In this episode of Lifeline Dialogues, Dr Mercy Korir sits with Dr Mercy Karanja, a consultant psychiatrist and addiction specialist with over 15 years of experience, to unpack why nicotine is so difficult to quit and what realistic recovery looks like
Tobacco addiction affects an estimated 2.6 million people in Kenya, many of whom start using tobacco products in adolescence. Although the desire to quit is common, the journey toward cessation is rarely straightforward.
Globally, tobacco kills more than eight million people each year. Kenya reports roughly 6,000 tobacco-related deaths annually, with 79 men and 37 women dying every week due to tobacco use. Despite Kenya’s ratification of the World Health Organization (WHO) Framework Convention on Tobacco Control in 2004 and the enactment of the Tobacco Control Act in 2007, tobacco use remains a stubborn public health challenge.
To understand addiction, Dr Karanja says, one must first understand how the brain communicates. The brain relies on neurons and chemical messengers called neurotransmitters to regulate emotions, reward, and motivation.
“When nicotine enters the body,” she explains, “it sits in specialised receptors in the brain’s reward centre, triggering the release of dopamine and creating feelings of euphoria and satisfaction.” Over time, the brain adapts by creating more receptors, meaning users need increasing amounts of nicotine to achieve the same effect. “The brain starts thinking that for an individual to experience happiness and satisfaction, you must have nicotine.”
This neurological engineering creates a powerful dependence cycle. When users attempt to quit, the brain reacts intensely to the absence of nicotine. Psychological withdrawal symptoms may include irritability, mood swings, anxiety, restlessness, difficulty concentrating, and depression.
“Withdrawal is like a child who has been denied their favourite toy”
Physical symptoms can manifest as headaches, sleep disturbances, increased appetite, intense cravings, and, in some cases, tremors. Dr Karanja compares the withdrawal experience to “a child who has been denied their favourite toy.” The brain, having been conditioned to rely on nicotine for basic emotional balance, perceives its absence as a threat.
Recovery from nicotine addiction, according to Dr Karanja, requires a combination of medical and psychological support. She outlines three primary treatment pathways.
The first is Nicotine Replacement Therapy (NRT) in combination with behavioural therapy. This approach uses controlled doses of nicotine delivered through patches, gums, lozenges, or sprays. The dosage is gradually reduced under medical supervision while the individual undergoes counselling. “This combination addresses both the physical dependence and the psychological factors driving tobacco use,” she notes.
The second pathway is cold turkey combined with behavioural therapy, where some people choose to quit abruptly without nicotine replacement. They rely solely on counselling, coping strategies, and behavioural change. However, research shows that only 3-5 per cent of people who quit cold turkey remain tobacco-free for more than six months.
The third is medication and behavioural therapy, whereby certain medications originally developed for depression can significantly reduce cravings and support cessation. When combined with counselling, clinical evidence suggests this approach can more than triple the likelihood of long-term quitting.
The latest WHO Global Report on Trends in Prevalence of Tobacco Use shows progress: global tobacco users have decreased from 1.38 billion in 2000 to 1.2 billion in 2024. Since 2010 alone, the number has fallen by 120 million. Yet progress is uneven, as tobacco continues to hook one in every five adults worldwide.
Young people remain vulnerable, with more than 220,000 children in Kenya using tobacco daily
Africa has the lowest prevalence globally at 9.5 per cent and is on track to meet reduction targets. However, population growth means absolute numbers continue to rise. With 80 per cent of the world’s tobacco users living in low- and middle-income countries, these regions, Kenya included, bear the heaviest burden of tobacco-related disease.
In Kenya, the 2014 Global Adult Tobacco Survey estimated that 2.5 million adults use tobacco products, representing 11.6 per cent of the adult population. Young people remain vulnerable, with more than 220,000 children using tobacco daily. Dr Karanja highlights social and systemic factors that complicate cessation. Tobacco is widely accepted in many social circles, unlike illegal drugs. This normalisation makes it easy to start and difficult to stop.
“Peer pressure plays a significant role,” she says. Smoking is often integrated into social activities, and group dynamics can undermine personal efforts to quit.
Access to cessation services also remains limited. Many treatment centres and specialists are concentrated in urban areas, leaving rural populations without adequate support. Nicotine replacement therapies, though effective, are often expensive and rarely covered by insurance.
Stigma within healthcare settings further deters people from seeking help. Some providers ask surface-level questions or judge patients instead of guiding them through the complexities of addiction. As a result, fewer than four in 10 adults who smoke use proven cessation tools, even though most want to quit and about half attempt to do so each year. Ultimately, fewer than 10 per cent succeed without support.
Nicotine addiction and mental health conditions reinforce each other in a bidirectional relationship. Some people start smoking to cope with stress, anxiety, or depression; others develop mental health challenges as a result of long-term nicotine exposure.
Nicotine is harmful to brain development, exposure during pregnancy can negatively affect the foetus
“You can’t separate the two, mental health and nicotine use,” Dr Karanja emphasises. “You must holistically manage this person to avoid a relapse driven by unattended mental health issues.”
Nicotine is particularly harmful to brain development, and exposure during pregnancy can negatively affect the foetus. Comprehensive treatment, therefore, requires evaluating underlying mental health issues, screening for other substance use, and addressing social stressors.
Dr Karanja speaks about several persistent myths. The notion that longtime smokers without visible health problems prove that smoking is safe ignores the fact that damage is often silent and cumulative. The absence of immediate symptoms does not mean the body is unharmed.
She also warns against the belief that e-cigarettes and heated tobacco products are safe or non-addictive. These products are marketed as harm-reduction tools but often introduce nicotine to young users at earlier ages.
“There is no evidence to demonstrate that heated tobacco products are less harmful than conventional tobacco products,” she says.
Perhaps the most harmful myth is that quitting is impossible once addiction takes hold. “Many people successfully quit,” she insists. “While it is challenging, cessation is absolutely achievable with proper support.”
The mistake families make is judging and waiting for a person to fail instead of waiting for them to succeed
Families and communities play a crucial role. Dr Karanja urges supporters to celebrate milestones, “even small ones like one smoke-free week,” and to provide emotional support without judgment. Connecting individuals to professional help and support groups also improves success rates.
Equally important is avoiding harmful behaviours: judging, stigmatising, focusing on relapses, applying pressure, or comparing one person’s recovery to another’s.
“The mistake we make as families is judging and always waiting for that person to fail instead of waiting for them to succeed,” she says.
For those struggling with nicotine addiction, Dr Karanja has simple but powerful advice: don’t despair. “Start where you are. The most important thing is recognising that you need to stop. Once you recognise that, seek help and take your journey individually.”
Recovery timelines vary widely. Some people quit in months; others take years or experience multiple relapses. What matters is sustained effort and access to the right support. Successful cessation requires more than individual determination. It demands a supportive ecosystem: accessible and affordable treatment options, healthcare providers trained in non-judgmental addiction care, and communities that celebrate recovery rather than stigmatise addiction.
With comprehensive support addressing both the biological and psychological aspects of dependence, recovery is achievable. She says the brain has a remarkable ability to heal, and with sustained abstinence, the pathways reshaped by nicotine can gradually return to healthier functioning.
