Tobacco Addiction

1. TobaccoAddiction NS184 K Farwell, PhD, RN, CARN-AP

2. Statistics • An estimated 66.5 million Americans reported current use (past month use) of a tobacco product in 2001, a prevalence rate of 29.5 percent for the population aged 12 or older. • Among that same population, 56.3 million (24.9 percent of the total population aged 12 or older) smoked cigarettes, 12.1 million (5.4 percent) smoked cigars, 7.3 million (3.2 percent) used smokeless tobacco, and 2.3 million (1.0 percent) smoked tobacco in pipes (Figure 4.1). Between 2000 and 2001, the percentage reporting past month cigar smoking increased from 4.8 to 5.4 percent, which was similar to the rate reported in 1999 (5.5 percent). There were no other significant changes in the rates of current use of other tobacco products. • Source: .S. Department of Health and Human Services. Substance Abuse and Mental Health Services Administration. (2002, September 4). Results from the 2001 National Household Survey on Drug Abuse: Volume I. Summary of National Findings

3. Potency • Nicotine is: • 1000 X more potent than alcohol • 10-100 X more potent than barbiturates • 5-10 X more potent than cocaine or morphine

4. Aspects of Nicotine Addiction • Physiological Dependence • Tolerance, dependence, & withdrawal • Psychological Dependence • Stimulation,  tension, craving, habit, relaxation • Socio-cultural Factors • Tied to rituals, select activities, family of origin, and cultural practices

5. Body’s Response to Smoking(within 7-10 seconds) • Short-term  bp • Short-term  pulse • Short-term  blood flow from heart • Causes arteries to narrow • Carbon monoxide,  oxygen • Acts on reward center in the brain

6. Neurotransmitter Effects • Dopamine: Pleasure, suppress appetite • Norepinephrine: Arousal, suppress appetite • Acetylcholine: Arousal, cognitive enhancement • Vasopressin: Memory improvement • Serotonin: Mood modulation, suppress appetite • Beta-endorphin: Reduce anxiety / tension

7. How long does nicotine stay in the body? • From 85– 90 percent of nicotine in the blood is metabolized by the liver and excreted from the kidney rapidly. • The estimated half-life for nicotine in the blood is two hours. However, smoking represents a multiple dosing situation with considerable accumulation during smoking. • Therefore, it can be expected that blood nicotine would persist at significant levels for six to eight hours after smoking stopped

8. Increased Risk of Heart Attack • Carbon monoxide may damage the inner walls of the arteries, encouraging fatty buildups in them. • Over time, this causes the vessels to narrow and harden. Nicotine may also contribute to this process. • Smoking also causes several changes in the blood that make clots — and heart attack — more likely.

10. Lung Comparison Lung: After 90 Days Smoke Free Lung: Smoking Pack Per Day

11. About Secondhand Smoke: • Cigarette smoke hurts many more people than just the smoker. Children under the age of one whose parents smoke are more than 2 times as likely than children of nonsmokers to suffer asthma, bronchitis, pneumonia, and other respiratory tract illnesses • Source: Committee on Passive Smoking, Board of Environmental Studies and Toxicology, National Research Council. (1986). Environmental tobacco smoke: Measuring exposures and assessing health effects. Washington, DC: National Academy Press.

12. A child’s lung tissue is especially vulnerable to damage, even when the concentration of secondhand smoke is relatively low • Source: Pedreira, FA, Guandolo, VL, & Feroli, EJ. (1985). Involuntary smoking and incidence of respiratory illness during the first year of life. Pediatrics. 75, 594-595. • This means that smoking in a car, even with the windows open, is still dangerous to a child.  The younger the child, the more vulnerable the lung tissue • Source: Guyatt, GH, & Newhouse, MT. (1985). Are active and passive smoking harmful? Determining causation. Chest, 88, 445-451.

13. Alcohol Use & Smoking • per person, smokers drink about twice as much alcohol as non-smokers • people who drink heavily are more likely to smoke heavily too • reducing drinking helps people quit smoking? • quitting smoking helps with sobriety among alcoholics • relapse to drinking may cause smoking relapse • Source: National Institute on Alcohol Abuse and Alcoholism.  Alcohol Alerts.  No. 39: Alcohol and Tobacco.  Site accessed 11/1/01.  http://www.niaaa.nih.gov/publications/aa39.jtml

14. The Big Three Health Benefits Of Quitting • Greatly reduced risk of premature death:Quitting lowers your risk of dying early by 50% within 5 years of quitting.  After 15 years the risk is the same as if you had never smoked • Source: Benowitz, N.L.  (1996).  Pharmacology of nicotine: addiction and therapeutics. Annual Review of Pharmacology and Toxicology, 36, 597-613.

15. Reduced risk of lung cancer, emphysema, and bronchitis: • Your risk of lung cancer drops by 30%-50% after 10 years of being smoke-free.  The longer you stay quit, the lower the risk.  If you’ve begun to develop emphysema and or chronic bronchitis, quitting will essentially stop the progression of the disease and allow your respiratory system to compensate for damaged tissue. • Source: Benowitz, N.L.  (1996).  Pharmacology of nicotine: addiction and therapeutics. Annual Review of Pharmacology and Toxicology, 36, 597-613.

16. Reduced risk of coronary heart disease:The potential for smoking-related heart disease is cut in half one year after quitting.  Within 15 years the risk is the same as that of someone who never smoked • Source: American Lung Association. What are the benefits of quitting smoking? Site accessed 11/1/01. http://www.lungusa.org/tobacco/quit_ben.jtmll

17. Quitting Cold Turkey • 91.2% of all successful long-term quitters are today quitting entirely on their own • They have done so without using Zyban, Wellbutrin, hypnosis, acupuncture, magic herbs, and without toying with any gradual nicotine weaning products like the patch, gum, lozenge, spray, or inhaler.  • Source: Cancer Facts & Figures 2003

18. irritability anger hostility anxiety nervousness panic poor concentration disorientation lightheadedness sleep disturbances constipation mouth ulcers dry mouth sore throat-gums- or tongue pain in limbs sweating depression fatigue fearfulness sense of loss, craving tobacco –May persist for 6 months or longer hunger coughing (body getting rid of the mucus clogging the lungs). Possible Withdrawal Symptoms

19. 100% Nicotine Free for 72 Hours: • Blood is now 100% nicotine-clean • 90% of nicotine's metabolites have passed through their urine • Chemical withdrawal has peaked in intensity and is now beginning to gradually subside.  • Any nicotine use at this point constitutes chemical relapse that will require them to repeat nicotine detox all over again

20. If you had stopped smoking last week, you would have already: • Lowered your blood pressure and pulse • Normalized your carbon monoxide and oxygen levels in your blood • Decreased your chances of having a heart attack • Improve your sense of taste and smell • Increased your lung capacity • Made your breathing easier • Improved your circulation • Began the process of your lungs cleaning themselves • Reduced your coughing • Increased your energy level

21. Quitting Interventions Source for information: Accessed 2/10/06 at http://www.quitnet.com/library/guides/Quitnet/B/getting_ready.jtml#methodsofquitting

22. Nicotine Replacement Therapy • On average, all nicotine replacement products are equally effective, roughly doubling the chances of quitting successfully • NRT minimizes withdrawal symptoms and helps control cigarette cravings to allow you to concentrate on using behavioral techniques to stay smoke-free

23. 4 different types of nicotine replacement therapies • nicotine patch • nicotine gum • nicotine spray* • nicotine inhaler* *Require prescription from your physician

24. What NRT does not do • It doesn't work equally well for everyone. • It doesn't eliminate withdrawal symptoms entirely. • It doesn't give you any more willpower.

25. What NRT does do: • It does let you concentrate on your habit before breaking the physical addiction to nicotine.

26. Medication: Zyban:™ • Zyban is a prescription medication that was originally used to treat depression • Zyban is at least, if not more, effective than the nicotine patch • Zyban is thought to work by blocking nicotine withdrawal, making smoking less reinforcing by stimulating certain centers of the brain, and improving mood. 

27. Other Quitting Aids: • Counseling – Individual or Group, Telephone or Internet • Support and Self-Help Groups • Nicotine fading:Rate fading and brand fading are two strategies of gradually reducing the amount of nicotine in your system before you quit.  They are different than the approach of cutting back since the ultimate goal is quitting, not continued smoking at a lower level.  Smoking fewer cigarettes and smoking low nicotine cigarettes are still hazardous to your health. • Note: Naltrexone (Trexan) is NOT used to help people quit smoking----it must have been my wishful thinking!

28. Nicotine Anonymous • Non-Profit 12 Step Fellowship of men and women helping each other live nicotine-free lives. • Welcomes all those seeking freedom from nicotine addiction, including those using cessation programs and nicotine withdrawal aids. • The primary purpose of Nicotine Anonymous is to help all those who would like to cease using tobacco and nicotine products in any form. • The Fellowship offers group support and recovery using the 12 Steps as adapted from Alcoholics Anonymous to achieve abstinence from nicotine.

29. http://www.quitnet.com/library/guides/Quitnet/B/getting_ready.jtml#methodsofquittinghttp://www.quitnet.com/library/guides/Quitnet/B/getting_ready.jtml#methodsofquitting http://www.nlm.nih.gov/medlineplus/smoking.html http://www.nicotine-anonymous.org/ http://www.nida.nih.gov/researchreports/nicotine/nicotine.html Helpful Nicotine Links