Cigarette smoking has been the most popular method of taking nicotine since the beginning of the 20th century. In 1989 the U.S. Surgeon General issued a report that concluded that cigarettes and other forms of tobacco are addictive and that nicotine is the drug in tobacco that causes addiction.

In addition, the report determined that smoking was a major cause of stroke and the third leading cause of death in the United States. Despite this warning, the National Household Survey on Drug Abuse shows that more than 61 million Americans were current cigarette smokers in 1996, making nicotine one of the most heavily used addictive drugs in the United States.

Nicotine is both a transient stimulant and a sedative to the central nervous system. Nicotine is physically and psychologically addictive. The ingestion of nicotine results in an almost immediate "kick" because it causes a discharge of epinephrine from the adrenal cortex. This stimulates the central nervous system, as well as other endocrine glands, which causes a sudden release of glucose. Stimulation is then followed by depression and fatigue, leading the abuser to seek more nicotine.

Extent of Use

National Monitoring the Future Study. Prevalence rates for smoking among young people remain high, in spite of the demonstrated health risk associated with smoking. Since 1975, cigarettes have consistently been the substance that the greatest number of high school students use daily.

Since peaking in the late 1970s, current cigarette smoking (smoking in the prior 30 days) among high school seniors remained between 28 to 34 percent through 1996. In 1996, 21.0 percent of 8th-graders, 30.4 percent of 10th-graders, and 34.0 percent of 12th-graders had smoked cigarettes during the past month. More than 4 percent of 8th-graders, 9 percent of 10th-graders, and 13 percent of 12th-graders said they smoked half a pack of cigarettes or more per day.

In 1995, among college students, 39.3 percent had smoked cigarettes within the past year and 26.8 percent within the past month. Of those young adults aged 19 to 28, about 39 percent had smoked cigarettes within the past year and 29.4 percent within the past month.

National Household Survey on Drug Abuse. Approximately 153 million people 12 years and older (71.6 percent) have tried smoking cigarettes; about 69 million (32.3 percent) have smoked cigarettes within the past year; and over 61 million (28.69 percent) have smoked cigarettes within the past month.

People aged 18 through 25 have the highest rates of smoking. In this age group, 38.3 percent had smoked cigarettes within the month preceding the 1996 survey. About 32 million males (31.1 percent) and almost 30 million females (26.7 percent) have smoked cigarettes within the past month. Current smokers are more likely to be heavy drinkers and illicit drug users.

Health Hazards

Nicotine has been reported to reduce anxiety, and smokers report that they get calming effects from it. Nicotine is absorbed readily from tobacco smoke in the lungs. With regular use, levels of nicotine accumulate in the body during the day and persist overnight. Thus, daily cigarette smokers are exposed to the effects of nicotine for 24 hours each day.

Nicotine taken in by cigarette smoking takes only seconds to reach the brain but has a direct effect on the body for up to 30 minutes. Cigarette smoke is primarily composed of a dozen gases (mainly carbon monoxide), nicotine, and tar. The tar in a cigarette, which varies from about 15 mg for a regular cigarette to 7 mg in a low-tar cigarette, exposes the user to a high expectancy rate of lung cancer, emphysema, and bronchial disorders. The carbon monoxide in the smoke increases the chance of cardiovascular diseases.

The effects of nicotine escalate bronchial and cardiovascular disorders chronic bronchitis and emphysema are common diseases among cigarette smokers. The risk of congestive heart failure also is increased by the effects of nicotine.

Nicotine produces effects on mood as well as on the heart, lungs, stomach, neurotransmitters, and sympathetic and parasympathetic nervous systems. Short-term effects of nicotine in cigarette smoke can include sweating, vomiting, and throat irritation. Over time, more serious conditions develop, including increased heart rate and blood pressure.

The most serious effects of smoking are lung cancer (only 12 percent of people diagnosed with lung cancer will live for 5 years) and stroke. Cancers of the esophagus, mouth, lips, and larynx also are associated with cigarette smoking.

Pregnant women who smoke cigarettes run an increased risk of having stillborn or premature infants or infants with low birthweight. Women who smoke generally have earlier menopause. If women smoke cigarettes and also take oral contraceptives, they are more prone to cardiovascular and cerebrovascular diseases than are other smokers; this is especially true for women older than 30.

The Environmental Protection Agency has concluded that secondhand smoke causes lung cancer in adults and greatly increases the risk of respiratory illnesses in children.

Treatment

Research suggests that smoking cessation should be a gradual process, because withdrawal symptoms are less severe in those who quit gradually than in those who quit all at once. Rates of relapse are highest in the first few weeks and months and diminish considerably after 3 months. The optimal treatment for smoking cessation includes behavioral therapy. Studies have shown that pharmacological treatment combined with psychological treatment, including psychological support and skill training to overcome high-risk situations, results in some of the highest long-term abstinence rates.

Nicotine chewing gum, available by prescription, is one medication approved by the Food and Drug Administration (FDA) for the treatment of nicotine dependence. Nicotine in this form acts as a nicotine replacement to help smokers quit the smoking habit. The success rates for smoking cessation treatment with nicotine chewing gum vary considerably across studies, but evidence suggests that it is a safe means of facilitating smoking cessation if chewed according to instructions and restricted to patients who are under medical supervision.

Another approach to smoking cessation is the nicotine transdermal patch, a skin patch that delivers a relatively constant amount of nicotine to the person wearing it. A research team at NIDA's Intramural Research Program studied the safety, mechanism of action, and abuse liability of the patch that was consequently approved by FDA. The nicotine patch can be obtained only with a doctor's prescription.

Both nicotine gum and the nicotine patch are adjuncts to nicotine cessation programs and are used to help people achieve abstinence, reduce withdrawal symptoms, and prevent relapse while under going behavioral treatment.

Information provided by NIH & NIDA

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