Tobacco Addiction

            Once you start, it's hard to quit. Tobacco is the most frequently used legal drug. About 21% of Albertans over 15 years old use it daily or occasionally. Tobacco contains nicotine, an addictive stimulant drug. Like heroin or other addictive drugs, the body and mind quickly become so used to the nicotine in cigarettes that a person needs to have it just to feel normal. Cigarette smoke also contains over 4,000 chemicals, about 50 such as tar, ammonia (household cleaner), carbon monoxide (car exhaust), oxides of nitrogen and benzopyrenes, can cause cancer. Spit tobacco contains over 3,000 chemicals, about 28 of which are known to cause cancer.
            People start smoking for a variety of reasons. Some think it looks cool. Others start because their family members or friends smoke. Statistics show that about 9 out of 10 tobacco users start before they're 18 years old. Most adults who started smoking in their teens never expected to become addicted. That's why people say it's just so much easier to not start smoking at all.

How Smoking Affects  Your Health?

            There are no physical reasons to start smoking. The body doesn't need tobacco the way it needs food, water, sleep and exercise. In fact, many of the chemicals in cigarettes, like nicotine and cyanide, are actually poisons that can kill in high enough doses.

  • Cigarette smoking causes 87 percent of lung cancer deaths and is responsible for most cancers of the larynx, oral cavity and pharynx, esophagus and bladder.
  • Secondhand smoke is responsible for an estimated 3,000 lung cancer deaths among U.S. nonsmokers each year.
  • Tobacco smoke contains thousands of chemical agents, including over 60 substances that are known to cause cancer.
  • The risk of developing smoking-related cancers, as well as noncancerous diseases, increases with total lifetime exposure to cigarette smoke.
  • Smoking cessation has major and immediate health benefits, including decreasing the risk of lung and other cancers, heart attack, stroke, and chronic lung disease.
  • Smoking decreases the blood flow to the skin, leaving it leathery and wrinkled.
  • Smoking can stress your immune system so that you get pimples and lose your hair.
  • Smoking causes heart disease, stroke and diseases of the blood vessels.

The benefits of quitting are immediate and long-term.

  • Within 8 hours: Eight hours after your last cigarette, carbon monoxide in your body decreases and the level of oxygen increases.
  • Within 48 hours:Your sense of smell and taste will start to improve. Your chance of having a heart attack starts to decrease.
  • Within 72 hours: Within three days of quitting, your bronchial tubes start to relax, making breathing easier. Your lung capacity increases.
  • Within 2 weeks: Two weeks after your last cigarette, your body circulation begins to improve and your lung functioning increases by up to 30%.
  • Within 6 months: The health of your lungs will improve. You experience less coughing, wheezing, congestion and shortness of breath. Your chance of developing an infection goes down.
  • Within 1 to 10 years: A year after your last cigarette, your chance of having a smoking-related heart attack is cut in half. Within 10 years, your risk of dying from lung cancer is also cut in half! 

How can I stop using  tobacco?

  • Medication, such as nicotine replacement therapy and bupropion (Zyban).
  • Stop-smoking programs
  • Support groups, such as Nicotine Anonymous.
  • Counseling from doctors, nurses, or therapists.

            Medication includes nicotine replacement therapy (NRT) and bupropion (Zyban).Nicotine replacement therapy replaces the nicotine in your body. You still get nicotine, but you do not use tobacco. Nicotine replacement products help you cope with cravings and withdrawal symptoms and come in several forms:

  • Nicotine patches.
  • Nicotine gum.
  • Nicotine lozenges.
  • Nicotine nasal spray.
  • Nicotine inhaler.

            Bupropion is a pill that your doctor prescribes. It does not contain nicotine. It helps you by reducing withdrawal symptoms, such as stress and anxiety. Using nicotine replacement products or bupropion doubles your chance of quitting tobacco for good.  While most young people do think  that smoking is harmful to health, they see these effects as something that may happen in the future. But, in fact, young smokers can reduce their rate of lung growth and they are also less physically fit, often have shortness of breath, coughing spells, wheezing and bad breath, which reduces social appeal. Young people also need to see that they will probably become addicted and that it can be just as hard for them to quit as for longtime smokers.
            Teenagers may feel that experimenting with lowtar and lownicotine cigarettes is safe, but that's not true. Young people can get hooked on smoking these brands as well as regular brands because both contain nicotine.

Secondhand smoke

The smoke from your cigarettes (secondhand smoke) may put your loved ones' health at risk. Even if you try to keep smoke out of your home by smoking outside, you still bring nicotine into your home on your clothing and hands and in your hair.

  • Babies whose parents smoke:
    • - Are more likely to have ear infections, pneumonia, and bronchitis in the first few years of their lives.
    • - Have a higher risk of sudden infant death syndrome (SIDS).
  • Spouses and children of people who smoke have increased risk of cancer and heart disease.
  • Children of people who smoke are more likely to be smokers themselves.

            When you quit smoking, you reduce all of these risk factors for health problems in your family. You also increase the chance that your children will not smoke or will quit if they already smoke.
            Nicotine is a stimulant drug, but paradoxically effects of both stimulation and
relaxation may be felt. The mental and physical state of the smoker and the situation in which smoking occurs can influence the way in which a particular cigarette will affect psychological perceptions. The addictive effect of nicotine is linked to its capacity to trigger the release of dopamine - a chemical in the brain that is associated with feelings of pleasure.
            However, recent research has suggested that in the long term, nicotine depresses the ability of the brain to experience pleasure.Thus, smokers need greater amounts of the drug to achieve the same levels of satisfaction.
            Smoking is therefore a form of self-medication: further smoking alleviates the withdrawal symptoms which set in soon after the effects of nicotine wear off.

            Tobacco is as addictive as heroin (as a mood & behavior altering agent).

  • Nicotine is:
    • - 1000 X more potent than alcohol
    • - 10-100 X more potent than barbiturates
    • - 5-10 X more potent than cocaine or morphine
  • A 1-2 pack per day smoker takes 200-400 hits daily for years. This constant intake of a fast acting drug (which affects mood, concentration & performance).. eventually produces dependence.

Pressures to relapse are both behaviorally & pharmacologically triggered.

            When a person smokes a cigarette, the body responds immediately to the chemical nicotine in the smoke. Nicotine causes a short-term increase in blood pressure, heart rate and the flow of blood from the heart. It also causes the arteries to narrow. The smoke includes carbon monoxide, which reduces the amount of oxygen the blood can carry. This, combined with the nicotine effects, creates an imbalance between the demand for oxygen by the cells and the amount of oxygen the blood can supply.

            Cigarette smoking may increase the risk of developing hardening of the arteries and heart attacks in several ways.

First, carbon monoxide may damage the inner walls of the arteries, encouraging fatty buildups in them. Over time, this causes the vessels to narrow and harden. Nicotine may also contribute to this process. Smoking also causes several changes in the blood that make clots — and heart attack — more likely.
            Smoking tobacco is the chief avoidable cause of death in our society. Smokers are more likely than nonsmokers to contract heart disease - some 170,000 die each year from smoking-related coronary heart disease. Lung, larynx, esophageal, bladder, pancreatic, and kidney cancers also strike smokers at increased rates. Some 30 percent of cancer deaths (130,000 per year) are linked to smoking. Chronic, obstructive lung diseases such as emphysema and chronic bronchitis are 10 times more likely to occur among smokers than among nonsmokers.

  • The annual cost of tobacco use is more than $50 billion in direct medical costs, for a total of 97 billion in health care costs and lost productivity.
  • If every smoker would smoke one less cigarette per day it would cost the tobacco industry one to two billion dollars per year.
  • In 2007, the US Centers for Disease Control an d Prevention estimated that the heath care costs associated with smoking were $10.28 per pack. (Lexington Herald Leader Nov 25, 2007).
  • Smokers pay twice as much for life insurance and will die an average of over 12 years sooner than non-smokers.
  • If instead of smoking 2 packs per day for 50 years, you could have had an estimated $1,000,000 if you invested it in a major tobacco company (see calculator below).
  • The average cost of treating squamous cell carcinoma of the head and neck ( a cancer caused almost exclusively by smoking ) is $25,542 more than the cost of treating other comparable solid tumors (Lang 2004). 

National Institutes of Health - Fact Sheet: Tobacco Addiction

Thirty Years Ago

  • The world was tallying the smoking-related deaths of more than 75 million people.
  • People did not realize that smoking was an addictive behavior and that nicotine was the cause; in fact cigarette smoking was widely perceived as a glamorous behavior.
  • Even though evidence that smoking caused various diseases was mounting, there was no understanding of the mechanisms underlying this association.
  • Between 1969 and 1980, the risk of premature mortality from smoking doubled in women and continued to rise in men.
  • Since 1965, the prevalence of cigarette smoking among U.S. adults declined by almost half, such that we would have 80 million smokers in America today instead of 45 million without science’s contributions.

Today

  • We now know that nicotine is powerfully addictive and that cigarette smoking is the greatest preventable cause of cancer, accounting for at least 30% of all cancer deaths and 87% of lung cancer deaths. We also know that persons who quit smoking before age 50 reduce by half their risk of dying in the next 15 years compared with continuing smokers.
  • Results of three decades of research informed massive public health education campaigns, which inspired dramatic reductions in cigarette use and in smoking-related disease and death. Prevention and publicity efforts are partly responsible for saving the lives of millions of Americans in the last 30 years.
  • A better understanding of the mechanisms underlying nicotine addiction enabled the development of first-line therapies such as nicotine replacement.
  • Behavioral approaches complement most nicotine addiction treatment programs and can prolong effects of medication therapies.
  • Bupropion became available as Zyban for smoking cessation. Research indicates that it is an effective alternative medication.
  • We know now that the brain continues to develop into early adulthood, and that exposure to nicotine in utero or during childhood or adolescence may adversely affect brain development and increase vulnerability to drug effects and addiction. This knowledge prompted a renewed emphasis on prevention efforts targeting early tobacco use, and partly underlies the current record low smoking prevalence among teens.
  • Breakthrough advances in human genomic science launched searches for genes that influence the risk of nicotine addiction and that can predict responses to treatment.
  • Clinical trials showed that a nicotine conjugate vaccine (NicVAX®) — designed to bind and eliminate nicotine from serum — is safe and effective in promoting abstinence in cigarette smokers.

Tomorrow

  • Redictive approaches to nicotine addiction. The identification of susceptibility genes for nicotine addiction will allow the targeting of individuals at risk of using and becoming addicted to tobacco products and enable the development of more effective and individualized prevention and treatment approaches.
  • Prevention messages that resonate. As we understand the interaction between nicotine addiction genes, and environmental and developmental influences, we will be able to tailor prevention interventions to more efficiently counteract risk factors.
  • Protecting people from nicotine addiction. Nicotine-specific antibodies herald a completely new prevention approach to cigarette smoking and nicotine addiction, especially if administered during periods of vulnerability (i.e., adolescence).
  • Personalized treatment strategies will garner better results. Significant differences characterize the way in which different people respond to nicotine in their system, which, in turn, influences their likelihood of becoming addicted and their response to treatment

            The 20th century will be remembered for the tobacco plague that has killed more than 100 million people worldwide.