Beating Addiction to Nicotine

Unlike most drugs, the adverse health effects of nicotine are only long-term. Even so, the total cost of nicotine addiction to smokers and to the community is exorbitant!

Statistics from the Centers for Disease Control and Prevention indicate that tobacco use remains the principal preventable cause of early death in the United States, being the cause of approximately 440,000 premature deaths each year and resulting in an annual cost of more than $75 billion in immediate medical expenses caused by smoking.

Over the past forty years, cigarette smoking has resulted in an estimated 12 million fatalities, including 4.1 million deaths from cancer, 5.5 million deaths from cardiovascular disease, 2.1 million fatalities from respiratory disease, and 94,000 infant deaths connected to pregnant women smoking during gestation.

Second-hand smoke, also referred to as environmental tobacco smoke, is a mixture of the smoke given off by the burning end of tobacco products (side stream smoke) and the conventional smoke exhaled by smokers. It is a complex mixture which contains many chemicals (including formaldehyde, cyanide, carbon monoxide, ammonia, nicotine and other poisons), many of which are known to be carcinogenic.

Non-smokers exposed to secondhand smoke at home or work increase their risk of developing cardio-pulmonary disease by 25 to 30 percent and lung cancer by 20 to 30 percent. Furthermore, secondhand smoke causes lung difficulties in non-smokers such as coughing, mucus, and reduced lung function.

Children open to secondhand smoke are at an increased risk for sudden infant death syndrome, severe lung infections, ear problems, and more severe asthma. Since 1964, 28 Surgeon General's reports on smoking and health have determined that tobacco use is the single most preventable cause of disease, infirmity, and death in the United States.

In 1988, the Surgeon General concluded that cigarettes and other forms of tobacco, such as cigars, pipe tobacco, and chewing tobacco, are habit-forming and that nicotine is the drug in tobacco that causes addiction.

Nicotine provides an almost immediate "kick" because it causes a discharge of epinephrine from the adrenal cortex. This stirs up the central nervous system and endocrine glands, which causes a sudden release of glucose. Stimulation is then followed by depression and fatigue, leading the user to seek more nicotine.

Nicotine is absorbed immediately from tobacco smoke in the lungs, and it does not matter whether the tobacco smoke is from cigarettes, cigars, or pipes. Nicotine also is absorbed instantly when tobacco is chewed. With standard use of tobacco, levels of nicotine accumulate in the body during the day and persist overnight. Thus, daily smokers or chewers are exposed to the effects of nicotine for 24 hours each day.

Addiction to nicotine results in withdrawal problems when a person attempts to stop smoking. For example, a study found that when chronic smokers were deprived of cigarettes for 24 hours, they had increased annoyance, hostility, and aggression, and loss of social cooperation. Persons suffering from withdrawal also take longer to regain psychological equilibrium following anxiety. During periods of abstinence and/or craving, smokers have shown deficiencies across a wide array of psychomotor and mental functions, such as linguistic comprehension.

Adult females who smoke generally have more premature menopause. Pregnant women who smoke cigarettes run an increased risk of producing stillborn or untimely infants or babies with low natal weight. Children of females who smoked while pregnant have an increased risk for contracting conduct disorders. National studies of expectant mothers and daughters have also found that maternal smoking during the perinatal period increased the probability that female children would smoke and would persist in smoking.

In addition to nicotine, cigarette and cigar smoke is mostly composed of a dozen gases (predominantly carbon monoxide) and tar. The tar in a cigarette, which varies from approximately 15 mg for a normal strength cigarette to 7 mg in a low-tar cigarette, exposes the user to an increased risk of lung cancer, emphysema, and respiratory problems. The carbon monoxide in tobacco smoke elevates the likelihood of vascular disease. The Environmental Protection Agency has resolved that secondhand smoke causes lung cancer in mature persons and greatly raises the risk of respiratory problems in children, along with sudden infant death.

Research has shown that nicotine, like cocaine, heroin, and marijuana, increases the amount of the neurotransmitter dopamine, which affects the brain pathways that regulate reward and gratification. Scientists have pinpointed a particular molecule - the beta 2 (b2) sub-unit of the nicotine cholinergic receptor - as a critical component in nicotine addiction. Mice that lack this subunit fail to self-administer nicotine, implying that without the b2 subunit, the mice do not undergo the positive reinforcing properties of nicotine. This finding identifies a possible site for targeting the growth of nicotine addiction medicines.

Other studies found that individuals have superior resistance to nicotine addiction if they have a genetic variant that decreases the functionality of the enzyme CYP2A6. The decrease in CYP2A6 slows the breakdown of nicotine and protects users against nicotine addiction. Understanding the role of this enzyme in nicotine addiction gives a new target for contracting more helpful treatment to help folks stop smoking. Medications might be developed that can hinder the function of CYP2A6, thus providing a new approach to preventing and treating nicotine addiction. Another study found great changes in the brain's pleasure circuits during withdrawal from chronic tobacco use. These changes are comparable in size and duration to similar changes documented during withdrawal from other addictive drugs such as cocaine, opiates, amphetamines, and liquor.

Scientists found significant decreases in the sensitivity of the brains of laboratory rats to gratifying stimulus after nicotine administration was abruptly stopped. These changes lasted several days and may correspond to the anxiety and melancholy experienced by humans for several days after quitting smoking "cold turkey."

The results of this research may help in the evolution of better treatments for the withdrawal symptoms that may obstruct smokers' attempts to quit.

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