Tobacco Addiction

Tobacco is a plant grown for its leaves, which are smoked, chewed, or sniffed. Tobacco contains a chemical called nicotine, which is an addictive substance. Research suggests that nicotine is as addictive as heroin, cocaine, or alcohol.

In general, addiction is a chronic brain disease that causes a person to compulsively use a substance or engage in an activity despite the harm it causes to the person’s life, relationships, responsibilities, or health. Addictions can involve drugs, alcohol, gambling, sex, food, and internet use, among other behaviors. An addiction can be physical – when the body actually adapts to the presence of a substance - or psychological – when the behavior is associated with stress or emotional states and not biological changes to the brain or body.

Most tobacco users are dependent on nicotine, and nicotine dependence is the most common form of chemical dependence in the United States. Both smoking and smokeless tobacco use carry many health risks, including cancer, stroke, and heart disease.

Quitting tobacco use is difficult and may require multiple attempts. Examples of nicotine withdrawal symptoms that you may experience while trying to quit tobacco use include irritability, anxiety, difficulty concentrating, insomnia, restlessness, and increased appetite. Medications are available that reduce these withdrawal symptoms while you quit using tobacco.

The hallmark symptom of any addiction is the inability to stop or limit the use of a substance or activity.

Nicotine produces physical and mood-altering effects in your brain that are temporarily pleasing. These effects make you want to use tobacco and lead to dependence.

Signs that you may be addicted to tobacco include:

• you cannot stop using tobacco products or you have made one or more serious, but unsuccessful, attempts to stop
• when you try to stop using tobacco, you experience withdrawal symptoms, such as strong cravings, anxiety, irritability, restlessness, difficulty concentrating, depressed mood, frustration, anger, increased hunger, insomnia, constipation or diarrhea
• you keep using tobacco despite health problems
• you give up social or recreational activities in order to smoke or use tobacco

There are no specific causes of addiction. There is no way to accurately predict who will become dependent on the use of a substance or activity.

Any substance or activity that is pleasurable can become an addiction by impacting the reward, motivation, and memory pathways of the brain.

Nicotine is the chemical in tobacco that keeps you smoking or using other tobacco-containing products. Nicotine is very addictive, especially when delivered to the lungs by inhaling tobacco smoke. It increases the release of brain chemicals called neurotransmitters, which help regulate mood and behavior. One of these neurotransmitters is dopamine, which may improve your mood and activate feelings of pleasure. Experiencing these effects from nicotine in tobacco is what makes tobacco so addictive.

Most addictions are diagnosed on the basis of your symptoms and behaviors. There are no specific tests to diagnose addiction.

In the case of tobacco addiction, your doctor may ask you questions or have you complete a questionnaire to get a sense of how dependent you are on nicotine. The more cigarettes you smoke each day and the sooner you smoke after awakening, the more dependent you are. Knowing your degree of dependence will help your doctor determine the best treatment plan for you to help you quit smoking or using tobacco.

Smoking is the single most preventable cause of death in the U.S. Your health will benefit almost immediately if you stop smoking. Younger smokers who stop can have a normal life expectancy, and even older smokers who stop add years and quality to their life expectancy.

If you have decided to stop using tobacco products, there are several steps that you can take to help manage nicotine withdrawal symptoms:

• exercise regularly. Regular physical activity has been found to reduce withdrawal symptoms and help people stop using tobacco. Exercise also helps avoid potential weight gain often associated with stopping.
• wait out cravings. Cravings or urges usually last less than five minutes. Wash the dishes, go for a walk, or have a healthy snack, such as carrots, an apple or sunflower seeds, which will keep your mouth busy. Pursue something that keeps your hands busy, and before you know it, the urge will have passed. Make sure you get rid of tobacco supplies when you decide to quit.
• identify rationalizations. Review your reasons for quitting, and replace that thought with something positive to support your stopping.
• talk to a support person. If you are feeling anxious or depressed or need encouragement, a support person can help you get through a difficult craving.
• avoid high-risk situations. Know your triggers, and stay away from people, places and situations that tempt you to smoke.
• be realistic about the energy and time it takes to stop smoking. Adjust your schedule to a lighter workload. Take time to do something fun or simply relax.
• eat regular, healthy meals. Include plenty of fruits and vegetables, and drink more water.

Counseling and medication are both effective for treating tobacco dependence, and using them together is more effective than using either one alone.

The following treatments are effective for smokers who want help quitting:

• help from a doctor
• individual, group, or telephone counseling
• behavioral therapies (such as training in problem solving)
• treatments with more person-to-person contact and more intensity (such as more or longer counseling sessions)
• programs that deliver treatments using mobile phones

Medications that help you quit smoking include:

• nicotine replacement products, which are available in over-the-counter products such as nicotine patches, gums, lozenges (Commit, Habitrol, Nicoderm CQ, Nicorette, Thrive) and prescription patches, inhalers, and nasal sprays (Nicotrol)
• non-nicotine medication such as bupropion SR (Zyban) and varenicline (Chantix)