Nicotine dependence

Nicotine dependence is a pathological need of the body to uptake nicotine, which develops as a result of tobacco smoking. In fact, nicotinism is the most common form of routine substance abuse. Although smoking is officially classified as a "bad habit" and is not considered a drug addiction, nicotine dependence occurs and develops by the same mechanism as in cases of alcohol or drugs. It also manifests itself in the growth of tolerance, withdrawal syndrome in response to the lack of nicotine in the body, regular uncontrolled consumption, chronic craving, unsuccessful attempts to reduce the "dose", etc. Though nicotine does not cause pronounced euphoria, addiction to this substance is so strong that it is comparable with the one to heroin and cocaine. Pathological craving for tobacco develops in 90% of those who have started smoking, 60% of nicotine dependent people recognize themselves as drug addicts who would like to quit smoking but are unable.

The biochemical action of nicotine is well understood. Nicotine is an alkaloid that accumulates in the leaves of the plants of the Solanaceae family (also known as nightshade, or potato family). Among all representatives of this group of plants, the biggest amounts of nicotine are found in tobacco (in small doses it is also present in eggplants, tomatoes, potatoes, coca leaves). During smoking, inhaling or chewing tobacco, nicotine rapidly gets through the mucosa of the mouth, the esophagus, the lungs and quickly spreads along the bloodstream. Just in 7 seconds, the so-called acetylcholinergic receptors of the brain react to nicotine, which results in the release of adrenaline, which in turn causes an increase in blood pressure and the blood glucose level, accelerating the heart and respiratory rate. Nicotine indirectly contributes to the release of dopamine - a "hormone of joy," which causes mild euphoria, a surge of vivacity, a temporary improvement in the function of the brain. As a result, the smoker's spirits rise, a sense of well-being comes. Initially, a small dose of nicotine is enough to achieve this, but since the substance is quickly neutralized by the body, the person feels a desire to smoke again in order to maintain the pleasant state. This way the nicotine dependence arises.

It should be noted that in effect, no one feels better when taking the first dose of nicotine. On the contrary, the person most likely suffers from cough, dizziness, nausea. The first cigarette is often lighted "for company's sake", out of curiosity, due to the desire to look more mature, in the hopes to cope with stress, etc. Moreover, to 60% the nicotine addiction is considered to be connected with the genetic makeup. There is a probability that the teenager had started smoking because his pregnant mother used to smoke, or it was a common practice to smoke at home - in other words, this ritual was followed by the family during his whole life.

It is believed that if a person simply "knows how to smoke", does it from time to time, rarely - smokes 1-2 cigarettes on special occasions, then he is not addicted to nicotine. However, any kind of stress (either positive or negative) can unexpectedly provoke the onset of the second stage of nicotine abuse - regular smoking. The number of cigarettes smoked increases (from 3 to 10 per day), now the person wants to smoke not only for the sake of tranquility, but also in order to get rid of the unpleasant physical sensations that arise within the intervals between smoking (as nicotine has already become a part of biochemical processes in the body).

In 3-4 weeks after the onset of active smoking, the person notices that cigarettes have become an essential way of maintaining his normal physical and mental state. There comes the third, or the middle stage of dependence with the typical chronic intoxication. At this stage, the addiction to nicotine is more of a physical than of a psychological nature. A smoker needs 15-30 cigarettes a day, an hour-long break causes withdrawal syndrome, manifesting not only in excessive petulance, but also in different kinds of somatic disorders.

At the fourth stage of dependence, the signs of severe chronic intoxication appear. The withdrawal syndrome is strongly pronounced. Craving for nicotine is so strong that a person smokes throughout the day and night, 2-3 packs of cigarettes per day. This is a lethal dose of nicotine, only the fact that it is administered in small amounts isolated from one another saves the patient from the fatal outcome. Impairments are observed in the pulmonary system (chronic bronchitis, emphysema of the lungs), ischemia of the heart develops along with the obliteration of the vessels, sometimes up to their complete occlusion (mainly in the lower extremities, which leads to gangrene and amputation).

It is worth remembering that nicotine is not the only component of tobacco smoke. In addition to this addictive substance, it contains tobacco tar, carbon monoxide, carcinogens, hydrocyanic acid, arsenic, radioactive substances, free radicals. Herewith, even best quality filters can catch only 20% of toxic substances. As a consequence, due to smoking, irreversible destruction of almost all organs and systems of the body occurs. The statistics of nicotinism is truly tragic: every year, as a result of health problems caused by tobacco abuse, 5.4 million people in the world die. 90% of lung cancer deaths happen due to smoking.

A huge work of research has been done and a great number of articles had been written about the harm of tobacco smoking, psychosocial causes of the dependence and possible ways to overcome it (up to the level of government measures). Nevertheless, neither restrictive acts, nor strong arguments of the healthcare professionals and educators are able to reduce the extent of the billion army of smokers. Why does it grow this way?

As it had already been mentioned above, nicotinism is one of the strongest kinds of addiction. This explains the fact that it is really uneasy to get rid of, even if the smoker is really eager to and comprehends all the risks and the harm of smoking. For good reason, there is a saying: “The best way to give up smoking is not to start at all”. An extremely strong willpower or a serious motivation, a powerful stimulus is needed to make a dependent person give up smoking on his own. But vast majority of smokers is unable to actualize it, while the only thing that stops them is the prospective of developing a distressing withdrawal syndrome.

When the person gives up smoking, the body has to reset its working mode to the one without regular nicotine “doping”. The severity of withdrawal syndrome in this case depends on the personal features and the current state of the particular patient. It goes rather hard in patients with a 10-year or more smoking history (when people smoke 20 or more cigarettes a day). However, in some cases, people with the less significant smoking history develop a rather unpleasant withdrawal syndrome. In any way, the symptoms of nicotine withdrawal are not as torturous as in case of hard drug abuse; they are more likely to be classified as uncomfortable sensations rather than as intense suffering.

The adverse symptoms develop after about 1 hour after smoking a cigarette. Then slight but persistent craving for another cigarette appears. In about 2 hours, a sense of discomfort gets noticeable, in 8 hours symptoms like causeless irritation, anxiety, inability to concentrate occur. The acute phase starts on the next day and culminates on the third day. After the culmination, the condition improves, although the desire to smoke does not leave the patient even after a month of withdrawal. During the first weeks after quitting smoking, patients typically suffer from sleeping difficulties, depression, lack of energy, headache, palpitations, high blood pressure, there may be intestinal issues, different kinds of spontaneous pains and other unexpected heath problems (for example, increased blood sugar levels). This is a period when chronic diseases often exacerbate; also the risk of catching a cold or gaining weight (this is usually a constraining factor for the women who plan to quit smoking) increases.

However, not every smoker nesessarily goes through these states of mental and physical discomfort. Many patients, after a couple of weeks of abstaining from smoking cigarettes, begin to appreciate the advantages of their "new life". Little by little, depression and obsessive desire to smoke disappear, as well as cough and dyspnea; the sense of smell improves, the person starts to enjoy breathing clean fresh air. In general, almost a year is needed to restore the acetylcholine receptors in the brain, during which there is a risk of withdrawal syndrome relapses.

There are many ways to help the people quit smoking, i.e., a gradual reduction in the number of cigarettes smoked (this method is considered unpromising), the use of nicotine-containing pharmaceuticals, the methods of alternative medicine. Unfortunately, they do not ultimately guarantee the efficiency and the use of them is not exclusive of smoking relapse (the effectiveness of acupuncture and hypnosis is defined as about 30%). The most compelling means to help the patient get rid of nicotine addiction is medication.

In this case, the treatment is carried out by a specialist who prescribes specially selected medicines. Therefore, if you feel that smoking is rigorously ruining your health and it’s impossible to cope with the dependence on your own, it is better to apply to a specialized health care institution.

Only a professional addictionologist is able to assess the stage of dependence, sort out all its psychophysiological features and work out a therapeutic course taking into account the characteristics of the individual patient. According to the statistics, positive results after the medical treatment are observed in 98% of cases, - the rate which is more than convincing.