Cigarette smoking

What is it?

Nicotine is a widely used addictive compound found naturally in tobacco and now available in pharmaceutical preparations such as gum, skin patches, and nasal spray. Some would consider nicotine among the most addictive drugs known, and no matter which form is used, there is potential for dependence.

Cigarette smoking is the most addictive method of using nicotine. About one in three smokers attempts to quit each year; of those who try, only one in twenty will succeed without help. Even with the use of support groups, nicotine patches and gum, only fifteen to twenty percent are able to quit. By way of comparison, treatment centers dealing with drug and alcohol dependence may have success rates anywhere from two to five times as great. The case for nicotine's huge addictive potential becomes even more compelling when one considers that initial exposure typically leads to nausea and dizziness.

Unlike alcohol or cocaine, there is little, if any, pleasurable sensation or psychological relief initially; one has to work at becoming addicted to nicotine and even long time users may have great difficulty in describing exactly what effects are being sought. Despite full knowledge of the harmful physical effects and a strong desire not to become addicted, casual use may evolve into dependence (continued use despite adverse effects, mostly on health).

How is it diagnosed?

History: The diagnosis of nicotine dependence is made on the basis of history. Almost by definition, any use of tobacco products constitutes abuse. According to the DSM-IV, dependence is established by the presence of three or more of the following symptoms during a twelve month period:

• tolerance (more of the drug is required to achieve the same effect),
• withdrawal (unpleasant physical or psychological effects when use is reduced),
• use is in greater amounts or over a longer period than intended,
• a persistent desire to quit or unsuccessful efforts made at control of the amount used,
• much time spent in using or obtaining substance (chain smoking),
• work, social, or leisure activities reduced because of use,
• continued use despite knowledge of or having experienced related health problems.

Physical exam is not necessary to make the diagnosis, but because of the large number of associated serious medical complications, it is recommended. Physical signs such as stained fingers or evidence of lung disease may be present.

Tests: Routine urine toxicology tests can detect nicotine use; continued smoking can be inferred from elevated levels of carbon monoxide in the blood. Pulmonary function tests may be used to assess lung damage.

How is it treated?

Treatment approaches include hypnosis, acupuncture, aversive conditioning, psychotherapy, medications, and tobacco substitutes, to name a few. None are exceptionally effective. A few broad principles are generally agreed upon.

Few individuals are able to successfully quit on the first try and the more attempts made, the greater the chance for success. Generally, various strategies should be used in combination and as much outside support as possible should be offered. While some people are able to quit "cold turkey," the presence of uncomfortable withdrawal symptoms commonly causes relapse within 48 hours. To minimize these, many methods use some form of taper or gradual reduction over time, and several over-the-counter preparations are now available.

Studies have shown that the transdermal (skin) patches appear to be an effective aid, at least in the short-term. Recent research with antidepressants has been promising, but, at this time, there are no quick or easy fixes for this addiction.

Medications

Information	Brand	Generic	Label	Rating
	Zyban	Bupropion
	Revia	Naltrexone

What might complicate it?

Cancer, lung, and heart disease are some of the major illnesses resulting from exposure to tobacco products. Smokers are also believed to be more susceptible to minor respiratory illness such as viral infection. Both asthma and allergies are exacerbated by exposure to smoke.

Predicted outcome

Those who are motivated and make persistent efforts to quit using nicotine have a good chance of success. Once abstinent, the risk for heart disease and cancers will decline with time and may even return to normal. More advanced pulmonary problems such as chronic bronchitis and emphysema can be slowed down or arrested, and early damage may be reversible.

Alternatives

The diagnosis is made by history and is usually obvious.

Appropriate specialists

Psychiatrist, psychologist, and internist.

Last updated 22 December 2011