What is the psychopathology of nicotine dependence?

Introduction

Nicotine produces a temporary mood-altering “lift,” or “buzz,” that encourages continued use and helps produce an addictive craving. The body receives nicotine (and other addictive substances) through receptors in the brain. Dependence increases slightly each time the drug is used, leading to more intense addiction. Thus, although going without the drug is easier for younger people, the addiction becomes more trenchant with age. Going without nicotine causes withdrawal symptoms, including irritability and anxiety, that vary in intensity and duration among individuals.

History and Health Risks

The smoking of tobacco once was deemed healthy. Nicotine was named for the tobacco plant Nicotiana tabacum, which itself was named after Jean Nicot de Villemain, a French ambassador who imported it to Portugal in 1560 as a medicine.

Until the 1950s, university lecture halls were built with ashtrays, and indoor smoking was commonplace. The newsroom of the New York Times, for example, contained so many chain smokers (people who smoke one cigarette after another) in the 1930s that by the end of the workday janitors used push brooms to sweep away a carpet of butts an inch or two deep.

In 1963, however, the US Surgeon General issued a report linking smoking with a large number of health problems, including heart disease, stroke, and cancer. Since then, even the inhalation of tobacco effluvia from other people’s lungs, so-called passive (or secondhand) smoking, especially by children, has been associated with health risks. The nicotine itself usually does not cause health risks. Other substances in tobacco, including tar and various chemicals, do most of the damage. As of 2012, about 18 percent of adults in the United States smoked tobacco, according to the Centers for Disease Control and Prevention. The percentage using tobacco was higher in other countries, such as China and Russia.

Physical and Psychological Cues

Nicotine reaches the brain within seven to ten seconds after inhalation. One of the major symptoms of nicotine dependence (addiction) is an inability to go without smoking, even after serious attempts to stop. Other symptoms of addiction, according to the Mayo Clinic, include anxiety, irritability, restlessness, difficulty concentrating, depressed mood, frustration or anger, increased hunger, insomnia, and constipation or diarrhea.

Continued use of tobacco even in the face of serious health problems is another obvious sign of serious addiction. Some people have been known to continue smoking even after lung-cancer surgery. Some people defend their “freedom” to smoke, as if engaging in addictive behavior could be defended as an exercise of free choice. Studies have found that a propensity to smoke may be related to genetic makeup. In other words, smoking behavior can be inherited, to a degree. Some people do not experience pleasure from the use of nicotine and are unlikely to continue its use after experimenting.

Beginning smoking at a young age increases the chances of serious and intense addiction later in life. Nicotine binds to nicotinic acetylcholine receptors in the brain, increasing levels of neurotransmitters that play a role in the brain’s regulation of mood and behavior. Nicotine provides many people’s brains with a shot of dopamine, a neurotransmitter, producing a brief sense of euphoria and relaxation that rewards continued use, reinforcing the physiological addiction of the drug. Use of nicotine also increases the flow of the stimulating hormone adrenaline (epinephrine). Nicotine also increases heart rate by about twenty beats per minute and elevates blood pressure, as it constricts arteries.

The combustion of tobacco provokes release of more than sixty cancer-causing chemicals. According to the American Lung Association, smoking plays a role in 90 percent of lung-cancer cases among men (80 percent among women), as well as in cases of emphysema and chronic bronchitis. It also aggravates asthma. Smoking plays a major role in cancers of the mouth, esophagus, larynx, and throat (pharynx). It plays a role in other pathologies in the kidneys, bladder, stomach, pancreas, cervix, stomach, and other parts of the body. It can increase the risk of impotence and infertility.

Tobacco dependence is a physical process that also brings into play psychological cues. A smoker’s desire to increase his or her nicotine level may be linked to well-established daily rituals, such as morning coffee, drinking alcohol at a bar, or free time between tasks at work. Certain friends may provoke an urge to smoke. Smoking also can be associated with specific locations, such as a particular automobile. Stress can raise anxiety levels and lead to smoking. The smell of burning tobacco can increase the desire to use it. People who experience depression, schizophrenia, and other mental illnesses are, statistically speaking, more likely to smoke tobacco. Abusers of alcohol and illegal drugs also smoke in higher proportion than do other people. However, tobacco use has been studied as a treatment for schizophrenia, as well as for attention-deficit hyperactivity disorder (ADHD) and Parkinson’s disease.

Products designed to help smokers quit using tobacco have become a multibillion-dollar industry worldwide. In some countries, smoking tobacco remains legal for adults, but the places where people can smoke have become limited. In the Netherlands, for example, the smoking of tobacco has become illegal in some cafés where the use of marijuana is allowed. California was the first US state to ban smoking in all enclosed work areas, doing so in 1995.

Bibliography

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