Nicotine dependence
| What is nicotine dependence? |
Nicotine dependence is the physical vulnerability of your body to the chemical nicotine, which is potently addicting when delivered by tobacco products. Smoke from cigarettes, cigars and pipes contains thousands of chemicals, including nicotine. Nicotine produces physical and mood-altering effects in your brain that are temporarily pleasing, and these effects reinforce your continued use of tobacco.
Being addicted to tobacco brings you a host of other health problems related to the substances in tobacco smoke. These effects include damage to your lungs, heart and blood vessels.
Breaking an addiction to nicotine is difficult and takes commitment, support and time. But even if you're a longtime smoker, stopping smoking plus taking healthy lifestyle steps can reverse much of the damage smoking has done to your body.
According to the National Center for Health Statistics, approximately 26 percent of American men and 21 percent of American women smoke. The health effects of tobacco smoking are estimated to cause the deaths of more than 400,000 Americans annually.
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| Signs and symptoms |
Being dependent on tobacco may mean you have these signs and symptoms:
- You can't stop smoking. You've made one or more serious but unsuccessful attempts to stop.
- You experience strong withdrawal symptoms when you try to stop. Your attempts at stopping have caused physical signs and symptoms, such as craving for tobacco, anxiety, irritability, restlessness, difficulty concentrating, headache, drowsiness, stomach upset, even constipation or diarrhea.
- You keep smoking despite health problems. Even though you've developed problems with your lungs or your heart, you haven't stopped or can't stop. This is one of the highest measures of tobacco dependence.
- You give up social or recreational activities in order to smoke. You may stop going to certain restaurants or stop socializing with certain family or friends because you can't smoke in these situations.
| Causes |
Tobacco smoke delivers more than 60 cancer-causing chemicals, tiny amounts of poisons such as arsenic and cyanide, and more than 4,800 other substances to your body.
Nicotine is the chemical in tobacco that keeps you smoking. It can be as addictive as cocaine. It increases the release of a brain chemical called dopamine, which makes you feel good. Getting that dopamine boost is part of the addiction process.
Tobacco dependence involves psychological as well as physical factors. You may develop strong, repetitive behaviors associated with smoking. You may smoke at certain times of the day or after a meal or in certain locations or under certain levels of stress. You'll need to address the behaviors and routines that you associate with smoking if you're to overcome your addiction to tobacco.
| Risk factors |
Anyone who smokes is at risk of becoming addicted to nicotine. Tobacco smoking is a behavior that often becomes established during adolescence. About 90 percent of smokers begin smoking before the age of 21, and most start before age 18.
The younger you begin smoking, the greater the chance that you'll become a heavy smoker as an adult. In 2001, more than 28 percent of high-school students surveyed by the Centers for Disease Control and Prevention reported that they had smoked one or more cigarettes in the past month. The good news is that this number has gone down from a high of 36.4 percent in 1997. Still, approximately half of those who smoke in high school continue smoking during their adult years. Also, teenagers who smoke are more likely to use alcohol and other drugs.
Among adolescents, nicotine addiction can begin within days or weeks of smoking their first cigarette, even among occasional users. Exposure to tobacco in movies or advertisements, particularly for young people, can become strong reinforcement for a decision to start smoking or keep smoking. Antismoking ads are on the rise, however, and most high-school students now see an equal number of smoking and antismoking ads. On the other hand, the amount of smoking seen in movies has increased.
| When to seek medical advice |
You may have tried to stop smoking because you've experienced health problems related to smoking or because you're concerned about potential health problems. If you've tried to stop, but have discovered you can't, talk to your doctor about which approaches to take.
| Complications |
When you inhale tobacco smoke, you're ingesting a chemical parade that will march through most of your body's vital organs. The negative health effects throughout your body are numerous, including:
- Lungs. Smoking is the cause of 87 percent of all lung cancer. Smoking is also the primary cause of other lung problems, such as emphysemaand chronic bronchitis.
- Heart and circulatory system. Smoking is associated with an increased risk of cardiovascular disease. The reason for this is unclear, but researchers suspect that nicotine triggers your adrenal glands to produce hormones that stress your heart by increasing blood pressureand heart rate. Carbon monoxide in tobacco smoke steals oxygen from the heart and other vital organs. Smoking may also constrict your blood vessels, placing you at greater risk of a heart attack or stroke.
- Cancer. Smoking is associated with cancer of the esophagus, larynx, pharynx, mouth, bladder, pancreas, kidney and cervix.
- Appearance. The chemicals in tobacco smoke can dry and irritate your skin and promote wrinkles. Smoking also yellows your teeth, fingers and fingernails.
- Fertility. Smoking increases the risk of infertility and miscarriage in women, and the risk of impotence and infertility in men.
- Sudden infant death syndrome (SIDS). Mothers who smoke while pregnant greatly increase the risk of SIDS in their newborns. Exposure to secondhand smoke in a newborn also increases the risk of SIDS.
- Senses. Smoking deadens your senses of taste and smell, so food isn't as appetizing as it once was.
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| Treatment |
The approved effective medications to help you stop smoking fall into two categories — nicotine replacement therapy and non-nicotine medications. Using one of these medications generally doubles your chances of quitting. The best-tested treatment available to help you stop smoking is based on psychological support in addition to medications.
Combining medications with follow-up visits to your doctor for support and counseling is usually more successful than if you try to stop on your own. If you've tried a medication on your own but haven't been successful in quitting, talk to your doctor about it. He or she can help you move in the right direction by adjusting the dose of your medication, recommending a different medication, or using a combination of medications. Quitting smoking is possible, even though it may take more than a few tries. More than 45 million Americans have quit smoking. So can you.
Nicotine replacement therapy
Most nicotine replacement products are available over-the-counter:
- Nicotine patch (Nicoderm CQ, Nicotrol, Habitrol). The patch delivers nicotine through your skin and into your bloodstream. You wear a new patch each day on your upper body. The treatment period may last for 6 or 10 weeks. Don't be in a hurry to stop using the patch, especially if you've stopped smoking or dramatically reduced your smoking. If you haven't been able to stop smoking completely after the first week or so of treatment, ask your doctor for help in adjusting the dose of the patch or adding another medication. Nicoderm CQ and Nicotrol are available over-the-counter; Habitrol is available by prescription.
- Nicotine gum (Nicorette). This gum-like resin delivers nicotine to your blood through the lining of your mouth. It's available in a 2-milligram dose for regular smokers (24 cigarettes or less daily) and a 4-milligram dose for heavy smokers (25 cigarettes or more daily). You usually chew 10 to 15 pieces a day, and the treatment period generally lasts about 12 weeks.
- Nicotine lozenge (Commit). This tablet dissolves in your mouth and, like nicotine gum, delivers nicotine through the lining of your mouth. The lozenges are also available in 2- and 4-milligram doses.
- Nicotine nasal spray (Nicotrol NS). The nicotine in this product, sprayed directly into each nostril, is absorbed through your nasal membranes into veins, transported to your heart and then sent to your brain. It's a quicker delivery system than the gum or patch.
- Nicotine inhaler (Nicotrol inhaler). This device looks something like a cigarette holder. You puff on it, and it gives off nicotine vapors in your mouth. You absorb the nicotine through the lining in your mouth, where it then enters your bloodstream and goes to your brain, relieving withdrawal symptoms.
The antidepressant drug bupropion, which doesn't contain nicotine, increases the level of dopamine, the chemical that's also boosted by nicotine, in your brain. As with many medications, bupropion (Wellbutrin, Zyban) has side effects, including sleep disturbance, headache and dry mouth. If you have a history of seizures or serious head trauma, such as a skull fracture, don't use this drug. Another antidepressant that may help is nortriptyline (Aventyl, Pamelor).
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| Prevention |
The best way to prevent tobacco dependence is to not smoke in the first place. The best way to prevent your children from smoking is to not smoke yourself. If you're a parent who smokes, the younger your children are when you quit, the less likely they are to become smokers themselves. Even if you don't smoke, here are some strategies you might try, as a parent:
- Talk with your teenagers. Ask whether their friends smoke. The risk of your child smoking is higher if his or her best friends smoke. Most teenagers smoke their first cigarette with a friend who already smokes.
- Learn what your children think about smoking. Ask them to read this information so that you can discuss it together. Emphasize the newest research, which shows that teens show signs of tobacco dependence after smoking intermittently for only a few weeks.
- Help your child explore personal feelings. Use nonjudgmental questions and rehearse with them how they could handle tough situations regarding peer pressure and smoking.
- Encourage your teenager to enjoy maximal energy and health. Explain to your teenager that the active, vivacious lifestyles portrayed in many cigarette advertisements are actually more representative of nonsmokers. People who smoke have colds and other respiratory infections more frequently.
- Note the social repercussions. Remind your teenager that smoking gives you bad breath and makes your hair and clothes smell.
- Work with your schools. Become active in community stop-smoking programs.
- Promote smoke-free environments. Encourage public areas and restaurants, including places where your teen may work, to offer smoke-free environments. This helps to de-normalize smoking, reducing the chances your teen will start and helping smokers to stop.
| Self-care |
When you stop smoking, you may experience symptoms of nicotine withdrawal. Your body is accustomed to regular, high doses of nicotine. It sends out distress signals when those levels of nicotine aren't present. Use of medications will markedly reduce withdrawal. Even so, it's important to know how to manage withdrawal symptoms.
Withdrawal symptoms are usually the most intense during the first 3 to 7 days after you stop smoking. But they may continue for several weeks, although at a declining level of intensity. You may experience unexpected changes in these levels during the first 3 months. Although most nicotine withdrawal symptoms pass within 4 weeks, you may experience periodic cravings, or strong urges to smoke, even months after stopping. Triggers or cues that were associated with smoking can provoke the cravings.
Most people who try to stop smoking experience a range of withdrawal signs and symptoms. Here are some of the more common ones and things you can do to deal with them:
Physical discomfort or depression
- Exercise. Even taking a brisk, 30-minute walk can help.
- Talk to a support person.
- Reduce or avoid caffeine or other stimulants.
- Relax before going to bed.
- Don't eat, watch television or discuss problems in bed.
- Make your bedroom quiet and comfortable.
- Keep a regular bedtime routine.
- Write down your worries on a piece of paper and leave them in another room.
- Use relaxation techniques.
- Exercise regularly.
- Try deep breathing.
- Reduce caffeine or other stimulants.
- Avoid stressful situations
- Use relaxation techniques.
- Exercise regularly.
- Try deep breathing.
- Reduce caffeine or other stimulants.
- Talk to a support person.
- Use distractions.
- Adjust your schedule to a lighter workload.
- Lower expectations on the amount of work you can do.
- Understand the amount of energy and time it takes to stop smoking.
- Take short exercise breaks. This not only takes you away from the situation, but helps relieve withdrawal symptoms.
- Try deep breathing.
- Avoid caffeine or other stimulants.
- Change focus of attention frequently.
- Eat healthful snacks.
- Don't delay regular meals.
- Drink more water.
- Exercise regularly.
- Wait out the craving, which is usually less than 5 minutes.
- Try deep breathing.
- Use distractions.
- Maintain diet of regular meals.
- Use bulk-producing foods.
- Limit gas-producing foods.
- Limit gum chewing.
- Exercise regularly.
- Eat regular meals.
- Plan more rest and take short naps.
- Drink water.
- Use cough drops to relieve throat irritation.
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| Coping skills |
Many smokers yearn to stop but find it hard because of nicotine's powerful addictive hold. You may need more than one attempt before you successfully stop.
Maybe you want to stop smoking but don't feel ready to stop right now. Many smokers experience similar feelings. Although they want to stop, most also have reasons to put off taking action. The good news is, most smokers eventually do stop. But how can you build the motivation to make the change now?
Start by addressing the mixed feelings you may have about smoking. Identify the reasons why you'd like to continue and the reasons why you'd like to stop. Make a list of your barriers and benefits to making a change. Continue to update the list as you think of more reasons.
Identify barriers
These barriers are real for you and may make you hesitant to change your smoking behavior. But by identifying barriers before you try to stop smoking, you can:
- Start thinking of ways to overcome these barriers. You may even decide that some barriers are not as big as you had originally thought. You may be able to control weight gain with just a little extra exercise.
- Already start working on overcoming certain barriers. For example, if you're concerned about a lack of social support, talk to a friend who used to smoke or a health care professional. If you're worried about the discomfort of withdrawal symptoms, consider the use of nicotine replacement or bupropion to help.
- Develop strategies to build your confidence to overcome these barriers. For example, in situations that trigger your urge to smoke, think of alternatives.
- Set smoke-free boundaries. If there's another smoker in your household, set boundaries by making your home and car smoke-free.
Giving up smoking is a good change for many reasons. Identify the reasons that are important to you.
- Think of short-term benefits (such as breathing easier, saving money, no more smoky-smelling clothes) and long-term benefits (lower risk of disease, increase chances for a longer life, no secondhand smoke affecting the health of your loved ones).
- Whether your list is long or short, the better you're able to identify the benefits of stopping, the stronger your reasons are to stop.
- These reasons build your motivation to make a change. Remind yourself of these reasons regularly, especially when you feel your motivation lagging.
You may have little confidence in your ability to stop smoking. You may have tried to stop many times. If so, try to change your perspective. Instead of thinking of stopping as a huge, impassable obstacle, focus on the smaller details. Identify specific situations in your day that could help or harm your attempt to stop.
- You may feel confident that you can stay smoke-free in certain situations, such as at your work desk, and less confident about other situations, such as at a party.
- Identify your major areas of concern. This will help you problem-solve and develop strategies to stop smoking.
- Identify the situations in which you have some confidence. You'll find that you have many situations in which you're already able to stay smoke-free.
- As you work on stopping, seek the social support you need and practice your new coping skills. In this way, you'll increase your confidence in being able to make a move toward being smoke-free.
- Develop a positive attitude by practicing positive self-talk. Start by looking in the mirror and saying, "I can stop smoking" or "I can be smoke-free."
- Think of one or two phrases to use repeatedly for encouragement, such as "I can make it" or "Keep it up."
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| Complementary and alternative medicine |
Aside from medications, these approaches may help you relax and relieve anxiety:
- Behavior therapy. A form of counseling, behavior therapy helps you change the behaviors and thoughts that contribute to anxiety. You can better understand your anxiety triggers, develop coping skills and learn relaxation techniques.
- Relaxation techniques. An approach such as meditation may reduce your level of stress. Meditation involves focusing on a word or object in a quiet environment to provide relaxation.
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— March 11, 2003 —
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