With Mayo Clinic behavioral counselor Jennifer A. Kern, M.S., C.T.T.S.

When going through the process of quitting smoking, I think it can be helpful to know something about how nicotine addiction develops. So here it is, in a nutshell.

Tobacco contains more than 2,000 chemicals. When it is burned, another 2,000 are produced. So when you smoke, you inhale more than 4,000 chemicals. Many of those chemicals are harmful to the body. Although nicotine is one of the chemicals in tobacco smoke, it does not directly cause cancer or other tobacco-related diseases. It is, however, what causes the addiction, making it difficult to stop smoking once you've started.

When you inhale the smoke from a cigarette, nicotine reaches the brain within 7-10 seconds. What it does when it gets there is stimulate the release of your body's own "feel good" chemicals, like dopamine. Because it happens so rapidly, your brain experiences instant gratification (like pleasure, relaxation, even a mild high), and you develop strong urges to want to smoke again.

Soon you develop memory pathways in the brain that connect smoking with the things you do when you smoke (drink coffee or alcohol, drive, talk on the phone, have sex). So even if you aren't smoking and you do these things the memory pathways still trigger an urge to smoke.

Using tobacco over an extended period of time causes chemical and structural changes to occur in the brain. When you continue to smoke, there is an increase in the number of receptors in the brain that are sensitive to nicotine and that react strongly to it. Over time, the brain may then require more nicotine to satisfy those areas (we call that tolerance) — so you gradually smoke more.

Stopping smoking typically leads to feelings associated with withdrawal — irritability, frustration, trouble concentrating, sadness, etc. This is essentially the brain's way of telling you that it wants and needs more nicotine. The proper use of nicotine replacement not only minimizes withdrawal by giving the brain the nicotine it needs, but it also in effect "reprograms" your brain to experience nicotine differently. When using nicotine replacement products, it takes anywhere from a few minutes to a couple of hours for the brain to get high enough levels of nicotine to relieve withdrawal symptoms, compared with 7-10 seconds when you smoke.

What this means is that with nicotine replacement medications, nicotine no longer provides the instant gratification that your brain craves. It's like eating a piece of chocolate, but having to wait minutes or hours to taste it! For most people, if you don't get the pleasurable flavor immediately, then it's not worth eating.

Once your brain realizes that nicotine no longer delivers that "quick fix," the number of receptors that respond to nicotine will gradually return to normal levels. But there's a catch — they never go away completely. Many are merely dormant, so to speak, and they always retain the memory of the effects of nicotine. That's what makes "just one puff" such a slippery slope once you've quit — even months or years later.

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