Disease: Nicotine dependence
Nicotine dependence â also called tobacco dependence â is an addiction to tobacco products caused by the drug nicotine. Nicotine dependence means you can't stop using the substance, even though it's causing you harm.
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. At the same time, stopping tobacco use causes withdrawal symptoms, including irritability and anxiety.
While it's the nicotine in tobacco that causes nicotine dependence, the toxic effects of tobacco result from other substances in tobacco. Smokers have much higher rates of heart disease, stroke and cancer than nonsmokers do.
Regardless of how long you've smoked, stopping smoking can improve your health. Many effective treatments for nicotine dependence are available to help you manage withdrawal and stop smoking for good. Ask your doctor for help.
For some people, using any amount of tobacco can quickly lead to nicotine dependence. Signs that you may be addicted include:
- You can't stop smoking. You've made one or more serious, but unsuccessful, attempts to stop.
- You experience withdrawal symptoms when you try to stop. Your attempts at stopping have caused physical and mood-related symptoms, such as strong cravings, anxiety, irritability, restlessness, difficulty concentrating, depressed mood, frustration, anger, increased hunger, insomnia, constipation or diarrhea.
- You keep smoking despite health problems. Even though you've developed health problems with your lungs or your heart, you haven't been able to stop.
- You give up social or recreational activities in order to smoke. You may stop going to smoke-free restaurants or stop socializing with certain family members or friends because you can't smoke in these locations or situations.
When to see a doctor
You're not alone if you've tried to stop smoking but haven't been able to stop for good. Most smokers make many attempts to stop smoking before they achieve stable, long-term abstinence from smoking.
You're more likely to stop for good if you follow a treatment plan that addresses both the physical and the behavioral aspects of nicotine dependence. Using medications and working with a counselor specially trained to help people stop smoking (a tobacco treatment specialist) will significantly boost your chances of success.
Ask your doctor, counselor or therapist to help you develop a treatment plan that works for you or to advise you on where to get help to stop smoking.
Nicotine is the chemical in tobacco that keeps you smoking. Nicotine is very addictive when delivered by inhaling tobacco smoke into the lungs, which quickly releases nicotine into the blood allowing it to get into the brain within seconds of taking a puff. In the brain nicotine increases the release of brain chemicals called neurotransmitters, which help regulate mood and behavior.
Dopamine, one of these neurotransmitters, is released in the "reward center" of the brain and causes improved mood and feelings of pleasure. Experiencing these effects from nicotine is what makes tobacco so addictive.
Nicotine dependence involves behavioral (routines, habits, feelings) as well as physical factors. These behavioral associations with smoking may act as triggers â situations or feelings that activate a craving for tobacco, even if you have not smoked for some time.
Behaviors and cues that you may associate with smoking include:
- Certain times of the day, such as first thing in the morning, with morning coffee or during breaks at work
- After a meal
- Drinking alcohol
- Certain places or friends
- Talking on the phone
- Stressful situations or when you're feeling down
- Sight or smell of a burning cigarette
- Driving your car
To overcome your dependence on tobacco, you need to become aware of your triggers and develop a plan to deal with the behaviors and routines that you associate with smoking.
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.
Tobacco smoke contains more than 60 known cancer-causing chemicals and thousands of other harmful substances. Even "all natural" or herbal cigarettes have chemicals that are harmful to your health.
Smoking harms almost every organ of your body and impairs your body's immune system. About half of all regular smokers will die of a disease caused by tobacco.
Women smokers are now at equal risk to men smokers of dying from lung cancer, COPD and cardiovascular disease caused by using tobacco.
The negative health effects include:
- Lung cancer and other lung diseases. Smoking causes nearly 9 out of 10 lung cancer cases. In addition, smoking causes other lung diseases, such as emphysema and chronic bronchitis. Smoking also makes asthma worse.
- Other cancers. Smoking is a major cause of cancers of the esophagus, larynx, throat (pharynx) and mouth and is related to cancers of the bladder, pancreas, kidney and cervix, and some leukemias. Overall, smoking causes 30 percent of all cancer deaths.
- Heart and circulatory system problems. Smoking increases your risk of dying of heart and blood vessel (cardiovascular) disease, including heart attack and stroke. Even smoking just one to four cigarettes daily increases your risk of heart disease. If you have heart or blood vessel disease, such as heart failure, smoking worsens your condition. However, stopping smoking reduces your risk of having a heart attack by 50 percent in the first year.
- Diabetes. Smoking increases insulin resistance, which can set the stage for the development of type 2 diabetes. If you have diabetes, smoking can speed the progress of complications, such as kidney disease and eye problems.
- Eye problems. Smoking can increase your risk of serious eye problems such as cataracts and loss of eyesight from macular degeneration.
- Infertility and impotence. Smoking increases the risk of reduced fertility in women and the risk of impotence in men.
- Pregnancy and newborn complications. Mothers who smoke while pregnant face a higher risk of miscarriage, preterm delivery, lower birth weight and sudden infant death syndrome (SIDS) in their newborns.
- Cold, flu and other illnesses. Smokers are more prone to respiratory infections, such as colds, flu and bronchitis.
- Weakened senses. Smoking deadens your senses of taste and smell, so food isn't as appetizing.
- Teeth and gum disease. Smoking is associated with an increased risk of developing inflammation of the gum (gingivitis) and a serious gum infection that can destroy the support system for teeth (periodontitis).
- Physical appearance. The chemicals in tobacco smoke can change the structure of your skin, causing premature aging and wrinkles. Smoking also yellows your teeth, fingers and fingernails.
- Risks to your family. Nonsmoking spouses and partners of smokers have a higher risk of lung cancer and heart disease compared with people who don't live with a smoker. If you smoke, your children will be more prone to SIDS, worsening asthma, ear infections and colds.
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. Research has shown that children whose parents do not smoke or who successfully quit smoking are much less likely to take up smoking.
Here are steps you can take to prevent future generations from nicotine addiction and the many diseases associated with smoking:
- Talk to your children about smoking. Tell them about the dangers of tobacco. Encourage them to value good health. You can be a great influence on whether your children smoke, despite what they see in movies and on the web.
- Stay in touch with your teens. Studies show that smoking is most likely to become a habit during the teen years. Ask whether their friends smoke. Those who have friends who smoke are more likely to start smoking than those who don't. Help them plan ways to handle peer pressure. Let your child know that other forms of tobacco, including cigars and smokeless tobacco, also carry significant health risks.
- Promote smoke-free environments. Ban smoking in your home. Support legislation to make all workplaces smoke-free. Encourage smoke-free public places, including restaurants. Become active in community and school-based stop-smoking programs.
- Support legislation to increase taxes on tobacco products. Higher prices discourage teens from starting to smoke. Higher prices on tobacco products, coupled with smoke-free workplace laws, are the most effective public health policies to reduce smoking in adults and prevent young people from ever starting.
Many products claim to be smoking-cessation aids. Many also claim to be "natural." Just remember that "natural" doesn't necessarily mean "safe." Talk with your doctor before trying any alternative medicine treatments.
- Acupuncture. Acupuncture involves stimulating points on the body, typically with thin, solid, metallic needles. Several studies have been conducted on the effects of acupuncture or acupressure for smoking cessation, but there's no definitive evidence that it works.
- Herbs and supplements. A few studies have been conducted on the dietary supplements SAMe, silver acetate and St. John's wort for the treatment of tobacco dependence, but there is no current evidence that any natural product improves smoking cessation rates.
- Hypnosis. Although no evidence supports the use of hypnosis â also called hypnotherapy â in smoking cessation, some people find it helpful. If you choose to pursue hypnosis, talk to your doctor about finding a reputable therapist.
- Meditation. Although no evidence supports the effectiveness of meditation in smoking cessation, some people find it helpful to reduce symptoms of anxiety.
Lifestyle and home remedies
It's important to have a plan for managing nicotine withdrawal symptoms. Withdrawal symptoms are usually the most intense during the first week after you stop smoking. They may continue for several weeks, with declining intensity.
Although most nicotine withdrawal symptoms pass within a month, you may occasionally experience a strong urge or craving to smoke months after stopping. Triggers or cues that were associated with your smoking can provoke these urges or cravings.
Here's what you can do to help manage nicotine withdrawal symptoms:
- Exercise regularly. Regular physical activity has been found to reduce withdrawal symptoms and help people stop smoking. 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. Do something that keeps your hands busy, and before you know it, the urge will have passed. This is why you want to get rid of tobacco supplies when you decide to quit. You don't want to have any on hand when a craving hits.
- Identify rationalizations. If you find yourself thinking, "I'll just smoke one to get through this tough time" or "Just one won't hurt," recognize it as a message that can derail your plan. Review your reasons for quitting, and replace that thought with something positive to support your stopping.
- Talk to a support person. If you're 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.
- Eat regular, healthy meals. Include plenty of fruits and vegetables, and drink more water.
Coping and support
To stay smoke-free over the long haul, consider these tips:
- Stay motivated. Decide to quit, pick a date and create a plan to make it happen. Start by thinking about the mixed feelings you may have about smoking. Then make a list of your reasons for stopping smoking.
- Don't get discouraged if you slip. Remember, it's common to lapse, and sometimes relapse. But your goal is no smoking at all â even light or occasional smoking is dangerous. You can learn from past experiences about what may have led to a lapse or relapse. Armed with that knowledge, you'll be stronger during your next attempt.
- Identify your major smoking triggers and challenges. This will help you solve problems and have a plan to deal with high-risk situations.
- Seek support. Social support is key to achieving a stable and solid, smoke-free life. Ask your family, friends and co-workers for support and encouragement. Be direct, and let them know what specifically helps you most.
- Practice positive self-talk. Think of one or two phrases to use repeatedly for encouragement, such as "I am grateful to be smoke-free."
- Set smoke-free boundaries. If there's another smoker in your household, set boundaries by making your home and car smoke-free. Ask smoking co-workers not to offer you a smoke or invite you outside for a smoke break.
- Regularly review the benefits you're getting from quitting. Short-term benefits include breathing easier, saving money and having better-smelling clothes. Long-term benefits include a lower risk of disease, increased chances for a longer life and a healthier environment for your family. Add up how much money you've saved.
- Avoid alcohol. Drinking is a high-risk situation. Avoid drinking situations until you're confident that you can remain smoke-free.
- Reward yourself. Buy a magazine, go to the park, meet a friend for lunch or take a class.
Anyone who smokes or uses other forms of tobacco is at risk of becoming dependent. Factors that influence who will use tobacco include:
- Genetics. The likelihood that you will start smoking and keep smoking may be partly inherited â genetic factors may influence how receptors on the surface of your brain's nerve cells respond to high doses of nicotine delivered by cigarettes.
- Home and peer influence. Children who grow up with parents who smoke are more likely to become smokers. Children with friends who smoke also are more likely to try cigarettes. Evidence suggests that smoking shown in movies and on the Internet can encourage young people to smoke.
- Age. Most people begin smoking during childhood or the teen years. The younger you are when you begin smoking, the greater the chance that you'll become a heavy smoker as an adult.
- Depression or other mental illness. Many studies show an association between depression and smoking. People who have depression, schizophrenia, post-traumatic stress disorder (PTSD) or other forms of mental illness are more likely to be smokers.
- Substance use. People who abuse alcohol and illegal drugs are more likely to be smokers.
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