What Nicotine does to the Brain

The reason why people smoke is to experience the effects that nicotine has on the brain. Cigarettes are a nicotine delivery system. Inhaling smoke into the lungs is the fastest way to get nicotine to the brain. The lungs have a large surface area and the capillary walls are very accessible. Up to 90% of the nicotine in mainstream smoke is absorbed and it enters the arterial system and moves fairly directly to the brain, arriving within 7 to 10 seconds. The concentration of nicotine can be three times higher than if the nicotine was injected into veins of the arm because through the venous system, first the blood is pumped to the heart, then to the lungs, back to the heart before finally going to the brain. No product reaches the brain as fast as smoking. Inhaling smoke gives higher, faster, and shorter surges of nicotine to the brain when compared to the nicotine replacement products.

Nicotine then needs to pass through the blood-brain barrier. Ammonia is added to tobacco to increase the PH of the cigarette because a higher PH allows nicotine to cross this barrier easier. Once in the brain nicotine binds to specific areas called nicotinic acetylcholine receptors. Smokers have more of these receptors than non-smokers. Smoking may increase the number of receptors or smoking may allow the receptors to live longer.

Nicotine affects the different parts of the brain in different ways depending on the dosage. Each cigarette is like getting 10 injections of nicotine. Smokers unconsciously regulate the amount of nicotine by either inhaling deeper or smoking more of the cigarette. Sometimes the smoker may use a cigarette to relax, at other times as a stimulant. Menthol cigarettes cool the smoke which causes the smoker to inhale deeper.

When nicotine occupies the receptors in the pleasure pathway, dopamine is released which causes pleasurable sensations (positive reinforcement) and removes unpleasant sensations of pain, anxiety or feelings of illness (negative reinforcement). When the brain has an increase in dopamine, it may be that this increases the attention that the individual places on external activities. These external activities become paired with the pleasurable sensations and become triggers themselves for smokers to light up. The brain becomes conditioned so that when a trigger happens, such as answering the telephone, the brain lights up and expects nicotine to occupy the receptors which the smoker experiences as “cravings”. So any event that a smoker does habitually can be paired with smoking and become a trigger to light up. The brain becomes conditioned to these pleasurable sensations and will “crave” nicotine when faced with these triggers even if they have just finished a cigarette.

Individuals smoke for a combination of both positive and negative reinforcement. When an individual starts smoking it is usually for the pleasurable effects and at some point the individual continues to smoke to avoid the unpleasant effects of withdrawals. Individuals with depression, Attention-Deficit Hyper Activity, and other mental conditions, will start smoking to relieve negative sensations, a form of self-medication. The pattern starts with the individual smoking irregularly but with each cigarette, the nicotine changes the structure of the brain until the individual increases the number of cigarettes and the frequency until addiction sets in, which can occur within three to six months of the first cigarette.

The other area of the brain that nicotine affects is the locus ceruleus which controls vigilance, arousal, concentration and stress reactions. It is also responsible for an individual’s response to stress, anxiety and panic, which may explain why smokers use tobacco in times of high stress and as a way of coping with negative emotions.

The brain structure is changed by smoking. Nicotine floods the brain with dopamine yet the body is constantly seeking balance or homeostasis. The receptor that normally accepts the dopamine is changed to lessen the effect of this flood of dopamine. This change can last five to ten years.

During the quitting process, the smoker may experience withdrawals which are physical symptoms when a drug has not been used for a period of time. Withdrawal symptoms from nicotine includes irritability, frustration, anger, anxiety, depression, difficulty concentrating, restlessness, decreased heart rate, a change in appetite, either hunger or an increase in appetite, a change in sleep habits, either insomnia or inability to fall asleep. The body is also recovering from the effects of smoking and the smoker may experience an increase in coughing, tightness in the throat, dry mouth, dizziness, lightheadedness, headaches, fatigue, difficulty in concentrating and confusion. Medications can help with these symptoms.

Cravings are not the same as withdrawals. Cravings or powerful urges to smoke happen when the brain is conditioned to want nicotine either through positive or negative reinforcement. The brain is shouting, “Where is my nicotine?” Over time cravings become less intense and less frequent. Medications can help with these cravings. Relapse occurs when a smoker will reintroduce nicotine which immediately lights up the receptors in the smoker’s brain. Often only one cigarette is all it takes for the individual to relapse back to full time smoking again because of the strong effect nicotine has on the brain. The brain has memory of how it felt with nicotine and re-addiction can happen within one day when nicotine is re-introduced. The brain has a memory and with the reintroduction of nicotine, the chemical state of the brain matches up with memories of how the individual was when he or she was addicted.

Besides nicotine there are estimated to be 4000 to 5000 chemicals in tobacco smoke. About 400 are either poisonous, cancer causing, or cancer promoting. It is unknown exactly what ingredients are in cigarettes because while the tobacco companies are required to give a list of their ingredients to the government, this information is not released to the public because it is considered a "trade secret". Additives are used to alter the pH level to make nicotine more accessible to the body and to keep the cigarettes burning longer. Nicotine delivery systems are the least regulated consumer product, yet one of the most deadly. There are a few of these chemicals:

Nicotine: A poisonous alkaloid that is the chief active principle of tobacco and is used as an insecticide.
Tar: A particulate matter made up of dozens of compounds. Some are toxic, some are cancer-causing agents. Tar cools inside the lungs, forming a sticky mass and damaging lung tissue. A quart of tar goes through the lungs of a pack a day smoker every year.
Carbon Monoxide: Deprives oxygen from the red blood cells. It stays in the blood hemoglobin for up to six hours after exposure. Is related to heart attacks and strokes. Affects non-smokers. Binds to red blood cells in the lungs 230 times faster than oxygen.
Hydrogen Cyanide: Poison used in the gas chamber. EPA standards indicate that 10 parts per million as safe however cigarette smoke produces an average 1600 parts per million.
Arsenic: A metallic substance, poisonous to all life. The human body can build up a tolerance to arsenic.
Benzene: A poison that interferes with cellular metabolism.
Cadmium: A metal which accumulates in the lungs and stays there. Has an adverse effect on the protective immune devices of the body. Used in batteries.
Ammonia: This chemical is added to tobacco to increase the pH level to make it easier for nicotine to cross the blood brain barrier. Used as a household chemical.
Acetone: Used as nail polish remover.
Toluene: Industrial solvent.
Formaldehyde: Embalming fluid.
Methanol: Rocket fuel.
Naphthalene: Mothball Chemical.
Nitrobenzene: Gasoline additive.
Mercury: Found in thermometers.
Nitrous oxide: Disinfectant.
Stearic acid: Candle wax
Butane: Cigarette lighter fuel.
Vinyl Chloride: Component of PVC pipe.
DDT: Insecticide banned by most Western industrialized nations.
Hexamine: Barbecue lighter

You CAN'T Quit or You Don't WANT to Quit???

I Can’t versus I don’t want to.

“I can’t quit smoking, it’s too stressful.”
“I can’t quit because I can’t use any medications.”
“It’s hopeless.”
“It’s impossible for me to quit.”

Rita was a middle aged woman that had returned to college. She smoked while she studied at her kitchen table. I suggested that she try studying at the library.
“Oh, I can’t do that!”

Dorothy commented on some of the homework assignments from a Stop Smoking, Stay Quit Workshop:

“I can’t eat oranges because they give me hives, I can’t eat carrots because I don’t like them, I can’t exercise because I don’t have the time and I can’t drink more water because I don’t get bathroom breaks at work.”

“What do you want from me?” I asked.

“I want you to tell me that I can’t quit.” Dorothy said.

I didn’t argue with her but said, “You’re right, you can’t quit.” But if you look at her reasons, what she was really saying is “I don’t want to quit.”
Saying “I Can’t” implies that whatever being asked is impossible to do. None of the homework assignments were impossible to do. There are very few things in life we CAN’T do, but this is usually just an excuse because we don’t WANT to.
It's easier to say, “I can't quit,” because that implies that the smoker is not responsible for the outcome. Once the smoker says “I can quit,” this implies that they are now taking responsibility for their actions.

In a different class, Jack said almost the same thing as Dorothy,

“I can’t eat more fruits and vegetables.”

This time I wanted to fall through the floor because Jack had lost his lower jaw to bone cancer due to smoking. He had no bottom teeth to eat with and was on a totally liquid diet. It was impossible for him to eat more fruits and vegetables.

“But I’m not going to let that stop me. I can do everything else because I want to quit.”

If a smoker believes that he can’t quit, he can’t but usually this means they don’t want to do what it takes to be successful and this usually means that the motivation is not strong enough or is non-existent. It is important to not push a smoker to a step they are not ready for yet. Resistance at this point, may mean that the focus needs to be on motivation instead of moving forward.
“You don’t understand, I can’t afford your class because I can’t afford milk for my children.” This smoker said this to me as she sucked on her cigarette. I didn’t point out to her the insanity of putting the buying of cigarettes before buying milk for her children.
A smoker needs to believe that they can be successful at quitting. By taking small steps instead of leaping forward, the smoker can build the confidence to quit. The process is easier as the smoker changes his beliefs from I can’t to I want to. So one step forward is to decide what you are willing to do--maybe it is something as simple as only smoking outside, or stop smoking in the car. Willingness to try can create success for the next step forward of what the smoker is willing to try until they are willing to stop altogether.

Alternatives to Medications to Stop Smoking

There are a number of reasons why some smokers resist using medications to help ease them through the withdrawal stage when they stop smoking. There are a number of things you can do to help:

Nicotine is water soluble so drink plenty of fluids. Cold water supplemented with fruit juices with Vitamin C is best. Drink enough until the color of your urine is clear. Avoid coffee if it is a trigger to smoke.

An increase in the oxygen you breathe can have the same calming effect as smoking a cigarette. Start the habit of deep breathing. Most smokers are shallow breathers yet our lungs are quite large. Practice breathing in through your nose and out through your mouth, expanding your abdomen.

Smoking generates an acidic condition and an alkaline diets consisting of fruits and vegetables helps in detoxification and withdrawals. So start eating more fresh fruits and vegetables, preferably raw. Stock up on crunchy low fat foods such as carrots, celery, radishes, broccoli, bell peppers, apples, pears, cinnamon sticks, sugarless candy, unbuttered popcorn, rice cakes, cereal. This will also help with weight gain since since withdrawing from nicotine can lower the blood sugar, it's better to reach for fruit for natural sugar instead of a candy bar or pastry.

Take a multi-vitamin with extra vitamin C and vitamin B’s. Smoking robs the body of vitamin C and this lowers the immune system making the smoker more likely to catch a cold or get the flu when they quit. Vitamin B's will help calm the nervous system.

Get plenty of rest. Do not take on extra responsibilities at this time. When quitting the smokers body is going through tremendous stress, this is not the time to burn the candle at both ends but to treat yourself gently and focus on what is important.

Exercise helps with unwanted weight gain and uncontrolled stress. Walk briskly for 20 minutes each day.

Avoid alcohol for several weeks. Alcohol impairs your judgment. If you will not stop drinking alcohol, you may want to look at your reasons why. 85% of hard core alcoholics smoke yet smoking is more likely to kill an alcoholic than their liquor.

Change the way you think about withdrawals--they are actually recovery symptoms, telling you that your body is healing itself.

If you have any health problems, speak with your physician before making any changes in your routine or starting an exercise program. If you are taking medications, the dosages may need adjusting after you stop smoking. If after 3 to 4 weeks, you are still having physical problems, go see your doctor. Smoking mask physical problems that quitting exposes. A middle age man in one of my workshops complained that every time he quit smoking, his stomach hurt, so he would go back to smoking. It turned out that he had an ulcer but the smoking was masking the pain. Quitting didn't cause the ulcer, but helped him get a diagnosis and get it treated.

You Don't Always Die from Tobacco

Smokers will often say that you have to die of something, which is true but what smokers die from are often horrible diseases such as cancer, heart disease, emphysema, chronic bronchitis, and COPD. but I don't think the real problem with smoking is that you might die too young (although 50% of smokers will die from a disease caused by their addiction) but you might live too long with the disabling effects from smoking. Check out The Truth's Ad on YouTube--You Don't Always Die From Tobacco.

http://www.youtube.com/watch?v=xRHvZazd4IM&feature=related

Dealing with the Rituals of Smoking

Often smokers continue their mantra of "I enjoy smoking" when they stopping enjoying it years before but they have continued to smoke unconsciously since each cigarette is paired with so many of the individual's daily routine. Everyone has a morning ritual that they go through, I wake up, get the newspaper, read the paper while drinking a cup of coffee. For a smoker, a cigarette fits in there someplace. I know that when something upsets my morning ritual such as running out of coffee or not getting the paper, it can throw my day off. The smoker has 20 rituals a day, so not only are they dealing with the physical aspects of quitting but every aspect of life where that cigarette fit into their daily rituals.
It helps to prepare before quitting to smoke by the clock and start disassociating smoking with daily activities. If you smoke a pack a day that is about one an hour, so smoke every hour on the hour, but don't drink you coffee when smoking, don't talk on the telephone, do nothing but stand and smoke the cigarette. This give you time to figure out how to have that morning cup of coffee without the cigarette, how to drive the car without the cigarette, how to talk on the phone without the cigarette but without having to deal with the physical aspects until you are ready to quit.

Is Harm Reduction the New Way to Quit Smoking?

Some health care professionals are encouraging smokers to switch to smokeless tobacco or snus as a way to quit smoking because smokeless is less harmful than the combustion and inhalation of smoke. I consider harm reduction the same as wearing a seatbelt--how often do you need to wear one?? Most would say everyday but really you only need a seatbelt when you get into an accident. If you don't get into an accident, then you don't need a seatbelt. The problem is that we don't know when that accident is ging to happen so we prepare for the worse by wearing seatbelts everytime we drive. Same with the use of any tobacco products--Wouldn't it be nice if we knew what our genetic weak link is, so that we could avoid those substances and environmental hazards that will increase our personal risk. What it boils down to is what is the risk an individual is willing to take. By switching to smokeless, there may be a reduction in some types of cancers but there is an increased risk for oral cancers. Regardless of the form, tobacco is a dangerous product. As a 20 year cancer thrivor (I did much more than just survive), I choose to eliminate as many known risks as I am able. The use of addictive substances usually is to satisfy an emotional or spiritual need. I advocate addressing the emotional or spiritual need rather than the use of addictive substances. The tobacco companies used this same philosophy when they came out with low tar and nicotine cigarettes but we found out that they didn't reduce the health risks at all but millions of smokers switched instead of quitting altogether and they health suffered for it. So instead of switching to smokeless, the best thing for you health is to embrace a tobacco free life and enjoy your better health.

Third Hand Smoke--Another Good Reason to Stop Smoking

The only disagreement about the dangers of secondhand smoke, come from the tobacco companies. Now a study in Australia shows that even when parents smoke outside, they carry nicotine and smoke particles attached to their clothes and hair and will continue to exhale components of smoke when returning indoors. The children that live with these smokers were three times more more likely to have asthma than children that lived in homes where neither parent smoked. the best way to protect your children is to Stop Smoking period.

http://www.news.com.au/story/0,23599,23908387-29277,00.html

Should the FDA Regulate Cigarettes?

There is a bill in front of congress giving the FDA the ability to regulate the tobacco industry. The bill is asking that flavors, such as mint, vanilla and clove, be banned since these products target children. There is a split among healthcare proponents whether this ban should include menthol also. The National African American Tobacco Prevention Network agrees with the former Surgeon General, Dr. Louis Sullivan that menthol flavoring should be banned. This represents about 30% of the tobacco market in the United States but is the flavor preferred by African American, which consume about 75% of the menthol cigarettes.
The tobacco industry opposes banning menthol because it states that menthol doesn't make smoking any more harmful but we all know the tobacco companies lie to protect their profits.
Menthol is a bronchial dilator. Menthol cigarettes cool the smoke down so that the smoker inhales deeper and causes cancer deeper inside the lung and usually is inoperable.
While I'm not sure that the FDA has the manpower to govern the tobacco industry, I believe that we should support the ban of menthol cigarettes since it can be more dangerous than regular cigarettes and it may help smokers to quit when they can't buy the brand they normally prefer.

Many Reasons Why We Smoke

There are many reasons why people smoke, these are just some, see how many apply to you


STIMULATION:
I smoke cigarettes in order to keep myself from slowing down, such as in the late afternoon.
I smoke to stimulate myself, to perk myself up or to wake up in the morning.
I smoke to give myself a “lift”
Smoking helps me to concentrate when I am reading or studying.

BOREDOM:
I smoke a lot when I am alone.
I smoke when I have extra time on my hands.

HANDLING:
Handling a cigarette is part of the enjoyment of smoking it.
Part of the enjoyment of smoking comes from the steps I take to light up, from packing the tobacco to lighting it up and holding the cigarette in my hand.
When I smoke, part of the enjoyment is watching the smoke as I exhale or blowing smokerings.
When I don’t have a cigarette to smoke, I feel awkward because I don’t know what to do with my hands.
When I smoke, I enjoy the feeling of the cigarette and the smoke on my tongue and lips.

PLEASURABLE RELAXATION:
Smoking cigarettes is pleasant and relaxing.
I find cigarettes enjoyable.
I light up a cigarette most when I am most relaxed and comfortable.
Smoking helps me relax quickly when I feel tense.

REDUCE STRESS AND NEGATIVE EMOTIONS:
When I am trying to solve a problem, I light up a cigarette.
When I feel “blue” or want to take my mind off cares and worries, I smoke.
When I feel uncomfortable or upset about something I smoke.
I light up a cigarette when I feel angry about something.
Few things help better than cigarettes when I’m feeling upset.
When I am faced with troubles of some kind, smoking a cigarette seems to help me face them more easily.

PHYSICAL ADDICTION/CRAVING:
I smoke at least one pack a day.
I smoke within 30 minutes of getting up in the morning.
I need to smoke at least one cigarette every hour.
I am very much aware of the fact when I am not smoking a cigarette.
I get a real gnawing hunger for a cigarette when I haven’t smoked in a while.
Between cigarettes, I get a craving that only a cigarette can satisfy.
When I run out of cigarettes I find it almost unbearable until I can get them.
I go on smoking even though I find the taste rather unpleasant

HABIT:
I smoke automatically without even being aware of it.
I always smoke in certain situations such as answering the phone, getting in the car or with a drink or with coffee.
I have found a cigarette in my mouth and didn’t remember putting it there or I light up and find one already burning in the ashtray.
There are specific times during the day when I regularly smoke.
Right after lighting a cigarette, I put it out because I realize I don’t really want it.
I smoke a lot when I am talking to friends.

When quitting, it is important to have many different tools to deal with the different cravings. What works for a "habit" cigarette, may not work for a "stress" cigarette.

Powerful Process to Quit Smoking

Every smoker is connected to their cigarettes in different ways. Individuals smoke at different times, have different triggers and each smoker can have a different response to the same trigger. What is important is to figure out what works for the individual--every method will work for some, no method works for everyone. A step to figuring out what works for you, is to smoke by the clock and disassociate smoking with all activities. If you smoke 20 cigarettes a day, that is about one an hour, so starting tomorrow, smoke every hour on the hour, not when you want a cigarette. Only smoke at this time. Create a smoking corner, at home, away from all household activities. When it is your time to smoke, go to your smoking corner and smoke one cigarette. Do not take your coffee with you, don't take the telephone, don't listen to your ipod, don't look through the window at the TV, just stand there and smoke your cigarette. This gives you the opportunity to figure out how to drink your coffee without smoking, how to talk on the phone without smoking. If it is your time to smoke and you are driving, stop the car, get out and smoke your cigarette. At work, it this process may need some adjustment, but the idea is to not do anything else when you are smoking, so don't talk to the other smokers, go someplace where you can be alone.
This is start breaking your associations with smoking while you are still getting the nicotine. It also allows you time to figure out which are your strongest triggers, so that you can learn how to cope with these triggers without smoking. So often we smoke unconsciously and the smoking becomes associated with other activities. Smoking by the clock breaks those associations and allows you time to reflect when you are smoking, in your smoking corner without any distractions. It's a great time to reflect on what smoking means to you and what is it that you truly want--a cigarette or a smoke free life.

Willingness to Stop Smoking

Are you willing to do whatever it takes to quit smoking? Quitting is hard work and it takes a willingness to go through the steps to get to the other side. It's like starting a diet, you have to be willing to reduce caloric intake and increase energy expenditure. Diets fail because most are willing to do this for a specific period of time but then they want to go back to their previous way of eating, and they gain the weight back. The are not willing to adopt a new way of relating to food.
Smoking is similar. First, the smoker needs to be willing to do what it takes to get through the withdrawals and cravings, just like losing the weight is the first part of dieting. Next is maintenance, which is resisting smoking even one cigarette. This is where the question, "Are you willing to do what ever it takes to resist this one cigarette?" comes into play again.
Until a person is ready to answer "Yes" to this question, they may have quit but they are likely to relapse because they figure, "One won't hurt." But they are under estimating how powerful nicotine affects their brain. By slipping and having one cigarette, the receptors in the brain wake up and shout, "Don't tease me with one, I want the whole pack!" Both dieting and quitting smoking require life style changes to have long term success. For future non-smokers, it requires finding the tools to resist having "Just One".

The Many Fears About Quitting Smoking

Part of our belief system is what we fear and often a smoker will continue to smoke because of different fears about quitting.

Fear of the unknown.

Smokers don't know what there is to be afraid of but change alone is scary. Change is risky. The belief is that it is better to face the known enemy than risk facing the unknown.
Confronting a fear is fearful in itself. Often a smoker doesn’t want to admit that quitting is a scary process but getting the fears out in the open, allows the healing to begin and the smoker can break through their fears. Self-knowledge about beliefs and fears promotes self choice and action. It takes courage to make major life changes and face the fears that come with changing. Often when the fear is identified, the smoker can begin to learn what tools they will need to learn to be successful.

Fear of gaining weight.

“I quit before and a lot of gained weight.”
“I'd rather smoke that be fat.”
“Once I start gaining, it wouldn't stop and I'll be huge.”

There are many misconceptions about weight gain and quitting smoking but many people are so afraid of gaining weight that they never try to quit smoking. For some people, this is the reason why they started smoking in the first place.

Fear of Pain

“I quit before and I was miserable.”
“Quitting sucks.”
“I can’t handle the withdrawals.”
Smokers may have hears horror stories from other smokers who have quit, about how difficult it was to quit or how bad the withdrawal symptoms were when they quit.
If the smoker has never tried to quit, she may be influenced by the stories she has heard about how hard it is and how bad the withdrawals can be or if she has quit herself and has experienced withdrawals, she may not want to face the cravings again.

Fear of Loss of Enjoyment or Deprivation

Smoking becomes associated with many activities that the smoker enjoys and there can be a fear that he will not longer enjoy these activities without smoking or that his enjoyment will be diminished. The fear can be that the smoker has to give up some of his pleasurable activities when he quits.

Fear of Being Unable to Control Stress

Many smokers use cigarettes to control their stress or reaction to negative emotions and the fear is that the smoker will be unable to handle stress and negative emotions and will be overwhelmed. Often the smoker has not developed other effective coping mechanisms and needs to learn effective stress relief and how to handle negative emotions.

Fear of Failure

“I might fail.”
“I might lose control.”

There is a fear of failure that the smoker might not succeed and will look foolish if he fails. This is especially true for those smokers who have tried and relapsed several times. He doesn’t want to try again and will give up instead because of the fear of failure.
Along with fear of failure is the fear of being ridiculed or loss of face. If the smoker tells someone that he has quit and then fails, how will others view him?

Fear of Success or loss of identity

“If I don’t smoke, I don’t know who am I.”

I remember being absolutely paralyzed because of the thought, "What do I do if I don't smoke?" Smoking has been integrated into the personality of the smoker and she can't see herself without that cigarette. It can become a much needed prop or security blanket in life.

Loss of Approval or Loss of Control?
Most fears boil down to either a fear of a loss of control or a loss of approval. The smoker feels that if he doesn't get it right that others will judge him or he will be out of control. Often the smoker just needs additional tools to deal with what ever aspect he fears.

The Easy Way to Quit Smoking

If there was an easy way to quit smoking, you would have done it already. But if you're like most smokers, quitting is the most difficult thing you will ever do. The reasons we keep smoking, vary with the smoker. We are getting something from the cigarettes that we are not getting someplace else. Figure out what you need (hint-it's not a cigarette)and fulfil that need in a different way.
The overwhelming attribute for those who are successful at quitting, boils down to one thing-motivation. They either wanted to quit or wanted something that was in direct conflict with smoking. So to make quittig easy--work on your motivation because when you want to quit more than you want to smoke, it will be like turning on a lightswitch and it will be the easiest thing you have ever done--when you take control and decide what is most important to you and you find out, it's not the cigarette. The fear of quitting keeps many in prison but desire, or motivation can set you free.

I Can't Quit Smoking is Usually I Don't Want to Quit

“I can’t quit smoking, it’s too stressful.”
“I can’t quit because I can’t use any medications.”
“It’s hopeless.”
“It’s impossible for me to quit.”

In one of my workshops, Dorothy commented on some of the homework assignments: Increase intake of fruits and vegetables, get more exercise and drink more water.

“I can’t eat oranges because they give me hives, I can’t eat carrots because I don’t like them, I can’t exercise because I don’t have the time and I can’t drink more water because I don’t get bathroom breaks at work.”

“What do you want from me?” I asked.

“I want you to tell me I can’t quit.” Dorothy said.

I didn’t argue with her but said, “You’re right, you can’t quit.” But if you look at Dorothy's reasons, what she was really saying is “I don’t want to quit.” Saying “I Can’t” implies that whatever being asked is impossible to do. None of the homework assignments were impossible to do. There are very few things in life we CAN’T do, but "can't" means being unable to do it which lets us off the hook for our smoking. Saying, "I can't" is just an excuse because we don’t WANT to.
It's easier to say, “I can't quit,” because that implies that we are not responsible for our behavior. Once the smoker says “I can quit,” this implies that they are now taking responsibility for their actions.

In a different class, Jack said almost the same thing as Dorothy,

“I can’t eat more fruits and vegetables.”

This time I wanted to fall through the floor because Jack had lost his lower jaw to bone cancer due to smoking. He had no bottom teeth to eat with and was on a totally liquid diet. It was impossible for him to eat more fruits and vegetables.

“But I’m not going to let that stop me. I can do everything else because I want to quit.”

If you believe that you can’t quit, you can’t but mostly this means you don’t want to do what it takes to be successful. The motivation to quit is not strong enough or is non-existent. Instead of looking at what you can’t or won’t do, focus on what you can do. Work on building motivation with either focusing on the benefits of quitting or the consequences of continuing to smoke.