Cigarettes and Other

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Cigarettes and Other
Nicotine Products
Nicotine is one of the most heavily used
Health Hazards ———
addictive drugs in the United States. In
2002, 30 percent of the U.S. population
Nicotine is highly addictive. It is both a
12 and older—71.5 million people—used
stimulant and a sedative to the central
tobacco at least once in the month prior
nervous system. The ingestion of nicotine
to being interviewed. This figure includes
results in an almost immediate “kick”
3.8 million young people age 12 to 17;
because it causes a discharge of epineph-
14 million people age 18 to 25; and
rine from the adrenal cortex. This stimu-
53.7 million age 26 and older.* Most of
lates the central nervous system, and
them smoked cigarettes.
other endocrine glands, which causes a
sudden release of glucose. Stimulation is
Cigarette smoking has been the most pop-
then followed by depression and fatigue,
ular method of taking nicotine since the
leading the abuser to seek more nicotine.
beginning of the 20th century. In 1989,
Nicotine is absorbed readily from tobacco
the U.S. Surgeon General issued a report
smoke in the lungs, and it does not matter
that concluded that cigarettes and other
whether the tobacco smoke is from ciga-
forms of tobacco, such as cigars, pipe
rettes, cigars, or pipes.
tobacco, and chewing tobacco, are
addictive and that nicotine is the drug in
Nicotine also is absorbed readily when
tobacco that causes addiction. In addi-
tobacco is chewed. With regular use of
tion, the report determined that smoking
tobacco, levels of nicotine accumulate in
was a major cause of stroke and the third
the body during the day and persist
leading cause of death in the United
overnight. Thus, daily smokers or chewers
States. Statistics from the Centers for
are exposed to the effects of nicotine for
Disease Control and Prevention indicate
24 hours each day. Nicotine taken in by
that tobacco use remains the leading
cigarette or cigar smoking takes only sec-
preventable cause of death in the United
onds to reach the brain but has a direct
States, causing more than 440,000
effect on the body for up to 30 minutes.
deaths each year and resulting in an
annual cost of more than $75 billion
Research has shown that stress and anxi-
in direct medical costs. (See www.
ety affect nicotine tolerance and depend-
ence. The stress hormone corticosterone
October 2003
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reduces the effects of nicotine; therefore,
Pregnant women who smoke cigarettes
more nicotine must be consumed to
run an increased risk of having stillborn
achieve the same effect. This increases tol-
or premature infants or infants with low
erance to nicotine and leads to increased
birthweight. Children of women who
dependence. Studies in animals have also
smoked while pregnant have an increased
shown that stress can directly cause
risk for developing conduct disorders.
relapse to nicotine self-administration
National studies of mothers and daugh-
after a period of abstinence.
ters have also found that maternal
smoking during pregnancy increased the
Other studies have shown that animals
probability that female children would
cannot discriminate between the effects
smoke and would persist in smoking.
of nicotine and the effects of cocaine.
Studies have also shown that nicotine
Adolescent smokeless tobacco users are
self-administration sensitizes animals to
more likely than nonusers to become
self-administer cocaine more readily.
cigarette smokers. Behavioral research
Addiction to nicotine results in withdrawal
is beginning to explain how social influ-
symptoms when a person tries to stop
ences, such as observing adults or other
smoking. For example, a study found that
peers smoking, affect whether adolescents
when chronic smokers were deprived
begin to smoke cigarettes. Research has
of cigarettes for 24 hours, they had
shown that teens are generally resistant to
increased anger, hostility, and aggression,
many kinds of anti-smoking messages.
and loss of social cooperation. Persons
suffering from withdrawal also take
In addition to nicotine, cigarette smoke is
longer to regain emotional equilibrium
primarily composed of a dozen gases
following stress. During periods of absti-
(mainly carbon monoxide) and tar. The
nence and/or craving, smokers have
tar in a cigarette, which varies from about
shown impairment across a wide range
15 mg for a regular cigarette to 7 mg in
of psychomotor and cognitive functions,
a low-tar cigarette, exposes the user to a
such as language comprehension.
high expectancy rate of lung cancer,
emphysema, and bronchial disorders.
Women who smoke generally have earlier
menopause. If women smoke cigarettes
The carbon monoxide in the smoke increas-
and also take oral contraceptives, they
es the chance of cardiovascular diseases.
are more prone to cardiovascular and
The Environmental Protection Agency has
cerebrovascular diseases than are other
concluded that secondhand smoke causes
smokers; this is especially true for women
lung cancer in adults and greatly increases
older than 30.
the risk of respiratory illnesses in children
and sudden infant death.
October 2003
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Promising Research ——
drawal from chronic nicotine use. These
changes are comparable in magnitude
Research has shown that nicotine, like
and duration to similar changes observed
cocaine, heroin, and marijuana, increases
during the withdrawal from other abused
the level of the neurotransmitter dopamine,
drugs such as cocaine, opiates, ampheta-
which affects the brain pathways that
mines, and alcohol. Scientists found signif-
control reward and pleasure. Scientists
icant decreases in the sensitivity of the
now have pinpointed a particular mole-
brains of laboratory rats to pleasurable
cule (the beta 2 (b2) subunit of the nicotine
stimulation after nicotine administration
cholinergic receptor) as a critical compo-
was abruptly stopped. These changes last-
nent in nicotine addiction. Mice that lack
ed several days and may correspond to
this molecule fail to self-administer nico-
the anxiety and depression experienced
tine, implying that without the b2 mole-
by humans for several days after quitting
cule, the mice do not experience the posi-
smoking “cold turkey.” The results of this
tive reinforcing properties of nicotine. This
research may help in the development of
new finding identifies a potential site for
better treatments for the withdrawal symp-
targeting the development of anti-nicotine
toms that may interfere with individual
addiction medications.
attempts to quit smoking.
Other new research found that individuals
Treatment ———
have greater resistance to nicotine addic-
tion if they have a genetic variant that
Studies have shown that pharmacological
decreases the function of the enzyme
treatment combined with behavioral treat-
CYP2A6. The decrease in CYP2A6 slows
ment, including psychological support
the breakdown of nicotine and protects
and skills training to overcome high-risk
individuals against nicotine addiction.
situations, results in some of the highest
Understanding the role of this enzyme in
long-term abstinence rates. Generally,
nicotine addiction gives a new target for
rates of relapse for smoking cessation are
developing more effective medications to
highest in the first few weeks and months
help people stop smoking. Medications
and diminish considerably after about
might be developed that can inhibit the
3 months.
function of CYP2A6, thus providing a new
approach to preventing and treating nico-
Behavioral economic studies find that
tine addiction.
alternative rewards and reinforcers can
reduce cigarette use. One study found
Another study found dramatic changes in
that the greatest reductions in cigarette
the brain’s pleasure circuits during with-
use were achieved when smoking cost
October 2003
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was increased in combination with the
replacement, as are the gum and patch.
presence of alternative recreational
Rather, this works on other areas of the
brain, and its effectiveness is in helping to
make controllable nicotine craving or
Nicotine chewing gum is one medication
thoughts about cigarette use in people try-
approved by the Food and Drug
ing to quit.
Administration (FDA) for the treatment
of nicotine dependence. Nicotine in this
Extent of Use ———
form acts as a nicotine replacement to
help smokers quit the smoking habit.
2002 Monitoring the Future Study
The success rates for smoking cessation
treatment with nicotine chewing gum vary
Despite the demonstrated health risk asso-
considerably across studies, but evidence
ciated with smoking, young Americans
suggests that it is a safe means of facilitat-
continue to smoke. However, past-month
ing smoking cessation if chewed accord-
smoking rates among high school students
ing to instructions and restricted to patients
are declining from peaks reached in
who are under medical supervision.
1996 for 8th-graders (21.0 percent) and
10th-graders (30.4 percent) and in 1997
Another approach to smoking cessation is
for seniors (36.5 percent). In 2002, rates
the nicotine transdermal patch, a skin
reached the lowest levels ever reported by
patch that delivers a relatively constant
MTF; 10.7 percent of 8th-graders, 17.7
amount of nicotine to the person wearing
percent of 10th-graders, and 26.7 per-
it. A research team at NIDA’s Division of
cent of high school seniors reported smok-
Intramural Research studied the safety,
ing during the month preceding their
mechanism of action, and abuse liability
response to the survey.
of the patch that was consequently
approved by FDA. Both nicotine gum and
The steady decrease in smoking rates
the nicotine patch, as well as other nico-
among young Americans corresponds to
tine replacements such as sprays and
several years in which increased propor-
inhalers, are used to help people fully quit
tions of teens said they believe there is a
smoking by reducing withdrawal symp-
“great” health risk associated with ciga-
toms and preventing relapse while under-
rette smoking and expressed disapproval
going behavioral treatment.
of “pack-a-day” smokers. In 2002,
roughly 60 percent of 10th- and 12th-
Another tool in treating nicotine addiction
graders and 64 percent of 8th-graders
is a medication that goes by the trade-
agreed with the statement, “I think becom-
mark Zyban. This is not a nicotine
ing a smoker reflects poor judgment.”***
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Other Information
Various issues of NIDA NOTES (search
Sources ———
by “nicotine” or “smoking”)
For more information on how to quit
For additional information on nicotine,
smoking, please visit the Tobacco
please refer to the following sources on
Information and Prevention Source (TIPS)
NIDA’s Web site,
Web site of the Centers for Disease
Control and Prevention, U.S. Department
Nicotine Addiction—Research Report
of Health and Human Services,
The Brain’s Response to Nicotine—Mind
over Matter
* These findings are from the 2002 National Survey on Drug Use and Health, produced by HHS’s Substance Abuse and
Mental Health Services Administration. The survey is based on interviews with 68,126 respondents who were interviewed
in their homes. The interviews represent 98 percent of the U.S. population age 12 and older. Not included in the survey
are persons in the active military, in prisons, or other institutionalized populations, or who are homeless. Findings from
the 2002 National Survey on Drug Use and Health are available online at
** Conducted annually since 1975, MTF assesses drug use and attitudes among 8th-, 10th-, and 12th-graders, college
students, and young adults nationwide. The survey is conducted by the University of Michigan’s Institute for Social
Research and is funded by NIDA. Copies of the latest published survey are available from the National Clearinghouse
for Alcohol and Drug Information at 1-800-729-6686 or may be downloaded from
*** LD Johnston, PM O’Malley, JG Bachman. (December 16, 2002). Teen smoking declines sharply in 2002, more than
offsetting large increases in the early 1990s
. University of Michigan News and Information Services: Ann Arbor, MI.
[Online]. Available:; accessed 09/25/03.
Revised 10/6/03
National Institutes of Health – U.S. Department of Health and Human Services
This material may be used or reproduced without permission from NIDA. Citation of the source is appreciated.
October 2003
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