What is Smoking?

Smoking

What is nicotine addiction?

If you smoke, you've probably become addicted to nicotine, a chemical in tobacco. This makes it very hard to give up smoking. Most people don't manage to quit the first time they try. You may need to try several times before you're able to stop smoking for good.

There are good treatments that can help you quit smoking. These treatments give you a better chance of stopping smoking than if you rely on willpower alone.

If you smoke, you've probably become addicted to nicotine, a chemical in tobacco.

The main thing is, don't give up trying to quit. Half of all smokers eventually manage to stop smoking.

Source:
Giovino GA, Henningfield JE, Tomar SL, et al.
Epidemiology of tobacco use and dependence.
Epidemiology Review. 1995; 17: 48-65.

Key points about smoking

Smoking is the biggest cause of death and illness in the United States.

Source:
American Lung Association.
Trends in tobacco use.
December 2006. Available at http://www.lungusa.org (accessed on 20 November 2008).

² More than half a million Americans die each year from diseases caused by smoking.

Source:
Peto R, Lopez AD, Boreham J et al.
Mortality from smoking in developed countries 1950-2000.
June 2006. Available at http://www.ctsu.ox.ac.uk/~tobacco/C2450.pdf (accessed on 19 November 2008).

³
Quitting smoking reduces your chances of getting

heart disease
You get heart disease when your heart isn't able to pump blood as well as it should. This can happen for a variety of reasons.

heart disease and cancer, and it may help you live longer.
Most smokers find it hard to quit because they are addicted to nicotine. Addiction is a serious condition, and you can get help to overcome it.

Source:
U.S. Public Health Service.
Treating tobacco use and dependence.
June 2000. Available at http://www.surgeongeneral.gov (accessed on 19 November 2008).

⁴
You have a better chance of quitting if you use nicotine replacement therapy and if you get professional help.
An

antidepressant
Antidepressants are medicines used to treat depression and sometimes other conditions. They work by changing the levels of chemicals in your brain called neurotransmitters. There are three main types of antidepressants, which work in different ways: selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs).

antidepressant drug called bupropion (brand name Zyban) helps many people quit. This drug can help you quit even if you aren't depressed.
A newer drug, called varenicline (brand name Chantix) may work better than buproprion.

Your body and nicotine

Most people who smoke are addicted to nicotine. This is a chemical that's found in tobacco. It doesn't matter whether you smoke cigarettes, cigars or a pipe, or if you chew tobacco. It's the nicotine that gives you a "hit." And it's because your body needs those hits from nicotine to feel "normal" and well that you keep up your habit.

Nicotine reaches your brain about 10 seconds after you take a drag on a cigarette.

Source:
Balfour DJ.
The neurobiology of tobacco dependence: a commentary.
Respiration. 2002; 69: 7-11.

⁵
It helps your brain make a chemical called dopamine. Dopamine plays a part in making us feel pleasure.

Source:
National Institute on Drug Abuse.
NIDA infofacts: cigarettes and other nicotine products.
September 2008. National Institute on Drug Abuse. Available at www.drugabuse.gov (acessed on 19 November 2008).

⁶
People who smoke say it makes them feel relaxed, and there's some evidence that nicotine may make you feel more alert.
It may also help you concentrate and put you in a better mood.

If you're addicted, from time to time you feel that you have to have a smoke. You crave a cigarette. You find it hard to stop smoking, or you get

withdrawal symptoms
Withdrawal symptoms are when you get unpleasant physical or mental symptoms because you stopped taking a drug you were physically dependent on. Your can become physically dependent on a drug if it alters the level of certain chemicals in your body. This makes your body produce less of those chemicals or change how it responds to them. Also, some drugs work in a similar way to chemicals that naturally occur in your body. This may mean your body stops making its natural versions. If either of those things happens, your body will need the drug to function normally and you will feel or become ill if you suddenly stop taking the drug. You can get withdrawal symptoms from some prescription medicines, as well as some illegal drugs.

withdrawal symptoms when you try to stop. You might feel miserable or find it hard to concentrate, for example.

You might want to read more about what we know about nicotine and why it's so easy to get addicted.

Starting young

If you smoke, chances are you started when you were a teenager, probably because your friends smoked. Most teens say that another reason they smoke is because it helps them feel less stressed.

Source:
Simantov E, Schoen C, Klein JD.
Health-compromising behaviors: why do adolescents smoke or drink? Identifying underlying risk and protective factors.
Archives of Pediatrics and Adolescent Medicine. 2000; 154: 1025-1033.

⁷

Young people may not realize smoking is addictive.

About 1 in 8 boys who smoke say they do it because it's "cool," while 1 in 6 girls say they smoke to stay slim.

⁷

Many young people try out smoking at some point. A big problem is that you may not realize smoking is addictive until you're hooked.

Source:
Rugkasa J, Knox B, Sittlington J, et al.
Anxious adults vs. cool children: children's views on smoking and addiction.
Social Science & Medicine. 2001; 53: 593-602.

⁸ Also, certain things seem to increase a person's chances of becoming addicted to nicotine. Doctors call these risk factors. The risk factors for getting addicted to nicotine include:

⁷

Smoking as a teenager
Coming from a poorer background
Family problems
Feeling depressed
Being physically or sexually abused
Having parents who smoke.

Other things seem to protect against getting addicted. These include:

⁷

Being close to your parents
Taking part in activities outside school or work, such as sports.

Some myths about smoking

"I'm not addicted. I smoke only when I see friends who smoke. I could give up at any time."

If this describes you, you may not be physically addicted, but you're probably psychologically addicted. If you need to smoke when your friends smoke, you'll find it hard to quit.

Even if you're not addicted, smoking still harms your health.
And smoking can hurt people close to you, too. People can breathe in smoke from your cigarettes. This "second-hand" smoke can cause breathing problems in children. And adults can get lung cancer from smoke without ever having a cigarette.

Source:
Department of Human and Health Services.
The health consequences of involuntary exposure to tobacco smoke: a report of the surgeon general.
June 2006. Available at http://www.surgeongeneral.gov/library/secondhandsmoke/ (accessed on 19 November 2008).

⁹ To find out more about this, see What smoking does to other people.

"Smoking 'light' cigarettes is less harmful."

Don't be fooled by the word "light" on your pack of cigarettes. They may be lower in nicotine but that won't help protect your health. Here's why.

If you smoke regularly (even just a few cigarettes a week), you're still addicted.
You get all the same harmful chemicals from light cigarettes as you get from standard ones.
Light cigarettes may actually be more harmful. If the cigarette gives you less nicotine than your body is used to, you'll have to smoke more or inhale more deeply to get the same effect.
So you may be sucking harmful chemicals deeper into your lungs than you would if you smoked stronger brands.

Source:
Carmona R, Surgeon General, US Public Health Service.
Can Tobacco Cure Smoking? A Review of Tobacco Harm Reduction.
June 2003. Available at http://www.surgeongeneral.gov/news/testimony/tobacco06032003.htm (accessed on 19 November 2008).

¹⁰

"I smoke cigars and don't inhale, so I won't get lung cancer."

Although most people don't inhale when they drag on a cigar, they still hold the smoke in their mouth, and they also breathe in smoke from the air around them. So the poisonous chemicals in tobacco smoke get into their lungs and their body.

Cigar smokers are just as likely to get mouth and throat cancer as cigarette smokers.
They're also much more likely to get lung cancer and other diseases linked to smoking than people who don't smoke.

Other chemicals in tobacco

There may be other chemicals in tobacco smoke that play a part in addiction.

Source:
National Institute on Drug Abuse.
NIDA infofacts: cigarettes and other nicotine products.
September 2008. National Institute on Drug Abuse. Available at www.drugabuse.gov (acessed on 19 November 2008).

⁶ But researchers are only just beginning to find out about them.

Sources for the information on this page:

Giovino GA, Henningfield JE, Tomar SL, et al.Epidemiology of tobacco use and dependence.Epidemiology Review. 1995; 17: 48-65.

American Lung Association.Trends in tobacco use.December 2006. Available at http://www.lungusa.org (accessed on 20 November 2008).

Peto R, Lopez AD, Boreham J et al.Mortality from smoking in developed countries 1950-2000.June 2006. Available at http://www.ctsu.ox.ac.uk/~tobacco/C2450.pdf (accessed on 19 November 2008).

U.S. Public Health Service.Treating tobacco use and dependence.June 2000. Available at http://www.surgeongeneral.gov (accessed on 19 November 2008).

Balfour DJ.The neurobiology of tobacco dependence: a commentary.Respiration. 2002; 69: 7-11.

National Institute on Drug Abuse.NIDA infofacts: cigarettes and other nicotine products.September 2008. National Institute on Drug Abuse. Available at www.drugabuse.gov (acessed on 19 November 2008).

Simantov E, Schoen C, Klein JD.Health-compromising behaviors: why do adolescents smoke or drink? Identifying underlying risk and protective factors.Archives of Pediatrics and Adolescent Medicine. 2000; 154: 1025-1033.

Rugkasa J, Knox B, Sittlington J, et al.Anxious adults vs. cool children: children's views on smoking and addiction.Social Science & Medicine. 2001; 53: 593-602.

Department of Human and Health Services.The health consequences of involuntary exposure to tobacco smoke: a report of the surgeon general.June 2006. Available at http://www.surgeongeneral.gov/library/secondhandsmoke/ (accessed on 19 November 2008).

Carmona R, Surgeon General, US Public Health Service.Can Tobacco Cure Smoking? A Review of Tobacco Harm Reduction.June 2003. Available at http://www.surgeongeneral.gov/news/testimony/tobacco06032003.htm (accessed on 19 November 2008).

This information was last updated on May 11, 2009

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© BMJ Publishing Group Limited 2009. All rights reserved.

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