Smoking

Also called Nicotine dependence, Tobacco dependence, Stopping smoking, Vaping

The largest single preventable cause of illness and death in the UK. Stopping helps at any age, and the NHS support triples the odds.

What it is

Tobacco dependence is a treatable condition, not a lifestyle choice, and nicotine is among the most addictive substances there is.

Smoking is the biggest single cause of preventable death in the UK. It causes or worsens most of the entries in this library: lung cancer, COPD, heart attack, stroke, peripheral arterial disease, bladder cancer, head and neck cancer, pancreatic cancer, osteoporosis, macular degeneration, leg ulcers, dental disease and rheumatoid arthritis among others.

The good news is unusually strong. Stopping at any age adds years, and the benefits start within days. Stopping at 60 still adds years; stopping before 40 removes most of the excess risk.

The method matters far more than willpower. Stopping unaided succeeds roughly 3 to 5 per cent of the time. Combining behavioural support from a stop smoking service with medication or a nicotine vape roughly triples the chance, and that combination is free on the NHS.

Vaping is substantially less harmful than smoking and is an effective way to stop. It is not harmless and it is not for people who do not smoke, particularly not for young people.

Smoking rates are two to three times higher among people with a severe mental illness, and that group is offered support least often.

Signs you might notice

Signs of dependence rather than habit: smoking within 30 minutes of waking, smoking when ill, having tried to stop and not managed it, and irritability or restlessness when unable to smoke.

Signs the body is being affected already: a morning cough, breathlessness on stairs, repeated chest infections, and slow healing.

Anything that should prompt urgent assessment on its own: coughing blood, a cough lasting more than three weeks, unexplained weight loss, hoarseness for three weeks, or chest pain.

Withdrawal, in the first fortnight: irritability, restlessness, poor concentration, low mood, increased appetite, and strong cravings that peak within minutes and pass.

How it can affect day-to-day life

Most people who stop have stopped before. Relapse is part of the process rather than evidence of failure, and the average is several attempts before it holds. Framing it that way keeps people trying.

The people who find it hardest are usually those using smoking to manage something: stress, anxiety, depression, boredom, or the structure of a day. Stopping without replacing what it was doing rarely lasts. Anxiety and depression scores improve after stopping, which surprises almost everybody.

Smoking speeds the metabolism of several medicines, notably some antipsychotics and clozapine. Stopping can raise blood levels significantly, so doses need reviewing rather than left. This is a genuine safety point that is regularly missed.

In care settings, smoking is often treated as a right to be facilitated rather than a dependence to be treated. Both can be true, and offering treatment is not the same as forcing it.

The cost is now a substantial part of a low income, and money is a stronger motivator than health for a lot of people.

Supporting someone well

Use the local stop smoking service. It is free, it is the single largest factor in success, and most people do not know it exists.

Combine behavioural support with medication or a nicotine vape. One without the other is a much weaker plan.

Use nicotine replacement properly: a long-acting patch for the background plus a fast-acting gum, spray or lozenge for cravings. Under-dosing is the commonest reason it fails.

Set a quit date, and get through the first fortnight, which is when withdrawal peaks.

Ask about medication reviews on stopping, especially for anybody on clozapine, olanzapine or theophylline.

Do not treat a lapse as the end. Ask what happened and go again.

For anybody with a long-term condition, raise it at every review. Brief advice from a clinician measurably increases quit attempts, and it takes 30 seconds.

Where to get help

The local NHS stop smoking service, which most councils run and which usually accepts self-referral.

A GP or pharmacist for medication and nicotine replacement.

The NHS Quit Smoking app and the Better Health quit smoking support.

Action on Smoking and Health publish reliable evidence on smoking and on vaping.