Tobacco smoke contains more than 7,000 chemicals, with nicotine being the primary component. Tobacco products include cigarettes, cigars, pipe tobacco and smokeless tobacco products, such as chewing tobacco.
Cigarettes are the most popular method of using tobacco. A cigarette delivers one to two milligrams of nicotine through tobacco smoke. Upon intake, nicotine is quickly absorbed into the bloodstream and crosses into the brain. An average smoker will take 10 puffs within five minutes of lighting up the cigarette, and a person who smokes a pack and a half daily will take in 300 puffs of nicotine to the brain each day.
Other methods of tobacco intake — those that don’t involve inhaling smoke — such as cigars, pipe tobacco and chewing tobacco, are slower to reach the brain because the nicotine must pass through the mucosal membranes in the mouth.
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The National Survey on Drug Use and Health reported that 64 million people 12 or older were current tobacco users in 2015. Despite the alarming numbers, cigarette use in 2015 was lower than in the years between 2002 and 2014.
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Tobacco use has been on the decline in the last decade, most rapidly among teenagers. However, the decline in tobacco products among the general population was not observed in people suffering from co-occurring disorders associated with tobacco addiction.
Adult tobacco use raises the risk of developing anxiety disorders in later life, which may worsen withdrawal symptoms during smoking cessation therapy. Rates of smoking are significantly elevated among those with mental disorders.
Individuals with post-traumatic stress disorder, bipolar disorder, major depression and other mental illnesses tend to smoke two to four times more than the general population. Nine out of 10 people suffering from schizophrenia reported tobacco use.
People suffering from psychiatric disorders account for an estimated 44 percent of cigarette purchases in the United States, according to a 2016 National Institute on Drug Abuse research report series. Studies have shown that up to four out of five alcoholics are regular smokers, and this group is more likely to die from smoking-related diseases than alcohol-related diseases.
The incidence of major episodes related to depression is higher in nicotine-dependent adults than in nondependent current smokers, former smokers or never smokers.
Approximately 1 million adolescents were current cigarette smokers in 2015, according to the National Survey on Drug Use and Health. The Centers for Disease Control and Prevention expressed concerns about dangers of tobacco products among youth. A 2016 CDC fact sheet estimated that 5.6 million Americans younger than 18 will die prematurely from a smoking-related illness.
Cigarette use increases the risk of mental disorders among young smokers. However, teenagers rarely have a proper diagnosis of their nicotine dependence, which may contribute to problems in later life. Preventive measures against tobacco are necessary to keep adolescents smoke free.
Several factors influence tobacco use among teenagers, such as:
Research suggests teenagers are more susceptible to developing a tobacco use disorder than adults. A study found that adolescent rats were more vulnerable to nicotine’s addictive properties and took more nicotine than adult rats when it was available to them.
Nicotine is addictive. Nearly 35 million smokers want to quit the habit yearly, but 85 percent of them relapse, according to the 2016 NIDA report. Most of those who relapse resume smoking within the first week.
Cravings occur because nicotine activates reward pathways in the brain and increases the levels of the neurotransmitter dopamine. Dopamine signals pleasurable sensations related to behavior and encourages people to repeat behaviors that make them feel good.
When a person smokes, nicotine takes 10 seconds to reach peak levels in the body. But the acute effects and pleasurable feelings dissipate quickly, often causing people to smoke more cigarettes to maintain the desired effects and avoid withdrawal symptoms.
Nicotine’s withdrawal symptoms can start within 30 minutes of a person’s last tobacco use. The symptoms typically peak within two to three days of cessation and generally stop within a few weeks. But some people struggle with symptoms for months.
Tobacco withdrawal symptoms include:
Several factors influence how serious the withdrawal symptoms will be, such as the length of use and the amount used on a daily basis. Some people get used to the feel, smell and sight of cigarettes, and they associate pleasurable memories to the ritual of obtaining, handling, lighting and smoking cigarettes. These pleasurable sensations worsen withdrawal symptoms and cravings.
Nicotine stimulates the adrenal glands and causes the body to discharge adrenaline, which increases blood pressure, breathing rate and heart rate. Nicotine may be as addictive as alcohol, cocaine and morphine.
Nicotine has several effects on the brain, including:
According to Healthline, tobacco contains roughly 70 cancer-causing chemicals, which contribute to smoking-related diseases such as lung cancer, heart disease and stroke.
Sixteen percent of American women smoke while pregnant.
Tobacco smoke contains carbon monoxide and nicotine, which may inhibit the supply of oxygen to the fetus. Nicotine concentrations in the placenta can be up to 15 percent higher than nicotine in the mother’s system. Concentrations of nicotine are present in fetal blood, amniotic fluid and breast milk.
From 1997 to 2001, tobacco use during pregnancy killed 910 babies, according to the NIDA report. The report estimated that smoking-related newborn care costs the United States more than $350 million per year.
Smoking during pregnancy may stunt fetal growth and reduce birth weight. Birth weight is proportional to the mother’s frequency of tobacco consumption. The more the mother smokes during pregnancy, the lower the birth weight will be. Similar to newborns exposed to other drugs, nicotine-exposed newborns suffer from stress and drug withdrawal symptoms.
Children whose mothers smoked more than a pack of cigarettes a day during pregnancy are twice as likely to develop a tobacco use disorder if they start smoking than children of nonsmoking mothers.
Tobacco use during pregnancy may also lead to miscarriage, sudden infant death syndrome, issues with learning and behavior, and a higher chance of child obesity.
Tobacco is the leading cause of preventable death in the United States. One in five of the estimated 440,000 tobacco-related deaths each year results from smoking, according to Nora Volkow, director of the National Institute on Drug Abuse.
Health issues from tobacco smoking cost the United States over $300 billion every year. The majority of expenses — $170 billion — go toward direct medical care for adults. Lost productivity accounts for more than $156 billion, with secondhand smoke exposure accounting for $5.6 billion in lost productivity yearly.
Smoking cigarettes causes cataracts and pneumonia, and it is responsible for one out of three cancer-related deaths. According to the NIDA report, smokers have a twofold chance of dying from cancer than nonsmokers, while heavy smokers have a fourfold chance.
Tobacco often causes lung cancer. About 90 percent of all lung cancer cases are associated with cigarette smoking.
Other forms of cancer that tobacco may cause include:
Smoking causes numerous heath complications other than cancer, including chronic obstructive pulmonary diseases such as emphysema and chronic bronchitis. Smoking worsens symptoms of asthma in both children and adults. According to the NIDA report, nine in ten COPD-related deaths are a result of cigarette smoking.
NIDA reported that smoking heightens the risk of heart diseases, such as strokes, heart attacks, vascular diseases and aneurysms. Smokers are two to four times more likely to develop coronary heart disease — the main cause of death in the country — than nonsmokers.
Passive or secondary smoking bears negative consequences to people and the environment. Secondhand smoke is responsible for roughly 3,000 lung cancer fatalities among nonsmokers and 35,000 fatalities related to cardiovascular disease yearly.
Environmental tobacco smoke gives rise to indoor air contaminants. Tobacco exposure to children in the home increases the risk for new cases of asthma and may worsen existing asthma conditions.
Toxic insecticide sprays that contain heavy doses of nicotine may result in vomiting, tremors, convulsions and even death. According to the 2016 NIDA report, a single drop of nicotine in its purest form can be deadly. Adults, children and domestic animals have been victims of accidental nicotine ingestion that led to intoxication.
Cigarettes that have not been put out before being thrown away are the primary cause of deadly residential fires, contributing to more than 1,000 deaths every year.
Treatments for tobacco addiction are effective. While some people can quit on their own, others require professional help. Within 24 hours of quitting tobacco, individuals are less likely to have high blood pressure or suffer from heart attacks. Over time, they will also benefit from a lower risk of stroke, cancer and coronary heart disease. If a man quits smoking at 35, he may increase his lifespan by five years, according to the NIDA report.
Nicotine replacement therapies such as nicotine gum and the transdermal nicotine patch help reduce withdrawal symptoms. Compared with tobacco-based systems, these therapies have milder physiological alterations and typically provide individuals with less nicotine.
Nicotine replacement therapies have a low potential for abuse. They do not cause the pleasurable effects of tobacco products, and they do not contain carcinogens and gases from tobacco smoke. Behavioral therapies enhance the effects and improve the long-term outcome of nicotine replacement therapies.
In 1997, the FDA approved the antidepressant bupropion to treat tobacco use disorders. Varenicline tartrate, a medication that acts on the nicotine-affected sites in the brain, may aid people in quitting smoking by alleviating withdrawal symptoms and blocking the rewarding effects of nicotine if people relapse.
Scientists have also been investigating a vaccine that targets nicotine to prevent relapse. The vaccine is intended to stimulate the production of antibodies that would prevent nicotine from accessing the brain, hence reducing its addictive properties.
Behavioral therapies are paramount to the success of smoking cessation treatment. They use self-help materials and cognitive behavioral therapy to teach former smokers to recognize high-risk situations and develop healthy coping mechanisms to stay away from tobacco.
Behavioral treatment also teaches stress management, improves problem-solving skills and increases social support.
In order to achieve the maximum success, behavioral therapies should be tailored to the client’s specific needs. In 2004, the U.S. Department of Health and Human Services set up 1-800-Quit-Now, a national toll-free number that smokers can call for information on how to quit their habit.
Smoking-related intervention programs are short, typically lasting one to three months, but 75 to 80 percent of people relapse within half a year of quitting tobacco. Studies have found that additional treatment after the smoking cessation program ends deterred relapse. Research shows continuing treatment after results in quit rates of up to 50 percent one year after cessation.
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