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Tobacco Use / Nicotine Dependence

Definition :
Nicotine dependence is the physical vulnerability of your body to the chemical nicotine, which is potently addicting when delivered by various tobacco products. Smoke from cigarettes, cigars and pipes contains thousands of chemicals, including nicotine. Nicotine is also found in chewing tobacco.

Nicotine produces physical and mood-altering effects in your brain that are temporarily pleasing; these effects reinforce your continued use of tobacco and nicotine dependence.

Being addicted to tobacco brings you a host of health problems related to the substances in tobacco smoke. These effects include damage to your lungs, heart and blood vessels. Smokers have significantly higher rates of heart disease, stroke and cancer.

Millions of Americans smoke, and smoking is the leading preventable cause of death in the United States. Men who don't quit smoking lose an average of 13.2 years of life, while smoking women lose even more — an average of 14.5 years.

Overcoming nicotine dependence is difficult and takes commitment, support and time. The sooner you quit smoking, the better. But even if you're a longtime smoker, stopping your nicotine dependence plus taking healthy lifestyle steps can reverse much of the damage smoking has done to your body.

Causes :
Tobacco smoke delivers at least 60 known cancer-causing chemicals, tiny amounts of poisons including arsenic and cyanide, and more than 4,000 other substances to your body.

Nicotine is the chemical in tobacco that keeps you smoking. It can be as addictive as cocaine. It increases the release of a brain chemical called dopamine, which makes you feel good. Getting that dopamine boost is part of the addiction process.

Tobacco dependence involves psychological as well as physical factors. You may develop strong, repetitive behaviors associated with smoking. You may smoke at certain times of the day or after a meal or in certain locations or under certain levels of stress. These behaviors and routines that you associate with smoking have to be addressed if you are to overcome your addiction to tobacco.

Risk Factor :
Anyone who smokes is at risk of becoming addicted to nicotine. Tobacco smoking is a behavior that often becomes established during adolescence. About 90 percent of smokers begin smoking before the age of 21, and many start before age 18.

The younger you begin smoking, the greater the chance that you'll become a heavy smoker as an adult. In 2004, 22 percent of American high schoolers said they were current smokers, as did nearly 12 percent of American middle-school-age children. While the rate of teen smoking has been declining since the 1990s, the decrease seems to have stalled in recent years. That's especially bad news because teenagers who smoke are more likely to use alcohol and other drugs.

Youngsters with two smoking parents are twice as likely to pick up the smoking habit themselves. And, children with friends who smoke are also more likely to try cigarettes. Exposure to tobacco in movies or advertisements, particularly for young people, may influence the decision to start smoking or keep smoking.

When to seek medical advice :
You may have tried to stop smoking because you've experienced health problems related to smoking or because you're concerned about potential health problems. If you've tried to stop, but have discovered you can't, talk to your doctor about finding a strategy to help you stop successfully.

Symptoms :
Nicotine dependence may mean you have these signs and Symptoms:

  • You can't stop smoking. You've made one or more serious, but unsuccessful, attempts to stop.
  • You experience strong withdrawal symptoms when you try to stop. Your attempts at stopping have caused physical signs and symptoms of addiction, such as craving for tobacco, anxiety, irritability, restlessness, difficulty concentrating, headache, drowsiness, stomach upset, even constipation or diarrhea.
  • You keep smoking despite health problems. Even though you've developed problems with your lungs or your heart, you haven't stopped or can't stop.
  • You give up social or recreational activities in order to smoke. You may stop going to certain restaurants or stop socializing with certain family members or friends because you can't smoke in these situations.

Your degree of addiction depends in part on how much you smoke and how long you've smoked.

Complications :
When you inhale tobacco smoke, you're ingesting a chemical parade that will march through most of your body's vital organs. The negative health effects throughout your body are numerous, including :

  • Lungs. Smoking is the cause of most cases of lung cancer. Smoking is also the primary cause of other lung problems, such as emphysema and chronic bronchitis.
  • Heart and circulatory system. Smoking increases your risk of dying from cardiovascular disease, including heart attack and stroke. If you smoke more than 25 cigarettes daily, your have five times the risk of heart disease compared to someone who doesn't smoke. Smoking 15 cigarettes a day doubles your heart attack risk. Even just one to four cigarettes daily increases your risk of heart disease. Smokers have a higher risk of stroke that nonsmokers do; the more you smoke, the higher your risk.
  • Cancer. Smoking is a major cause of cancer of the esophagus, larynx, throat (pharynx) and mouth and contributes to cancer of the bladder, pancreas, liver, kidney, cervix, stomach, colon and rectum, and some leukemias.
  • Appearance. The chemicals in tobacco smoke can dry and irritate your skin, as well as promote wrinkles. Smoking also yellows your teeth, fingers and fingernails.
  • Fertility. Smoking increases the risk of infertility and miscarriage in women and the risk of impotence and infertility in men.
  • Pregnancy and newborn complications. Mothers who smoke while pregnant increase the risk of low birth weight, preterm delivery and impaired lung function in their newborns.
  • Cold, flu and other illnesses. Smokers are more prone to illnesses, such as colds, flu or bronchitis, than nonsmokers are.
  • Senses. Smoking deadens your senses of taste and smell, so food isn't as appetizing as it once was.

Breaking an addiction to nicotine can be very difficult, and many smokers have to make repeated attempts before they're successful. Quitting smoking is possible, even though it may take more than a few tries. Almost 46 million Americans have quit smoking, and so can you.

The benefits of quitting
Although it may be tough to break your nicotine addiction, the benefits are well worth the effort. If you manage to quit smoking before you're 35, you'll miss out on at least 90 percent of the health risks associated with tobacco use. If you quit before you're 50, you can halve your risk of dying in the next 15 years, compared with those who continue smoking.

But, no matter what your age, your health will benefit if you stop using tobacco. Just 20 minutes after your last cigarette, your heart rate goes down. Twelve hours later, the carbon monoxide levels in your blood return to normal. Your lung function improves and your circulation starts to get better between two weeks and three months after your last cigarette. Between one and nine months after quitting, your risk of infections drops and coughing and shortness of breath decrease. After one year, the risk of coronary artery disease drops by half. And, after five to 15 years, your stroke risk will be the same as that of a nonsmoker.

Methods of quitting are numerous
There are many ways to quit smoking, including using medications and getting some sort of counseling or support.

The approved effective medications to help you stop smoking fall into two categories — nicotine replacement therapy and non-nicotine medications. Any of these effective medications combined with behavioral changes can double your chances of quitting.

Combining medications with follow-up visits to your doctor for support and counseling is usually more successful than is trying to stop on your own. If you've tried a medication on your own but haven't been successful in quitting, talk to your doctor about it. He or she can help you move in the right direction by adjusting the dose of your medication, recommending a different medication, or using a combination of medications.

Nicotine replacement therapy
Most nicotine replacement products are available over-the-counter :

  • Nicotine patch (Nicoderm CQ, Nicotrol, Habitrol, others). The patch delivers nicotine through your skin and into your bloodstream. You wear a new patch each day on your upper body. The treatment period may last for eight weeks or longer. Don't be in a hurry to stop using the patch, especially if you've stopped smoking or dramatically reduced your smoking. If you haven't been able to stop smoking completely after the first week or so of treatment, ask your doctor for help in adjusting the dose of the patch or adding another medication.
  • Nicotine gum (Nicorette, others). This is a gum-like resin that delivers nicotine to your blood through the lining of your mouth. It's available in a 2-milligram dose for regular smokers and a 4-milligram dose for heavy smokers. The maximum number of pieces a day is 20, though you'll probably chew less. Nicotine gum is recommended for one to three months, with a maximum of six months.
  • Nicotine lozenge (Commit). This is a tablet that dissolves in your mouth and, like nicotine gum, delivers nicotine through the lining of your mouth. The lozenges are also available in 2- and 4-milligram doses. The recommended dose is one lozenge every couple of hours for six weeks, then gradually increasing the intervals between lozenges over the next six weeks.

These nicotine replacement products are available by prescription :

  • Nicotine nasal spray (Nicotrol NS). The nicotine in this product, sprayed directly into each nostril, is absorbed through your nasal membranes into veins, transported to your heart and then sent to your brain. It's a quicker delivery system than that of the gum or patch. It's usually prescribed for three-month periods, for a maximum of six months.
  • Nicotine inhaler (Nicotrol inhaler). This device is shaped something like a cigarette holder. You puff on it, and it gives off nicotine vapors in your mouth. You absorb the nicotine through the lining in your mouth, where it then enters your bloodstream and goes to your brain, relieving withdrawal symptoms.

Non-nicotine medication
Medications that don't contain nicotine include :

  • Antidepressants. The antidepressant drug bupropion increases the level of dopamine, the chemical that's also boosted by nicotine, in your brain. As with many medications, bupropion (Zyban) has side effects, including sleep disturbance and dry mouth. If you have a history of seizures or serious head trauma, such as a skull fracture, don't use this drug. Another antidepressant that may help is nortriptyline (Aventyl, Pamelor).
  • Varenicline (Chantix). This medication acts on the brain's nicotine receptors, decreasing withdrawal symptoms and reducing the feelings of pleasure you get from smoking. Potential side effects include headache, nausea, an altered sense of taste and strange dreams.
  • Nicotine vaccine. The nicotine conjugate vaccine (NicVax) is under investigation in clinical trials. This vaccine causes the immune system to develop antibodies to nicotine. These antibodies then catch nicotine as it enters the bloodstream and prevent the nicotine from reaching the brain, effectively blocking the effects of nicotine.

Counseling, support groups and smoking cessation programs
Many people need help to quit smoking. A number of telephone help lines are available for people giving up nicotine, such as the National Cancer Institute's 800-QUITNOW, or 800-784-8669, and the American Cancer Society's at 800-ACS-2345, or 800-227-2345.

Your doctor may also be able to recommend local support groups or smoking cessation programs. Additionally, some people find that a form of counseling called behavior therapy can help them come up with productive ways to change the behaviors and thoughts associated with smoking.

The best way to prevent tobacco dependence is to not smoke in the first place. The best way to prevent your children from smoking is to not smoke yourself. If you're a parent who smokes, the younger your children are when you quit, the less likely they are to become smokers themselves. Even if you don't smoke, here are some strategies you might try as a parent :

  • Talk with your teenagers. Ask whether their friends smoke. The risk of your child smoking is higher if his or her friends smoke. Most teenagers smoke their first cigarette with a friend who already smokes.
  • Learn what your children think about smoking. Ask them to read this information so that you can discuss it together. Emphasize that research has found teens can show signs of tobacco dependence after smoking intermittently for only a few weeks.
  • Help your children explore personal feelings. Use nonjudgmental questions and rehearse with them how they could handle tough situations regarding peer pressure and smoking.
  • Encourage your teenager to enjoy maximal energy and health. Explain to your teenager that the active, vivacious lifestyles portrayed in many cigarette advertisements are actually more representative of nonsmokers. People who smoke have colds and other respiratory infections more frequently.
  • Note the social repercussions. Remind your teenager that smoking gives you bad breath and makes your hair and clothes smell.
  • Work with your schools. Become active in community stop-smoking programs.
  • Promote smoke-free environments. Encourage public areas and restaurants, including places where your teen may work, to offer smoke-free environments. This helps to denormalize smoking, reducing the chances your teen will start and helping smokers to stop.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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