Tobacco dependence refers to the dependence on nicotine , an alkaloid of the tobacco plant , in interaction with various other ingredients of tobacco or tobacco smoke. Tobacco addiction arises mostly and in a particularly pronounced way through smoking tobacco containing nicotine. However, nicotine can be addictive in any form of administration , although there are considerable differences in whether it is smoked, chewed or snorted .
Effects of tobacco smoke
Tobacco smoke, together with nicotine and other substances, is a rapidly addicting substance. It not only has psychostimulatory effects like cocaine or amphetamine , but also triggers the entire range of neuromodulators in the brain .
In connection with other substances, nicotine attacks two different compartments , the presynaptic and postsynaptic acetylcholine receptors (“nicotine receptors”). When it binds to the receptors, various neurotransmitters (chemical substances that serve to exchange information between the individual nerve cells) such as dopamine , serotonin , noradrenaline and endorphins are released . These influence different functional structures of the brain, with individual variations. The nicotinic acetylcholine receptors are very closely related to the prefrontal cortex . This may temporarily improve brain functions such as attention, memory and learning through nicotine. However, if nicotine is considered in connection with tobacco smoke, studies come to the conclusion that memory performance deteriorates due to tobacco abuse.
Comparisons of animal studies and studies on human drug use show that pure nicotine is only slightly addictive, while tobacco cigarette smoke is very addictive. Nicotine is jointly responsible for the dependence on tobacco products and, in connection with other substances in tobacco smoke, has a high potential for dependency and can very quickly lead to dependent behavior. According to an article by D. Nutt et al. Published in 2007. the addiction potential of tobacco smoke lies somewhere between alcohol and cocaine. More precisely, the potential for physical dependence is that of alcohol or barbiturates and the potential for psychological dependence is that of cocaine. A few cigarettes or a few days with small cigarette consumption are enough to become physically dependent. The potential for dependence on orally ingested nicotine is significantly lower, and patches have almost no potential for dependence.
Studies on the question of whether the consumption of a single cigarette is enough to cause typical symptoms of dependency such as inner restlessness, irritability and difficulty concentrating and to cause a loss of personal self-determination (autonomy) have so far not led to reliable results because they are sometimes untenable or headstrong Addiction definitions and superficial criteria were used for the diagnosis of “nicotine dependence”, and the data were interpreted biased.
Above all, it is important that nicotine, in conjunction with other substances in tobacco smoke, subliminally creates the desire for a tobacco product and that the increasingly shorter habit-related stimulus-response interval creates an increasingly pronounced dependency in the form of increased tobacco consumption. Possible withdrawal symptoms can include irritability, restlessness, circulatory problems, headaches and sweating. However, the symptoms go away in 5-30 days.
Today we know that after three weeks of abstinence there is no longer any measurable change in the acetylcholine receptors - that is, they have returned to normal. During this time there can be restlessness and irritability up to aggressiveness and depression. At this point in time, the nicotine itself is no longer detectable in the brain (up to a maximum of three days after the end of nicotine consumption).
As a result, it can be stated that during withdrawal the dependence on the effects produced by the tobacco smoke is less important, as shown by many failed therapies with nicotine substitutes, but rather the learning process induced by the nicotinergic stimulation of the nucleus accumbens . Appropriately, this learning process can only be influenced or reversed by strong self-motivation or professional behavioral therapies. Nicotine substitutes and other medications can help with withdrawal.
The psychological dependency due to imprinted behavior patterns that develop in the course of a “smoking career” can still be present years after physical withdrawal.
The likelihood of relapse among smokers who quit tobacco without aids is 97% within six months of quitting. Up until 2012, it was assumed that nicotine replacement preparations with the correct dosage and further professional guidance could increase the chances of success by three percent. Recent studies after 2013 indicate that the relapse rate among those who used nicotine replacement supplements to quit was just as high as those who quit without aids.
Additives as addiction enhancers
Numerous substances that increase the addiction potential of tobacco smoke can be added to tobacco.
A scientific study by the Dutch RIVM ( Rijksinstituut voor Volksgezondheid en Milieu - National Institute for Public Health and the Environment) examined two brands of cigarettes with significantly different ammonium levels in tobacco (brand 1 contained 0.89 mg ammonium / g tobacco; brand 2 contained 3.43 mg ammonium / g tobacco), but the same nicotine content in the smoke. 51 study participants each smoked one of the cigarettes (mark 1 in the morning and mark 2 in the afternoon). Both brands had to be smoked according to an identical puff protocol. The individual train volumes were determined for each participant. After smoking, nicotine uptake and nicotine excretion in the blood were measured. No differences in nicotine intake were found between the two brands of cigarettes. The ammonium content in tobacco therefore has no influence on nicotine intake.
Economic aspects of tobacco smoking
Depending on the inclusion and consideration of the tobacco tax and the consequences for the health and social system (lost work, treatment costs , earlier death, lower pension payments, falling tobacco tax revenues ...) the calculations of the costs caused by tobacco consumption fluctuate considerably.
Ways to quit smoking include:
- drug therapy with nicotine agonists
- Nicotine in chewing gum, depot plaster, inhaler, nasal spray, oral spray, micro-tablets
- accompanying low-potency neuroleptics , antidepressants
- Behavior therapy
- Hypnosis treatment
- Acupuncture , acupressure
The scientific study on the effectiveness of hypnotherapy is considered inconsistent. The effectiveness of acupuncture does not go beyond the placebo effect.
There are currently three active ingredients available for drug therapy (nicotine preparations, bupropion , varenicline ), which can help with weaning. Cases of adverse effects on the cardiovascular system were documented in all of them. With varenicline, cases of depression , thoughts of suicide and committed suicide , aggressiveness and abnormal behavior have been documented. In the USA, this led to the drug having to be given warning labels. A review from 2013, which included 63 individual studies, found no increase in serious cardiovascular risks.
If the habit is stronger than the pure nicotine addiction (the secondary effects of smoking also apply to substitutes):
- End point method
- Fagerström test (tobacco addiction test)
- Smoking cessation program
- Unit packaging
- Tobacco smoking
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