Why do some people smoke despite being aware of the risks? Why do ex-smokers relapse years after quitting? What keeps people addicted to tobacco? What role, if any, do emotions play in addictive behaviour?
A Harvard University research team set out to answer these questions. They did this by examining data from more than 10,000 people collected during a national survey that took place over 20 years. They then designed experiments to test the responses of current smokers to negative emotions. Their findings were recently published in the Proceedings of the National Academy of Sciences (PNAS)1 journal.
One emotion stands out in addictive substance use
The research showed that more than a negative mood or other emotions like fear, anger or shame, sadness drives addictive substance use. What’s more is that this emotion, and not any other was the most reliable predictor of current smoking as well as relapse 20 years later. In fact, in laboratory settings where experiments involving real smokers were conducted, sadness increased both impatience to smoke and the volume of puffs taken.
According to the study’s lead researcher and doctoral candidate, Charles A. Dorison, conventional wisdom in the field of addiction research has held that any negative emotions, whether they be stress, anger, fear, shame, sadness or disgust would increase people’s propensity for addictive drug use. The findings from the Harvard study suggest that there is far more to smoking addiction than merely feeling bad and smoking more. From the results, sadness appears to be a potent trigger.
According to the study’s senior co-author, Dr Jennifer Lerner, this information could have useful public health policy implications. One such example could be redesigning anti-smoking campaigns to eliminate images or messages that trigger sadness and inadvertently cause smokers to crave cigarettes.
However, this information can also help smokers battling tobacco addiction to understand what is driving this rather than putting it all down to a lack of self-control.
Understanding sadness
Sadness is a normal, human emotion that we all experience from time to time. It is not inherently negative as it is a natural part of the human experience. Trying to avoid it altogether can lead to destructive behaviours and adverse outcomes.
Sadness can, however, be challenging to deal with not only because of the pain it causes but also due to the factors that led to it in the first place. It may be associated with stressful life events such as the loss of a loved one, the end of a relationship, disappointment, perceived failure or hurtful experiences.
Sadness can often be alleviated by crying, venting, exercising or doing something that allows the release of emotion. It generally lifts over time. Persistent, deepening sadness can, however, be a sign of depression. Unlike sadness, depression is not universal, and not everyone who feels deeply sad will develop depression.
Sadness has multiple functions and adaptive features, and many of these can have a positive long-term effect. In social situations, sadness can strengthen bonds and lead to selfless behaviours as we are more likely to help others when we feel sad for them. On a personal level, sadness related to disappointment and perceived failure can encourage reflection. This, in turn, can increase self-focus as people review their priorities, goals and role fulfilment in ways that foster stability and promote growth.
The link between sadness and addiction
People often turn to addictive substances during times of sadness because they provide fast-acting relief. So, for example, when a person smokes, a dose of nicotine reaches the brain within approximately 10 seconds2. This not only affects the body physically, improving concentration, relaxing the muscles and decreasing appetite, it also influences emotions, improving mood and reducing feelings of anger, stress and sadness.
In a way, nicotine temporarily medicates the person’s feelings of sadness, delaying the need to address its underlying cause. When the person continues to smoke to alleviate negative emotions instead of dealing with them, a feedback loop is perpetuated. The underlying cause of sadness remains, as does the need to ‘medicate’ it, and so addiction develops.
Combatting addiction
Part of overcoming sadness is realising that it does not equate to weakness. Instead, showing sadness requires vulnerability which demonstrates strength and courage in the face of the fear of being hurt. Enduring the pain of sadness is a hallmark of resiliency, not an indication of inadequacy3. When people realise this, it is often far easier to deal with sadness and identify its root cause.
Addictions do not all come down to a lack of self-control. It is a multi-faceted condition that can be overcome if sufferers are willing to be honest with themselves and do the work required. A multi-prong treatment approach that enlists the help of both a doctor and psychologist or a psychiatrist is often most effective in dealing with addiction. This ensures that an individual treatment plan that addresses both the physical and psychological aspects of addiction using behaviour therapies and medications, where necessary, can be designed.
References
1. Dorison C, Wang K, Rees V, Kawachi I, Ericson K, Lerner J. Sadness, but not all negative emotions, heightens addictive substance use. Proceedings of the National Academy of Sciences. 2019:201909888. doi:1073/pnas.1909888116
2. Smoking and mental health. Mental Health Foundation. https://www.mentalhealth.org.uk/a-to-z/s/smoking-and-mental-health. Accessed January 10, 2020.
3. Why Do People Use Drugs? The Relationship Between Emotions and Addiction, pt. 3: Sadness - Non 12 Step Drug Rehab and Alcohol Treatment. Non 12 Step Drug Rehab and Alcohol Treatment. https://www.practicalrecovery.com/prblog/people-use-drugs-relationship-emotions-addiction-pt-3-sadness/. Accessed January 10, 2020.