Why quitting smoking is harder than you think

Every smoker has heard it before: “Just quit. Throw away the pack. Use willpower.” If only it were that simple.

For many people who have never smoked, quitting might look like a straightforward choice.

You wake up one day, decide you’ve had enough and never touch a cigarette again. But anyone who has lived with nicotine knows the story is different.

Nicotine isn’t just a bad habit tucked into a cigarette. It’s one of the most addictive substances known. Within seconds of inhaling, nicotine floods the brain, releasing dopamine, the same “reward chemical” that reinforces powerful addictions like alcohol or opioids. That’s why smokers don’t just want a cigarette — they feel they need it.

And when they try to stop? The brain fights back. Irritability, anxiety, difficulty concentrating, sleepless nights, cravings that gnaw at the edges of daily life. These are not signs of weak character. They’re withdrawal symptoms of drug dependency.

This is why “cold turkey” quitting — stopping abruptly without support — fails for most smokers. Research shows that more than 9 out of 10 relapses within a year. It’s not because they don’t care about their health. It’s because nicotine rewires the brain in a way that makes sustained abstinence incredibly difficult without the right tools.

Addiction is a Chronic Condition

We don’t often talk about smoking in medical terms, but we should. Nicotine addiction is a chronic, relapsing condition. Just like diabetes or hypertension, it needs management, monitoring, and often multiple attempts at intervention. Telling someone with high blood pressure to “just think positively and stop having hypertension” would be absurd. Yet this is how we sometimes approach smokers.

Every smoker’s journey is different. Some manage to quit abruptly and stay smoke-free for life. But for many, the cycle of trying, failing, and trying again becomes a heavy burden. And each failed attempt can chip away at self-confidence, making the next attempt feel even harder.

Lessons from HIV

We’ve seen this pattern before in public health. Decades ago, when Malaysia faced a growing HIV epidemic, the early message was clear: “Just stop risky behaviour.” But real life proved more complicated. Telling people not to inject drugs didn’t make the problem go away.

Simply warning about the dangers of unsafe sex didn’t stop infections.

What worked was harm reduction — practical, compassionate strategies that recognised human behaviour. Needle-exchange programs reduced the spread of HIV among people who inject drugs. Later, the introduction of PrEP (pre-exposure prophylaxis) helped protect men who have sex with men. These approaches didn’t encourage risky behaviour. They saved lives by meeting people where they were and guiding them towards safer choices.

Tobacco deserves the same honesty.

Why Smokers Need Phased Approaches

Abstinence — a smoke-free life — should always be the gold standard. No question about it.

But for many smokers, going straight from daily dependence to zero nicotine is almost impossible. That’s why health experts around the world have begun to promote phased approaches: • Behavioural counselling to address triggers and habits.

• Nicotine replacement therapies such as patches or gums.

• Prescription medications that reduce cravings.

• Harm reduction options such as electronic cigarettes or heated tobacco products, which dramatically reduce exposure to the harmful chemicals in smoke.

Not every tool works for every person. Some will respond best to counselling. Others will find success with medications. And many — especially heavy, long-term smokers — may need harm reduction options as a bridge toward eventual abstinence.

The Human Side of Quitting

It’s easy to think of this issue in terms of statistics. Tobacco kills over 27,000 Malaysians every year and costs billions in healthcare. But behind each number is a face: the father who dies too early, the mother left breathless from chronic lung disease, the child who grows up without grandparents.

I’ve met smokers who have tried to quit dozens of times. They know the risks. They’ve felt fear when they cough too hard. They’ve promised their families, sometimes on their deathbeds, that they’ll stop. Yet the grip of nicotine pulls them back. These are not careless people. They are people living with an addiction that is stronger than most outsiders can imagine.

A Call for Compassion and Science

For decades, our public messaging around smoking has been harsh and shaming: “Just quit.

Think of your children. Don’t be selfish.” The intention is good, but the effect is often the opposite. Shame drives addiction underground. Compassion brings it into the open where it can be treated.

If we truly want to reduce smoking in Malaysia, we must combine compassion with science.

That means educating the public about nicotine as an addiction, not a moral failing. It means acknowledging relapses as part of the journey, not a reason to give up. And it means providing a spectrum of tools — from counselling to safer alternatives — so that every smoker has a realistic pathway forward.

The Way Forward Quitting

Smoking is not just a matter of willpower. It’s a matter of biology, psychology and support. And if we can begin to see smoking through that lens, we can save thousands of lives every year.

Malaysia cannot afford to wait another generation. Tobacco kills. It drains our economy. It breaks families. But change is possible if we shift the way we think about addiction.

The first step is education. Let’s start by reshaping the conversation: smoking is not a sign of weakness, but a medical condition that requires treatment, patience, and hope.

Because quitting smoking is harder than you think — but with the right approach, it is absolutely possible.

Dr Anita Suleiman is the founder and president of Harm Reduction Action Network (HaRAN). The views expressed in this article are her own and do not necessarily reflect those of Sinar Daily.