The Relationship Between Stress and Smoking

What is Stress?    

Stress is what we have when life gives us challenges. There are many ways that we may be challenged. Perhaps we have to change the way we live (like when we get a new job or have a baby). Perhaps we have to solve a problem (like finding ways to pay bills). Perhaps we have to get a task done in a short amount of time (like when the boss wants our report first thing in the morning). Perhaps we have to make a hard choice (for example, whether or not to have surgery). When we are challenged we may have stress. These challenges are called stressors. Stressors come in all shapes and forms. Major events that happen to us are one type of stressor.

Tobacco is a well-established risk factor for various diseases including lung cancer, cardiovascular disease, and lung disease. Passive smoking has been associated with upper respiratory tract infections (URTIs) and bronchial asthma in children (Stanton, Lowe & Silva, 1995). Despite its health risks, the use of tobacco is common throughout the world, especially in developing countries like Pakistan. The consumption of cigarettes in Pakistan was estimated at 90,000,000,000 cigarettes in 2005.

Adolescent smoking is associated with various factors, including demographic characteristics, interpersonal issues (e.g., social norms and social influence of smoking), and physical environmental factors (e.g., availability of cigarettes and space for smoking). The proximal and distal psychological risk factors of smoking behavior and intention vary based on the cultural context (Way, Stauber &  Nakkula, 2007). Proximal factors include peer influence, which is often expressed as peer pressure , and positive attitude toward smokers and smoking cohabitants (Leventhal & Cleary, 2002). Distal factors include emotional distress from having a reciprocal relationship with smoking behavior , such as social motives, effect and stress, knowledge about smoking, perceived benefits of smoking, risk perception of smoking, media, and tobacco advertising/promotion, and family and school environment (Kandel  & Davies, 2006). Barriers or physical constraints are similarly related to the change in smoking behaviors among adolescents (Igra  & Irwin 2004).

Smokers commonly report smoking more under conditions experienced as stressful, and it has been suggested that smoking is a technique for dealing with stress. Prospective studies have found associations between anxious, aggressive, and generally neurotic personality traits in childhood and a tendency to smoke later in life. Using a crosssectional sample of 668 adults, Billings & Moos (1983) found that smokers, especially heavy smokers, differed from non-smokers in showing higher levels of anxiety/depression symptoms and negative

life events.

The large overlap between mental illness and smoking is not entirely surprising considering the known effects of nicotine on the brain. Nicotine is a psycho stimulant that effects several neuro regulators that influence behavior and mood (Leonard, Adler, Benhammou & Berger, 2001). In some circumstances, nicotine can relieve symptoms of both depression and anxiety (Picciotto & Brunzell, 2002). Nicotine cessation can also precipitate depressive symptoms, particularly in people with a history of major Depression (Berman &  Glassman 2001). However, it has been questioned whether these are independent depressive symptoms or unpleasant withdrawal symptoms (Glassman, 1993). The onset of depressive symptoms following smoking cessation has been linked with lower quit rates, and most commonly occurs in people with depression (Ziedonis  & Hitsman, 2008). These factors have lead to the self-medication hypothesis – that smokers with mental illness choose to smoke because it is the easiest, most readily accessible way to control symptoms of mental illness, especially for those who are not receiving any prescribed form of treatment for their mental

health condition (Khantzian, 1997).

While the self-medication theory implies there is a therapeutic benefit to smoking which people with depressive or anxiety symptoms find helpful, research suggests that smoking provides temporary relief from immediate symptoms, while overall creating a greater level of anxiety and stress (Williams & Ziedonis, 2004). Thus the alleviation of stress and anxiety by smoking may be part of the withdrawal feedback mechanism. It has been suggested that the self-medication hypothesis has too often been used as a justification for not acting to curb cigarette smoking in this population despite the fact that nicotine is not regarded as the most appropriate therapy for any mental health problem, and that even if it were, cigarettes would not be an appropriate form of administering it (Ziedonis, Hitsman, Beckham  &  Zvolensky, 2008).  

Although most people understand that smoking harms a person’s health, many smokers believe it helps them cope with stress. Since nicotine is a psychoactive (mood altering) drug, tobacco use seems to make the subjective effects of stress (such as feelings of frustration, anger, and anxiety) less severe. This is because the nicotine in cigarettes reaches the brain in only 8 seconds, releasing a chemical called dopamine. Dopamine causes an initial sense of calm and well-being, and causes your body to crave that sensation again and again. This is a cruel illusion; while one may feel an initial sense of calm when he/she smokes, the body is actually under a great deal of increased stress. Blood pressure and heart rate increase, muscles become tense, blood vessels constrict, and less oxygen is available to the brain and body to facilitate healthy coping. Smoking also leads to ineffective coping, as the causes of the initial feelings of stress are still present – smoking does not change the situation at all.

Contrary to the belief that smoking is an aid for mood control; it actually heightens tension, irritability and depression, during nicotine depletion in the body (Farrell,  Howes,  Bebbington  &  Brugha,  2001). This mood swing arises between smokes or during periods of nicotine abstinence. Dependent smokers need nicotine to remain feeling normal (Hastie  & Tibshirani, 1986).

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