Why are You Addicted to Cigarettes?
By Bob Sherman
Drug addiction or dependence is characterized by the inability to exercise control over drug taking. While many people have quit smoking, it is very difficult to reduce or eliminate cigarettes altogether. The number of people who succeed in quitting in any year is only 2 to 4% of all daily smokers.
Why Are Cigarettes Addictive?
The addictiveness of cigarettes is closely associated with how quickly you feel good after taking a puff. Since the nicotine in the puff is rapidly absorbed in the lungs and moves to the brain in about 15 seconds, there is a spike in good feelings very quickly after inhaling. Several factors are involved in making nicotine addictive.
First, the spike effect causes high levels of nicotine to quickly reach the brain to produce a pleasurable effect. This strong effect helps produce addiction. Compare this to the almost constant, low level of nicotine introduced into the bloodstream with the nicotine patch. While that same amount of nicotine may enter the body in a day with the patch as by smoking a pack of cigarettes, there are no spikes in mood alternation, so the patch is not addicting.
Second, the speed with which you feel good helps you associate the good feelings with the cigarette. Compare this to the elevated feelings you get from caffeine; since caffeine takes about half an hour to be adsorbed through the digestive track, only about 10% of coffee drinkers become addicted to caffeine.
Third, since the effect you get from nicotine appears immediately, you can easily control the intensity of the feeling by adjusting your dose (type of cigarettes and smoking parameters like puff intensity and puff frequency). This close association between the dose and the resulting feeling is addictive.
The initial effects of smoking are desirable. You feel a spike in pleasure, calmness and reduction of anxiety, and a moderation of your mood.
Early smokers, especially youth smokers, are not daily smokers. They smoke on certain occasions and refrain from smoking most other times. Youths in school may smoke at a party or when out on a date. They often cannot smoke at home or in the company of other adults. Their money is often limited and they cannot buy cigarettes whenever they want.
Adults who take up smoking often do so when in the company of other adults who are smoking. To the starting adults, smoking is associated with social gatherings or with specific occasions. As stresses from daily life take their effect, people often switch from social smokers to daily smokers. When a person becomes a daily smoker they almost always become addicted to the positive, pleasurable feelings they get when smoking. They continue smoking to continue to get these pleasurable feelings.
Two Stages of Nicotine Addiction
The first stage in nicotine addiction is an addiction to the pleasurable feelings that nicotine produces. After a few years of daily smoking, the second stage is established.
The second stage involves an addiction to smoking in order to relieve symptoms of withdrawal. A person in the second stage of addiction attempting to quit smoking will experience these withdrawal symptoms most intensely for the first week or two. Then they will being to subside.
How You Get to the Second State of Nicotine Addiction
Over a period of several years, the addiction to nicotine makes a transition. This transition occurs because your body adapts to the constant presence of nicotine. As you body adapts, it develops a tolerance that helps reduce the initial effects of nicotine.
Daily smokers have nicotine in their blood stream 24 hours a day. The brain, to a greater or lesser extent, is being artificially stimulated 24 hours a day.
Over time, the brain begins to adapt to this artificial stimulation. This adaptation includes an increase in nicotine receptors in the brain. This increase in nicotine receptor concentration requires more nicotine for the brain to continue functioning properly. That is, the brain physically changes and becomes dependent on nicotine to function normally. This neuroadaptation produces tolerance.
At this point, when the brain is unable to get the needed nicotine, withdrawal symptoms appear. Withdrawal symptoms include irritability, restlessness, difficulty in getting along with family and friends, sleeplessness, anxiety, depression, hunger, difficulty concentrating, and lethargy. When withdrawal symptoms start to appear they can be eliminated by taking nicotine through smoking.
Dependency on smoking to reduce or eliminate withdrawal symptoms is the second stage in nicotine addiction.
Nicotine Addiction is in the Brain
Nicotine is a complex chemical that is similar in structure to a natural neurotransmitter that is found in the body: acetylcholine. The neurotransmitter acetylcholine helps communication take place from one brain cell to another.
When you take a puff from your cigarette, nicotine and 4,000 other chemicals are inhaled and travel into your lungs. Nicotine is rapidly absorbed into your blood stream. Within 15 to 20 seconds of your puff, nicotine has traveled to your brain.
Since nicotine is very similar to acetylcholine, nicotine binds to receptors that are intended for acetylcholine. When nicotine binds to these receptors a change takes place in the walls of the nerve cell. Calcium or sodium ions can more easily enter the cell. When this occurs, a number of brain hormones are released. These hormones affect your mood and behavior.
Among the hormones that are released are dopamine, serotonin and GABA. Dopamine has the effect of causing feelings of pleasure. Whenever you do something pleasurable, you feel pleasure because of the release of dopamine. Serotonin helps moderate your moods and control your appetite. GABA helps produce a calming effect that reduces anxiety.
Self-administering nicotine through smoking artificially stimulates the acetylcholine system. It results in feelings of pleasure, calmness, and a moderation of mood.
And, the tobacco companies have been slowly increasing the nicotine dose levels in each cigarette.
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Why You Need Another Cigarette
Nicotine is broken down by the liver, primarily into cotinine. Approximately half the nicotine in your body is converted to cotinine every 2 hours. When the concentration of nicotine is reduced, your feelings of pleasure and calmness are also reduced. You then have an urge to restore these feelings and so you seek another cigarette.
Now Combine Cigarettes and Alcohol
Many people who drink alcohol also smoke. Go into any bar and you'll see the majority of people engaging in both activities. Both alcohol and nicotine reinforce each other and work in a symbiotic relationship. While alcohol acts as a sedative and reduces cognitive ability, nicotine appears to delay these effects. Nicotine also seems to reduce the toxic effects of alcohol as well as the effects of withdrawal from alcohol.
Both alcohol and nicotine enhance dopamine in the nucleus accumbens of the brain.
Studies of young people in college indicate that drinking frequency was associated with the initiation of smoking. Students who drank on 40 or more occasions in the past year were 16 times more likely to take up smoking than non-drinkers. And, people who smoke, increase their normal cigarette use while drinking.
So, the pleasant feelings created by nicotine and alcohol combine to reinforce each other. In addition, nicotine reduces some of the negative effect of alcohol. This combination is difficult to break. But, some detoxification centers are beginning to combine treatments for nicotine and alcohol.
Conclusion
If you start smoking, for whatever reason, the pleasing effects of smoking will frequently cause you to continue smoking. As you continue, your brain accommodates and become dependent on nicotine for normal functioning. You develop a tolerance to nicotine and need and increased amount--making you a daily smoker. After a few years of daily smoking, you continue to smoke to reduce the negative effects of withdrawal. In short, you're hooked.
- Biological Psychiatry,The Biological Bases of Nicotine and Alcohol Co-Addiction, 61:1-3
- John R. Highes & Matthew J Carpenter, The feasibility of smoking reduction: an update, Addiction 100(8), 1074-1089
- Mark B. Reed, Rong Wang, Audrey M Shillington, John D. Clapp & James E. Lange, The relationship between alcohol use and cigarette smoking in a sample of undergraduate college students, Addictive Behaviors, 32 (2007) 449-464.
- Unites States' Written Direct Examination of Neal Benowitz, M.D., United States of America v. Philip Morris USA Inc, Civil No. 99-CV-02496 (GK)
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