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Nicotine Addiction

Nicotine is the main ingredient in cigarettes and is one of the major causes of death in the U.S. 1 in 5 deaths are attributed to cigarette smoking, annually, and nicotine is the significant cause of heart and lung disease, vascular disease, stroke, high blood pressure, artery constriction, cancer, chronic obstructive pulmonary disease (COPD), emphysema, low birth weight and perinatal mortality. So, why do people continue to smoke? Research shows that smoking behavior is influenced nicotine dependence (both physical and psychological), genetic and environmental factors and psychosocial behavior. Some smokers may be predisposed to nicotine addiction through the effects of a gene responsible for metabolizing nicotine. Non-smokers are twice as likely to carry a mutation in a gene that helps the body dispose of nicotine. Nicotine is highly addictive and is a potent psychoactive drug that induces euphoria, thereby reinforcing its use.

Patients who quit will often experience nicotine withdrawal symptoms. While cigarette manufacturers have publicly denied the addictive effects of nicotine research indicates that smoking is not a habit but, in most cases, is because of the addictive cycle established by nicotine. Like most addictive drugs, Nicotine changes the chemical balance in the brain. It acts as both a stimulant and a relaxant, with a blend of effects that includes increased focus, reduced fatigue reduced anxiety and induced euphoria. It acts on stress hormones and endorphins. The addictive effect of nicotine is linked to the triggered release of dopamine, a chemical in the brain that is associated with feelings of pleasure. Recent research suggests that the long-term use of nicotine depresses the brain’s ability to experience pleasure and therefore requires more nicotine to achieve the same level of satisfaction. Some research indicates that nicotine ranks ahead of alcohol, cocaine, and heroin as an addictive substance. One of the most telling signs of the addictive properties of nicotine is the discrepancy between the desire to quit and the actual number of people who do quit. Studies indicate that about 70% of smokers want to stop smoking, yet 20% or less abstain for as long as a year, and only 3% quit, using will power alone. Most smokers make several attempts to quit before they succeed. Smokers are often reluctant to quit even after undergoing surgery for smoking related diseases. 40% of laryngectomy patients smoke afterwards and 50% of lung cancer patients resume smoking after surgery

What are the symptoms?

Since nicotine is not an illegal substance, it is not difficult to recognize the primary signs of smoking. Just look for the cigarette in the patient’s hand or the pack in their pocket or purse. Secondary symptoms that are less obvious, and may be life threatening include:

• Needing a cigarette the first thing in the morning, during a long car trip, after dinner
• Morning coughing or persistent cough throughout the day
• Heart disease, lung cancer, stroke, low birth weight, throat problems, high blood pressure, hardening of the arteries
• Recurrent lung problems (bronchitis, pneumonia, infections)
• Patient is calmer, less irritable, more focused after a cigarette
• Voice can become deeper after using nicotine for a number of years
• Depression – dependent smokers often experience depression from decreased monoamine oxidase A and B activity
• Difficulty in breathing, heaving or strained breath

Withdrawal Symptoms?

• Irritability, impatience, hostility, anxiety
• Difficulty in concentrating or focusing
• Increased appetite and taste, weight gain
• Headaches, insomnia
• Depression (lasting 2 days to 6 weeks after abstinence)
• Decreased heart rate
• Restlessness, craving for cigarette

How is it diagnosed and treated?

Doctors do not have to look far to diagnose nicotine addiction. Patients are typically willing to admit smoking, though they may downplay the frequency and the number of packs per day they smoke.

The official diagnostic criteria for Nicotine Addiction include any three of the following signs within a one- year period:

• Increased tolerance to nicotine with decreased effects, increased dose to obtain the same effect
• Unable to quit smoking
• Increased time spent smoking and purchasing tobacco
• Continued smoking in spite of health hazards
• Postponing or interrupting social, work or recreational activities to smoke
• Smoking more than usual
• Withdrawal symptoms after nicotine is stopped

Treatment(s) can include:

• Education on health problems and side effects associated with smoking
• Group Therapy and Behavioral Counseling
• Nutritional and Dietary Counseling, exercise
• Coping skills to avoid smoking when craving strikes
• Hypnosis, acupuncture
• Medications as appropriate: Nicotine gum or patch, anti-depressants if appropriate

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