Tobacco Addiction

What Causes Tobacco Addiction?

Nicotine alters a user’s brain chemistry so that they need regular doses of the chemical to feel well. Eventually, the brain builds a tolerance to nicotine, so the user will likely need to smoke more to keep feeling well. Smoking is likely to cause addiction because it very quickly and directly introduces nicotine into the lungs. It can be absorbed into the bloodstream and delivered directly to the brain within seconds of inhalation.

Once in the brain, nicotine triggers the release of chemicals called neurotransmitters, naturally occurring chemicals that help the brain’s nerve cells communicate with one another. One particular neurotransmitter, called dopamine, stimulates parts of the brain that produce feelings of well-being, happiness, or even euphoria. The result is a quick, intense “high” that makes the user associate smoking with good feelings.

The high associated with nicotine happens quickly, but it also dissipates quickly, much more so even than the high associated with other addictive drugs. The fleeting euphoria drives the user to continue smoking to maintain the good feeling. Regular tobacco use also alters the brain circuitry that controls learning, stress, and impulse control. These changes can contribute to withdrawal symptoms.

Is Tobacco Addiction Hereditary?

Outside influences play an essential role in a given individual’s decision to begin using tobacco. Peer pressure is a significant factor, and when someone lives or works in an environment where smoking is prevalent, they’re more likely to start smoking themselves. Scientists have found evidence; however, that susceptibility to nicotine addiction may also be inherited.

Studies have found that the heritability of nicotine addiction risk may be as high as 80%. People with a family history of tobacco addiction are more likely to develop the habit themselves. Studies of identical twins that have been isolated from each other have ruled out the home-life environment as the culprit, suggesting that genes probably play a role.

Scientists have not, though, been able to determine which genes might increase the risk. Analysis of study data has shown hundreds of different gene variations that may be a factor in addiction risk. These genes may affect how nerve cells communicate with each other in the brain or affect the brain’s response to dopamine and other neurotransmitter chemicals.

How is Tobacco Addiction Detected?

Early detection of tobacco use by your child or loved one can make it easier to prevent the development of dependency and, in turn, prevent the long-term consequences of the addiction. Parents and loved ones should watch for these signs of smoking or tobacco use:

• Lingering odors. Smoking typically produces a tenacious odor that clings to a smoker’s skin, clothing, belongings, and surroundings.
• Stained teeth, tongue, or fingers. Nicotine and cigarette smoke produce yellow-ish stains.
• Changes in food preferences. Smoking can cause decreased taste sensitivity, so users may begin to salt or season their food more enthusiastically.
• Coughing. Tobacco use often results in a “smoker’s cough,” a persistent, deep cough that often differs in character from the cough produced by colds.
• Voice changes. Irritation of the throat caused by smoking often changes the character of a smoker’s voice, giving it a deeper or more gravelly tone.

How is Tobacco Addiction Diagnosed?

There is no medical or laboratory test for nicotine addiction, and a patient must be honest about their tobacco use for a diagnosis to be made. To determine whether a patient has a nicotine addiction, a doctor will ask questions about the patient’s smoking or tobacco use.

The frequency of smoking and the length of time that the patient can go without tobacco use (especially first thing in the morning) indicate the addiction’s intensity. A more intense addiction will likely indicate the need for a different kind of treatment than that required for a lesser dependency.

How is Tobacco Addiction Treated?

Because of how it changes a user’s brain chemistry, nicotine dependency is very challenging to treat. Withdrawal symptoms can be intense, and even when a user sincerely wants to quit using tobacco, relapses are very common. Medications and drug-based therapies can help control withdrawal symptoms and make it more likely that a user can successfully stop permanently.

• Nicotine replacement therapies. A common treatment for nicotine addiction involves products that deliver nicotine in a less harmful way than smoking. Nicotine patches, gum, lozenges, or other products relieve withdrawal symptoms and gradually reduce the patient’s dependence on nicotine.
• Medications. Some antidepressants may reduce nicotine dependence by increasing dopamine levels in the brain. The drug varenicline (brand name Chantix) works by reducing nicotine’s pleasing effect and controlling withdrawal symptoms. However, Chantix is not recommended for use by people under the age of 16.
• Support groups. Peer support groups and addiction counseling can be helpful, especially when used in combination with other treatments.

How Does Tobacco Addiction Progress?

Tobacco damages the body in a wide variety of profound ways. Nicotine dependency often leads to a long-term (and often escalating) pattern of tobacco use that has a devastating effect on the user’s health.

The health impacts of smoking arise from the stress placed on the body from tobacco’s chemical effects and the toxins and fine particles introduced directly into the lungs, one of the most sensitive parts of the body.

Smokeless tobacco products don’t have the same effect on the lungs that cigarettes do, but they are far from harmless. Fatal illnesses caused by smokeless tobacco products are not uncommon.

Effects of Long-Term Tobacco Use

Some of the most common health impacts of smoking include:

• Heart disease and cardiovascular disease. Smoking as few as five cigarettes a day can increase the risk of these problems.

• Stroke. Damage to blood vessels increases the likelihood that blood flow to the brain may be disrupted.

• Chronic Obstructive Pulmonary Disease (COPD). Lung diseases such as emphysema and chronic bronchitis, which are many times more common in smokers, are progressive and often ultimately fatal.

• Cancer. Almost all cases of lung cancer are linked to smoking. Smoking increases cancer risks elsewhere in the body, including the kidneys, blood, bladder, liver, cervix, pancreas, and colon.

• Fertility effects. Smoking can make it harder for a woman to become pregnant, and it is linked to low birth weight, stillbirth, premature delivery, and other problems.

• Rheumatoid arthritis

• Tooth loss

• Diabetes

• Cataracts and vision problems

• Chronic inflammation and immune-system deficiency

Health Impacts of Smokeless Tobacco

• Heart disease

• Cancer of the throat, mouth, cheek, gums, lips, or tongue

• Mouth sores

• Low birth weight or stillbirth

• Tooth loss and dental problems

How Is Tobacco Addiction Prevented?

The earlier someone starts using tobacco, the more likely they are to become dependent on it. And once a user is dependent, nicotine addiction is extremely difficult to overcome. Therefore, the best way to prevent tobacco dependency is to be sure that your child or loved one never starts smoking in the first place.

• Focus on education. Ensure your child or loved one knows that smoking has real, lasting, and potentially fatal health effects. Ensure that they understand the reality of nicotine dependency and how easy it is to become a long-term smoker even if you don’t want to be one.
• Don’t ignore warning signs. Watch for the tell-tale indications that your loved one is smoking, and speak up when you see them.
• Set a good example. An individual is much more likely to start smoking if they live in a household where other people smoke. If you don’t want your child to smoke, don’t smoke yourself.

Tobacco Addiction Caregiver Tips

If your loved one is addicted to tobacco, you can take steps to help them to quit.

• Educate yourself. Learn about what causes nicotine dependency, and understand the chemical’s effects on the body. The symptoms of nicotine withdrawal can be intense and not unlike withdrawal symptoms associated with strong drugs such as opioids. It will help you to be more understanding if you know what your loved one is going through.
• Don’t have an all-or-nothing mentality. Beating tobacco addiction is very difficult, even for someone who truly wants to quit. So don’t get discouraged if there are setbacks, relapses, and frustrations. Instead, continue to be supportive and help your loved one to try again.
• Get help. Intense addictions are not easy to overcome on your own. Encourage your loved one to seek professional treatment when self-motivated attempts to quit are not doing the trick.

Many people with tobacco addiction also suffer from other brain and mental health-related issues, a condition called co-morbidity. Here are a few of the conditions commonly associated with tobacco addiction:

• Tobacco addiction in adolescents has been associated with increased risk of disruptive behavior disorders such as oppositional-defiant disorder or conduct disorder.
• Tobacco addiction is often associated with co-morbid depression or anxiety.
• People with tobacco addiction are at increased risk for alcoholism and other substance use disorders.

Tobacco Addiction Brain Science

The development of nicotine dependency is related to a neurotransmitter chemical called acetylcholine. Acetylcholine transmits messages about breathing, heart rate, movement, memory, and alertness in the brain. Nerve cells have special receptors that bind with acetylcholine, allowing the messages to be passed from nerve cell to nerve cell.

Nicotine is chemically similar to acetylcholine, so it binds to the same receptors on the nerve cells. When both nicotine and acetylcholine are present, the receptors are overstimulated, which causes the brain to produce less acetylcholine to compensate. The result is that when a smoker stops smoking, and there is no nicotine in the body, levels of acetylcholine are also low.

Withdrawal symptoms are a product of this imbalance. The smoker is driven to get more nicotine to make the symptoms go away, and the cycle starts over again.

Tobacco Addiction Brain Science

Title: Optimizing Tobacco Dependence Treatment in the Emergency Department

Stage: Recruiting 

Principal Investigator: Steven L Bernstein, MD     

Yale Univerity School of Medicine

New Haven, CT

The investigators propose an innovative full-factorial design in a cohort of 1056 adult smokers in an urban emergency department (ED) to test the efficacy of four key intervention components: motivational interviewing, medication, quitline referral, and texting. At the trial’s completion, a mixed-methods approach will be used to identify the components that were efficacious within the proposed cost constraint, along with feasibility and acceptability to providers and subjects. The investigators will then assemble an intervention that maximizes efficacy, given a cost-effectiveness constraint and qualitative analysis findings.

Title: Does Switching to Nicotine Containing Electronic Cigarettes Reduce Health Risk Markers

Stage: Not Yet Recruiting 

Principal Investigator: Jonathan Foulds, PhD

The Pennsylvania State University College of Medicine

Hershey, PA

This project’s overall goal is to understand the likely health effects of cigarette smokers switching to a Standardized Research Electronic Cigarette (SREC) and assess the role of nicotine delivery on switching and acceptability and markers of health outcomes.

 Current smokers who meet all eligibility criteria will completely switch from their combustible (regular) cigarettes to an electronic cigarette (SREC) that either contains 15 mg/ml of nicotine or 0 mg/ml of nicotine in the liquid.

The investigators’ hypothesis is that attempting to switch to an SREC will reduce markers of harm to health compared with the baseline (smoking) measures. The investigators also hypothesize that nicotine-containing SRECs will facilitate switching from smoking more efficiently than zero nicotine SRECs and significantly improve health risk markers, but will result in higher ratings of dependence on the SREC (as compared to the zero nicotine SREC).

Title: Helping Poor Smokers Quit

Stage: Recruiting 

Principal Investigator: Matthew Kreuter, PhD

Washington University School of Medicine

Saint Louis, MO

Using a 2×2 randomized factorial design, a statewide field trial will be conducted in Missouri, comparing the relative and combined effects of these two strategies for augmenting an existing, evidence-based tobacco quitline program. Among 2000 low-income smokers, half will receive standard Missouri quitline services, and half will receive new Specialized Quitline services targeted to this group. In each of these groups, half will receive calls from a trained navigator to help them address unmet Basic Needs and accompany psychological distress that act as barriers to smoking cessation.