About Tobacco

Smoking & Other Forms of Tobacco Dependence    

Tobacco Addiction and Health

Tobacco has been around since ancient times and has actually played a large part in American History.  When Christopher Columbus discovered America in 1492, he also discovered smoking tobacco.  Tobacco proved to be quite appealing to those early explorers.  As a result, tobacco from America spread to other parts of the world.   Tobacco was first grown commercially in America in the early 1600s.  In the 1800s the revenue from taxed tobacco actually helped finance the Civil War.  In the early 1900s RJ Reynolds began producing and selling the first brand-name cigarette, Camel.

While it has been popular and appealing, tobacco use has led to serious health problems in the United States (and world-wide).  Around 23-25% of Americans smoke.  Fifty percent of those who use tobacco will die from a smoking-related illness, approximately 450,000 each year.  The statistical numbers for American using smokeless tobacco range from 2% to 9%.  Financial costs of treating tobacco-related illness in the US reach over 50 billion dollars a year.

It may be surprising to learn that tobacco dependence is actually under-diagnosed by providers in the health care community.  However, because of an increasing awareness in recent years of the physical dangers to health along with financial burden for society, tobacco has been gaining more attention in public health education and research.  There is a focus on improving the health of Americans by the year 2010 (which is already here!), and Healthy-People 2010 provides health objectives for the first decade, which include the cessation of tobacco. 

There are reasons why healthcare professionals have failed in the past to recognize, diagnose, and treat tobacco dependence. For one thing, until recently, the subject of tobacco dependence as a treatable disorder has been limited in the formal training of health care professionals.  As a result, in comparison to other kinds of disorder experts, there are only a small number of researchers and specialists who provide scientific information about the effects of tobacco use and effective methods of treatment.  Tobacco companies are also responsible for the negligible attention paid to the dangers of tobacco use. 

For many many years the tobacco companies misled the public about the dangers of tobacco.  Then, in 1994 and 1995 a lawsuit against tobacco companies was filed in response to financial burden on states.  Money and publicity from the 1998 Master Settlement Agreement (MSA) made between tobacco companies and 46 states has helped fund, draw interest toward, and generate tobacco and nicotine research.  For example the Society for Research on Nicotine & Tobacco, or SRNT publishes evidence-based articles on tobacco dependence and nicotine addiction and also sponsors annual conferences on tobacco and nicotine research.

Because of an increase in research, such as SRNT, we now have a much better understanding of tobacco.  We now know that tobacco products contain both 1) harmful toxins that damage health and 2) nicotine which is a powerful addictive drug.  Research has also led to the development of evidence-based methods of tobacco cessation treatments.  As a result, specialists in tobacco and the treatment of tobacco addiction, such as myself, have been increasing. 

Tobacco researchers and specialists are now providing health care providers with the necessary tools and guidelines to talk with their patients about smoking and offer tobacco cessation treatment. Today, there are multiple agencies providing information to the public on smoking and tobacco addiction and help for quitting. 

A main publication produced by the US Department of Health and Human Services,  Treating Tobacco use and Dependence:  Clinical Practice Guideline 2001 and 2008  Update  outlines specific guidelines on smoking and cessation for physicians and various healthcare organizations.

Forms of Tobacco

Common forms of tobacco include cigarettes, cigars, pipe, snuff, and chewing tobacco.  Tobacco products come in smoked (inhaled) and smokeless forms. Cigarettes, cigars, and pipe tobacco are inhaled.  Both the harmful chemical toxins and the nicotine in tobacco smoke enter the body through the lungs. Snuff and chewing tobacco are used orally.  The harmful chemical toxins and the nicotine in the tobacco enter the body through the mucus linings of the mouth and jaw.

Some other more exotic forms of smoking tobacco are produced in other parts of the world and imported to the United States.  These forms of tobacco imported to the United States include:  kreteks, bidis, and hookahs.  These forms of tobacco are often flavored and appeal to adolescents and college students. Kreteks, known as clove cigarettes, contain a mixture of tobacco and cloves.  Bidis are grape, strawberry, vanilla and other candy-flavored or non-flavored cigarettes.  Hookah, also called waterpipe smoking, is smoking flavored tobacco through a pipe.
 
Many people believe that these exotic forms of tobacco are non-toxic and contain no nicotine.  However, while these products may appear safe, especially to young people, they can contain even higher levels of toxins and nicotine than the types of tobacco sold in the United States.  Simply put:  There are no forms of tobacco that are safe and non-addictive.

How Tobacco Damages Heath

Smoking tobacco contains nicotine and a mixture of harmful chemicals and gases.  The nicotine in tobacco smoke (cigarettes, cigars, and pipes) is absorbed in the lungs and quickly (10-19 seconds) travels to the brain. In addition to nicotine, the smoke inhaled from tobacco contains substances that cause cancer and cause damage to vital organs such as the heart, lungs, and kidneys, and also produces negative effects on nearly every aspect of the body.  There are over 4,000 various chemical substances and gases in tobacco smoke including tar (7mg to 15 mg per cigarette).  Sixty (60) of these are known to cause cancer.  Poisonous gases include nitrogen oxide and carbon monoxide. 

Nicotine is a powerful addictive drug that produces pleasurable feelings in the brain.  Toxic chemicals in cigarette smoke are destructive to health and can be lethal.  Chewing tobacco contains over 2,000 chemicals of which many are cancer-causing nitrosamines.  These harmful chemicals are absorbed orally through the mouth.  The treatment for oral cancer is aggressive and often leads to physical disfigurement.   

Nicotine from smokeless tobacco reaches the brain more slowly than cigarette smoke.  However, smokeless tobacco contains more nicotine than cigarettes and can lead to intensely strong addiction.  Smokeless tobacco is a major cause of gum disease.

Secondhand Smoke

Secondhand smoke or passive smoke is another serious health problem that affects non-smokers, many of them children.  Also called Environmental Tobacco Smoke (ETS), secondhand smoke is a mixture of exhaled smoke and smoldering smoke from the lighted tobacco product. 

Exhaled smoke is also called mainstream smoke.  The smoldering smoke from a burning tobacco product is called sidestream smoke.  Also, secondhand smoke also contains nicotine.Secondhand tobacco smoke, like inhaled smoke, also contains harmful chemicals and contains substances that cause cancer. 

Constant or significant exposure to secondhand smoke is a danger to non-smokers’ health.  Exposure to secondhand smoke is especially harmful to children.  Children breathing secondhand smoke have increased chances of suffering from decreased lung capacity, asthma, SIDS, ear infections, pneumonia, and bronchitis.  

There are approximately five states that have laws prohibiting smoking in motor vehicles with child passengers, Smokefree Cars - no-smoke.org.  Countries around the world have similar laws to protect their children from deadly second-hand smoke. 

Understanding Tobacco Addiction Nicotine Addiction

If it is so damaging to health, why do so many people continue or even begin to smoke or chew tobacco?”  Although many understand tobacco use as a “habit,” the nicotine in tobacco products is actually a strong addictive drug.  Nicotine produces changes in brain chemistry that lead to changes in mood and behavior.  The idea that tobacco use is a “habit” stems from the fact that the behaviors associated with tobacco become “habitual.”  From the lungs, nicotine from inhaled smoke enters into the blood stream and quickly travels to the brain.  Nicotine from smokeless tobacco enters the bloodstream through the mucus lining of the mouth. 

There are two ways in which tobacco use leads to physiological nicotine addiction and dependence:

ONE:  Nicotine produces a relaxing effect, increases mental alertness, and lifts mood.  In order to maintain these positive feelings (rewards) the brain begins to rely on nicotine.  In time, however, more and more nicotine is needed to produce the same level of pleasurable effects.

Nicotine is a positive reinforcement in that consumption leads to positive feelings and mood.  The tobacco user becomes dependent on nicotine to produce positive effects.

TWO:  Over time, nicotine levels in the blood stream drop.  Lower levels of nicotine cause negative withdrawal symptoms like anxiety, irritability, and difficulty concentrating.  Tobacco use increases nicotine levels in the blood stream.  Increased nicotine becomes a negative reinforcement because it temporarily relieves or removes painful uncomfortable symptoms of withdrawal. 

Tobacco users become dependent on nicotine to avoid unpleasant withdrawal symptoms.  Tobacco dependence is complex and also affects the user physically, psychologically/emotionally, socially, and behaviorally. 

• Physical:  Nicotine is a powerful drug that causes changes in brain neurobiology, similar to the effects of cocaine and heroin.  Within seconds, nicotine from cigarette smoke reaches the brain where nicotine binds to receptors that stimulate chemicals which have a powerful effect on mood and behavior. 

• Psychological:  Tobacco is used often to cope with emotions and conflict.  The pleasurable feelings induced by tobacco can cover and numb feelings and emotions associated with grief, loss, and mourning.  Stressful situations or emotionally upsetting events can act as triggers to use tobacco.  Nicotine also increases concentration and may be associated with tobacco use and Attention-Deficit Disorder (ADD) and in work performance that requires focused attention to detail.

• Social:  Using tobacco is often used to cope with uncertainty and/or awkwardness in social situations.  People who smoke usually feel comfortable with others who smoke.  For example, employees often gather during work breaks.  It provides a time for social interaction and acceptance.  Tobacco users also suffer from social stigma from non-smokers.  A social culture of rituals and shared experience in tobacco users develops that centers on tobacco.

• Behavioral:  Once addicted, a belief develops that tobacco is needed in order to function effectively.  The belief can become so strong that the reality of the harm tobacco has on the body is denied or ignored.  A compulsive pattern of unhealthy behaviors centered on tobacco use develops in response to stress and strong emotions and avoidance of withdrawal. 

Certain behaviors become “associated” with the effects of nicotine in the brain, causing a strong connection between behaviors and the physiological addiction.  For example, after quitting, the behavior of reaching for a pack of cigarettes or can of chewing tobacco can trigger the brain to “crave” nicotine.

Over time, tobacco users rely more and more on nicotine to regulate mood and concentration.  Healthy and even invigorating approaches to lift mood, cope with stress, and anger are abandoned or never learned.  Tobacco users are cheated of opportunities to learn creative ways to cope.

When Does Tobacco Use and Addiction Begin?

Most tobacco use begins during adolescence.  In fact, tobacco addiction specialists call smoking a “pediatric disease” because most tobacco use begins in childhood and adolescence.  About 5,000 adolescents a day experiment with smoking.  Of that number, approximately 2,000 will go on to become addicted to tobacco smoke.

One-third of these adolescents die from a smoking-related disease.  Smoking at a young age also leads to serious impairments in physical health.  Cigarette smoking in adolescence leads to increased lung-related illnesses, decrease in physical fitness, and decreased levels of lung function.

Teenagers are often eager to be adults.  Tobacco use may be a way to rebel against dependence on parents and other adults.  Smoking may be a result of internalized sports and movie star celebrity role models.  For example, smoking and other forms of tobacco use may be connected for males with strength and masculinity.  For females, smoking is associated with sexy and strong.

Other reasons teenagers take up smoking include peer pressure and wanting to belong.  Adolescence can be a time of uncertainty and ambivalence because of no longer being a dependent child yet not quite an independent adult either.  The rituals of tobacco use provide certainty in what to do and how to act in social situations. 

For many adolescents, mainly females, weight control plays large role in tobacco use.  Girls feel cultural and societal pressure to be slim and sleek.  Often, the addiction to tobacco becomes tied to eating disorders and frantic attempts to maintain alarmingly low body weight.

Low self-esteem and depression can also lead to vulnerability to tobacco use.  Strong emotions and identify issues, etc. come into play.  Tobacco becomes a way to cope with stress and becomes a very part of identity.  While the reasons adolescents begin tobacco use vary, the reasons they become dependent on tobacco is directly tied to addiction to nicotine. 

Today, there are committed and dedicated advocates fighting to protect children and adolescents from the dangers of tobacco and tobacco smoke and tobacco addiction specialists to promote and support quitting.  Concerned parents, loved ones, educators and others interested in the wellbeing of children and adolescents can find local and national resources and help.

Quitting Tobacco:  What to Anticipate