Why people don’t stop smoking

Every day in my clinic, I have the same conversation with multiple patients who, despite having tried to quit numerous times, went back to lighting up cigarettes each time. It’s not that they’re unaware. They know about the harm. They’ve read the warnings on the packet more times than they can count. They are concerned about their health and quality of life as well. And yet, they can’t move away from cigarettes. This pattern is not unique to my clinic. Tobacco use remains linked to lung cancer and cardiovascular diseases in current and former smokers alike, and despite knowing the risks, the number of people who continue to smoke remains high in both developed and developing countries. Among teenagers, smoking is often treated as a rite of passage, and peer pressure makes early intervention difficult. The diseases that follow—hypertension, diabetes, and respiratory illness— tend to surface later, in middle age and beyond. This raises an obvious question: why do so many people continue to smoke despite knowing the toll it takes on the heart and increases the risk of cancer? The answer is not the same for everyone. Some quit after watching the consequences play out in people around them. Others simply cannot, no matter how clear the warning signs become. Studies suggest that 80 percent of smokers would like to stop, yet relapse rates remain stubbornly high. That gap between intention and outcome says less about will power than it does about the nature of addiction itself, which is physiological, psychological, and behavioural all at once. After years in medicine, I’ve come to accept an uncomfortable truth: telling people to quit isn’t enough. And as a doctor who wants his patients to live the best life they can, I have to help them find a way towards a better life instead of telling them to find it themselves. And with the information that we have now, guiding them towards a better lifestyle has become much easier. During my discussions, what often surprises people is that nicotine is not the primary cause of smoking-related disease. Burning a single cigarette releases roughly 7, 000 chemical compounds, and science has proven, one study at a time, that it is this combustion, not the nicotine, that drives the harm. At temperatures exceeding 600°C, carbon monoxide, tar, and a cascade of carcinogens flood the lungs with every puff. Nicotine’s role is different: it is the agent that sustains addiction. It acts on the brain in ways that produce genuine dependence, and withdrawal brings irritability, low mood, anxiety, insomnia, and craving severe enough that abstinence often gives way to relapse. The behavioural side of addiction matters just as much. Many smokers reach for a cigarette in specific situations, while driving, socialising with friends, standing in a queue, or simply feeling stressed, and any serious effort to reduce smoking has to reckon with these triggers alongside the chemical ones. Understanding addiction means understanding all three layers together: people often keep smoking because they believe, consciously or not, that the benefits still outweigh the risks. This distinction between nicotine and combustion matters enormously because it changes how we approach the consumption of tobacco. The public health community has sometimes been its own worst enemy on this issue. Overstating the harm of alternatives or treating any acknowledgment of reduced-risk products has alienated the very people we most need to reach. It also completely ignores scientific evidence that has shown that smokeless methods to administer nicotine are a better, if not harmless, alternative to cigarettes. Telling a patient, clearly and honestly, that their journey towards a smokeless life might not be as straightforward as they are led to believe is not a lie. My first advice to smokers is always simple: even if it’s not easy, try to quit. If you cannot quit today, reduce. But if you cannot even do that, switch. It is the first step toward an exit. Even if it doesn’t lead to complete cessation, it protects the smoker from a great degree of harm that is caused by combustion. Progress, after all, does not have to be linear. Decades of anti-smoking campaigns can claim some progress. Yet billions of people still smoke, and more might take it up. The lack of meaningful success has taught us the limits of the quit-or-nothing approach. So, to my colleagues in medicine and public health, I would say this: our job is not to judge the choices people make, but to give them accurate, evidence-based information to make their choices wisely. A policy that prioritizes ideological purity over measurable outcomes is not a public health policy. It is a posture. Smokers deserve better than that. They deserve to be told that they have a less harmful route that leads to a better way forward. Copyright Business Recorder, 2026

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