"But my stress is real"

There's a fair complaint about the last chapter. Your life may be hard in ways that have nothing to do with nicotine. You might have a job that asks too much, a parent who's ill, or money that doesn't stretch. Perhaps a teenager has stopped talking to you. Telling someone in that position that their stress is withdrawal would be insulting, and it isn't what I'm saying.

What I'm saying is that a smoker under pressure is carrying two loads. One is life, and it's as heavy as it is. The other is the need, which rises and falls every hour or so on its own timetable. The two feel alike, they arrive mixed together, and only one of them responds to a cigarette.

Think about what a cigarette can do about the first load. It can't shorten the hours or make your father well, and it can't pay anything. It costs money, which is a small extra weight if money is the problem. When you come back in from the back door, every real difficulty is exactly where you left it. What's changed is that the second load has been lifted for an hour, and that feels like coping.

This matters because of what it predicts. If cigarettes helped people cope with stress, you'd expect people who stop to cope worse. They'd have lost their tool, and over the following months you'd expect them to be more anxious and lower in mood than people who carried on.

Researchers have looked at this many times, and it isn't what they find. In 2014 a team led by Gemma Taylor pooled 26 studies that measured people's mental health while they smoked and again at least six weeks after some of them stopped. Compared with people who kept smoking, the ones who stopped showed falls in anxiety, depression and stress, and their mood and quality of life went up. The same group repeated the exercise on a larger scale for a Cochrane review in 2021, with 102 studies covering about 169,500 people. The result held. It held for people with diagnosed mental health conditions as well as for everyone else.

I need to be careful about how much weight that carries. These weren't experiments where people were assigned to stop or continue. They followed people who chose to try, and then compared those who managed it with those who didn't. People who succeed in stopping may differ from people who don't, in ways that also affect mood. Life may have got easier for them that year, and that may be why they succeeded. The Cochrane reviewers rated their certainty as low to moderate for that reason. Their most cautious conclusion is the one I'd lean on. They found no sign that people's mental health gets worse as a result of stopping. The thing smokers fear most about stopping, which is being left defenceless, doesn't show up in the data.

An older study makes the same point from another angle. Sheldon Cohen and Edward Lichtenstein measured stress in people before they tried to stop and at one, three and six months afterwards. Those who never got past the first day stayed at a fairly high, steady level of stress throughout. Those who stayed stopped reported less stress the longer they went. And those who relapsed showed a rise in stress as they went back. The authors pointed out that this could run both ways, since stress can cause relapse as well as follow it. Even so, it's hard to square with the idea that the cigarette was the thing keeping stress down.

Now the objection, and it's a strong one because it comes from experience. You may have stopped before, for a few days or a week, and been in a terrible state. You were snappy, you couldn't sleep, you cried at an advert. Then you had a cigarette and felt human again. From where you stood, that was proof. Without cigarettes you fell apart, and with them you were fine.

But look at what that week was. It was the need at full volume, unrelieved, for the first time in years. It tells you what withdrawal is like at its peak. It can't tell you what life without cigarettes is like, because you hadn't got there yet. Judging it that way is like judging a new house by the day of the move, when you're standing among boxes and can't find the kettle. The studies above measured people at six weeks and later, after the move, and that's where the improvement shows.

I'm not going to tell you the first week is nothing. Chapter 10 deals with it properly. The point for now is narrower. The week when you felt worst without cigarettes is the week you were most under the influence of cigarettes. It belongs in the evidence against them.

If your stress is real, it deserves a real answer. That might be a conversation with your manager or a visit to the GP about your sleep. It might be a debt advice line, or just a friend who'll listen. A cigarette looks like an answer, and you can do it in five minutes by the bins. That's exactly why it crowds out the slower things that would help.