Tobacco Addiction


According to the Center For Disease Control (CDC), an estimated 43.5 million people smoke cigarettes.  That is roughly 19.3% of adults over the age of 18 who is lighting up the cigarette.  Men (21.5%) tend to smoke more than women (17.3).  Cigarette smoking is the leading cause of preventable deaths in the United States.   It is estimated that 443,000 deaths each year are accounted for by smoking.  That is about 1 in 5 deaths each year in the United States. 

American Indians/Alaskan Natives have a smoking rate of 31.4%.  This is the most for any ethnic group in the United States.  The lowest ethnic group smoking is Asian at 9.2%.  In 2010, the lowest tobacco use state was Utah at 9.1%.  The highest prevalent rate by state was West Virginia at 26.8% of it’s citizens smoking tobacco. 

Adults with a GED account for the highest percentage of smokers at 45.2%.  People with an advanced degree have the lowest rate at 6.3%.  As it pertains to Socioeconomic Status, those living below the poverty level have a smoking rate of 28.9%.  Those at or above the poverty level have a smoking rate of 18.3%. 

In 2010, 19.5% of high school students reported smoking one or more cigarettes in the last nine months. It was almost equally split between males and females.  White represent 22.5% of this high school group.  African-American high school student use is 9.5%.  Even 5.2% of middle school students report being a cigarette smoker. 

I tell you these statistics not just for the information you can get from them but also to let you know that tobacco is one of the most widely used and abused substances in the United States.  The numbers listed above actually indicates a substantial decrease in tobacco use since its zenith in 1965 by almost 50%.Tobacco AddictionCredit:

There have been many reviews of data and research to find out if there is common denominators in the use of tobacco. We will take a look at some of these correlations.  We will also look at how tobacco is delivered in the body.  We will talk about nicotine addiction.  We will talk about other chemicals that are accessed when smoking tobacco.  We have to talk about the medical and economic consequences of using cigarettes.  Then we will talk about ways that people can quit smoking.  The following is a list of demographics research shows are correlations to people who smoke tobacco:

  • Low Socioeconomic Status
  • Use and approval by peers and siblings (especially in youths)
  • Exposure to smoking in media resources (television, radio, internet, books, etc.)
  • Lack of skills to resist pressure to use tobacco
  • Smoking by parents while growing up or presently
  • Accessibility of getting the tobacco
  • A perception that tobacco use is the norm
  • Low levels of academic achievement
  • Low self-image or low self-esteem.
  • Aggressive behaviors

According to the National Institute on Drug Abuse (NIDA), which is part of the U.S. Department of Health and Human Services, National Institute of Health, there are more than 4000 chemicals found in the smoke of tobacco products.  Nicotine is the most prevalent and the primary chemical in tobacco that reinforces the behavior of smoking.  In essence, nicotine is the primary addictive substance when smoking. 

Smoking cigarettes is the most common or popular way of using tobacco.  The statistic listed above are only reported for smoking tobacco, primarily cigarettes.  However, there are other ways to use tobacco such as smokeless tobacco, snuff, cigars, and etc.  For brevity purposes we will only talk about smoking cigarettes.  This is the most common, but most issues related to smoking cigarettes can be applied to other forms of uses of tobacco. 

By inhaling the cigarette a person is receiving 1 mg to 2 mg of nicotine per cigarette.  The typical smoker will take 10 puffs on a cigarette and  a person who smokes 1 pack a day will be getting 200 “hits” of nicotine applied to their system.  Nicotine that is smoked takes about 4-6 seconds to get into the bloodstream.  It takes about 6-8 seconds to get to the brain.  The person will have almost immediate gratification from smoking the cigarette.  People like instant gratification and this is a process that addictions are based on.  If it took the person a long time to feel the effects of nicotine, people would not smoke as much as they do.  This would be the same with all addictions.  If a person is not rewarded for a behavior they will not continue the behavior. 

It is very hard for substance to cross the blood brain barrier set up by the body system to protect the brain.  However, nicotine seems to cross this barrier very easily.  The brain, as you know, controls the other parts of the body.  The brain can control the speed and reaction times of all parts of the body.  The nicotine in the brain can cause the heart rate to increase and can cause abnormal muscle movements. 

In the brain, nicotine activates the pleasure parts of the brain and releases a neurotransmitter called dopamine.  This neurotransmitter is the “feel good” neurotransmitter and often called the “natural heroin” of the body.  Dopamine is the same neurotransmitter that is released when we smile, laugh and/or very happy.  Too much or too little dopamine plays an integral part in correlations with many mental disorders.  As a side note, many people who suffer from mental disorders also are reported to be smokers.  For instance, 80% of schizophrenic people are reported to be smokers by the National Institute of Health.  This is in comparison to 19.3% of the general population over the age of 18 in the statistic listed in the beginning of this article.  This is not a cause and effect, it is just a correlation.  That means smoking or schizophrenia does not cause the other one, but they are found to be related. 

Most people smoke cigarettes because they are addicted to the nicotine.  This may not be the case with young people.  The young people may be smoking the cigarettes to impress their friends, or to gain acceptance to a group.  However, this is the gateway to the addictive process.  I do not believe most adolescent start smoking a cigarette and say “Geez, I wish I would hurry up and become addicted to these, because they taste horrible.”  I also do not believe they say “I want to die from lung cancer some day, so let me smoke this cigarette.”  The addiction process comes from that first thought of being socially accepted and then they person is trapped because of the immediate gratification that we discussed above. 

Addiction is the compulsive seeking and use of substance or repeating of a behavior, even when the person knows of the negative results.  This is not to say a person could not become addicted to something and not even be aware of the negative consequences.  Sure they can.  A person could start using a drug to ease pain and become addicted to it.  However, with smoking, this is not the case most of the time.  Schools, advertisements, family members, and other avenues tell of the harmful effects of cigarette smoking.  The person knows in this case and continues to use. tobacco addictionCredit:

According to the Diagnostic and Statistical Manuel of Mental Disorder, Fourth Edition, Text Revision (DSM-IV-TR), nicotine dependence is classified as a mental disorder.  Although 80% of individuals who smoke have a desire to quit smoking only 35% TRY to stop each year.  Less than 5% stop without an intervention to quit.  Mark Twain is famous for saying Quitting smoking is quite easy to do, he had done it a thousand times.  I find this to be true even today.  

I believe that tobacco addiction is a mental and medical concern, but it was classified as a mental disorder to easily address the psychological addiction of nicotine as well as the physiological addiction.  It will take a combination of treatments to effectively quit smoking.   We will talk about these later in this article. 

Nicotine is not the only substance that is active in crossing the blood-brain barrier or affecting parts of the brain and body.  Monoamine Oxidase (MAO) are not affected by nicotine in research studies.  However, when someone is smoking there is a decrease in two forms of MAO resulting in higher dopamine levels.  This is indication there are other chemicals involved that can affect the brain and it’s functioning. 

What are the Medical Consequences of Tobacco Use?

As stated above, smoking can be linked to almost 450,000 deaths in the United States each year.  That is more than alcohol, cocaine, heroin, homicides, suicides, car accidents, fires, and AIDS combined. 

Cigarette smoking harms every organ of the body.  The National Institute of Health reported it has been conclusively linked to leukemia, cataracts and pneumonia.  Cigarette smoking accounts for one-third of all cancer deaths in the United States.  Smoking has been linked to about 90% of all lung cancer cases.  Smoking is also associated with cancers of the mouth, pharynx, larynx, esophagus, stomach, pancreas, cervix, kidney, ureter, and the bladder.  Basically, like I said, every organ of the body. 

In addiction to cancer, smoking has been linked to other lung diseases, such as COPD and emphysema.  More than 90 of all COPD deaths can be linked to smoking.  Smoking can cause problems with asthma symptoms. 

It has also been found with research, that smoking cigarettes can substantially increase the risks of heart diseases, including strokes, heart attacks, vascular diseases, and aneurysms. 

Nicotine is uses in insecticides and have been shown to cause extreme toxicity, vomiting, tremors, convulsions, and death.  A research study said one drop of pure nicotine can kill a person.  The nicotine is put in insecticides to stop the insect from breathing and kill them.  Kills them dead as one popular insecticide commercial says.  The same thing is happening when a person is smoking the cigarette.  It is speeding up the process of stopping the breathing and killing the cigarette smoker.  What is important is the cigarette smoker knows all this and still continues to smoke.  That goes back to my definition of addiction listed above. 

On top of killing themselves, 18% of pregnant women smoke cigarettes.  Nicotine readily crosses the placenta and goes directly into the blood stream of the baby.  The fetus is getting 15% more amounts of nicotine than the mother is getting when she smokes the cigarette based on availability studies.  Nicotine concentrates in fetal blood, amniotic fluid, and breast milk.  The National Institute of Health shows that from 1997 to 2001 smoking during pregnancy caused about 910 deaths per year and cost the $350 million per year in health related cost for the neonates. 

Economic Considerations

In 2012 the average pack of cigarettes sold in the United States is about $6 per pack.  The average smoker will smoke about 1.5 packs a day.  That is around $9 per day the person is using to “feed” this habit.  This comes out to be around $3,300 per year for just one smoker. 

In 2009, the average car payment was about $400 per month.  The smoker is burning up enough money to pay for 8 months of car payments.  The average mortgage on a home in the United States is $1600 per month.  The smoker could pay two months of house payments if they would just quits smoking and add that money to their mortgage payment.  How fast would that house and car be paid off?

The average family of four spent $6,300 on food in 2009.  If there were two smokers in the house, this would mean the family is spending more on cigarettes than they would be spending on food. 

Those figures are just the direct cost of purchasing cigarettes compared to other family expenditures.  The cost of health insurance is rising and as stated above the medical problems associated with smoking is causing a rise in medical insurance for everyone.  The smoker will be paying more in health care cost and insurance because of the choice of being a smoker.  I pay more for my health insurance because others choose to smoke.  There is no way I can give an correct number on the amount of cost a person in the United States is having to pay because of that person or another person choosing to smoke.

Businesses lose a great amount of productivity when the workers are smokers.  If a person takes 5 minutes to smoke and smokes only 1 per hour, in a typical 8 hour workday the smoker is not being productive for 40 minutes probably closer to 1 hour with the walking to and walking back from their workstation.  There is no telling how much wasted time and money business endure because of a person choosing to smoke. 

Treatment Considerations for Tobacco Addiction

Research has shown that within 24 hours of quitting smoking, blood pressure and chances of a heart attack decreases.  A 35-year-old man, who quits smoking will have a life expectancy of about 5 years longer than what he had if he had not quit. 

Nicotine Replacement Therapy (NRT) is administration of nicotine to the body other than through tobacco and gradually decreasing the amounts until the person is able to not have any nicotine.  The primary benefit is for the person to not have the cravings anymore and  get rid of the psychological and then the physiological effect of nicotine. 

One form of NRT is with transdermal patches, which administer the amount of nicotine through the skin to the body from a patch that is placed on the skin and held into place by an adhesive.  Nicoderm was the first and most widely know trade name for the transdermal patches.  It was approved by the FDA in 1991.  It looks much like a bandage applied usually to the arm.  The patches come in three different forms 7 mg to 21 mgs.  The person starts off with the higher milligrams of nicotine and then gradually moves down to the lower point and then completely off.   

Tobacco AddictionCredit:

Another way NRT is administered is with nicotine gum, which the person chews to get the nicotine administered in their body. Nicorette is the trade name of the most popular form of this type of gum for NRT.  The full dose of Nicorette should be used for 8 weeks and then gradually decrease the amount until the gum is no longer needed. 

Harvard University did a study over NRT and found that these methods may decrease the short-term use of nicotine but was not conclusive to the long-term cessation of the smoking.   

Additional Medications

Even before the Harvard Study came out there were medications being reviewed to take to stop smoking.  However, after the Harvard study showed the low reliance on the efficacy of the NRT, the FDA started giving more approval to other medications.  In 1997, the FDA, gave approval for bupropion to be use in smoking cessation cases. Bupropion is an antidepressant with the trade name of Wellbutrin.  However, when it is marketed for smoking cessation, they called it Zyban.  Chantix has been approved for smoking cessation in the last few years. 

These medications act on the brain to block the receptor sites where the nicotine binds to the neurons and eases the withdrawal symptoms associated with smoking cessation.  These drugs also block the effects of nicotine if the person resumes smoking and they do not feel the immediate gratification they once felts. 

Behavior Treatments

For the NRT and medication treatments to be very effective they have to be combined with Cognitive Behavior Therapy (CBT).  These interventions teach the person how to recognize situation where they are most apt to want to smoke, develop alternatives to smoking, developing coping strategies and mechanisms, manage stress, and improve problem solving skills.  In addition, behavior treatments give the social support the person needs to overcome the addiction.

Remember how I said that most people start smoking as a way to relate or be accepted socially?  This has to be addressed.  The behavior treatments for smoking cessation includes “unlearning” the “learned” behaviors of having to smoke to gain acceptance.  The behavior treatment will need to be combined with the drug therapy if physiological addiction is also prevalent, which it most likely is in a long-term smoker. 

When you are addressing the smoking process you must address the physiological addiction.  This is done with the medications.  However, you must address the psychological addiction and this is done with psychotherapy. 

A person may be successful with only one of these types of therapies, but when the combined effects of both psychotherapy and medications are used, the person has a greater chance of breaking the addiction than when only one is used.  It creates a synergistic effect for each treatment. 

Good luck and hope you can quit smoking and add 5 years or more to you life.  It will add quality as well. Make today and everyday a great day.




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