What is nicotine?
Nicotine is a drug found in the leaves of tobacco plants. It’s used in cigarettes, cigars, and smokeless tobacco, or synthesized for use in e-cigarettes, patches, gums, and other products designed to help smokers quit. All forms deliver nicotine very quickly to the brain and stimulate the nervous system. Tolerance to nicotine quickly develops, and users soon need more to achieve the desired effect. This tolerance, in turn, leads to increased dependence and addiction.
How does nicotine use affect the brain?
Nicotine affects the neurotransmitter acetylcholine (ACh). Eight seconds after the user takes a puff, nicotine enters the brain and changes the way it works. Nicotine stimulates neurons or brain cells to release unusually large amounts of dopamine, the brain chemical associated with pleasurable activities. To make up for the artificially induced dopamine increase, the brain decreases natural production of dopamine. As a result, users need nicotine not because they enjoy it, but to avoid feeling depressed or irritable.
In forty minutes half the effects of nicotine are gone. This stimulates the urge to light up for another dose of nicotine in order to feel pleasure again.
The American Psychiatric Association (APA) uses the term “tobacco use dis- order” to define a pattern of tobacco use that leads to significant physical, interpersonal, medical, or work problems. Tobacco use disorder is rated as mild, moderate, or severe based on how many criteria are met. A person diagnosed with tobacco use disorder can also be classified as in remission, or what is commonly referred to as “in recovery.” Those with tobacco use disorder who identify themselves as addicts often find the skills and support to quit and stay quit through online or in-person support programs provided by their insurance company or local community.
Addiction is considered a brain-based disease characterized by abnormal drug-seeking behavior that leads to impaired control over one’s drug use. Addiction means a person will continue using alcohol or other drugs despite the harm it does to their health, family, work or school, and relationships. An addict may experience withdrawal symptoms (physical pain, fatigue, depression, trouble sleeping, irritability) if he or she stops using, and may need to keep using just to feel normal. “Curing” addiction is not a matter of willpower or moral strength any more than is curing diabetes or cancer. Like diabetes and cancer, addiction is considered a chronic disease which is beyond one’s control and fatal if left untreated.
How does nicotine use affect a co-occurring mental health disorder?
Co-occurring disorders, or dual disorders, occur when a mental health disorder, like depression or schizophrenia, is present along with addiction, alcoholism, or other substance use disorders. Screening for co-occurring disorders should be part of any good assessment or treatment plan.
Like all drugs, nicotine disrupts the normal flow of neurotransmitters, which can also be disrupted due to mental illness. Nicotine can make the detection and treatment of mental illness that much more challenging.
Researchers at the Harvard School of Public Health have discovered that Americans with mental illness are nearly twice as likely to smoke cigarettes as people with no mental illness. A large percentage of people with schizophrenia smoke nicotine. This means that, in addition to mental challenges, patients also face the physical challenges of emphysema and lung cancer, major diseases caused by smoking. The authors estimate that people with diagnosable mental illness comprise nearly 45 percent of the total tobacco market in the United States.
Nicotine is a stimulant, and it is believed to ease the symptoms of severe disorders such as schizophrenia. The Harvard authors quote documents from the tobacco industry indicating the use of marketing strategies that intentionally target psychologically vulnerable consumers. Such marketing was to imply that smokers can use nicotine to treat symptoms of depression, for mood enhancement, for anxiety relief, to cope with stress, and to gain self-control. Tobacco- company marketing also suggested that smoking “helps perk you up” and “helps you think out problems.”
Tobacco use is the leading preventable cause of disease, disability, and death in the United States.
Is addiction to nicotine treatable?
Yes. It’s difficult, as any ex-smoker will tell you, but possible—thanks to a number of options for nicotine dependence: patches, gum, lozenges, nasal sprays and non-nicotine medications. In addition, many quit-smoking programs offer smokers social support.
E-cigarettes are a fairly new technology that is helping people quit. These devices are a little larger than a pen, and house an electronic heating element that heats a small amount of fluid containing nicotine. The resulting vapors are inhaled and exhaled like smoke, delivering nicotine, but without the smell and harmful chemicals that come along with smoking. Many former smokers find that e-cigarettes help reduce or eliminate their nicotine use. However, it should be noted that few studies have been conducted on their effectiveness or their long-term safety.
Although quitting can be difficult, the health benefits of smoking cessation are immediate and substantial—including reduced risk for cancers, heart disease, and stroke. A thirty-five-year-old man who quits smoking will, on average, increase his life expectancy by five years.
The stages of change treatment model has been found to be especially effective in treating nicotine addiction. In this program, the smoker identifies where he or she is in readiness and confidence to stop smoking, and is able to quit gradually.
There are many resources out there. The websites for the following organizations were chosen for their usefulness and user friendliness.
American Lung Association: The website for the American Lung Association provides information about lung disease, healthy air, and how to quit smoking.
National Institute on Drug Abuse (NIDA): This government organization is dedicated to addiction research and education. Through its website you can access up-to-date publications about many different drugs of abuse as well as emerging trends.
Substance Abuse and Mental Health Services Administration (SAMHSA): SAMHSA is part of the U.S. Department of Health and Human Services. Its mission is to reduce the impact of substance abuse and mental illness on America’s communities. Its website offers information and resources about preventing and treating addiction and mental illness.