SMOKING is so common in China and so much a part of the social fabric that quitting seems like impossible for millions of people. The lack of effective education on the dangers of smoking is staggering. And everyone knows someone who smoked three packs a day and lived to be a healthy 90 years of age.

Lung cancer, other cancers, heart disease, cardiovascular problems, stroke - all pale in comparison to the addictive pleasures of smoking, especially the pleasures of smoking in social situations.

Everyone smokes, passes out cigarettes, and it's considered rude to decline.

For 27-year-old Alex Geng, quitting is impossible. Early this year the accountant failed for the fifth time. He stopped for 11 days, but finally surrendered at the mahjong table with three heavy smoker friends.

Starting out of curiosity when he was 13 years old, Geng went on to smoke three or four packs a day. He had frequent throat problems and stomach upset, but that didn't stop him.

He first tried to quit in 2004 when his girlfriend worried about his health. He was smoke-free for one and a half months but quit when his girlfriend left him.

Geng has lots of company. Kicking the habit is extremely difficult because of physical addiction and unpleasant withdrawal symptoms (irritability, lack of concentration, depression), psychological addiction (a deeply ingrained routine, like the cigarette after dinner) and social pressure to be convivial.

Nonsmokers don't get a lot of help from their smoker friends.

The 24th World No-Tobacco Day last Tuesday was no occasion for celebration in China (except for cigarette makers). The number of smokers has not declined; China is the world's biggest tobacco producer and consumer. Around 350 million Chinese smoke, according to the 2011 China Tobacco Control Report released on May 26. And around 740 million people are "second-hand" smokers, exposed to the smoking of others.

Every year around 1.2 million people die of smoking-related problems, meaning 2 people die every minute.

Experts estimate that without major intervention, around 2 million people will die of smoking-related causes every year.

Doctors worldwide concur that in general heavy smokers have a life expectancy around 10 years shorter than nonsmokers, emphasized Dr Bai Chunxue, chief of the Pulmonary Department of Zhongshan Hospital.

Lung cancer is the top risk. Though not every smoker will develop lung cancer, their risk is 10-15 times higher than non-smokers, says Dr Bai. The more they smoke, the earlier they start and the longer they smoke all increase the risk.

People exposed to second-hand smoke have a lung cancer risk around 20 times higher than those who are not exposed. Those who quit smoking for 10 years cut their lung cancer risk by 30-50 percent, compared with those who don't.

Smoking also harms the reproductive system and can cause infertility, fetal anomalies and cancer, says Dr Tang Jie of the Pulmonary the Department of Yueyang Hospital attached to Shanghai University of Traditional Chinese Medicine.

Though people are vaguely aware of the health risks, they generally think risks are exaggerated and they can quit any time they want.

"We used to consider smoking addiction a bad habit, but actually, it is a disease," says Dr Tang. "For some heavy smokers, will power alone is not strong enough to beat the monster."

A burning cigarette releases a great deal of nicotine and this combines with receptors that affect the release of dopamine in the brain, causing feelings of pleasure or reward. Since dopamine drops quickly after a cigarette is finished, the urge is to light up again.

"I found I was unable to concentrate and I felt my brain didn't work if I didn't have a cigarette in my hand, either at work or chatting with friends," says Geng, the young heavy smoker.

Unpleasant withdrawal symptoms such as irritability, depression, anxiety and fatigue drive many smokers to light up again.

Heavy smokers experience symptoms within hours, according to Dr Tang.

"Those who are heavily addicted find that will power alone is not enough; only 5 percent of them succeed that way," he says.

Therapies are available, such as nicotine replacement. Since it is the tar oil in cigarettes, rather than the addictive nicotine, that is dangerous, gradually providing less nicotine without tar can help. Nicotine gum, candy and patches are widely used.

Some medicines can combine with nicotine receptors and thus block the nicotine from combining, which gradually reduces withdrawal symptoms. Some medication, such as generic topirimate, can be used off-label to reduce craving for alcohol, cigarettes and food.

Traditional Chinese medicine, in addition to other therapies, can be helpful in kicking the habit. Qigong, acupuncture and er xue (ear acupoint with tiny beads).

Easy qigong such as tai chi and ba duan jin (eight section brocade) can help soothe nerves, relieve anxiety and depression.

Acupuncture and acupoint therapies aim to relieve physical discomfort of withdrawal, such as difficulty concentrating, fatigue and lack of energy.

"All TCM therapies aim to relieve withdrawal symptoms to make it easier to quiet," says Dr Tang, "but nothing can replace will power."

Smokers who are not physically addicted, may be psychologically addicted since cigarettes are part of every social gathering and smoking together is a way to bond and is part of communication in many settings in China.

When the urge for a smoke strikes, drinking water, eating low-calorie snacks or taking a walk around the block may help. Reducing stress and getting enough sleep are important.

As for the social pressure, it is commonly suggested to stay away from heavy smokers and smoking situations in the early period of abstinence.

Announcing that you are not smoking can help reinforce your own resolve and may discouraging others from pressuring you. Of course, every smoker loves to tease and see a nonsmoker succumb.

A few tips for quitting

1. Make a plan. It usually requires three to four months before you feel comfortable not smoking. Some try to cut down gradually, and some quit "cold turkey." Either way, make a plan and consider seeing a doctor.

2. Write down your reason for quitting; keep it with you. When you feel like smoking, read it.

3. Get rid of the tools. Throw away cigarettes, ashtrays, lighters and other things that remind you of smoking.

4. Tell everyone you are quitting.

5. Stay away from people, places and things that remind you of smoking. Stick with non-smokers.

6. Distract yourself. Drink water, eat a snack and exercise.

7. See a doctor if withdrawal is too uncomfortable. Therapies are available and clinics can help.