through various types of messages in the media and in public social reality. In short, while an anti-smoking center can over time discharge a smoker freed from addiction, an unknown number of new non-smokers have been captured by the tobacco industry, in an endless cycle that will never put an end to smoking.

P. What is the probability of quitting for a smoker who relies on an anti-smoking center?
M. Some studies have found that people who participated in a 12-week smoking cessation program, which included behavioral therapy and medication, had a 50 to about 60 percent chance of success at 12 months. Therefore, one year after treatment, only 5 or 6 smokers out of 10 treated still manage not to smoke.

P. But is it possible to quit smoking on your own, that is, to get rid of nicotine addiction without resorting to drugs or medical facilities?
M.

Of course, you just have to overcome all the withdrawal symptoms caused by the absence of the substance that led you to addiction, and stop thinking that you are cool with the cigarette flaunted in public.. Nicotine is a very powerful addictive substance, and When you quit smoking, you may experience a variety of symptoms, including nervousness, anxiety, irritability, and difficulty concentrating. These symptoms are temporary and usually subside within a few weeks.

 

You have to organize yourself to face this difficult, very difficult "ford," to reach the non-smoking shore, but it's not impossible. I know people who have done it, and I myself quit overnight at 33, after eight years of smoking about 15 cigarettes a day. I suddenly realized I no longer needed the habit, and I decided to hang up the last open pack and throw the few new ones still unopened in the trash, and I felt incredibly good about making that decision forty years ago.

P. How can I find truthful and reliable information on the Internet about smoking?
M. In Italian, the site most committed to providing authoritative information is certainly https://www.tabaccoendgame.it/, endorsed by scientific societies and even by individual citizens.
The website states, among other things: “Tobacco Endgame is also a set of strategies aimed at permanently changing the structural, political, and social dynamics that sustain the tobacco epidemic, with the aim of ending it.”
On the social network Facebook you can use the data published on the "We want an end to smoking" page, which I personally curate based on my 13-year experience on the problem: https://www.facebook.com/vogliamolafinedeltabagismo?locale=it_IT

P. I'm curious, doctor, is cigarette smoke a gas, a liquid or a solid?
M. There is a simple home experiment to get an idea of ​​the physical state of smoking. You take a clean glass with a flat bottom, light a cigarette and let the smoke rise under the external bottom of the glass, keeping it close to you. Most of the smoke will escape into the air, but that part that will hit the glass of the glass, when the cigarette is completely consumed, will make you understand what it physically is. All you have to do is turn the glass upside down and you will see a yellowish-brown collection of a very acrid-smelling oil that is greasy to the touch. So cigarette smoke is a suspension of microscopic drops of oil in the air. Research tells us that it contains around 7000 substances, of which 250 are toxic, 70 carcinogenic.

P. I have heard that a smoker who stops smoking will have the same probability of getting sick again after a few years as a non-smoker. It is true?
M. Let's say that in any case, stopping introducing 7000 substances foreign to our body into the blood, complete with carcinogens and toxic substances, certainly leads to an improvement in health conditions. However, the damage must be taken into account irreversible that brings the smoke:

• DNA damage: Smoking can damage the DNA of cells, increasing the risk of cancer.
• Lung damage: Smoking can damage the lungs, causing respiratory diseases such as chronic bronchitis and emphysema.
• Damage to blood vessels: Smoking can damage blood vessels, increasing the risk of heart disease and stroke.
• Teeth damage: Smoking can stain your teeth and increase the risk of gum disease.

It is important to note that these damages can occur even in people who smoke for only a short period of time.

P. Doctor, we often hear it said by those who maintain that everyone must be left free to choose what they like about their life, that smokers are responsible for their own evil, because they continue to buy cigarettes, so with this reasoning the industry dumps the blame for the damage of smoking on its customers. But if those who smoke do so because they are driven by chemical dependence, and cannot do without it, how can they be able to make the choice to continue, when rather they are forced to do so because they have agreed to bite a hook that has been given to them? stuck in the flesh and can only be extracted at the cost of unspeakable suffering?

M. In fact, let's say you've already given yourself the answer. Furthermore, one wonders whether the tobacconists are inhabitants of this planet or come there every day with spaceships from another galaxy. How can they tolerate, for example, walking on sidewalks covered in cigarette butts that their customers throw away without thinking about the consequences for the environment. If at least tobacconists put up signs in their shops inviting smokers not to smoke in the presence of minors and not to throw cigarette butts and empty packets wherever they are, they would demonstrate that they care about the health of the areas in which they operate.

P. Doctor, one last question. When we hear of plans to ban smoking, for example outdoors in public environments, such as in parks, at bus stops, on station platforms, on beaches, many smokers, but also non-smokers, rise up very vehemently and begin to agitate the specter of prohibitionism. What do you think?
M. Prohibition was a social phenomenon that manifested itself in the United States of America in the early 1900s. Prohibiting, prohibiting, is not prohibitionism. Then it would be necessary to abolish red traffic lights, no entry and no parking signs, level crossing bars, and all the other thousand rules that every society gives itself through the laws agreed to optimize everyday social life. Prohibiting behavior that leads a State to lose 12 billion euros every year, taking away resources that can be used in services useful to the community, is not prohibitionism, but an act that the leaders of a community take on the burden of making become law in favor of improvement of everyone's living conditions.

P. Excuse me, doctor, allow me another question, an important one I think. What about e-cigarettes?
M. The e-cigarette was invented by a pharmacist obsessed with intense nicotine addiction. It was designed to help smokers overcome their addiction by tapering off nicotine doses until they no longer needed it. The commercial sector then seized control, transforming a treatment tool into a billion-dollar business. Today, we've even reached the absurd point where some teenagers ask for an e-cigarette for their birthday, despite evidence that it's a first step toward smoking. Some researchers have even concluded that e-cigarettes and those using heated tobacco, which therefore contain addictive nicotine, are ten times less harmful to health than traditional cigarettes. Thinking like a judge, would you acquit a defendant accused of killing just one person and convict someone who killed ten? Not in the slightest. The tobacco industry touts this move as a step forward in seeking minimal harm, but for a civilized society, regarding a useless fad, serving only to make money for a criminal industry, minimal harm is not acceptable. Harm MUST NOT EXIST, since it is merely a luxury fad, not essential and not vital. Therefore, e-cigarettes must be used only for therapeutic purposes, as decreed in Australia, where just last year they banned the recreational use of any type of e-cigarette.