Millions of Americans smoke, despite the fact that smoking is the leading preventable cause of death in the United States. Nicotine
is the primary drug found in cigarettes that is potentially very addictive. It causes the same physiological changes in brain chemistry that cause an individual to want to use a drug more and more. Nicotine also creates the symptoms of tolerance and withdrawal common in alcohol and other addictive drugs. The cycle of euphoric recall (remembering the pleasant feeling the drug induces) and the physical and psychological discomfort that is caused when the drug is stopped make breaking any addiction very difficult. As far back as 1988, The Surgeon General's Report, "Nicotine Addiction", concluded that:
- Cigarettes and other forms of tobacco are addicting.
- Nicotine is the drug that causes this addiction.
- Quitting smoking historically has been one of the hardest addictions to break.
- The characteristics that determine nicotine addiction are similar to those that determine addiction to harder drugs such as heroin and cocaine.
Cigarette smoking usually begins in adolescence. Many smokers report trying their first cigarette while in the sixth or seventh grade. Research has shown that teen smokers between the ages of 13 and 17 who smoke daily are more likely to try other substances. And the earlier one begins smoking the more likely smoking will continue into adulthood.
Health Effects of Nicotine Addiction
The body responds immediately to the chemical nicotine in the smoke when an individual is smoking a cigarette. There is an immediate increase in blood pressure, increase in heart rate and in the flow of blood from the heart. The arteries begin to narrow. There is carbon monoxide present in smoke which reduces the amount of oxygen in the blood. This creates an imbalance between the demand for oxygen by the cells and the amount of oxygen the blood can supply the cells.
Nicotine also produces physical and mood-altering effects in the brain that are both pleasing and calming for many individuals. This calming, pleasant effect reinforces the continued use of nicotine and then the ensuing dependence.
Being addicted to smoking carries with it a host of health problems related to the substances in tobacco smoke. When an individual inhales tobacco smoke they are ingesting a group of chemicals that will pass through most of the body's vital organs. The effects of these toxic chemicals include damage to the lungs, heart and blood vessels. It is for this reason that smokers have significantly higher rates of heart disease, stroke and cancer. It is thought that smoking nicotine in tobacco may increase the risk of developing a hardening of the arteries and heart attacks in a few ways. One possible way is that carbon monoxide may damage the inner walls of the arteries by encouraging fatty buildups in them over time. These build-ups cause the vessels to narrow and harden. Nicotine may also contribute to changes in the blood that make clots more likely, which increases the risk of heart attack.
What Determines Nicotine Dependence?
In the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association, nicotine dependence is included under the general definition of substance dependence. "The essential feature of Substance Dependence is a cluster of cognitive, behavioral, and physiologic symptoms indicating that the individual continues use of the substance despite significant substance-related problems." The DSM definition of nicotine dependence has 7 criteria as follows:
- Tolerance. (needing more and more of the substance and more frequently to achieve the desired effect)
- Withdrawal. A minimum of four withdrawal symptoms are required to meet the criteria. The withdrawal symptoms must "cause clinically significant distress or impairment in social, occupational, or other important areas of functioning." Some symptoms of nicotine withdrawal area feeling irritable, impatient, angry, anxious, depressed, distracted, restless and increased appetite and weight gain.
- The substance is used in larger amounts or over a longer period than was initially intended.
- Unsuccessful efforts to cut down, regulate, or discontinue use.
- A great deal of time spent obtaining the substance, using the substance, or recovering from its effects.
- Important social, occupational, or recreational activities may be given up or reduced because of substance use.
- Substance use continues despite the individual's realization that the substance is contributing to a psychological or physical problem.
The DSM requires a person to meet at least three of the seven major criteria to be considered nicotine dependent. Therefore, an individual is not considered to be addicted to nicotine just because he or she cannot quit according to the DSM. Neither tolerance nor withdrawal is necessary or sufficient for a diagnosis of substance dependence. With smoking addiction and nicotine dependence it is important to note that the DSM does not determine when an individual is hooked on smoking, rather it determines when the use of nicotine constitutes a "mental disorder" as is outlined on page 245 of the DSM. Some proponents of smoking cessation programs state that dependence begins with the loss of complete autonomy over the use of tobacco and nicotine.
Every year it is estimated that half of all smokers try to quit and 10% succeed. Despite the fact that smoking cigarettes can be the hardest addiction to quit, it is difficult to see the effects readily on an individual's life. Witnessing the effects of heroin or cocaine on an individual are more obvious and drastic than the effects of tobacco. It is rare that someone will lose a job or a marriage over smoking. The "rock bottom" for smokers is usually more of an internal process or due to a life threatening physical illness, such as lung cancer.
Nicotine Dependence Treatment
The most common smoking treatment
in the effort to assist addicted individuals is nicotine replacement. This can be administered by using nicotine patches, nicotine lozenges, nicotine nasal sprays, nicotine inhalers or gum. There is also Nicotine Anonymous
Psychopharmacological medications that are commonly used that do not contain nicotine are certain groups of antidepressants that increase the level of dopamine in the brain along with a relatively newer drug called Varenicline (Chantix). Chantix works on the brain's nicotine receptors both decreasing withdrawal symptoms and decreasing the pleasure that is derived from smoking.
Nicotine addiction is a chronic, progressive and often fatal disease. Relapse after committing to quit is common. Persistent efforts at quitting are essential. Besides treatment centers, nicotine replacement and medication therapy, 12 step programs and support groups are available as well as individual and group counseling and treatment centers
to assist in quitting and remaining free from nicotine.