The Problem of Tobacco Addiction

Tobacco may be smoked in the form of cigarettes, chewed and inhaled as snuff. Cigarettes and other forms of tobacco are addictive because of the presence of nicotine. Nicotine blood levels achieved by smokeless tobacco use are similar to those from cigarette smoking.

Nicotine – A Stimulant

Nicotine, the chemical that makes addicts out of tobacco users, is a stimulant with properties similar to those of cocaine and amphetamines. It provides the pick-me-up feeling that tobacco users feel. It increases the heart rate, blood pressure, and respiratory rate, and makes the user feel more alert.

Unfortunately these effects wear off after twenty minutes or so, and the tobacco user is left craving for another pick-me-up. Chronic use affects brainstem structures. Noradrenergic cells become more excitable. When a person abstains, the firing rates become abnormally high, causing withdrawal symptoms like feeling tense and irritable, trouble in concentrating, sleep disturbance, headaches, digestive upset etc.

One of the reasons smoking causes shortness of breath within 10 seconds is that nicotine is taken to the brain, triggering the release of dopamine and other neurotransmitters, creating the craving sensation that makes smoking highly addictive. The role of nicotine in the compulsive use of tobacco products is now known to be equivalent to the role of cocaine, ethanol and morphine.

Effects of Nicotine

A). Central Nervous System

• Arousal or relaxation

• Enhanced concentration, vigilance

• Appetite suppression

B). Hematological

• Increase in platelet adhesiveness

C). Cardiovascular

• Increased heart rate, cardiac rythm

• Contractility

• Increased blood pressure

• Cutaneous vasoconstriction

• Systemic veno-constriction

• Increased muscle blood flow

• Catecholamine release

D). Metabolic

• Lipolysis with fatty acid release

• Increased energy expenditure

E). Endocrine

• Increased growth hormone

• Inhibition of prostacyclin synthesis

Acetaldehyde & Carbon Monoxide

Acetaldehyde, a by-product of cigarette smoke has some sedative properties. The carbon monoxide in cigarettes makes people feel dull the way one would in a stuffy room without enough air. These chemicals seem to dampen some people’s feelings of tension, anger, or strong emotion.

Other Psychological Effects

Conditioning occurs over many years after exposure to things in the environment, which stimulate the user to want a cigarette or other forms of tobacco. People learn to manage their emotions with tobacco. For many, the act of smoking or chewing itself - pausing in one’s work, lighting up, exhaling a certain way - becomes a comforting ritual in itself. The act of tobacco use may go hand in hand with other activities, such as toilet rituals in the morning, drinking tea or alcohol, or relaxing after a meal. These “triggers” are the reason why quitting involves more than just kicking the nicotine habit. Patterns of behavior are very difficult to change.

Stages of Development of Addiction

The initiation and development of tobacco use among children and adolescents progresses in stages:

• Forming Attitudes and Beliefs about Tobacco,

• Trying Tobacco,

• Experimenting with Tobacco,

• Regularly Using Tobacco,

• Becoming Addicted to Tobacco.

This process generally takes about 3 years.

Withdrawal

Attempts to stop use lead to craving, withdrawal symptoms, and high rates of relapse.

Withdrawal begins within a few hours of the last cigarette and manifests as:

• Dysphoric or depressed mood

• Insomnia

• Irritability, frustration, or anger

• Anxiety

• Difficulty in concentrating

• Restlessness

• Decreased heart rate

• Increased appetite or weight gain

The following questionnaire may be administered to tobacco users to identify whether their dependence on tobacco is more physical, psychological or behavioral. This questionnaire will help you identify why you use tobacco and where your addiction is the highest. Addiction affects the body in three areas: physically, psychologically and behaviorally (habit). Knowing where your addiction is strongest will help you select the tools and resources to deal with your withdrawal process.

♤ Rate the following statements that best describes you using:

(5) Always

(4) Frequently

(3) Occasionally

(2) Seldom

(1) Never

A). I use tobacco to keep from slowing down.

B). Handling a cigarette is part of the enjoyment of smoking.

C). Smoking is pleasant and relaxing.

D). I use tobacco when I’m upset about something.

E). When I run out of tobacco, I find it unbearable.

F). I use tobacco automatically without being aware of it.

G). I use tobacco to perk myself up.

H). Part of the enjoyment of smoking comes from the steps I take to light up.

I). I find cigarettes pleasurable.

J). When I feel uncomfortable about something, I use tobacco.

K). I am very much aware of the times when I am not using tobacco.

L). I light up a cigarette without realizing I still have one burning in the ashtray.

M). I use tobacco to give myself a “lift.”

N). Part of the enjoyment of smoking is watching the smoke I exhale.

O). I want to use tobacco when I am comfortable and relaxed.

P). When I feel “blue” or want to take my mind off my cares, I use tobacco.

Q). I get real cravings for tobacco when I haven’t used in a while.

R). I’ve found a cigarette in my mouth and couldn’t remember having put it there.

Consider the following as per your answers above:

A + G + M = Stimulation

B + H + N = Handling

C + I + O = Pleasure

D + J + P = Relaxation/Tension Reduction

E + K + Q = Craving

F + L + R = Habit