Disclaimer: The COVID-19 pandemic is stressful, and we understand that smoking is a coping mechanism. This post is not meant to judge smokers but to serve as a resource for people who want to quit.
At the urging of the International Olympic Committee, Japan moved to pass new smoking laws to make Tokyo smoke-free. The Tokyo Metropolitan Government Smoking Prevention Ordinance and the Revised Health Promotion Act, which came into effect on April 1st, aim to reduce smoking indoors. Starting today, all indoor smoking will be effectively banned with the exception of designated smoking rooms where available. This means that café chains like Dotour can no longer have entire smoking floors within their shops.
Heated tobacco, like those used with iQOS holders, are in the same category as cigarettes for the time being which means that they must also be used in designated heated tobacco rooms or smoking rooms in cafés and restaurants. More on this below.
Tokyo Metropolitan Government’s Smoking Ordinance vs Japan’s Revised Health Promotion Act
Since July of 2019, the Tokyo government has been slowly enforcing parts of its new smoking ordinance, starting with the banning of indoor smoking in hospitals and government buildings. In September of the same year, smoking was prohibited within school and daycare premises. Now, offices, staffed restaurants and bars, and other establishments will follow.
On the whole, the Tokyo Metropolitan Government Smoking Prevention Ordinance and the Revised Health Promotion Act are the same. The biggest difference is that Tokyo’s ordinance is a lot stricter. According to the Mainichi Shimbun, since the latter uses floor space and financial assets as deciding factors, it would only cover about 45% of dining establishments; on the other hand, because the former is not based on the same factors, it will encompass a larger 84%. Penalties served to violators also vary between the two. Whereas the city ordinance will fine violators up to ¥50,000 for establishments and ¥30,000 for individuals, the national law will fine violators up to ten times more – ¥500,000 and ¥300,000, respectively.
For the benefit of smokers and non-smokers alike, both laws require establishments to indicate whether or not smoking is allowed on their premises. To help them adjust, the Tokyo government has prepared printable signs for each point included under the city ordinance – non-smoking, smoking, heated tobacco only, etc.
How will these Laws Affect Smokers?
Of course, it is hoped that these laws will have a positive impact on the health of Japanese citizens. However, as of the time of writing, with the drastic reduction in smoking areas in Tokyo, smokers have taken to gathering in larger numbers in outdoor smoking spaces. The smoking area outside of Tamachi station, for instance, exposes passersby to more smoke than before.
On a more sympathetic note, the new restrictions might be worse for smokers than they seem on the surface. Their choices become either to box themselves in rooms – increasing their exposure to smoke, or to take steps to quit smoking – a very tall order.
However, in the interest of keeping safe from respiratory illnesses like the novel coronavirus, quitting should ideally be considered by smokers as they are a vulnerable demographic.
No one can force a smoker to quit. Addiction doesn’t work that way. In fact, with doctors, friends, and family reminding them at every turn, smokers aren’t exactly unaware of how smoking affects their bodies. But there is a very big difference between knowing something and it making sense to you and acting on it. An ex-smoker put it this way, quitting an addiction is a personal decision – one that external input has very little hope of affecting. Nobody, and I mean NO ONE, likes to be told what to do, and a person struggling with nicotine addiction is no different.
But for people who are inclined to try, we’ve compiled as much information as we can to help you help yourself. From the gold standard to a novel approach on how to quit tobacco for good, read on below!
How to Quit Smoking
According to this letter from the Japan Society for Tobacco Control, quitting on your own, without professional help or intervention, has a very poor success rate – only about 5%. They also write that cigarettes are designed to sell themselves. Citing the findings of a study on drug misuse, the JSTC shows that nicotine is so addictive that it only loses to heroin and cocaine in terms of dependency.
Quitting is hard, but not impossible.
In addition to private practices, many governments have taken it upon themselves to try and resolve nicotine dependency by publishing tried-and-true guides on how to quit smoking. The gold standard practice points out the following key areas to be aware of when quitting.
*To help keep you on track, smokefree.gov has prepared a personalized smoking plan template to fill in and print out.
Timeline
Having a plan and committing to it is part and parcel of any addiction intervention. The main point here is to be decisive. Set a date that’s as close to now as possible so you don’t lose your conviction. For example, HelpGuide suggests setting your quit date within the next two weeks, while MedicineNet suggests picking a day within the next month.
It’s important to give yourself enough time to prepare for what’s ahead both mentally and physically.
Support
Quitting constitutes a big life change, so it’s typically advised to find a buddy for mutual support. Family members and friends who also want to quit are prime candidates for this.
If you can’t find a quitting buddy, joining an online community (like BecomeAnEX) can help immensely. It’s important to have someone in your journey who holds you accountable and offers moral support.
Cravings and Triggers
Because nicotine is physically addictive – it causes a rapid release of dopamine in your brain – smokers become trained to seek and use it as a way to get an instant feel-good moment. Cravings are the powerful urge smokers get to reproduce that moment. They usually last between 5 to 10 minutes at a time and can be managed in several ways.
Triggers, on the other hand, are things that you have subconsciously tied to smoking. They come in many forms – physical, emotional, behavioral, and social. For example, smoking while drinking is typical. In that case, alcohol becomes a behavioral trigger so that buying a pint comes with the urge to light a cigarette. Ex-smoker Terry Martin, writing for Verywell Mind, has a different way to classify cravings and triggers – H.A.L.T. (Hunger, Angry, Lonely, Tired), which she says must be dealt with in a healthy way. In her article, she describes each one and offers alternative options.
Stress relief is another big trigger, due to nicotine’s ability to create a surge of dopamine. Loneliness may also play a part in smoking behavior, as in The Cut writer Aude White’s case. She wrote and illustrated an article about using cigarettes to help her cope with loneliness. However, as Terry Martin explains in her article, perceived loneliness may actually be boredom. She explains that cigarettes and smoking take up idle time and serve as a distraction for smokers.
Genetics is another factor that can affect nicotine dependency. A research paper published in 2010, found three genes were linked to whether a person would smoke and how much.
Staying Busy
One way to curb cravings is to keep yourself occupied when the feeling hits you. Battling a craving is enormously stressful and, unfortunately, the logical part of your brain is the first thing that shuts down. Having a list of small things you can do to keep your mind and hands busy will definitely help. For example, following along to the lyrics of three songs you know well is already a 10-minute activity. Another measure you can take to keep these feelings under control is identifying things that make you happy.
Substitutes
Another way to bypass cravings is to use substitutes. Whether it’s keeping your hands occupied with anything else or chewing gum rather than puffing another stick, replacing cigarettes in your daily life can help carry you through.
Replacing your triggers with something benign can also help you work through them. To be more specific, certain foods and beverages can make cigarettes more appealing, so changing your diet can help make smoking less desirable and enjoyable. Incorporating fruits and vegetables into your diet has also been found to be helpful in quitting.
Withdrawal
The worst part of addiction is withdrawal – your body’s reaction to the absence of its feel-good substance. At the top of the list of withdrawal symptoms is intense cravings. Irritability, nervousness, and restlessness are also common. Withdrawal can also come with some intense mood changes and even depression. Although withdrawal symptoms can last longer, it’s important to remember that, like cravings, they too will pass.
Nicotine Replacement Therapy
Since constant cravings and withdrawals are the most challenging part of quitting, products containing nicotine like Nicorette gum and nicotine patches can make quitting MUCH easier. Over time, ex-smokers can also start to wean themselves off nicotine altogether.
In combination with behavioral therapy, smokers can fully eliminate their smoking habit by retraining themselves to not respond to triggers and cravings.
Prescription Drugs
Certain medication like varenicline and bupropion can also make quitting nicotine (and tobacco) easier by disrupting or dulling its effects on the brain. However, these will need to be used in conjunction with a psychiatrist, since they come with potential side-effects.
Behavioral Therapy
Another factor that plays into addiction is learned behavior.
Trigger → Behavior → Reward
Nicotine is highly addictive because it delivers a surge of dopamine almost instantaneously. This causes the brain to register it as such an easy way to feel good that it becomes a need. From this, cravings and triggers take over until the habit becomes fully ingrained and tolerance to nicotine builds, creating a need for more and more nicotine to reproduce the same feeling.
*Tolerance is when the effectiveness of a substance weakens because the brain is producing less dopamine in response.
For this reason, behavioral therapy is a powerful intervention to consider, especially when used with other methods, to overcome nicotine addiction. Through therapy, smokers unlearn detrimental behaviors and replace them with beneficial ones.
Relapse
Addiction is tough to break, especially in times of stress.
Relapse, or falling back into addiction, is not uncommon when quitting. A study that analyzed data from the Ontario Tobacco Survey, confirmed that the average number of quit attempts before success is 6 times, with this average being accepted by experts. The same study found that, when accounting for people who have not quit successfully at the time of the survey, the average increased to 30.
However, they also mention that the likelihood of success is determined individually, citing the findings of another study which found the success rate of a first time quit to be between 40-52%.
Moreover, the likelihood of relapse drops significantly with time – from an estimated 60-90% chance within the first year to a 2-4% chance from the second to sixth year to a less than 1% chance from the tenth year.
Another silver lining of relapses is that they make you aware of things you may have overlooked before. Many factors play into a successful quit, so don’t beat yourself up if you have to try a second, third, or nth time.
Mindfulness
As mentioned above, the laws obviously want to encourage smokers to reconsider their habit, which is exactly what psychiatrist Judson Brewer has found to be the most effective way to quit smoking. In his TEDTalk, Dr. Brewer points to mindfulness and being present as the best way to combat addiction.
He found that asking smokers to be curious about their experience, rather than forcing them to quit, made them more likely to quit their habit. He explains that this is because when we develop a deeper understanding of our habits and become disenchanted by how they affect us, letting go comes naturally.
Dr. Brewer goes further, saying that curiosity is itself rewarding and this helps it to counter the pull of instant gratification caused by addiction.
Other Resources:
- https://www.health.gov.au/health-topics/smoking-and-tobacco/how-to-quit-smoking
- https://stopsmokinglondon.com/smoking-and-you/boredom
If you are a smoker, your situation may be different from the examples given here and you’ll surely have your own reasons for smoking. Whatever the cause and the case, it’s important to understand that smoking is a coping mechanism. Again, this post is not meant to judge smokers but to serve as a resource for those who want to quit.
