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Since 1 July smoking in public buildings has been banned in England, as it is in many EU states now. Many smokers have taken this as an opportunity to stop or at least cut down on their smoking. For some though, this has been seen as an additional pressure to cope with. I speak with lots of smokers who say that smoking is one of their stress management strategies ' it helps them cope with pressure. Undoubtedly this is their perception ' when they begin to feel stressed, the ritual of lighting up a cigarette combined with the hit of the nicotine will generate a temporary sense of relief. However, what really happens to our system when we light up a cigarette is quite different:

' The intake of smoke raises the carbon monoxide level in our lungs

' This affects the blood, making it less oxygen rich and 'stickier'

' This increases blood pressure

' The heart has to work harder to pump this sticky blood around the system, increasing the heart rate

' Smoking also triggers the release of chemicals which raise stress levels ' effectively inducing the 'fight or flight' response, which is the automatic response to a threatening situation ' in other words, the combination of physiological and psychological symptoms which we describe as 'stress'.

So how come having a cigarette makes smokers feel better?

Because nicotine is a strongly addictive substance. This means, that an 'addict' will have a large number of receptors in the brain which crave nicotine. When they are deprived of nicotine, this will trigger withdrawal symptoms. When they have a nicotine 'fix', the withdrawal symptoms will subside.

Imagine this scenario:

Two women go shopping in the local supermarket. Each has a small child with them. One of the children is placid and well-behaved. The other is irritable, crying, and prone to tantrums.

Which is experiencing most stress, do you think?

As they continue shopping, one child remains placid, whereas the other starts screaming and crying. What's happening to each of the women's stress levels?

At some point, each of the women drop a jar they are taking from the shelf. Both are likely to experience an increase in stress at that point, but it's fairly safe to assume that the stress level of the woman with the screaming child is higher than that of the woman with the placid child.

If, at this point, someone intervenes and takes care of the screaming child, leaving that woman to continue her shopping knowing the child is safely taken care of, how will that affect her stress level?

Nicotine addiction is like the screaming child. Its demands will overlay whatever other demands are being faced at the time. So when those demands are appeased (by having a cigarette or using nicotine replacement therapy) feelings of stress will reduce.

So what's the answer?

Smoking and stress both represent threats to long term health and well being. Some studies have shown that acute stress can be as significant factor in heart disease and other serious conditions as smoking (Daniel Goleman: Emotional Intelligence 1995). This is clearly bad news for smokers as it means that they are effectively suffering a 'double whammy' in terms of damage to their health.

Quitting smoking undoubtedly brings health benefits which start within 20 minutes! However, for someone who is experiencing high levels of stress breaking the habit will be doubly difficult. So in essence we have two issues to address:

' Reducing the level of stress
' Managing the withdrawal from smoking

Reducing the level of stress

A programme of stress management training can help with this ' either one to one, or in a group.

Stress management training will typically address the following areas:

' The nature of stress, its symptoms and causes
' Breaking the cycle ' learning to relax
' Identifying triggers for stress
' Identifying effective coping strategies which may include

o Relaxation
o Thinking positively
o Assertiveness
o Personal organisation
o Self nurturing

Understanding the stressors we are dealing with and identifying ways of responding to those more positively is the first step in getting back in control.

Kicking the habit!

The next step is to set a date to quit ' then do it! Help is available through smoking cessation advisers in General Practices, pharmacies, and through online services such as http://www.gosmokefree.co.uk and http://www.quit.org.uk. Nicotine replacement therapy (NRT) can be very effective in breaking the habit of having a cigarette and eliminating the damaging effects of smoking tobacco, while minimising the effects of withdrawal. Some of the benefits you can expect to experience in the short term are:

' Within 20 minutes blood pressure and pulse return to normal. Circulation improves

' Within 8 hours blood oxygen levels return to normal and your chance of having a heart attack falls

' Within 24 hours carbon monoxide leaves your body, and lungs start to clear out mucus and debris

' Within 48 hours your body is nicotine free. Sense of taste and smell improve.

' Within 72 hours breathing is easier, and you have more energy.

Over the long term, your chances of suffering from a serious smoking related illness such as heart disease or lung cancer significantly reduce.

NRT is available in a number of different forms ' patches, gum, lozenges, inhalators, and sublingual tabs. Each has different characteristics. Your smoking cessation adviser will be able to discuss with you your smoking patterns and level of dependence to decide on the best method or combination of methods for you.

The combination of support in withdrawing from nicotine with proactive strategies for responding to stressful situations greatly increases your chances of kicking the habit for good and enjoying multiple health benefits!

So if you've been thinking of smoking as your friend in a stressful situation, then think again!

For a FREE introduction to stress management, including a self-assessment questionnaire, email contact@freefromstress.co.uk