Tobacco use continues to account for a considerable number of preventable deaths and diseases in the United States. According to the Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health, a report prepared by the Substance Abuse and Mental Health Services Administration (SAMSHA), approximately 66.9 million people of ages 12 and older were users of tobacco products, including 55.2 million cigarette smokers. The data also disclosed that about 32.5 million people reported smoking cigarettes on a daily basis, according to this report.
Smoking or ingesting tobacco products including cigarettes, cigars, pipes, hookahs, and smokeless tobacco poses dangerous health threats not just to the smoker but to those exposed to secondhand smoke. The Centers for Disease Control and Prevention (CDC) estimate that each year, about 42,000 nonsmokers die from diseases caused by exposure to secondhand smoke.
Facts About Tobacco Abuse and Addiction
Tobacco is one of the most frequently abused substances in the country. People are drawn to experiment with tobacco use for a number of reasons such as pleasure, stress relief, weight control, enhanced mental acuity, and image building.
Because it is not declared as a controlled or illicit substance, it is highly accessible compared to dangerous drugs. The convenience of acquisition somehow causes users to overlook the addictive nature of the substance.
The main addictive chemical in tobacco products is nicotine, which is quickly absorbed into the bloodstream when tobacco is inhaled, smoked, or chewed. Nicotine stimulates an increase in dopamine levels which affect the areas of the brain that control pleasure and reward.
The other components of the products such as acetaldehyde may heighten the effects of nicotine on the brain. Over time, tobacco use can lead to physiological addiction or abuse, in the same manner as a user gets addicted to cocaine, heroin or other addictive substance.
Addiction is characterized by a compulsive drug seeking behavior, despite knowledge of the negative effects or consequences. There is a high probability of addiction when a person:
- Cannot stop smoking or ingesting tobacco despite a desire or attempt to quit
- Feels the need or compulsion to smoke or chew tobacco after meals, during breaks, or after long periods without using tobacco
- Cannot function normally without tobacco use
- Seeks a tobacco product during stressful situations
- Continues smoking or chewing despite illnesses or health problems
- Has developed a tolerance for the substance and requires more frequent use or higher doses to achieve the desired effects
- Spends a great deal of time on smoking activities or on trying to obtain tobacco products
- Continues to smoke even in hazardous conditions (e.g. in bed, near a gasoline station)
- Experiences withdrawal symptoms whenever he attempts to quit
Withdrawal symptoms include irritability, anxiety, sleep disturbances, changes in appetite, fatigue, increased heart rate, and intense cravings. Avoidance of these symptoms can prevent a user from quitting the bad habit. This prolongs the phase of addiction and increases his risks of incurring medical complications related to tobacco abuse.
Effects of Tobacco Abuse
There are several ill-effects that can arise from prolonged tobacco use or addiction. The detriment can affect several areas including personal health and societal economic costs. Here are some of the dangerous consequences of tobacco abuse:
Impact on personal health
Nicotine is only one of the thousands of poisonous chemicals found in tobacco products. Other substances such as tar, carbon monoxide, acetaldehyde, nitrosamines, formaldehyde, cyanide, and ammonia that also make up these products are toxic chemicals and carcinogenic to humans. The same components are contained in smokeless tobacco.
This is why tobacco use is the leading cause of several cancers. It accounts for about 90% of lung cancer cases, according to drugabuse.gov.
Aside from cancers, it also leads to other severe medical conditions such as bronchial diseases, chronic obstructive pulmonary disorders, heart diseases, stroke, vascular diseases, aneurysm, and diabetes. In addition, smoking has been found to cause erectile dysfunction among males.
Tobacco use not only affects the direct user. The exhaled smoke called environmental tobacco smoke or secondhand smoke is likewise hazardous for those exposed to the emissions. Frequent exposure to secondhand smoke increases the risks for developing heart diseases, respiratory infections, and lung cancer.
Secondhand smoke is especially unsafe for children. Children exposed to the smoke can develop severe asthma and other respiratory infections. In worse cases, parental smoking can result in sudden infant death syndrome (SIDS).
Pregnant women who smoke incur increased risks of miscarriage, stillborn delivery, or giving birth prematurely. This is because exposure to nicotine and carbon monoxide may hinder oxygen supply to the fetus, which leads to severe consequences for the child including respiratory difficulties and sudden infant death syndrome.
Tobacco use during pregnancy could also result in learning and developmental difficulties in the child including attention deficit hyperactivity disorder (ADHD). Moreover, maternal smoking affects the childâ€™s behavioral and psychological patterns and he is more likely to become addicted to nicotine when he starts smoking.
Tobacco use is also costly for society. It contributes to loss of productivity and to high costs in terms of healthcare. The CDC reports that the total economic cost of smoking exceeds $300 billion a year. The amount represents expenses for medical care, premature deaths, and loss of workforce productivity.
Quitting tobacco use is challenging. A tobacco addict will normally attempt to do this several times but the addiction will keep him craving to consume the substance. His dependence on nicotine becomes a chronic disease that will require a combination of treatment approaches guided by medical professionals and counseling experts.
However, with the right attitude, support, and motivation, recovery from tobacco abuse is possible. These are the treatment options for tobacco addiction:
Nicotine replacement therapy
Nicotine replacement therapy (NRT) is a pharmacological treatment approved by the Food and Drug Administration as safe and effective for use as a remedy for nicotine addiction. NRT works by replacing the nicotine from the cigarettes by releasing the substance in smaller amounts at a slower pace, controlling the dose that enters the bloodstream. This satisfies the cravings for nicotine that occur during the withdrawal phase.
NRT aids in reducing the withdrawal symptoms and affects the psychological aspects by moderating the patientâ€™s mood. Thus, he is able to function normally even without using a tobacco product. Continuous use will help the patient abstain from cigarette smoking or ingesting other forms of tobacco.
The 6 types of NRT products that are currently approved include transdermal nicotine patches, nicotine nasal sprays or inhalers, nicotine lozenges, nicotine gums, and sublingual nicotine tablets. This form of therapy is most effective for heavy smokers and it increases the quit rate by 50 to 70%, based on data from this article.
However, NRT is not the ultimate remedy for smoking cessation. It is recommended that these products be used in conjunction with non-nicotine preparations to ensure better chances of recovery from nicotine addiction.
Another approach is to administer medications that do not contain nicotine but help to control and eliminate the physiological dependence on the substance. Two drugs have been approved by the FDA as effectual in smoking cessation therapy. These are:
- Bupropion, also known by its trade name Zyban, controls the symptoms of withdrawal, especially depression. It has shown to double smoking cessation rates.
- Varenicline tartrate, which also goes by the trade name Chantix, targets the nicotine receptors in the brain and ensures balanced levels of dopamine. This helps to prevent withdrawal symptoms.
The use of varenicline may increase risks for developing cardiovascular problems such as myocardial infarction, angina, coronary artery disease, arrhythmia, ischemia, and stroke. As such, this remedy should be taken with caution and should only be resorted to after proper consultation with a physician.
The other second-line therapies recognized by the U.S. Clinical Practice Guideline are Nortriptyline and Clonidine. Both drugs have shown to effectively diminish withdrawal symptoms and to elevate abstinence rates.
Combination of pharmacotherapy
In some cases, a combination of drugs and NRT approaches may be necessary to help a patient effectively quit smoking or chewing tobacco.
The use of a passive NRT product such as a transdermal patch may be used together with another medicine with an acute dosing preparation such as a gum or nasal spray. For heavy abusers, the combination of these therapies may be more efficacious than using either product alone.
NRT may also be used together with a non-nicotine medication. For instance, a nicotine patch when with the drug Bupropion may produce better results.
Combining the use of pharmacotherapy methods should be directed and supervised by a physician or a licensed treatment facility.
It is recommended that pharmacological treatment is accompanied by behavioral therapy. The latter is an intervention mechanism that addresses psychological factors which can strengthen a patientâ€™s resolve to focus on recovery and avoid temptations that can lead to relapse.
Methods in behavioral treatment include self-help materials and individual counseling. These are intended to help the patient develop stress management and coping mechanisms as alternative strategies to smoking tobacco during highly stressful situations. It also teaches the patient to recognize situations where he could be enticed to use a tobacco product and to avoid such settings or adeptly handle them.
Cognitive-behavioral therapy methods such as hypnotherapy and neuro-linguistic programming (NLP) have also been effectual for some patients. These approaches assist the users to change their perceptions and behavior towards tobacco use.
Conventional behavioral methodologies are conducted at formal treatment facilities, smoking cessation clinics, and community health centers. The modern approach, however, permits patients to avail of treatment by phone, mail, or over the internet.
In 2004, the U.S. Department of Health and Human Services (HHS) launched a toll-free number for smokers who want to quit the bad habit. The number is 800-QUIT-NOW (800-784-8669) and callers are redirected to their respective stateâ€™s cessation quitline or to the National Cancer Institute, according to this article.
Quitting smoking can be tough for a highly-dependent user and the chances of relapse are high. Because intervention programs usually last from 1-3 months, about 75-80% of patients are likely to resume the habit within the first year from treatment. To be effectual, programs are usually extended to about six months or longer. In most cases, long-term management and support including administration of low-dose medications may be necessary.
Advances in medical science research are promising and more potent remedies may be available in the near future. While the alterations to the central nervous system brought about by nicotine dependence could not be completely reversed by pharmacologic preparations, proper treatment can manage the addiction.
The success of any treatment approach ultimately lies in the strength of the patientâ€™s determination to overcome his dependence on the substance. Help from various agencies and clinics are available. However, what a patient needs most of all is an attitude of firm commitment to recovery.