Salamanca-based psychologist Alexandra Vega has outlined the three social, psychological and biological factors that drive people to start smoking and make quitting difficult.
Speaking in a report published by Spanish radio station COPE Salamanca alongside physical education teacher Ignacio Hernando Valle, Vega said understanding addiction requires looking beyond the substance itself to see why the behaviour begins and what keeps it going.
According to Vega, substance use is best understood through a biopsychosocial model in which biological traits, psychological states and social environments constantly interact. Developed by psychiatrist George Engel in the late 1970s, the clinical framework is widely used by health professionals in Salamanca and internationally to address a patient's surroundings and mental state alongside physical dependence.
Peer pressure and social habits
Vega identified a person's social environment as the main trigger for starting to smoke. Because tobacco, alcohol and similar habits are closely tied to leisure time, friends and parties, young people often encounter them in group settings.
When a peer group regularly uses a substance, the behaviour is more likely to become normalised and viewed as natural. Vega added that social pressure to fit into a group and avoid exclusion frequently pushes people toward experimentation and their first use.
Once the habit starts, psychological factors often keep it in place. Vega explained that people may begin smoking out of curiosity, boredom or an attempt to manage stress and anxiety.
In many cases, individuals use smoking as an emotional regulation strategy. However, specialists consider this approach ineffective and counterproductive because it relies on avoiding an underlying problem rather than managing it.
Vega said that emotional avoidance actually serves as the strategy that maintains the conflict and the problem itself.
Brain reward circuits and warning labels
The third pillar maintaining the habit is biological addiction. Vega noted that substances such as nicotine are addictive because they activate the brain's reward circuits.
Nicotine, the primary stimulant in tobacco, triggers the release of neurotransmitters in the brain's reward pathway. When an activity produces pleasure, the brain seeks to repeat the experience to feel good again, operating on a mechanism of avoiding negative feelings and repeating positive ones.
According to Vega, the combined weight of social, psychological and biological factors explains why health warnings on cigarette packets, including labels stating that smoking kills, are usually ineffective. Mandatory health warnings have appeared on tobacco packaging across the European Union for more than two decades.
Because deeper personal and biological elements sustain the habit, Vega said the key is not explaining why tobacco is negative, but seeing what the consumption is hiding.
Hookah and vape use among young people
In recent years, the use of waterpipes, electronic cigarettes and alcohol has become normalised among young people as a social act aimed at finding calm or connecting with a group. Waterpipes, known in Spain as cachimbas, pass flavoured tobacco smoke through water, while vapes heat liquid into an inhalable aerosol.
Ignacio Hernando Valle, a physical education teacher with a degree in Physical Activity and Sport Sciences who specialises in physical activity and health, said healthy alternatives can provide the same or greater benefits for psychological wellbeing.
Hernando recalled trying a waterpipe sporadically during his adolescence, though he never became hooked on it. He said he took part because of the social context, doing it simply because everyone else was doing it and to pass the time, comparing the habit to eating sweet food out of anxiety when not hungry.
Looking back, Hernando said that at the age of 18 he was unaware of the harm those substances could cause to his health. While acknowledging that smoking and drinking are normalised in certain social settings, he stressed that people do not need alcohol or tobacco to achieve social wellbeing, as there are other ways to relate to others, share experiences and enjoy life.
Years later, Hernando said he found peace of mind away from smoke and alcohol in the mountains. He credited his psychological wellbeing to his family, his friends, his partner and, to a large extent, spending time in the mountains.
Trail running and marathon preparation risks
An avid trail runner, Hernando has practised the mountain running discipline for more than five years. He joked that he loves going to the mountains and running around there like crazy, like a mountain goat.
However, he warned of the dangers of starting to run without proper preparation, especially in demanding events such as marathons, where a lack of training can cause sudden death. Hernando emphasised that a person really has to be very well prepared to run.
Forest bathing and exercise for mental health
Combining physical exercise with nature offers a double benefit for mental health. Research has demonstrated that exposure to natural areas improves psychological wellbeing.
In countries such as Japan, doctors recommend forest bathing to people with anxiety or depression before prescribing medication. Known in Japan as shinrin-yoku, the practice involves spending quiet time in forest environments to reduce stress.
Exercise on its own is also backed by strong scientific evidence for improving mental health. According to Hernando, major studies have shown that physical activity can have the same effectiveness as some medication against anxiety.
He stated that combining exercise and exposure to nature through trail running brings major benefits for mental health. Hernando acknowledged having gone through periods of anxiety and difficulties related to his psychological wellbeing, and explained that physical exercise and contact with nature helped him improve his mental health to a large extent.
His experience points to alternative ways of finding wellbeing beyond habits such as tobacco use, which can lead to serious illnesses including lung cancer.
