Nicotine Addiction – You Are Not Alone

Introduction

Nicotine addiction is common enough that the CDC reports that as of 2016 there is an estimated 37.8 million American adults that are addicted to nicotine. Considering that the United States Census Bureau notes there were approximately 194.3 million adults in America in 2010, that means that almost 20 percent of the American adult population is lighting up to serve their nicotine addiction. If this is something you are struggling with, you are certainly not alone. Approximately one in five people around you are doing the exact same thing.

The New England Journal of Medicine notes that just as many people that are lighting up are dying, and estimate that 435,000 Americans die every year, prematurely, to smoking related deaths. The same report notes that the chances of dying prematurely from a smoking related illness is 50 percent. The CDC notes that smoking is the leading cause of preventable deaths in America. Here’s everything you need to know about nicotine addiction, and what can be done to get it under control.

Why is nicotine so addictive?

Health Canada and the Canadian Government says that nicotine is the chemical found in a tobacco leaf, and these leaves are manufactured into cigarettes. When that cigarette is burned, or, smoked, the lungs absorb the chemical and the rest of the body moves it through the system as it would any other chemical. The chemical can also be vaporized in liquid form, and the use of e-cigarettes and vaping has become very popular since it hit the market in 2007.

The Canadian Government says that nicotine can reach the brain in as little as 10 seconds, and even less time with vaping. This is why nicotine is so addictive. And once you start, it’s very difficult to stop. The Council of Chemical Abuse reports that nicotine is as addictive as heroin.

Causes of nicotine addiction

The Canadian Association of Mental Health (CAMH) says that nicotine addiction was not always considered an addiction. It was merely a bad habit. But as smoking related deaths are now the leading cause of preventable deaths in America, that mindset has changed. But the question of why nicotine is addictive is different for every smoker.

This is because nicotine addiction is broken down to both a physiological dependency and a psychological dependency. Some smokers like to light up after a big meal, some need a cigarette within minutes of waking up in the morning, while other smokers will just have one or two cigarettes through the day on work breaks or when they feel like it. The “why” of nicotine addiction is different for every smoker. But it is this combination of physiological and psychological dependence that is the same for everyone.

The answer to the question of “why is nicotine so addictive” first lies in the chemical response of the body when nicotine is consumed according to the CAMH. This is regardless of how it is consumed, whether through nicotine gums and patches, or through a smoked cigarette. When nicotine is consumed, once it reaches the brain, in about ten seconds of consumption according to Psychology Today, a chemical is released in the brain called dopamine.

Dopamine is the chemical that is released when someone says something nice and sweet to you, or you are feeling nice and relaxed. It’s also that “feel good” chemical that smokers enjoy every time they smoke. When someone smokes at the long-term level, the brain begins to depend on this chemical release. This is why when someone tries to quit smoking they are particularly cranky, and don’t “feel good.”

How long does it take to get addicted to nicotine?

The answer of “how long does it take to get addicted to nicotine” will vary by the individual. Psychology Today notes that it takes approximately 10 seconds for nicotine to reach the brain and release dopamine. The CAMH reports that frequent use of nicotine will lead the brain to adapt at the long-term level. So it stands to reason to conclude that it could take as little as 10 seconds to become addicted to nicotine.

The Center for Disease Control (CDC) concurs that nicotine is as addictive as heroin, and they also assert that it is also even as addictive as cocaine and alcohol. Nicotine addiction happens quickly. The Mayo Clinic notes that nicotine is a stimulant, and that it is this stimulant property of nicotine that makes humans crave it more.

What are the risk factors that lead to nicotine addiction?

The Mayo Clinic notes that just starting the habit of smoking puts someone at risk of nicotine addiction. But the Mayo Clinic also notes there are other risk factors, such as genetics, peer influences, environmental surroundings, prior history of substance abuse, age, and a history of mental illness such as anxiety or depression.

Of these factors, the Mayo Clinic notes that smoking can be inherited in two ways. It can be inherited genetically, as the Mayo Clinic has found that certain brain receptors on the surface of neurons are susceptible to high amounts of nicotine. That brain physiology can be a genetic code that is transferred to descendants. But children exposed to smoking in the home, or to parents or relatives that are addicted to nicotine can be an environmental influence that leads them to choose smoking later in life.

The Mayo Clinic also notes that there is a wide body of research connecting smoking to mental illnesses that range from depression to schizophrenia, and also even post-traumatic stress disorder.

Prior substance use, or any substance use is also developed as a part of the addictive personality. Many patients in rehab from other substances frequently turn to smoking and replace a substance addiction with nicotine addiction. In a study examining this, Psychiatric Times noted that whereas in the general population only 20 percent of Americans are smokers, in rehabilitation facilities approximately 75 to 95 percent of rehab patients are smokers. One individual in that study reported that on their weekend pass from rehab, they had to make a choice, “It was either cocaine or smoke.”

More and more rehab facilities today are trying to turn away from this, and are encouraging a path to full body health, considering how many deaths occur from smoking related causes today. Willingway Recovery Center says that they followed up on patients after their program and found that 50 percent died from smoking related causes.

Withdrawal: Symptoms of Nicotine Addiction

The CAMH notes there are a number of obvious signs of nicotine addiction. If one needs to smoke within the first half hour of waking up for they day, their body is addicted to nicotine. Smokers that rank their first cigarette of the day as the most important are also considered addicted. When a smoker has set intervals in their daily schedule that are regular and frequent, they are addicted to nicotine.

When a smoker is not able to meet those set intervals, including that first cigarette of the day, their body will respond with withdrawal symptoms. An individual that is experiencing withdrawal of nicotine is also showing symptoms of nicotine addiction according to the CAMH and the Mayo Clinic.

According to the CAMH, symptoms of nicotine withdrawal:

  • crankiness
  • anxiety
  • unable to sleep fatigue
  • inability to concentrate headaches and restlessness
  • Those symptoms can occur as soon as one hour after the individual has not had their last cigarette. The CAMH notes that it takes approximately two weeks, depending on the individual and the amount of nicotine they regularly consumed, to get over the worst of their nicotine addiction symptoms.

Diagnosis of Nicotine Addiction or Tobacco Use Disorder

The American Psychiatric Association has a “Bible” of sorts for diagnosing mental health issues, and nicotine is considered a mental health issue, like any other addiction. That “Bible” is called the DSM-V, Diagnostic and Statistical Manual of Mental Health Disorders, version five. In the DSM-V, the term for nicotine addiction is called Tobacco Use Disorder, and a diagnosis for this is noted by a number of symptoms. The DSM-V stipulates that two of the following symptoms must be noted in a 12-month period for nicotine addiction or tobacco use disorder to be diagnosed.

  • Tobacco or nicotine is consumed in high quantities or for long periods of time
  • A “persistent desire” accompanied with failed attempts at quitting smoking
  • Procuring and using nicotine consumes a large amount of time in one’s life
  • There is an overwhelming desire or “craving” to use it.
  • When one can not use tobacco or nicotine, their daily life functions suffer.
  • Social or interpersonal problems lead to anxiety that “force” someone to smoke.
  • Nicotine use is prioritized in life. For example, if you can’t go to the store, finish a job, or do an activity
  • with your family until you have that cigarette.
  • Tobacco and nicotine use continues despite physical hazards for the person. Patients with lung cancer and emphysema are known to continue smoking during treatment for example.
  • Withdrawal symptoms occur when nicotine use is ceased.

Treatment of Nicotine Addiction

Medications along with over the counter products that include nicotine are the most widely known treatments for nicotine addiction. The CAMH has divided nicotine addiction treatment into medication categories, and considers “the patch” or nicotine gum a form of medication to treat nicotine addiction.

The Patch

The Patch, along with gums, inhalers, nicotine sprays, and other forms of nicotine are called nicotine replacement therapies. How they work or what their efficacy or effectiveness is will depend on the individual and their commitment to quitting smoking.

Varenicline

Varenicline, also known as Champix, is a very popular smoking cessation drug due to its high success rate.
Bupropion is a medication that functions as an antidepressant to combat the stimulant effects of nicotine while also working on dopamine receptors in the brain.

Cytisine

Cytisine is another common nicotine addiction treatment as a medication, and is popular as it is usually less expensive than CMHA.

In addition to medications and over the counter nicotine replacement programs, treatment can also include behavioral treatment such as support groups or counseling if the individual feels it is necessary. With nicotine addiction being as serious as heroin addiction, and even causing more deaths than heroin, behavioral counseling is a productive option for quitting.

But a popular alternative treatment for nicotine addiction that is becoming preferred over all of these methods is vaping. Many smokers are turning to vaping to quit smoking. Liquid nicotine for vaping comes in a variety of strengths of nicotine. The user could, for example, begin with 8 mg strength of liquid nicotine and taper down to 6 mg, until they get to 0 mg and have lost their desire or addiction to nicotine.

Outlook

There is the old adage, “How many psychologists does it take to change a light bulb? One. But they really have to want to change it.” The same concept applies to nicotine addiction. Wanting to change that habit and prevent premature death, and really being committed to that, is the first step in treating the addiction.

But the outlook for smokers that quit the nicotine is promising enough to inspire them to want to “change that lightbulb.” WebMd reports that the body begins returning to a healthier state within twenty minutes of quitting! Within 20 minutes heart rate and blood pressure begin to return to normal, by the eight hour mark nicotine and carbon monoxide levels in the body have been reduced by half, by the 12 hour mark carbon monoxide levels in the body are normal, and by the 24 hour mark an individual has reduced their risk of heart attack by 50 percent.

Within two weeks, the lungs have become pinker and returned to normal state, and blood flow is better. “That is huge” says WebMD, and if one can handle a little crankiness and cravings and get by within 2 weeks, they will have conquered their nicotine addiction and launched a path to recovery that reduces and maybe even eliminates their chance of becoming one of the statistics of the reported leading cause of preventable death in America.

Conclusion

The research shows that nicotine addiction is dangerous and deadly, and is the leading cause of preventable deaths in America. As such, it makes sense that quitting this habit is important to prevent a premature death. But it’s not easy. Nicotine is addictive because it trains the brain to depend on it, and nicotine addiction treatment has to undo that damage, while the other human systems in the body have to heal and repair damage caused by smoking. Treatment is available however, and a positive outlook is possible for smokers to lead healthier and longer lives if they become committed to quitting their smoking habit.

REFERENCES

1. American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed), DSM-V. p. 571.

2. Benowitz, N.L. (2010). “Nicotine Addiction.” New England Journal of Medicine. (17). Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2928221/

3. CAMH “Nicotine Dependence.” Retrieved from: https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/nicotine-dependence

4. Center for Disease Control and Prevention. (2013). Tips From Former Smokers. 2013; Retrieved from: www.cdc.gov/tobacco/campaign/tips/diseases/

5. Centers for Disease Control and Prevention (2014). “Current Cigarette Smoking Among Adults — United States, 2005–2013”. Morbidity and Mortality Weekly Report (63): 1108–1112. Retrieved from: https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.htm

6. Council on Chemical Abuse. (2015). National Drug Facts Week: Nicotine vs. Heroin. Retrieved from: https://www.councilonchemicalabuse.org/ndfw-nicotine-vs-heroin.html

7. Government of Canada, Health Canada. “What nicotine does.” Retrieved from: https://www.canada.ca/en/health-canada/services/smoking-tobacco/effects-smoking/smoking-your-body/nicotine-addiction.html

8. Heffner, J.L.; Anthenelli, R. M. (2009). “Smoking Cessation During Substance Abuse Treatment.” Psychiatric Times, 26, (9). Retrieved from: http://www.psychiatrictimes.com/addiction/smoking-cessation-during-substance-abuse-treatment

9. Magerman, Daniel. (2017) Myth: Smoking Cigarettes Will Help Me In Rehab. Willingway Recovery Center. Retrieved from: https://willingway.com/myth-smoking-cigarettes-will-help-me-in-rehab/

10. Mayo Clinic Staff. “Nicotine Dependence.” Mayo Clinic Guides to Diseases and Conditions. Retrieved from: https://www.mayoclinic.org/diseases-conditions/nicotine-dependence/symptoms-causes/syc-20351584

11. Psychology Today. “Nicotine.” April 2017. Retrieved from: https://www.psychologytoday.com/us/conditions/nicotine

12. United States Department of Commerce, U.S. Census Bureau. Age and Sex Composition: 2010. Retrieved from: https://www.census.gov/prod/cen2010/briefs/c2010br-03.pdf

13. WebMd. “What happens to your body when you quit smoking?” Retrieved from: https://www.webmd.com/smoking-cessation/what-happens-body-quit-smoking#2

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