Besides physical hazards, smoking causes behavioral problems in the form of dependence syndrome, characterized by progressively increasing the amount of smoke, intense craving, and withdrawal symptoms in the absence of smoke. Though it can be quit on its own, it also requires specific treatment for a complete cure. Smoking is one of the common modes of substance use. Usually, people smoke cigarettes, pipes, bidis, chillums, and hookahs. A common ingredient of smoke is tobacco, derived from dried leaves of the tobacco plant. Tobacco consists of an alkaloid known as nicotine, which is water soluble and is a psychoactive substance.
Why Is Smoking Bad for Health?
When a person smokes, the harmful chemicals enter the lungs and spread throughout the body. They are capable of reaching the heart, brain, and other organs within ten seconds of the first puff. They can go to every part of the body through the bloodstream and harm them. Smoking causes disease and disability, and it also harms almost every organ of the body. Smoking causes poor health, increased health care utilization and cost, and increased absenteeism. Smoking causes cancer, lung diseases, stroke, heart disease, and chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema. Smoking may cause tuberculosis, eye diseases, and immune system disorders like rheumatoid arthritis. The chemicals can damage the body in many ways:
Nicotine narrows the arteries and veins, damaging the heart and forcing it to work harder. It also slows the blood reaching the organs and reduces the oxygen reaching the feet and hands.
Tar coats the lungs like soot in chimneys as it is a sticky substance.
Carbon monoxide reduces the oxygen the heart needs to pump blood around the body. Over time, the airways get swollen and let less air into the lungs.
Phenols kill the cells resembling hair in the airways. These cells sweep the lining of the airways and protect it from infections.
Ammonia and formaldehyde cause irritation to the nose, eyes, and throat.
Tiny particles in tobacco smoke cause irritation to the lungs and throat, resulting in a smoker’s cough. This makes the person produce more mucus and damage tissues of the lungs.
Cancer-causing chemicals cause the cells to grow abnormally or too fast, resulting in cancer cells.
How Does One Get Addicted to Nicotine?
On average, one cigarette consists of 1 to 1.5 mg of nicotine. Once you start to smoke, nicotine reaches the brain within 15 seconds. In the brain, nicotine primarily acts on alpha nicotinic receptors, distributed in different areas of the brain, predominantly in the frontal cortex, where it acts to enhance concentration. Besides the frontal cortex, nicotine also acts on the nucleus accumbens, where it produces its craving causing effect just like other psychoactive substances, hence leading to dopamine surge leading to increased pleasure with smoking and hence causing dependence in long term use.
What Are the Withdrawal Effects?
Usually, people begin smoking too early (by the age of 14 to 15 years). In the beginning, they smoke one to two puffs which can lead to pleasurable sensations. But gradually, the amount needs to be increased to seek the same pleasure. This is called tolerance, one of the features of dependence. With long-term use, the brain cannot bear the mere absence of nicotine. Hence with the lack of nicotine, a person starts developing withdrawal effects in the form of irritability, headaches, restlessness, and difficulty concentrating. They also develop specific behaviors reflecting the need for smoke, the urge to smoke in public places, and to smoke with tea or coffee. They will not be able to enjoy it until they get a chance to smoke and would remain preoccupied most of the time in regard to seeking out a smoke.
How to Diagnose Tobacco Dependence?
There are a few criteria by which a person can be diagnosed with tobacco dependence. One such commonly used criteria is the modified Fagerstrom tolerance questionnaire, used by clinicians regularly. This test consists of six items that evaluate the compulsion of use, the quantity of cigarette consumption, and dependence. “Yes” or “no” items are scored from zero to one, and multiple choice items are scored from zero to three. The items are summed to have a score between zero to ten. The higher the total score, the more intense the patient’s dependence on cigarettes.
What Are the Treatment Options for Tobacco Dependence?
Once diagnosed with dependence, the next question which arises is how to treat it. Currently, there are many modes to treat tobacco dependence. It is commonly divided into two broad categories, pharmacological and non-pharmacological.
Pharmacological modes include drugs:
Nicotine Replacement Therapy (NRT) - Nicotine replacement therapy provides a nicotine substitute for smoking and can be given under supervision, and the dose can be regulated and gradually tapered. The dose of nicotine replacement therapy is determined by the number of smokes required per day by a person. The average duration of treatment is ten weeks. NRT can be given in the form of gums, lozenges, patches, and nasal sprays.
Bupropion - It is a noradrenergic dopamine reuptake inhibitor antidepressant, which acts by increasing the level of dopamine. It increases the dopamine level in the nucleus accumbens, hence reducing the pleasure produced by tobacco smoke. Hence reduces the craving for a smoke.
Also, motivation assessment is also important and should be carried out alongside the treatment because if the motivation level is low, the risk of relapses is high. Hence, the person should be motivated enough to quit smoking, and their motivation should always be increased by the therapist with every session to increase the success of the treatment. To enhance motivation, motivational enhancement therapy can be used as well.
In the end, though smoking is easy to start, it is difficult to quit. But if one is motivated enough, it can be stopped, and abstinence can be maintained as well. Quitting smoking improves overall health and reduces the risk of smoking-related illnesses. It is never too late to stop smoking.
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