Use, Abuse, and Addiction

Smoking has long been called a habit, and that’s certainly part of what smokers live out. Some people are able to limit their tobacco use to occasional social settings, such as being at a party or out at a bar. Other people do get in the habit of smoking or chewing at particular times but don’t mind skipping it either. But for the majority of users, the real reason that they continue to smoke, especially in this day and age with antismoking messages everywhere, is singular: addiction.

Are You Addicted to Nicotine?

If you use tobacco or smoke, do you think you could be addicted? Answer the following twelve questions as you consider this possibility.1

YES NO

1. _ _ Have you ever tried to quit smoking but couldn’t?

2. _ _ Do you smoke now because it is too difficult to quit?

3. _ _ Have you ever felt like you were addicted to tobacco?

4._ _ Do you have strong cravings to smoke?

5._ _ Have you ever felt like you really needed a cigarette?

6._ _ Is it difficult to keep from smoking in places where you are not supposed to smoke?

7. _ _ Has it been difficult to keep from smoking when you have tried to stop smoking?

8. _ _ Has it been difficult to keep from smoking when you haven’t used tobacco in a while?

9._ _ Have you found it difficult to concentrate because you couldn’t smoke?

10. _ _ Have you ever felt irritable because you couldn’t smoke?

11. _ _ Do you feel a strong need or urge to smoke?

12._ _ Have you ever felt nervous, restless, or anxious because you couldn’t smoke?

If you answered yes to one or more of these questions, you may be experiencing nicotine addiction.

Christine’s Story

Let’s talk about what draws people into smoking in the first place. Take the story of Christine, a young woman who tried smoking a cigarette just once in her life. It was shortly before she graduated from college and Christine panicked at the thought of all the “wild” things she hadn’t done over her college career. Smoking a cigarette was on her list. So she found a friend who smoked (that was easy) and asked her to teach her how to properly light up and inhale. Soon after, a small group of friends met one sunny day outside, and then a lot of coughing ensued as Christine and her friends strutted along waving their cigarettes around. Christine reports having had a fun time that day, but that, other than having the opportunity to act out her vision of a cool smoker with the real thing—compared with the candy cigarettes she had done this with as a kid—the nicotine hit did absolutely nothing for her.

What would have happened if Christine kept at it, say bought her own pack—or even a carton—of cigarettes rather than bumming one off a friend? Undoubtedly, with continued use, her smoking life would have taken off. That’s because smoking produces a number of effects. And, strange as it sounds, those effects can be polar opposites, both soothing and stimulating.

New smokers also discover that dependence on nicotine develops rather quickly. First, the user experiences tolerance to nicotine, meaning the effect is less pronounced and more is needed to achieve the same effect. Eventually, dependence and addiction take hold.

Tobacco Use Disorder

What does it mean to be diagnosed as a nicotine addict? Officially, there is no such diagnosis, but the current Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) includes “tobacco use disorder” under the umbrella of “substance use disorder”; in previous editions of the diagnostic manual, these were separated into diagnoses of “substance abuse” and “dependence.” To be officially diagnosed with this disorder, users must meet at least two or three criteria for “mild” disorder, four to five criteria for “moderate” disorder, and six or more criteria to have a “severe” disorder.

Here are the criteria for tobacco substance use disorder outlined in the DSM-5:

Severity of the DSM-5 substance use disorders is based on the number of criteria endorsed: two to three criteria indicate a mild disorder; four to five criteria, a moderate disorder; and six or more, a severe disorder.

Nicotine as a Gateway Drug

Once a teen or young person crosses the threshold of smoking or using other forms of tobacco, the gate seems to slide open to other drug experimentation and use. The Johns Hopkins Bloomberg School of Public Health, for example, studied results from a survey on different types of drug use and found a link between those who began smoking early in life and later drug use. Smokers were seven times more likely to use marijuana than nonsmokers. When compared with nonsmokers, smokers were also more likely to use cocaine (again seven times more likely), crack (fourteen times more likely), and heroin (sixteen times more likely). The younger the smoker is upon first smoking, the more likely he is to move on to these other drugs.2

While the reasons for this correlation have not been firmly established, one study on adolescent tobacco users found that their brains metabolize nicotine at a slower rate than the brains of adults do. This longer exposure may make them more susceptible to addiction.3 Researchers now believe that 25 percent of adolescents who smoke become hooked in just one month.4 In addition, animal studies have found that when mice are exposed to tobacco, their brains are more prone to cocaine addiction.5

Effects of Nicotine and Tobacco Use

When tobacco is burned, the resulting smoke contains more than 7,000 chemicals and chemical compounds; at least 250 of these are toxic. When we smoke, chew, or vaporize nicotine, the effects extend through our central nervous system and include feelings of pleasure, reduced stress, and mental alertness. In this way, nicotine acts as both a stimulant and a sedative on the body. This explains why people smoke both to kickstart their day and to wind down as the day draws to a close. The stimulant effect occurs when the adrenal glands are activated and trigger a rush of epinephrine, or adrenaline. This rush of adrenaline leads to the release of glucose and raises our blood pressure, heart rate, and breathing. Let’s take a closer look at how tobacco use can affect our bodies over the long term.

Health Consequences and Risks for the User

Tobacco use and smoking-related diseases lead to more than 393,000 deaths in the United States each year; another 50,000 each year are attributed to disease from secondhand smoke.6 But tobacco use doesn’t always kill users quickly, and many develop chronic and debilitating diseases that affect them for years before their untimely deaths finally occur.

The harm caused by smoking begins immediately and progressively gets worse with continued use. However, upon quitting, the risk of developing many of the diseases associated with smoking goes down over time. Let’s take a closer look at the most common diseases caused by tobacco use.

Cancer

Lung cancer, once considered a rare disease before smoking rates exploded beginning in the late 1800s, is now viewed as an epidemic.7 In 2009, more than 200,000 people were diagnosed with lung cancer in the United States. This widespread disease is also a deadly one, killing more people than any other type of cancer. The connection between smoking and lung cancer has been firmly established, and smoking causes more than 85 percent of lung cancers in the United States.8

Smoking has also been found to cause many other cancers—about one-third of all cancers—including cancer of the throat, larynx, tongue, esophagus, mouth, bladder, cervix, kidney, pancreas, stomach, and leukemia, a cancer of the blood and bone marrow. Because smoking also weakens the body’s immune system, smokers have a more difficult time fighting cancer.

Respiratory Conditions

In addition to causing lung cancer, smoking leads to other problems and diseases in the respiratory system. It irritates and damages the airways. This can cause complications with asthma and lead to the development of chronic obstructive pulmonary disease (COPD), which includes bronchitis (inflammation of the lungs) and emphysema. The problems may start with wheezing and coughing that produces phlegm and progress to shortness of breath and difficulty exhaling as the lungs become more and more incapacitated.9

Heart Disease, Heart Attack, and Stroke

Research shows a causal relationship between smoking and heart disease. That’s because smoking damages your blood cells and blood vessels in a way that increases the risk of developing atherosclerosis, a disease that causes plaque buildup in your arteries. When arteries are clogged with plaque, blood is more likely to clot—which can lead to heart attacks, stroke, or sudden death.10

Diabetes

Although tobacco use has not been shown to cause diabetes, if you smoke and already have diabetes, your risk for dangerous complications from the disease increase. For example, smoking makes you two to three times more likely to develop kidney disease than diabetics who don’t smoke. Diabetics who smoke also increase their risk for heart disease, eye disease and blindness, and nerve damage.11

Tooth Decay and Gum Disease

Smokeless tobacco increases your risk for developing oral health problems. Chewing tobacco contains sugar, which contributes to cavities and tooth decay. The coarse particles in chewing tobacco can also damage your gums and tooth enamel. Sugar and irritants can also make you more likely to develop gum disease, as gums may pull away from affected teeth and areas where you chew. If untreated, this may eventually lead to bone and tooth loss.12

Sleep Apnea

People who have sleep apnea repeatedly stop and start breathing in their sleep. Smoking poses a significant risk for the most common type of sleep apnea, called obstructive sleep apnea. This means that the person’s throat muscles relax too much during sleep, creating an obstruction for airflow and wakening the person to breathe. People with sleep apnea may get a full night’s sleep but not feel rested due to this constant wake-sleep cycle. Researchers estimate that smokers are three times more likely to struggle with sleep apnea than people who do not smoke. Higher levels of inflammation and fluid retention in the upper airway are thought to be the cause.13

Pneumonia

Smoking is the largest single risk factor in developing pneumonia in otherwise healthy, nonelderly individuals. Pneumonia is a lung infection caused by either bacteria or a virus that may be mild or severe, but it has the potential to lead to complications, especially in smokers. Those who have been smoking the longest and who smoke more are at greater risk. What’s more, the risk for pneumonia is increased for nonsmokers who breathe secondhand smoke as well as for the smokers themselves.14

Buerger’s Disease

One little-known side effect of smoking is thromboangiitis obliterans, otherwise known as Buerger’s Disease. In some smokers and users of tobacco, the effect on their arteries and veins causes poor circulation in the hands and feet that can become gangrenous if left untreated. This is often treated with medications, costly and painful bypass surgeries, or even amputation in extreme cases.

Overdosing on Nicotine?

Did you know that nicotine can be lethal in high doses? That’s right, it’s possible to die from too much nicotine. This issue has been raised quite frequently with the introduction of new smokeless tobacco products, especially those that resemble candy and mints. The lethal dose of nicotine for children is much lower than for adults, and some worry that kids may inadvertently get into an older sibling’s or parent’s stash of these products, as well as nicotine patches and gum.

Symptoms of an overdose of nicotine include abdominal cramping, rapid or difficulty breathing, confusion, coma, fainting, or vomiting. If you suspect nicotine poisoning, do not make the person throw up. Instead, seek immediate medical attention, call 911, or call the National Poison Control Center at 800-222-1222.

Pregnant Mothers and Reproductive Effects

According to a report by the Surgeon General on tobacco and women, women who smoke are at risk for a number of consequences related to their own health, their ability to have children, and the health of their unborn children. Smoking compromises fertility, and smoking during pregnancy increases the risk for complications including premature birth, low-birth-weight infants, stillbirth, and infant mortality. Research also shows a link between smoking by mothers and sudden infant death syndrome (SIDS).

What’s more, smoking may also lead to more painful or irregular menstrual periods or the absence of menstruation.15

Smoking can have a negative effect on male fertility as well.

Could Tobacco Really Produce Some Health Benefits?

Let’s recall that Native Americans originally used tobacco for ceremonial and medicinal purposes. Then, when it was brought to Europe, it continued to be used in the treatment of various ailments, with some supposed success. Yet in today’s world, only the hazards of tobacco use are spoken of, but research is showing some benefits as well. Here are some examples:

Pregnant women who smoke in the latter half of their pregnancy reduce their risk for developing preeclampsia and gestational hypertension. This is most likely a byproduct of the carbon monoxide in cigarette smoke; smokeless tobacco has not been shown to produce the same benefits.16

In 2011, the journal Arthritis & Rheumatism reported on a study that found male smokers were less likely to need joint replacements than men who didn’t smoke—50 percent less likely to need new knees or hips. The decreased risk seems to be related to a number of factors: the lower weight of most smokers; smokers’ reduced activity level, which reduces the wear and tear on their joints; and nicotine’s effect in activating cells that increase cartilage in our joints.17

Researchers are looking for ways to use tobacco in the developing of health care products. A California-based company, for example, is using an antibody from a tobacco leaf extract in a product that would help prevent cavities. The product is currently undergoing clinical trial.18

Health Consequences and Risks for Secondhand Smoke

Also called environmental tobacco smoke or involuntary smoke, secondhand smoke has consequences greater than leaving an odor on your clothes or causing you to cough. We now know that the consequences can be just as deadly for the person who breathes secondhand smoke as it is for the smoker. According to the National Cancer Institute, people who are breathing secondhand smoke are ingesting at least sixty-nine known carcinogens. While restrictions on smoking tobacco in workplaces and public places have certainly lowered the exposure most people receive, the problem has not been eliminated since no level of exposure has been deemed safe.

Secondhand smoke can be caused by burning tobacco products or by the smoke that a user exhales. The following paragraphs show how secondhand smoke causes harm.

Effects on Children

Because children’s bodies are generally smaller than adults’ and are still developing, they are especially susceptible to the negative effects of breathing tobacco smoke. According to the U.S. Surgeon General, secondhand smoke has been linked to SIDS in infants, bronchitis and pneumonia in young children, and more frequent and intense asthma attacks in children who have asthma; plus, it may cause respiratory symptoms such as coughing, wheezing, and breathlessness in school-age children and may increase their risk of ear infections. Some evidence suggests it may even cause cancer, leukemia, or brain tumors, though this is not yet conclusive.19 In the United States, 34 million children and youth are regularly exposed to secondhand smoke.20

Cancer

Breathing secondhand smoke has been linked to lung cancer, increasing your risk by 20 to 30 percent.21 Some evidence suggests that secondhand smoke may also cause breast cancer and increase the risk for developing nasal sinus cancer.

Cardiovascular System

When adults are exposed to secondhand smoke, the effects can include harm to the heart, blood, and vascular systems and thereby increase your risk of having a heart attack. Breathing secondhand smoke increases your risk of developing heart disease by 25 to 30 percent.

Respiratory Effects

Evidence suggests that breathing secondhand smoke may damage your airways and exacerbate asthma symptoms.

Reproductive Effects

Evidence shows that when mothers are exposed to secondhand smoke, their babies may weigh slightly less at birth and may be born earlier than they otherwise would.

Other Effects

In addition to the health effects described above, adults exposed to secondhand smoke may deal with nasal irritation as well as simply be bothered by the odor.

Sights and Smells—How Smoking Affects Our Appearance

It seems ironic that many people begin smoking because they think it makes them look cool, that they may continue smoking because it helps to suppress their appetite and control their weight, and thus make them look good, and yet the conclusion of continued use over the long term is anything but attractive. With time, smoking is said to speed up the aging process. The skin becomes dry and dull looking; premature wrinkles develop around the lips and eyes; teeth become discolored; and fingers and fingernails become stained. And if smoking-related disease sets in, a person’s appearance will undoubtedly decline even further.

The good news is that quitting cigarettes can improve your appearance—and do so rather quickly. In as little as five days, your skin may start to look better as your circulation improves. Plus, the odor of smoke will fade from your hair, clothes, vehicle, and home. These are smells that you may not have even been aware of, even though those around you certainly smelled it.

Fire Risk

According to the U.S. Fire Administration, almost one thousand people are killed each year in fires caused by cigarettes and other smoking materials. This is the number one cause of preventable fire deaths in the United States. If you smoke in your home, be sure to do the following:

Economic Effects

Personal Financial Costs

While the cost of a pack of cigarettes varies widely across the United States—federal excise taxes are the same everywhere, but states and localities set their own tax rates—the national average for a pack of cigarettes is about six dollars. Using this figure, let’s do the math for what a pack-a-day smoker would pay for cigarettes.

Over a month, that’s a tank of gas each week. Over a year, that’s enough to take an extra vacation each summer. And over twenty years, that’s enough to buy your dream sports car for retirement. It’s easy to see why the tobacco industry’s goal is reaching new smokers and keeping them for life.

Societal Financial Costs

The significant financial cost to governments and society are what led to the state lawsuits against the tobacco industry in the first place. Cigarette smoking costs the nation $96 billion in direct medical costs and $97 billion in lost productivity annually.23 Secondhand smoke is estimated to cost roughly $5 billion in direct medical costs and another $5 billion in indirect costs.24

Turning It Around—The Benefits of Quitting (Reversing Harms)

If you’ve smoked for thirty years, are you a lost cause? Everyone around you may now be touting the benefits of a smoke-free lifestyle, and even though most of the places where you formerly smoked with abandon now prohibit smoking, you keep at it—going outside even in the bitter cold to light up. Perhaps you doubt it would do any good to quit now. You would be wrong in this assessment. Let’s look at what research is showing us about the reversal of damage and how the body regains health.25

In addition, the American Cancer Society reports that the improvements to your blood vessels that come with quitting reduce the risks for diabetics.26 Whether you quit after a few months or years of use, or after decades of use, your body will benefit and you may live longer.