1. What causes cigarette cravings?
A brief guide by Professor Robert West,
University College London

2. The first cigarette
Cigarette smoke is inhaled leading to a spike of nicotine hitting the brain with each puff

3. The first cigarette
To the brain, nicotine looks somewhat like the naturally occurring chemical messenger, acetylcholine
Nicotine
Acetylcholine

4. The first cigarette
So it attaches itself to some of the ‘receptors’ in the nerve cells that normally respond to acetylcholine

5. The first cigarette
There are a large number of these receptors in a part of the mid-brain called the Ventral Tegmental Area (VTA)

6. The first cigarette
This causes a surge of activity in the nerve cells concerned, which project forward to the Nucleus Accumbens

7. The first cigarette
This this leads to release in the Nucleus Accumbens of another chemical messenger called ‘dopamine’

8. The first cigarette
This trains the brain to associate the immediately preceding activity with the current situation

9. The first cigarette
So the brain strengthens the impulse to smoke the next time the situation is encountered

10. Situation Impulse With each cigarette
The stimulus-impulse link grows stronger creating powerful situational urges to smoke
Situation
Impulse

11. So smokers develop situational cravings for cigarettes because nicotine trains the brain to generate an urge to smoke in situations where smoking normally occurs

12. But that’s not all …

13. ‘Nicotine hunger’
In many smokers, the central reward pathway functions abnormally unless it is bathed in nicotine so when nicotine levels are low the smoker feels a drive to smoke

14. Withdrawal symptoms
Neural adaptation to nicotine leads to ‘nicotine withdrawal symptoms’: irritability, depressed mood, hunger, restlessness, difficulty concentrating … and more

15. But that’s not all …

16. Smokers come to believe that smoking helps with stress
False beliefs
Smokers come to believe that smoking helps with stress
quitsmokingcommunity.org

17. Smoking becomes socially rewarding
Social reward
Smoking becomes socially rewarding

18. So rapid hits of nicotine from cigarettes lead to:
Situational cravings
Nicotine hunger
Withdrawal symptoms
False beliefs about smoking benefits
Social rewards from smoking

19. Stopping smoking
Staying off cigarettes means keeping the resolve not to smoke greater than the urge to smoke at al times