Why we keep smoking despite knowing the damage it does to our health

Smoking is not just a bad habit, doctors say; it is nicotine, stress relief, routine and brain conditioning working together, which is why quitting can feel far harder than it looks

You already know smoking is harmful. Yet the hand still reaches for the lighter, almost on autopilot. You can be perfectly aware of long-term risks and still crave that short burst of calm. So why does the rational brain lose this battle to this paradox so often?

What makes the brain choose short-term relief over long-term harm?

According to Dr Astik Joshi, Child, Adolescent & Forensic Psychiatrist at Fortis Healthcare, nicotine is not just a chemical, it is a master negotiator working directly with the brain’s reward circuitry. "Nicotine reshapes the brain’s pathways so that the quick hit of relaxation feels far more immediate than the distant possibility of disease," he explains.

 

 

It’s the classic tug-of-war between now and later. The cigarette provides a tiny moment of quiet, where heart rate slows, anxiety dips, the world feels briefly manageable.

 

But the consequences such as lung cancer, heart disease, COPD, that sit far in the future, abstract and invisible, are inevitable.

 

"Humans are wired to prioritise what brings relief in the next ten seconds, not what might harm them ten years later," says Dr Joshi.

 

This is why knowing the risks doesn’t automatically translate into stopping. Biology has already struck a bargain: “Give me calm now; we’ll worry about the rest later.” 

Why does smoking feel like control during stress?

Many smokers don’t reach for a cigarette to feel pleasure, they reach for it to feel normal. When stress spikes, their anxiety regulation threshold is crossed, and as Dr Joshi points out, this triggers physical and psychological unease. Lighting a cigarette becomes a fast-acting coping tool, a way to regain control over the moment.

 

It’s not the smoke; it’s the ritual. The pause. The breath. The familiar chemical reassurance that tells the brain, “You’re handling this.”

 

"Even though the relief is false and brief, the mind clings to that one dependable lever it can pull when life feels chaotic," explains Dr Joshi.

 

Also, over time, smoking becomes a behaviour stitched into daily rhythms. Tea? Smoke. Office break? Smoke. Feeling bored, angry, overstimulated, lonely? Smoke.

 

What began as a deliberate choice morphs into something more reflexive. Dr Joshi describes how the mental preoccupation around smoking disrupts clarity of thought. The person isn’t choosing anymore, they are responding to cues their brain now treats as triggers.

 

Yet the same mind is also capable of change. "With support, structure and treatment, those very rewarding circuits can be rewired. The short-term “need” can lose its power. The body can recover. The habit can loosen its grip," stresses Dr Joshi.  

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This content is for informational purposes only and is not a substitute for professional medical advice.