Smoking: Health Risks, Myths, Withdrawal Symptoms & How to Quit Successfully

Nicotine dependence is powerful. As Mark Twain famously said, “It is easy to quit smoking. I’ve done it hundreds of times.”

“Nicotine is very addictive, even more addictive than drugs. It has a physiological, behavioural and psychological hold on you,” says Ms Evelyn Boon, Senior Principal Psychologist, Department of Psychology, Singapore General Hospital (SGH).
She adds that smokers can experience physical and psychological withdrawal symptoms, especially moderate to heavy smokers.

Some smoke as an emotional crutch — when stressed, upset or angry. For others, smoking is a habitual routine (e.g., after meals or first thing in the morning).

The good news is that each of these contributing components can be addressed, using practical strategies, medications, and support.

The benefits start almost immediately: 

• 20 minutes: Blood pressure and heart rate begin to normalise

• 8 hours: Oxygen levels improve

• 24 hours: Your body starts clearing carbon monoxide; breathing improves

• 2–5 years: Stroke risk reduces to that of a non-smoker

• 10 years: Lung cancer risk drops by half

Quitting also protects your family — exposure to second-hand smoke increases their risks of lung cancer, heart disease, stroke, asthma and bronchitis.

Myth 1: Quitting won’t help me because I’ve smoked for years.

Fact: It is never too late. Your body starts healing within minutes of your last cigarette.

Myth 2: Smoking only a few cigarettes a day is safe.

Fact: There is no safe number of cigarettes. Even 3–5 cigarettes a day significantly increases cardiovascular and heart attack risks.

Myth 3: Smoking is relaxing and improves mood.

Fact:  Each cigarette delivers 1mg of nicotine to the brain within 7–10 seconds, triggering dopamine release. This creates a short-lived “reward” cycle — not true relaxation — and increases heart rate and artery narrowing.

Myth 4: Hand-rolled cigarettes or vaping are safer.

Fact: Chemical levels in urine are similar in smokers of factory-made and hand-rolled cigarettes.

Vaping is not proven to help long-term quitting and carries its own risks.

Myth 5: Light cigarettes are less harmful. 

Fact: These labels often refer to flavour, not nicotine content. Smokers of “light” cigarettes often inhale more deeply or smoke more sticks — negating any perceived benefit.

Myth 6: Smoking at the window or balcony protects my family

Fact: Third-hand smoke  refers to the toxic chemicals from tobacco smoke that remain in surfaces and in dust after a cigarette has been extinguished. These invisible residues are transferred via clothes, furniture and hands – can persist for weeks to months indoors.

Myth 7: Quitting smoking is all about willpower

Fact: Willpower alone is unreliable. Changing routines, environments and using support greatly improves success

During the first two weeks, the body adjusts to being smoke-free.

Possible physical symptoms

• Coughing

• Flu-like symptoms

• Constipation

• Headaches

Possible psychological symptoms

• Mood swings

• Irritability

• Low mood

Weight changes 

Some people gain 2-5kg due to improved appetite and metabolic changes. Nevertheless, the health benefits of quitting far outweigh the risks of modest weight gain.

Helpful tips

• Choose high-fibre, low-calorie foods 

• Keep healthy snacks on hand 

• Stay well hydrated well 

• Exercise regularly.

Quitting requires determination and a plan. Here’s how to get started:

1. Identify your smoker pattern

Physical dependence:

o   Nicotine replacement therapy such as patch, spray help ease withdrawal while gum, lozenge can be a substitute for “hand-to-mouth” routine  

Behavioural habits:

o   Replace routines with alternatives (short walk, light chores, hobbies)

o   Cravings usually peak for 5-10 minutes – try the 4 Ds: Delay, Distract, Drink water, Deep breathing.

Emotional dependence:

o   Learn to recognise emotions that trigger smoking

o   Replace cigarettes with healthier ways to manage stress, boredom, or frustration,

o   Each resisted craving strengthens your ability to cope without smoking
 

2. Set a quit date

Pick a meaningful and realistic date (e.g., birthday, New Year, first of the month).
 

3. Choose your quitting method

·       Gradual reduction

·       Stopping immediately (Cold turkey)

·       Medications with  behavioural support

There is no single ‘best’ way but using support and medication together gives you highest chance of success — choose what suits you best.
 

4. Set up for success

·       Don’t buy extra packs “just in case”

·       Consider a smoke-free home policy

·       Remove ashtrays, lighters and smoking items from your home

·       Create a quit-smoking piggy bank: Fine yourself $10 (price of a pack) each time you smoke; reward yourself monthly if you stay smoke-free.

·       Expect some crankiness — it’s normal

·       Stock healthier snacks

·       Quit together if multiple family members smoke

·       Avoid smoking in front of someone who is trying to quit

There are many avenues for help: 

1. SGH Smoking Cessation Programme

Run by the Department of Respiratory and Critical Care Medicine.

Call: 6321 4377

2. SGH Smoking Cessation Service (Pharmacist-led)

For both patients and non-patients.

Call: 6326 5361 (8am–5pm, Mon–Fri)

3. Health Promotion Board (HPB)

• Quit Smoking Helpline: 1-800-438-2000

• “I Quit” programme and mobile app

4. Community pharmacies

Provide advice, nicotine replacement therapy and quit tools.

Quitting is hard — but possible. With help, planning and persistence, you can live a healthier, smoke-free life.

Ref: F26

Check out articles on lung cancer:

New Study Links Genetic Diversity in Asian Lung Cancer and Resistance to Treatment

Why Non-Smoking Asian Females Can Still Be at Risk of Lung Cancer

Why Asian Lung Cancer Tumours May Be Tougher to Treat