Chapter 1:

Addiction & Cessation

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Nicotine is as addictive as cocaine, alcohol, or heroin.1,2,3,4

 

In the U.S., more people are addicted to nicotine than any other drug.5

 

Approximately 49 million people in America use some type of tobacco product.6 

 

In 2018, an estimated 34.2 million adults in the U.S. were current cigarette users.6

1. Fitzgerald, P. J. (2013). Elevated Norepinephrine may be a Unifying Etiological Factor in the Abuse of a Broad Range of Substances: Alcohol, Nicotine, Marijuana, Heroin, Cocaine, and Caffeine. Substance Abuse: Research and Treatment, 7, SART.S13019. https://doi.org/10.4137/SART.S13019

2. National Institute of Drug Abuse (NIDA). (2020, April 13). Is nicotine addictive? Retrieved from https://www.drugabuse.gov/publications/research-reports/tobacco-nicotine-e-cigarettes/nicotine-addictive

3. Stolerman, I. P., & Jarvis, M. J. (1995). The scientific case that nicotine is addictive. Psychopharmacology, 117(1), 2–10. https://doi.org/10.1007/BF02245088

4. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (USDHHS). (2014). The Health Consequences of smoking - 50 years of progress: A report of the surgeon general. Ch. 5, “Nicotine”. Atlanta, GA:  National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

5. American Academy of Addiction Psychiatry. (2015, May). Nicotine dependence. https://www.aaap.org/wp-content/uploads/2015/06/AAAP-nicotine-dependence-FINAL.pdf

6. Creamer, M. R., Wang, T. W., Babb, S., Cullen, K. A., Day, H., Willis, G., Jamal, A., & Neff, L. (2019). Tobacco Product Use and Cessation Indicators Among Adults—United States, 2018. Morbidity and Mortality Weekly Report, 68(45), 1013–1019. https://doi.org/10.15585/mmwr.mm6845a2

 

When nicotine is absorbed,

It will cause the user to experience a short period of euphoria1. The euphoric feelings are due to the increased levels of dopamine that flood the brain’s reward circuits after nicotine is absorbed through the bloodstream.1,2,3

Dopamine is a neurotransmitter in charge of emotions, movement, motivations, and feelings of happiness. Long-term use of nicotine changes the brain’s sensitivity to dopamine. In other words, the brain will need increasing amounts of nicotine in order to feel its euphoric effects.4,5,6

1. Picciotto, M. R., & Mineur, Y. S. (2013). Molecules and circuits involved in nicotine addiction: The many faces of smoking. Neuropharmacology, 76 Pt B, 545–553. https://doi.org/10.1016/j.neuropharm.2013.04.028

2. Balfour, D. J. K. (2015). The role of mesoaccumbens dopamine in nicotine dependence. Current Topics in Behavioral Neurosciences, 24, 55–98. https://doi.org/10.1007/978-3-319-13482-6_3

3. Cosgrove, K. P., Esterlis, I., Sandiego, C., Petrulli, R., & Morris, E. D. (2015). Imaging Tobacco Smoking with PET and SPECT. Current Topics in Behavioral Neurosciences, 24, 1–17. https://doi.org/10.1007/978-3-319-13482-6_1

4. National Institute on Drug Abuse (NIDA). (2019, May 13). Say What? “Dopamine”. Retrieved from https://teens.drugabuse.gov/blog/post/say-what-dopamine on 2020, August 16.

5. Izenwasser, S., & Cox, B. M. (1992). Inhibition of dopamine uptake by cocaine and nicotine: Tolerance to chronic treatments. Brain Research, 573(1), 119–125. https://doi.org/10.1016/0006-8993(92)90120-X

6. Turton, S., & Lingford-Hughes, A. (2016). Neurobiology and principles of addiction and tolerance. Medicine, 44(12), 693–696. https://doi.org/10.1016/j.mpmed.2016.09.007

 

Nicotine harms the developing brain of adolescents,

and it changes the way the brain synapses are formed, thus affecting how new memories and new skills are formed.1 The brain does not fully develop until 25 years of age, so tobacco use in adolescence is dangerous.2

 

 Prolonged nicotine use can “lead to lower impulse control and mood disorders, disrupt attention and learning among youth and young adults, and prime the developing brain for addiction to alcohol and other drugs, such as cocaine.”1 Moreover, the addicting effects that nicotine has on developing brains makes young users more likely to become hooked.3,4

1. U.S Department of Health and Human Services. (2016). E-cigarette Use among Youth and Young Adults: A Report of the Surgeon General - Executive Summary. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

2. Arain, M., Haque, M., Johal, L., Mathur, P., Nel, W., Rais, A., Sandhu, R., & Sharma, S. (2013). Maturation of the adolescent brain. Neuropsychiatric Disease and Treatment, 9, 449–461. https://doi.org/10.2147/NDT.S39776

3. Smokefree Teen. (n.d.). Nicotine & Addiction. Smokefree.gov. Retrieved from https://teen.smokefree.gov/the-risks-of-tobacco/nicotine-addiction

4. Tobacco 21. (2020). Kids & Tobacco the Nicoteen Brain. Tobacco 21. Retrieved from https://tobacco21.org/kids-tobacco/

Short-term effects of nicotine use

  • Increased heart rate
  • Increased blood pressure
  • Increased alertness
  • Increased metabolism
  • Sense of euphoria
  • Reduced appetite

Long-term effects of nicotine use

  • Cognitive decline
  • Increased risk of Alzheimer’s disease
  • Increased risk of addiction to other drugs
  • Increased impulsivity
  • Learning and concentration difficulties

1. National Institute of Drug Abuse (NIDA). (2020, April 13). Is nicotine addictive? Retrieved from https://www.drugabuse.gov/publications/research-reports/tobacco-nicotine-e-cigarettes/nicotine-addictive

2. Smokefree Teen. (n.d.). Nicotine & Addiction. Smokefree.gov. Retrieved from https://teen.smokefree.gov/the-risks-of-tobacco/nicotine-addiction

If you’ve ever thought about smoking casually with friends, remember that “between 33% and 50% of people who try smoking cigarettes escalate to regular patterns of use. Among college students, 90% of daily smokers and 50% of non-daily smokers continue to smoke over 4 years.” 

1. Waters, K., Harris, K., Hall, S., Nazir, N., & Waigandt, A. (2006). Characteristics of Social Smoking Among College Students. Journal of American College Health : J of ACH, 55(3), 133–139.

Most people who are addicted to smoking want to quit, but few are able to:

Ashtray 68% full

68%

of adult smokers wanted to quit smoking 

1. Babb, S. Malarcher, A., Schauer, G, Asman, K., Jamal, A. (2017). Quitting Smoking Among Adults—United States, 2000–2015. MMWR. Morbidity and Mortality Weekly Report, 65. https://doi.org/10.15585/mmwr.mm6552a1

Ashtray 55.4% full

55.4%

of adult smokers tried to quit in 2015

Ashtray 6% full

1 in 10

adult smokers successfully quit each year

Nicotine reaches peak levels within 10 seconds of inhalation, and in a few minutes, the effects of nicotine diminish. Consequently, one must continue administering nicotine (inhaling, absorbing, etc.) to feel its desirable effects.

1. National Institute of Drug Abuse (NIDA). (2020, April 13). Is nicotine addictive? Retrieved from https://www.drugabuse.gov/publications/research-reports/tobacco-nicotine-e-cigarettes/nicotine-addictive

Withdrawal symptoms can make quitting any tobacco product extremely hard. Just a few hours after inhaling or absorbing nicotine, withdrawal symptoms may begin, which unfortunately causes many people to continue using tobacco products.1 Withdrawal symptoms can last anywhere from a few days to a few months.

1. National Institute of Drug Abuse (NIDA). (2020, April 13). Is nicotine addictive? Retrieved from https://www.drugabuse.gov/publications/research-reports/tobacco-nicotine-e-cigarettes/nicotine-addictive

2. National Institute of Drug Abuse (NIDA). (2020, July 30). Brain Power. Retrieved from https://www.drugabuse.gov/publications/brain-power on 2020, August 16

Withdrawal symptoms may include, but are not limited to:

 

  • Irritability
  • Depression
  • Anxiety
  • Increased appetite
  • Cognitive and attention deficits
  • Sleep disturbances

1. National Institute of Drug Abuse (NIDA). (2020, July 30). Brain Power. Retrieved from https://www.drugabuse.gov/publications/brain-power on 2020, August 16

 

Need Help Quitting?

If you or someone you know wants to be free from nicotine addiction, there are plenty of helpful resources.

Clicking on the boxes will direct you to a different page.

These resources are offered for informational purposes only. you need not visit them as part of the curriculum

Let’s review…

True or False.
Nicotine is as addictive as cocaine.
True or False.
Nicotine is as addictive as cocaine.

quizonehelper

  Correct

  Wrong

Nicotine is as addictive as cocaine, alcohol, or heroin.1,2,3,4 In the U.S., more people are addicted to nicotine than any other drug.

1. Fitzgerald, P. J. (2013). Elevated Norepinephrine may be a Unifying Etiological Factor in the Abuse of a Broad Range of Substances: Alcohol, Nicotine, Marijuana, Heroin, Cocaine, and Caffeine. Substance Abuse: Research and Treatment, 7, SART.S13019. https://doi.org/10.4137/SART.S13019

2. National Institute of Drug Abuse (NIDA). (2020, April 13). Is nicotine addictive? Retrieved from https://www.drugabuse.gov/publications/research-reports/tobacco-nicotine-e-cigarettes/nicotine-addictive

3. Stolerman, I. P., & Jarvis, M. J. (1995). The scientific case that nicotine is addictive. Psychopharmacology, 117(1), 2–10. https://doi.org/10.1007/BF02245088

4. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (USDHHS). (2014). The Health Consequences of smoking - 50 years of progress: A report of the surgeon general. Ch. 5, “Nicotine”. Atlanta, GA:  National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

5. American Academy of Addiction Psychiatry. (2015, May). Nicotine dependence. https://www.aaap.org/wp-content/uploads/2015/06/AAAP-nicotine-dependence-FINAL.pdf

What is the neurotransmitter in charge of emotions, movement, motivations, and feelings of happiness?
What is the neurotransmitter in charge of emotions, movement, motivations, and feelings of happiness?

quiztwohelper

  Correct

  Wrong

Dopamine is a neurotransmitter in charge of emotions, movement, motivations, and feelings of happiness. Long-term use of nicotine consumption changes the brain’s sensitivity to dopamine, so overtime an individual will need greater quantities of nicotine to feel its euphoric effects.

1. National Institute on Drug Abuse (NIDA). (2019, May 13). Say What? “Dopamine”. Retrieved from https://teens.drugabuse.gov/blog/post/say-what-dopamine on 2020, August 16.

2. Izenwasser, S., & Cox, B. M. (1992). Inhibition of dopamine uptake by cocaine and nicotine: Tolerance to chronic treatments. Brain Research, 573(1), 119–125. https://doi.org/10.1016/0006-8993(92)90120-X

3. Turton, S., & Lingford-Hughes, A. (2016). Neurobiology and principles of addiction and tolerance. Medicine,44(12), 693–696. https://doi.org/10.1016/j.mpmed.2016.09.007

Approximately what age is the brain fully developed?
Approximately what age is the brain fully developed?

quizthreehelper

  Correct

  Wrong

The brain does not fully develop until approximately 25 years of age, so tobacco use in adolescence is dangerous1, because it changes the way the brain synapses are formed and affects how new memories and new skills are shaped.2 

1. Arain, M., Haque, M., Johal, L., Mathur, P., Nel, W., Rais, A., Sandhu, R., & Sharma, S. (2013). Maturation of the adolescent brain. Neuropsychiatric Disease and Treatment, 9, 449–461. https://doi.org/10.2147/NDT.S39776

2. U.S Department of Health and Human Services. (2016). E-cigarette Use among Youth and Young Adults: A Report of the Surgeon General - Executive Summary. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

What is a long-term effect of nicotine?
What is a long-term effect of nicotine?

quizfourhelper

  Correct

  Wrong

ALL OF THE ABOVE ARE TRUE. Some long-term effects of nicotine include but are not limited to: cognitive decline, increased risk of Alzheimer's disease, increased risk of developing addiction to other drugs, increased impulsivity, and learning and concentration difficulties. 

1. National Institute of Drug Abuse (NIDA). (2020, April 13). Is nicotine addictive? Retrieved from https://www.drugabuse.gov/publications/research-reports/tobacco-nicotine-e-cigarettes/nicotine-addictive

2. Smokefree Teen. (n.d.). Nicotine & Addiction. Smokefree.gov. Retrieved from https://teen.smokefree.gov/the-risks-of-tobacco/nicotine-addiction

What percentage of smokers successfully quit each year?
What percentage of smokers successfully quit each year?

quizfivehelper

  Correct

  Wrong

Most people who are addicted to smoking want to quit, but few are able to. Only about 1 in 10 people successfully quit smoking each year.

1.  Babb, S. Malarcher, A., Schauer, G, Asman, K., Jamal, A. (2017). Quitting Smoking Among Adults—United States, 2000–2015. MMWR. Morbidity and Mortality Weekly Report, 65. https://doi.org/10.15585/mmwr.mm6552a1

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