Why is Smoking a Problem?

 

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.