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Nicotine Addiction at 15-Year High in U.S.

By Hugh C. McBride

Ask most Americans to describe what drug addiction looks like and they're apt to evoke images of seedy alleyways, strung-out criminals, or mind-frazzled aging rock stars.

Their descriptions probably won't include young moms sipping lattes outside Starbucks, or old men reading newspapers in the park - but if those folks are enjoying a quick smoke as well, then perhaps they should be added to the list.

According to research that was presented during the 74th annual gathering of the American College of Chest Physicians (ACCP), nicotine dependence has risen to a 15-year high in the United States. The researchers also discovered that, between 1989 and 2006, the severity of nicotine addiction in the U.S. increased by 12 percent, and the prevalence of smokers who are classified as "highly nicotine dependent" has increased by 32 percent.

In an Oct. 31 article on the ScienceDaily website, the study's lead author said that the results of the research reflected what he has observed over the past quarter-century.

"After treating tobacco-dependent patients for the last 25 years and conducting many tobacco dependence clinical treatment trials, I began to see a shift in severity of physical, nicotine dependence that required me to develop more intensive treatment plans for my patients," said Dr. David P. Sachs of the Palo Alto Center for Pulmonary Disease Prevention.

The team that Sachs led analyzed data that had been collected on 632 individuals who had participated in three studies between 1986 and 2006. Each of the studies had employed the Fagerström Tolerance Questionnaire to determine the severity of the subjects' nicotine dependence before they entered treatment.

ABOUT NICOTINE ADDICTION

The American Heart Association has described nicotine addiction as "historically ... one of the hardest addictions to break," and has noted that the "pharmacologic and behavioral characteristics that determine tobacco addiction are similar to those that determine addiction to drugs such as heroin and cocaine."

Writing on the "Quit Smoking" section of the Mayo Clinic website, behavioral counselor Jennifer A. Kern, M.S., C.T.T.S., describes the manner in which even a first-time smoker can begin to become dependent upon nicotine.

When you inhale the smoke from a cigarette, nicotine reaches the brain within 7 [to] 10 seconds. What it does when it gets there is stimulate the release of your body's own "feel good" chemicals, like dopamine. Because it happens so rapidly, your brain experiences instant gratification (like pleasure, relaxation, even a mild high), and you develop strong urges to want to smoke again...

Using tobacco over an extended period of time causes chemical and structural changes to occur in the brain. When you continue to smoke, there is an increase in the number of receptors in the brain that are sensitive to nicotine and that react strongly to it. Over time, the brain may then require more nicotine to satisfy those areas (we call that tolerance) - so you gradually smoke more.

HEALTH EFFECTS

Nora Volkow, the director of the National Institute on Drug Abuse (NIDA), is quite direct when describing the scope and severity of nicotine's negative effects.

"Tobacco use kills nearly half a million Americans each year, with one in every six U.S. deaths the result of smoking. Smoking harms nearly every organ of the body, causing many diseases and compromising smokers' health in general," Volkow wrote in an introduction to a research report that was posted on the NIDA website. "Nicotine, a component of tobacco, is the primary reason that tobacco is addictive, although cigarette smoke contains many other dangerous chemicals, including tar, carbon monoxide, acetaldehyde, nitrosamines, and more."

Individuals who are addicted to nicotine, and thus unable to stop smoking cigarettes or using other tobacco products, put themselves at elevated risk for contracting a wide range of diseases and disabling conditions, including the following:

  • Lung cancer - NIDA reports that about 90 percent of all lung cancer cases have been linked to smoking, and that lung cancer is the number-one cancer killer of both men and women in the United States.
  • Other cancers - In addition to the lung cancer risk, the Cardiology Channel reports that tobacco use has been linked to more than 30 percent of all cancers, including those of the mouth, throat, stomach, bladder, cervix, pancreas, and kidneys.
  • Short-term respiratory conditions - Smokers are more likely to get (and have trouble getting rid of) coughs, colds, and pneumonia.
  • Chronic lung diseases - Smoking tobacco can cause emphysema and chronic bronchitis, and can intensify symptoms associated with asthma.
  • Heart disease and hypertension - The American Lung Association reports that cigarette smoking has been proven to be a major cause of coronary heart disease, which leads to heart attack. And according to WebMD, smoking decreases the amount of oxygen that gets to the heart, increases blood pressure and heart rate, and damages coronary artery cells.

TREATMENT

Nicotine addiction can be treated in a number of ways, including behavioral therapy and the use of pharmacological replacement agents (such as nicotine gum or a transdermal patch) or medications (including bupropion or Zyban).

But the findings of the Sachs research team may indicate a need for alternative treatments specifically designed for individuals with severe addictions to tobacco.

"The more severely nicotine dependent a person is, the greater the medical need for more intensive tobacco-dependent therapies," Sachs said in an Oct. 29 article on the Medical News Today website. "Today's severely nicotine-dependent patient may not respond to the current 'standard' in tobacco dependence treatment, much of which is based on nicotine dependence data and outmoded treatment concepts from 15 years ago."

Regardless of what techniques are used, experts agree that the benefits of quitting smoking are worth the effort. Within 24 hours of quitting a person's blood pressure begins to lower, and his odds of suffering a heart attack decrease. Long-term benefits include a lowered risk of stroke, heart disease, and cancer. According to NIDA, a 35-year-old man who quits smoking increases his life expectancy by an average of 5.1 years.

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