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Smoking Addiction

Tobacco use and abuse results in the death of as many as 440,000 Americans each year, with one out of every 5 deaths in the United States attributed to smoking (as compared with other methods of tobacco ingestion). Smoking harms nearly every organ in the body, is the cause of many diseases, and compromises smokers' health in general. Nicotine, the primary mood-altering chemical component of tobacco, is the main reason that tobacco is addictive, although tobacco smoke contains numerous other unhealthy chemicals, including carbon monoxide, tar, acetaldehyde, nitrosamines, etc..

A consistently improving understanding of addiction in general and of nicotine as an addictive drug has been essential in developing medications and behavioral treatments for smoking addiction. Some examples of effective medical treatments for smoking cessation when combined with behavioral therapy include:

  • the nicotine patch
  • nicotine gum
  • Wellbutrin / Zyban
  • Chantix

The development of advanced neuroimaging technologies have made it possible for researchers to observe changes in brain activity and functionality that result from smoking tobacco. Researchers are now also identifying genes that they believe predispose individuals to tobacco addiction, and even predict their response to smoking cessation treatments. This research presents new opportunities to discover, develop, and apply new treatments for smoking addiction, including scientifically based prevention programs to help minimize the public health burden that tobacco use and abuse represents.

Smoking Addiction: As Real and Dangerous as any Drug Addiction

Cocaine, crystal methamphetamine and heroin are three drugs known to be highly addictive, incredibly dangerous, and devastating to user's bodies and minds. Thousands of people die each year as a result of addiction to these of drugs, and millions of dollars are spent each year on combating drug abuse. Few people realize that tobacco is statistically the most addictive drug in existence, and the one that kills more people each year than all the other legal and illegal mood-altering drugs combined.  Smoking addiction is a silent killer, more deadly than anything in any drug dealer's inventory.

Why don't we think of tobacco as a drug? It fits the World Health Organization's guidelines of a drug:

  • "...broadly speaking, [a drug] is any substance that, when absorbed into the body of a living organism, alters normal bodily function."
  • Tobacco users also fit the description of addiction laid out by the National Institute on Drug Abuse:
  • "Addiction can be characterized by an impaired response inhibition and abuse, even in the face of negative health consequences."

When compared objectively, the definitions of "hard" drugs are a spot on match for tobacco, and with good reason - tobacco is a highly addictive, dangerous drug. Not convinced? Let's take a hard look at two more statistics.

  • According to the National Center for Health Statistics, In 2006, a total of 38,396 persons died of drug-induced causes in the United States. This category includes not only deaths from dependent and non-dependent use of legal or illegal drugs, but also poisoning from medically prescribed and other drugs.
  • The National Institute on Drug abuse reports that 440,000 deaths are attributed directly to tobacco use every year in America, and one in five deaths in the US are the result of smoking. In 2007, over 70.9 million Americans over the age of 12 reported daily tobacco use, with 60.1 million being smokers.

That's 401,604 more people killed yearly by tobacco compared with other drugs. In other words, the risk of death from smoking is roughly 11 times that of addiction to other drugs!

Smoking addiction is real and as dangerous as any drug addiction, and perhaps more so because it is so pervasive. It is also exceedingly easy for tobacco addicts to minimize their addiction because tobacco doesn't produce the massive euphoria of other drugs of addiction.  Despite being a drug that kills people at over 10 times the rate of other substances, tobacco is still accepted in our society.  Tobacco products of all kinds can be purchased in nearly every grocery store, gas station, and discount store across the United States and worldwide.

Why is tobacco so addictive?

Tobacco contains nicotine, an alkaloid found in the nightshade family of plants. In low concentrations (an average cigarette yields about 1-2 mg of absorbed nicotine when smoked), the substance acts as a stimulant in mammals and is the main factor responsible for the dependence-forming properties of tobacco smoking. According to the American Heart Association, nicotine addiction has historically been one of the hardest addictions to break, while the pharmacological and behavioral characteristics that constitute tobacco addiction are similar to those that determine addiction to other drugs such as heroin and cocaine. Nicotine content in cigarettes has continually increased over the years, one study finding that there was an average increase of 1.6% per year between the years of 1998 and 2005. The average cigarette delivers between 1mg and 2mg of nicotine into a smoker's bloodstream, which stimulates the adrenal glands, releasing adrenaline. This in turn increases the smoker's blood pressure, respiration, and heart rate, which, over time, produces negative effects in a smoker's body.

If these symptoms were the body's only reaction to nicotine, it would still be unhealthy, but not necessarily addictive. To understand the addictive nature of nicotine, one must understand nicotine's effect on the brain.

Nicotine activates the brain's reward pathways (the mesolimbic dopamine system), which regulate feelings of pleasure. Of the various neurotransmitters that create feelings of pleasure, dopamine is the one primarily responsible for euphoric response to mood-altering chemicals and experiences. Within ten seconds of the first inhale of a cigarette, nicotine levels in the blood and brain have peaked. This peak triggers an increase in dopamine levels in the reward pathways, thus giving the brain a "kick". This is known as a pharmacokinetic response, and is a property shared by all addictive drugs.

Smoking Addiction Quick Fix

The acute effects of nicotine and other addictive drugs wear off relatively quickly - including feelings of pleasure associated with increased dopamine levels in the brain. When this happens, the addicted smoker no longer has high levels of dopamine in his or her reward pathways, and rapidly seeks to recreate the feelings of pleasure again with another cigarette.  Addictive drugs make it so that the reward pathways in the brain rely on regular doses of the drug for regulation.

Researchers are also in the midst of identifying other chemicals in cigarettes that contribute to the addictive effects of smoking on the reward pathways in the brain. For example, an as-yet unidentified chemical in cigarettes dramatically decreases the MAO levels in the brain. MAO is an enzyme in the brain responsible for breaking down high levels of dopamine, and when MAO levels are decreased, the reward pathways of the brain learn to rely on high levels of dopamine for happiness.

Another trait shared by nicotine and other addictive drugs is the fact that over time, the same amount of chemical no longer stimulates the reward pathways as it once did; the brain develops a tolerance. When this happens, the user must introduce increasing amounts of the drug to the brain in order to get the same "kick" or "rush" as before. This is why many people with a smoking addiction start out smoking just a few cigarettes a day, and over time progress to smoking a pack or more each day.

Research has shown, and is continuing to show, that nicotine is just one of many highly addictive chemicals in tobacco, and that smoking addiction is every bit as dangerous if not more dangerous than other drugs of addiction.

Smoking Addiction Treatment

If you or someone you love is addicted to smoking, and have tried to quit to no avail, a combination of medication and behavioral treatment is recommended. In addition to gaining new insight into the addictive nature of tobacco and how it works in the brain, researchers are also finding that treatment for smoking cessation works.  Statistics show that the most effective method of quitting smoking involves behavioral therapy as an adjunct to medical treatment (nicotine gum, patches, Chantix etc.).  Treatment focuses on what smoking really is - addiction to a mood-altering chemical, and therefore is often offered alongside treatment for other drugs of addiction in most drug treatment centers.

There are numerous quit smoking programs, products, and therapies offered in states and contries throughout the world.  Many doctors are trained to treat smoking addiction, and there are literally thousands of studies documenting the dangerous and harmful effects of smoking addiction. Help for smoking cessation is widespread and easy to find.  To locate a treatment program for smoking cessation visit our rehabilitation program directory, speak with your doctor, or call our 24/7 addiction hotline at 1 , we're here to help.

**Some of the sources used for the article:

http://oas.samhsa.gov/nsduh/2k8nsduh/2k8Results.cfm

http://www.nel.edu/pdf_/NEL250404R01_Esch-Stefano_p_.pdf

http://ajp.psychiatryonline.org/cgi/reprint/164/1/43.pdf

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