Cigarette smoking, the chief avoidable
cause of premature death in this country, is responsible for more than 300,000
premature deaths each year. (Letter from Otis Bowen, Secretary of Health and
Human Services, to President George Bush, May 3, 1988)
Smoking is an
avoidable cause of death. The way to avoid it? Quit
smoking. But people can't quit because it's too hard -- because smoking is
addictive. In 1988 the Surgeon General issued a report entitled
Nicotine
Addiction. Throughout its 600+ pages he gives a highly detailed explanation
of just why nicotine is addictive.
(Flash Surgeon General warning) The Surgeon General listed criteria
for establishing a drug as addictive and showed how nicotine adheres to these
criteria. The following are some of those criteria for determining that a drug
is addictive (all information is based on US Department of Health and Human
Services.
The Health Consequences of Smoking: Nicotine Addiction: A
Report of the Surgeon General 1988.):
Users develop a compulsive use of the drug despite damage
to individual or society. Smoking causes lung cancer, other cancers,
chronic obstructive lung disease, heart disease, complications of pregnancy, and
several other adverse health effects. Smoking has been associated with
antiestrogenic effects such as earlier menopause and increased osteoporosis.
Nicotine is known to enter the amniotic fluid, umbilical cord of the fetus, and
the breast milk of expectant mothers. Despite these known negative effects of
smoking, people continue using cigarettes.
The drug is rewarding and drug seeking takes superiority
over other important priorities. In a study by Henningfield, Miyasato,
Jasinshki (1985) nicotine was seen to act as a euphoriant and at high doses
acted similar to stimulants such as cocaine or amphetamines. Nicotine has been
seen to produce other desirable effects as well. It is possible that nicotine
improves attention, however most studies in this area compare smokers smoking to
smokers not smoking, thus it is unsure whether smoking enhances attention or
abstinence for someone who regularly smokes impairs attention. Due to a wide
range of results, studies have not been able to conclusively show that smoking
improves learning or memory; nonetheless, many smokers claim it does both. They
also assert that smoking is relaxing and causes pleasurable feelings. Indeed
studies have associated the onset of smoking during the teenage years with high
levels of stress present at this time. Because smokers believe smoking to cause
all of these beneficial effects, smokers will often stop what they are doing to
take breaks for smoking in order to maintain the nicotine level to which their
body has grown accustomed.
The drug produces changes in a person’s mood that are
mainly controlled by effects in the brain. When a smoker inhales, tobacco
smoke reaches the lungs and absorbs rapidly because of the huge surface area.
From here the nicotine enters the blood. Nicotine concentration in the blood
rises quickly and there is a rapid uptake of nicotine into the brain, as shown
by animal studies. A 1950 study by Werle and Meyer showed that the brain had the
highest levels of nicotine compared to other bodily organs immediately after the
injection of nicotine into the blood stream.
Tolerance to the drug develops. Repeated use of
nicotine produces diminished results so that a smoker needs more cigarettes to
produce the desired effects. Studies show that smokers will gradually increase
their number of cigarettes smoked per day until they reach a level that they
then maintain day after day, largely without change. The 1985 National Health
Interview Survey showed that 89.4% of smokers smoked over 5 cigarettes per day.
Smokers increase their cigarette intake until they reach the nicotine level that
produces the effects that they desire.
Physical dependence with withdrawal syndromes are present
as well as a strong tendency to relapse after quitting. Nicotine
withdrawal can cause craving for nicotine, irritability, frustration, anger,
anxiety, difficulty concentrating restlessness, decreased heart rate, and
increased appetite or weight gain. These signs of withdrawal can be detected
within 2 hours after the last cigarette use and will decline as time passes.
Some of what happens is a reversal of the effects of the nicotine. For example,
nicotine has been shown to suppress appetite thus when nicotine is no longer
used, the appetite would return to what it would normally be when nicotine is
not in the system and body weight would increase. The urge to smoke may persist
despite a desire to quit or repeated attempts at quitting.
Recognizing tobacco use as an addiction is critical for treating the user.
Again from Otis Bowen’s letter to President Bush, he states:
Private health organizations, health-care providers, community
groups, and government agencies should initiate or strengthen programs to inform
the public of the addicting nature of tobacco use. A warning label on the
addicting nature of tobacco use should be rotated with other health warnings now
required on cigarette and smokeless tobacco packages and advertisements.
Preventing the initiation of tobacco use must be a priority because of the
difficulty in overcoming nicotine addiction once it is firmly established.
Because most cases of nicotine addiction begin during childhood and adolescence,
school curricula on the prevention of drug use should also include tobacco...The
disease impact of smoking justifies placing the problem of tobacco use at the
top of the public health agenda.
By treating the user, and more importantly by educating people in order to
prevent them from taking that first cigarette, we can prevent the hundred
thousands of avoidable deaths that occur each year.