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What Is Nicotine?
Nicotine is the drug in tobacco leaves. Whether someone smokes, chews, or sniffs tobacco, he or she is delivering nicotine to the brain. Each cigarette contains about 10 milligrams of nicotine. Nicotine is what keeps people smoking despite its harmful effects. Because the smoker inhales only some of the smoke from a cigarette and not all of each puff is absorbed in the lungs, a smoker gets about 1 to 2 milligrams of the drug from each cigarette . A drop of pure nicotine would kill a person—in fact, nicotine can be used as a pesticide on crops.
What Are the Common Street Names?
You might hear cigarettes referred to as smokes, cigs, or butts. Smokeless tobacco is often called chew, dip, spit tobacco, or snuff.
How Is Nicotine Used?
Tobacco can be smoked in cigarettes, cigars, or pipes. It can be chewed or, if powdered, sniffed.
An alternative to cigarettes is "bidis." Originally from India, bidis are hand-rolled. In the U.S., bidis are popular with teens because they come in colorful packages with flavor choices. Some teens think that bidis are less harmful than regular cigarettes. But bidis have even more nicotine, which may make people smoke more, causing them to be more harmful to the lungs than cigarettes.
What is the extent and impact of tobacco use?
According to the 2004 National Survey on Drug Use and Health, an estimated 70.3 million Americans age 12 or older reported current use of tobacco—59.9 million (24.9% of the population) were current cigarette smokers, 13.7 million (5.7%) smoked cigars, 1.8 million (0.8%) smoked pipes, and 7.2 million (3%) used smokeless tobacco, confirming that tobacco is one of the most widely abused substances in the United States. While these numbers are still unacceptably high, they represent a decrease of almost 50 percent since peak use in 1965.
NIDA’s 2005 Monitoring the Future Survey of 8th-, 10th-, and 12th-graders, used to track drug use patterns and attitudes, has also shown a striking decrease in smoking trends among the Nation’s youth.
The latest results indicate that about 9% of 8th graders, 15% of 10th graders, and 23% of 12th graders had used cigarettes in the 30 days prior to the survey. Despite cigarette use being at the lowest levels of the survey since a peak in the mid-1990s, the past few years indicate a clear slowing of this decline. And while perceived risk and disapproval of smoking had been on the rise, recent years have shown the rate of change to be dwindling. In fact, current use, perceived risk, and disapproval leveled off among 8th graders in 2005, suggesting that renewed efforts are needed to ensure that teens understand the harmful consequences of smoking.
Moreover, the declining prevalence of cigarette smoking among the general U.S. population is not reflected in patients with mental illnesses. For them, it remains substantially higher, with the incidence of smoking in patients suffering from post-traumatic stress disorder, bipolar disorder, major depression, and other mental illness twofold to fourfold higher than the general population, and smoking incidence among people with schizophrenia as high as 90%.
Tobacco use is the leading preventable cause of death in the United States. The impact of tobacco use in terms of morbidity and mortality costs to society is staggering. Economically, more than $75 billion of total U.S. healthcare costs each year is attributable directly to smoking. However, this cost is well below the total cost to society because it does not include burn care from smoking-related fires, perinatal care for low birth-weight infants of mothers who smoke, and medical care costs associated with disease caused by secondhand smoke. In addition to healthcare costs, the costs of lost productivity due to smoking effects are estimated at $82 billion per year, bringing a conservative estimate of the economic burden of smoking to more than $150 billion per year.
What are the Common Effects?
With each puff of a cigarette, a smoker pulls nicotine into his or her lungs where it is absorbed into the blood. In eight seconds, nicotine is in the brain, changing the way the brain works. This process happens so fast because nicotine is shaped like the natural brain chemical acetylcholine. Acetylcholine is one of many chemicals called neurotransmitters that carry messages between brain cells. Neurons have special spaces called receptors, into which specific neurotransmitters can fit, like a key fitting into a lock. Nicotine locks into acetylcholine receptors in different parts of the brain, rapidly causing changes in the body and brain. Nicotine raises the heart rate and respiration (breathing) rate, and causes more glucose, or blood sugar, to be released into the blood. This might be why smokers feel more alert after smoking a cigarette.
Nicotine also attaches to neurons (brain cells) that release a neurotransmitter called dopamine.
Nicotine stimulates neurons to release unusually large amounts of dopamine. Dopamine stimulates the brain's pleasure and reward circuit, a group of brain structures called the limbic system involved in appetite, learning, memory, and feelings of pleasure. Normally, pleasurable feelings come from food, comfort, and the company of people you love. But smoking cigarettes causes a flood of dopamine in the smoker's brain. ItÕs this flood of dopamine that gives the smoker intense feelings of pleasure.
Normally, neurons reabsorb neurotransmitters after they've done their job of signaling other brain cells. But cigarette smoke causes dopamine to stay in the spaces between neurons called synapses. Researchers don't yet know exactly what component of tobacco smoke blocks the reabsorption of dopamine into neurons.
In 40 minutes, half the effects of nicotine are gone. So smokers get the urge to light up for another dose of the drug. After repeated doses of nicotine, the brain changes. To adjust to too much dopamine, the brain cuts production of the neurotransmitter and reduces the number of some receptors. Now, the smoker needs nicotine just to create normal levels of dopamine in his or her brain. Without nicotine, the smoker feels irritable and depressed. The smoker has trained the limbic system to crave tobacco. Think about how you long for a cold drink on a hot day. Or how you want a sandwich when you are hungry. Craving for tobacco is much stronger.
These changes in the brain and body make nicotine highly addictive. Other addictive drugs of abuse, including heroin and cocaine, cause the same changes in the brain.
While inhaling a cigarette, smokers are pulling more than nicotine into their lungs. Tobacco smoke contains more than 4,000 chemicals. Besides nicotine, the most dangerous chemicals in cigarette smoke are tar and carbon monoxide. Tar causes lung cancer, emphysema, and bronchial diseases. Carbon monoxide causes heart problems; smokers are at high risk for heart disease.
Smokers also have a dulled sense of smell and taste, reduced stamina for exercise and sports, and they smell of smoke. After smoking for a long time, smokers find that their skin ages faster and their teeth turn brown or discolored.
Nervous or Depressed?
Scientists are learning how tobacco and nicotine affect teen smokers. Studies going on for 25 years show a link between heavy teen smoking and fear of going outside (agoraphobia). Teens who smoke were 6 times more likely to get agoraphobia. And, teen smokers were 15 times more likely to have panic attacks than teens who did not smoke. Scientists think the reason is that nicotine hurts blood vessels to the brain, and also blocks air from the lungs. Whatever the reason, teen smokers are more likely to have panic attacks, anxiety disorders, and depression.
Is Nicotine addictive?
Yes. Most smokers use tobacco regularly because they are addicted to nicotine. Addiction is characterized by compulsive drug seeking and use, even in the face of negative health consequences. It is well documented that most smokers identify tobacco use as harmful and express a desire to reduce or stop using it, and nearly 35 million of them want to quit each year. Unfortunately, only about 6% of people who try to quit are successful for more than a month.
Research has shown how nicotine acts on the brain to produce a number of effects. Of primary importance to its addictive nature are findings that nicotine activates reward pathways—the brain circuitry that regulates feelings of pleasure. A key brain chemical involved in mediating the desire to consume drugs is the neurotransmitter dopamine, and research has shown that nicotine increases levels of dopamine in the reward circuits. This reaction is similar to that seen with other drugs of abuse, and is thought to underlie the pleasurable sensations experienced by many smokers.
Nicotine’s pharmacokinetic properties also enhance its abuse potential. Cigarette smoking produces a rapid distribution of nicotine to the brain, with drug levels peaking within 10 seconds of inhalation. However, the acute effects of nicotine dissipate in a few minutes, as do the associated feelings of reward, which causes the smoker to continue dosing to maintain the drug’s pleasurable effects and prevent withdrawal.
Nicotine withdrawal symptoms include irritability, craving, cognitive and attentional deficits, sleep disturbances, and increased appetite. These symptoms may begin within a few hours after the last cigarette, quickly driving people back to tobacco use. Symptoms peak within the first few days of smoking cessation and may subside within a few weeks. For some people, however, symptoms may persist for months.
While withdrawal is related to the pharmacological effects of nicotine, many behavioral factors can also affect the severity of withdrawal symptoms. For some people, the feel, smell, and sight of a cigarette and the ritual of obtaining, handling, lighting, and smoking the cigarette are all associated with the pleasurable effects of smoking and can make withdrawal or craving worse. While nicotine gum and patches may alleviate the pharmacological aspects of withdrawal, cravings often persist. Other forms of nicotine replacement, such as inhalers, attempt to address some of these other issues, while behavioral therapies can help smokers identify environmental triggers of withdrawal and craving so they can employ strategies to prevent or circumvent these symptoms and urges.
Are there Effective Treatments for Tobacco Addiction?
Yes, extensive research has shown that treatments for tobacco addiction do work. Although some smokers can quit without help, many individuals need assistance in quitting. This is particularly important because smoking cessation can have immediate health benefits. For example, within 24 hours of quitting, blood pressure and chances of heart attack decrease. Long term benefits of smoking cessation include decreased risk of stroke, lung and other cancers, and coronary heart disease. A 35-yearold man who quits smoking will, on average, increase his life expectancy by 5.1 years.
Behavioral Treatments
Behavioral interventions play an integral role in smoking cessation treatment, either in conjunction with medication or alone. They employ a variety of methods to assist smokers in quitting, ranging from self-help materials to individual cognitive-behavioral therapy. These interventions teach individuals to recognize high-risk smoking situations, develop alternative coping strategies, manage stress, improve problem solving skills, as well as increase social support. Research has also shown that the more therapy is tailored to a person’s situation, the greater the chances are for success.