Chapter 1:

Addiction & Cessation

Completing TobaccoEDU for credit?

Information message

NOTE: To earn credit you MUST complete each chapter in one sitting. At the bottom of this chapter, you will be asked to enter your email address and submit your request for credit. If you exit before completing the exercises, entering your email address, or submitting your request for credit,  you WILL NOT recieve credit for the chapter.

 Scroll To Continue  

Information message

Enjoy the presentation!

 Scroll To Continue  

Nicotine is as addictive as cocaine, alcohol, or heroin.1,2,3,4

 

In the U.S., more people are addicted to nicotine than any other drug.5

 

Approximately 49 million people in America use some type of tobacco product.6 

 

In 2018, an estimated 34.2 million adults in the U.S. were current cigarette users.6

1. Fitzgerald, P. J. (2013). Elevated Norepinephrine may be a Unifying Etiological Factor in the Abuse of a Broad Range of Substances: Alcohol, Nicotine, Marijuana, Heroin, Cocaine, and Caffeine. Substance Abuse: Research and Treatment, 7, SART.S13019. https://doi.org/10.4137/SART.S13019

2. National Institute of Drug Abuse (NIDA). (2020, April 13). Is nicotine addictive? Retrieved from https://www.drugabuse.gov/publications/research-reports/tobacco-nicotine-e-cigarettes/nicotine-addictive

3. Stolerman, I. P., & Jarvis, M. J. (1995). The scientific case that nicotine is addictive. Psychopharmacology, 117(1), 2–10. https://doi.org/10.1007/BF02245088

4. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (USDHHS). (2014). The Health Consequences of smoking - 50 years of progress: A report of the surgeon general. Ch. 5, “Nicotine”. Atlanta, GA:  National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

5. American Academy of Addiction Psychiatry. (2015, May). Nicotine dependence. https://www.aaap.org/wp-content/uploads/2015/06/AAAP-nicotine-dependence-FINAL.pdf

6. Creamer, M. R., Wang, T. W., Babb, S., Cullen, K. A., Day, H., Willis, G., Jamal, A., & Neff, L. (2019). Tobacco Product Use and Cessation Indicators Among Adults—United States, 2018. Morbidity and Mortality Weekly Report, 68(45), 1013–1019. https://doi.org/10.15585/mmwr.mm6845a2

 

When nicotine is absorbed,

It will cause the user to experience a short period of euphoria1. The euphoric feelings are due to the increased levels of dopamine that flood the brain’s reward circuits after nicotine is absorbed through the bloodstream.1,2,3

Dopamine is a neurotransmitter in charge of emotions, movement, motivations, and feelings of happiness. Long-term use of nicotine changes the brain’s sensitivity to dopamine. In other words, the brain will need increasing amounts of nicotine in order to feel its euphoric effects.4,5,6

1. Picciotto, M. R., & Mineur, Y. S. (2013). Molecules and circuits involved in nicotine addiction: The many faces of smoking. Neuropharmacology, 76 Pt B, 545–553. https://doi.org/10.1016/j.neuropharm.2013.04.028

2. Balfour, D. J. K. (2015). The role of mesoaccumbens dopamine in nicotine dependence. Current Topics in Behavioral Neurosciences, 24, 55–98. https://doi.org/10.1007/978-3-319-13482-6_3

3. Cosgrove, K. P., Esterlis, I., Sandiego, C., Petrulli, R., & Morris, E. D. (2015). Imaging Tobacco Smoking with PET and SPECT. Current Topics in Behavioral Neurosciences, 24, 1–17. https://doi.org/10.1007/978-3-319-13482-6_1

4. National Institute on Drug Abuse (NIDA). (2019, May 13). Say What? “Dopamine”. Retrieved from https://teens.drugabuse.gov/blog/post/say-what-dopamine on 2020, August 16.

5. Izenwasser, S., & Cox, B. M. (1992). Inhibition of dopamine uptake by cocaine and nicotine: Tolerance to chronic treatments. Brain Research, 573(1), 119–125. https://doi.org/10.1016/0006-8993(92)90120-X

6. Turton, S., & Lingford-Hughes, A. (2016). Neurobiology and principles of addiction and tolerance. Medicine, 44(12), 693–696. https://doi.org/10.1016/j.mpmed.2016.09.007

 

Nicotine harms the developing brain of adolescents,

and it changes the way the brain synapses are formed, thus affecting how new memories and new skills are formed.1 The brain does not fully develop until 25 years of age, so tobacco use in adolescence is dangerous.2

 

 Prolonged nicotine use can “lead to lower impulse control and mood disorders, disrupt attention and learning among youth and young adults, and prime the developing brain for addiction to alcohol and other drugs, such as cocaine.”1 Moreover, the addicting effects that nicotine has on developing brains makes young users more likely to become hooked.3,4

1. U.S Department of Health and Human Services. (2016). E-cigarette Use among Youth and Young Adults: A Report of the Surgeon General - Executive Summary. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

2. Arain, M., Haque, M., Johal, L., Mathur, P., Nel, W., Rais, A., Sandhu, R., & Sharma, S. (2013). Maturation of the adolescent brain. Neuropsychiatric Disease and Treatment, 9, 449–461. https://doi.org/10.2147/NDT.S39776

3. Smokefree Teen. (n.d.). Nicotine & Addiction. Smokefree.gov. Retrieved from https://teen.smokefree.gov/the-risks-of-tobacco/nicotine-addiction

4. Tobacco 21. (2020). Kids & Tobacco the Nicoteen Brain. Tobacco 21. Retrieved from https://tobacco21.org/kids-tobacco/

Compared to knowledge about conventional tobacco products, fewer people are aware of the dangers of e-cigarettes, or they believe ENDS are not as harmful as smoking. The lack of awareness and knowledge may continue to fuel the growth in ENDS usage.

Research suggests that pod-style E-cigarettes (e.g. JUUL) may deliver higher levels of nicotine than traditional cigarettes.

Any exposure to nicotine is unsafe for young people. E-cigarette use is strongly associated with the use of other tobacco products, among youth and youth adults.

  1. Amrock, S. M., Lee, L., & Weitzman, M. (2016). Perceptions of e-cigarettes and noncigarette tobacco products among US youth. Pediatrics. 138(5).
  2. National Cancer Institute (NIH). (2018). Vaping Pods Produce High Nicotine Levels in Young Users. Retrieved from https://www.cancer.gov/news-events/cancer-currents-blog/2018/youth-vaping-high-nicotine-levels
  3. oneji, S., Barrington-Trimis, J. L., Wills, T. A., Leventhal, A. M., Unger, J. B., Gibson, L. A., & Spindle, T. R. (2017). Association between initial use of e-cigarettes and subsequent cigarette smoking among adolescents and young adults: a systematic review and meta-analysis. JAMA pediatrics, 171(8), 788-797.

Individuals with mental illnesses, behavioral health conditions, and trauma histories have disproportionate tobacco use rates and are more likely to lack access to health insurance, cessation resources, and healthcare. Studies have also "linked some mental health disorders with biological tendencies to use nicotine and difficulty quitting.

  1. Williams, J. M, Steinberg, M. L., Griffiths, K. G., & Cooperman, N. (2013). Smokers with behavioral health comorbidity should be designated a tobacco use disparity group. American Journal of Public Health. 103(9), 1549-1555.
  2. Centers for Disease Control and Prevention. (2013 February). Vital Signs Fact Sheet: Adult Smoking Focusing on People with Mental Illness. Retrieved from https://www.cdc.gov/vitalsigns/smokingandmentalillness/index.html
  3. American Academy of Family Physicians. (n.d.) Behavioral Health and Tobacco Cessation. Retrieved from https://www.aafp.org/family-physician/patient-care/care-resources/tobacco-and-nicotine/office-champions/behavioral-health-tobacco-cessation.html
  4. Schroeder, S. A., & Morris, C. D. (2010). Confronting a neglected epidemic: tobacco cessation for persons with mental illnesses and substance abuse problems. Annual Review of Public Health. 31, 297-314.

Individuals who have substance use disorder are typically more heavily nicotine-dependent.

For example, "individuals who use cocaine and opioids have higher rates of cigarette smoking."

Additionally, data show that  tobacco use may serve as a gateway to illegal drug use and can even cause relapse in those recovering from substance use disorder.

  1. American Academy of Family Physicians. (n.d.) Behavioral Health and Tobacco Cessation. Retrieved from https://www.aafp.org/family-physician/patient-care/care-resources/tobacco-and-nicotine/office-champions/behavioral-health-tobacco-cessation.html
  2. Hall, S. M., & Prochaska, J. J. (2009). Treatment of smokers with co-occurring disorders: emphasis on integration in mental health and addiction treatment settings. Annual Review of Clinical Psychoogyl. 5, 409-431.
  3. Kalman, D., Morissette, S., & George, T. P. (2010). Co-morbidity of smoking in patients with psychiatric and substance use disorders. American Journal of Addiction. 14(2),106-23.
  4. Lai, S., Lai, H., Page, J. B., & McCoy, C. B. The association between cigarette smoking and drug use in the United States. Journal of Addictive Disease. I 19(4), 11-24.
  5. National Institute of Drug Abuse (NIDA). (2018, May 31). Cigarette Smoking Increases the Likelihood of Drug Use Relapse. Retrieved from https://www.drugabuse.gov/news-events/nida-notes/2018/05/cigarette-smoking-increases-likelihood-drug-use-relapse

Short-term effects of nicotine use

  • Increased heart rate
  • Increased blood pressure
  • Increased alertness
  • Increased metabolism
  • Sense of euphoria
  • Reduced appetite

Long-term effects of nicotine use

  • Cognitive decline
  • Increased risk of Alzheimer’s disease
  • Increased risk of addiction to other drugs
  • Increased impulsivity
  • Learning and concentration difficulties

1. National Institute of Drug Abuse (NIDA). (2020, April 13). Is nicotine addictive? Retrieved from https://www.drugabuse.gov/publications/research-reports/tobacco-nicotine-e-cigarettes/nicotine-addictive

2. Smokefree Teen. (n.d.). Nicotine & Addiction. Smokefree.gov. Retrieved from https://teen.smokefree.gov/the-risks-of-tobacco/nicotine-addiction

If you’ve ever thought about smoking casually with friends, remember that “between 33% and 50% of people who try smoking cigarettes escalate to regular patterns of use. Among college students, 90% of daily smokers and 50% of non-daily smokers continue to smoke over 4 years.” 

1. Waters, K., Harris, K., Hall, S., Nazir, N., & Waigandt, A. (2006). Characteristics of Social Smoking Among College Students. Journal of American College Health : J of ACH, 55(3), 133–139.

Most people who are addicted to smoking want to quit, but few are able to:

Ashtray 68% full

68%

of adult smokers wanted to quit smoking 

1. Babb, S. Malarcher, A., Schauer, G, Asman, K., Jamal, A. (2017). Quitting Smoking Among Adults—United States, 2000–2015. MMWR. Morbidity and Mortality Weekly Report, 65. https://doi.org/10.15585/mmwr.mm6552a1

Ashtray 55.4% full

55.4%

of adult smokers tried to quit in 2015

Ashtray 6% full

1 in 10

adult smokers successfully quit each year

Nicotine reaches peak levels within 10 seconds of inhalation, and in a few minutes, the effects of nicotine diminish. Consequently, one must continue administering nicotine (inhaling, absorbing, etc.) to feel its desirable effects.

1. National Institute of Drug Abuse (NIDA). (2020, April 13). Is nicotine addictive? Retrieved from https://www.drugabuse.gov/publications/research-reports/tobacco-nicotine-e-cigarettes/nicotine-addictive

Withdrawal symptoms can make quitting any tobacco product extremely hard. Just a few hours after inhaling or absorbing nicotine, withdrawal symptoms may begin, which unfortunately causes many people to continue using tobacco products.1 Withdrawal symptoms can last anywhere from a few days to a few months.2 

1. National Institute of Drug Abuse (NIDA). (2020, April 13). Is nicotine addictive? Retrieved from https://www.drugabuse.gov/publications/research-reports/tobacco-nicotine-e-cigarettes/nicotine-addictive

2. National Institute of Drug Abuse (NIDA). (2020, July 30). Brain Power. Retrieved from https://www.drugabuse.gov/publications/brain-power on 2020, August 16

Withdrawal symptoms may include, but are not limited to:

 

  • Irritability
  • Depression
  • Anxiety
  • Increased appetite
  • Cognitive and attention deficits
  • Sleep disturbances

1. National Institute of Drug Abuse (NIDA). (2020, July 30). Brain Power. Retrieved from https://www.drugabuse.gov/publications/brain-power on 2020, August 16

 

Need Help Quitting?

If you or someone you know wants to be free from nicotine addiction, there are plenty of helpful resources.

Clicking on the boxes will direct you to a different page.

These resources are offered for informational purposes only. you need not visit them as part of the curriculum

The truth initiative logo
Center for Disease Control logo
SAMHSA Logo
Nicotine Anonymous Logo
Smart Recovery Centers Logo
smokefree.gov logo
American Addiction Centers Logo

Let’s review…

True or False.
Nicotine is as addictive as cocaine.

  Correct

  Wrong

Nicotine is as addictive as cocaine, alcohol, or heroin.1,2,3,4 In the U.S., more people are addicted to nicotine than any other drug.5 

1. Fitzgerald, P. J. (2013). Elevated Norepinephrine may be a Unifying Etiological Factor in the Abuse of a Broad Range of Substances: Alcohol, Nicotine, Marijuana, Heroin, Cocaine, and Caffeine. Substance Abuse: Research and Treatment, 7, SART.S13019. https://doi.org/10.4137/SART.S13019

2. National Institute of Drug Abuse (NIDA). (2020, April 13). Is nicotine addictive? Retrieved from https://www.drugabuse.gov/publications/research-reports/tobacco-nicotine-e-cigarettes/nicotine-addictive

3. Stolerman, I. P., & Jarvis, M. J. (1995). The scientific case that nicotine is addictive. Psychopharmacology, 117(1), 2–10. https://doi.org/10.1007/BF02245088

4. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (USDHHS). (2014). The Health Consequences of smoking - 50 years of progress: A report of the surgeon general. Ch. 5, “Nicotine”. Atlanta, GA:  National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

5. American Academy of Addiction Psychiatry. (2015, May). Nicotine dependence. https://www.aaap.org/wp-content/uploads/2015/06/AAAP-nicotine-dependence-FINAL.pdf

What is the neurotransmitter in charge of emotions, movement, motivations, and feelings of happiness?

  Correct

  Wrong

Dopamine is a neurotransmitter in charge of emotions, movement, motivations, and feelings of happiness. Long-term use of nicotine consumption changes the brain’s sensitivity to dopamine, so overtime an individual will need greater quantities of nicotine to feel its euphoric effects.

1. National Institute on Drug Abuse (NIDA). (2019, May 13). Say What? “Dopamine”. Retrieved from https://teens.drugabuse.gov/blog/post/say-what-dopamine on 2020, August 16.

2. Izenwasser, S., & Cox, B. M. (1992). Inhibition of dopamine uptake by cocaine and nicotine: Tolerance to chronic treatments. Brain Research, 573(1), 119–125. https://doi.org/10.1016/0006-8993(92)90120-X

3. Turton, S., & Lingford-Hughes, A. (2016). Neurobiology and principles of addiction and tolerance. Medicine,44(12), 693–696. https://doi.org/10.1016/j.mpmed.2016.09.007

Approximately what age is the brain fully developed?

  Correct

  Wrong

The brain does not fully develop until approximately 25 years of age, so tobacco use in adolescence is dangerous1, because it changes the way the brain synapses are formed and affects how new memories and new skills are shaped.2 

1. Arain, M., Haque, M., Johal, L., Mathur, P., Nel, W., Rais, A., Sandhu, R., & Sharma, S. (2013). Maturation of the adolescent brain. Neuropsychiatric Disease and Treatment, 9, 449–461. https://doi.org/10.2147/NDT.S39776

2. U.S Department of Health and Human Services. (2016). E-cigarette Use among Youth and Young Adults: A Report of the Surgeon General - Executive Summary. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

What is a long-term effect of nicotine?

  Correct

  Wrong

ALL OF THE ABOVE ARE TRUE. Some long-term effects of nicotine include but are not limited to: cognitive decline, increased risk of Alzheimer's disease, increased risk of developing addiction to other drugs, increased impulsivity, and learning and concentration difficulties. 

1. National Institute of Drug Abuse (NIDA). (2020, April 13). Is nicotine addictive? Retrieved from https://www.drugabuse.gov/publications/research-reports/tobacco-nicotine-e-cigarettes/nicotine-addictive

2. Smokefree Teen. (n.d.). Nicotine & Addiction. Smokefree.gov. Retrieved from https://teen.smokefree.gov/the-risks-of-tobacco/nicotine-addiction

What percentage of smokers successfully quit each year?

  Correct

  Wrong

Most people who are addicted to smoking want to quit, but few are able to. Only about 1 in 10 people successfully quit smoking each year.

1.  Babb, S. Malarcher, A., Schauer, G, Asman, K., Jamal, A. (2017). Quitting Smoking Among Adults—United States, 2000–2015. MMWR. Morbidity and Mortality Weekly Report, 65. https://doi.org/10.15585/mmwr.mm6552a1

Thank You  for viewing our presentation. Since you have elected not to submit this for class credit you may now return home or view some of the other chapters.

 

 

A complete list of all of the cited references can be downloaded here.

In order to recieve your certificate please remember to use the same email address when you complete each chapter.