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Overview, Causes, & Risk Factors

Smoking involves inhaling and absorbing nicotine into the body. Nicotine is a poisonous, addictive chemical found in tobacco.

What is going on in the body?

In the 1960s, medical research began to show that cigarette smoking was quite bad for a person's health. At least 70% of smokers in the United States have made at least one attempt to quit smoking. The nicotine in tobacco is as addictive as cocaine. It is because of this addiction that smoking cessation can be so difficult.

What are the causes and risks of the condition?

People quickly become dependent on nicotine when using tobacco products. Anyone who uses these substances is at risk of experiencing withdrawal symptoms. A trigger is anything that creates an impulse to use tobacco. Triggers can be feelings, such as stress, anxiety, depression, or boredom. They can be visual, such as a picture of a poised glamorous movie star taking a long, seemingly satisfying drag. Triggers can even be certain times of the day, such as work breaks or meals.

Symptoms & Signs

What are the signs and symptoms of the condition?

Nicotine has both stimulant and depressant effects on the central nervous system. It can cause a wide variety of symptoms, including the following:

  • alertness or relaxation
  • changes in mood and behavior
  • diarrhea
  • increased pulse and blood pressure
  • nausea and vomiting
  • tremors

  • Diagnosis & Tests

    How is the condition diagnosed?

    Someone who is addicted to nicotine will have strong cravings for it. When the person doesn't smoke for a period of time, he or she will have nicotine withdrawal symptoms.

    Prevention & Expectations

    What can be done to prevent the condition?

    Once a person starts smoking, he or she quickly becomes addicted to nicotine. The key is to never start smoking. Antismoking campaigns can be effective in spreading this message.

    What are the long-term effects of the condition?

    The health risks from the chemicals found in tobacco are enormous. Tobacco use can cause the following diseases:

  • chronic bronchitis
  • coronary artery disease and other forms of heart disease
  • emphysema
  • gastroesophageal reflux disease
  • lung cancer
  • Tobacco also is a factor in causing the following conditions:

  • decreased life expectancy
  • erectile dysfunction, or impotence
  • gray hair and baldness
  • high blood pressure and circulation problems
  • infertility in men and women
  • osteoporosis and increased risk for bone fractures
  • premature wrinkles
  • weakened immune system
  • What are the risks to others?

    Smoking is a form of air pollution. It exposes others to secondhand smoke. People who are exposed to a significant amount of secondhand smoke share many of the same risk factors as people who smoke. A pregnant woman who smokes increases her risk for miscarriage and other health problems for her baby.

    Treatment & Monitoring

    What are the treatments for the condition?

    The first step in smoking cessation is setting up a Quit Plan. A Quit Plan includes the following:

  • quit date and written commitment to stop smoking
  • preferred quit option(s)
  • preferred quit method(s)
  • support team
  • coping strategies for dealing with triggers, withdrawal symptoms, and other challenges
  • There are a number of methods for quitting smoking that address the addiction to nicotine. Going cold turkey, which means stopping smoking abruptly, is one method. Two other methods are non-nicotine medication and various forms of nicotine replacement therapy. The person's level of nicotine dependence and any prior quit attempts should be taken into consideration. The individual can work with the healthcare provider to choose the best method.

    Regardless of the method chosen, the person must also pay attention to breaking the smoking habit. Research shows that smokers who use behavior modification strategies in addition to addressing the physical addiction have a better chance of succeeding.

    Nicotine replacement products help reduce the physical withdrawal symptoms that occur with smoking cessation. These medicines reverse the process in which the person's body learned to crave more and more nicotine. Over time, they help the person's body stop craving nicotine. Nicotine replacement therapy doesn't completely eliminate withdrawal symptoms. It doesn't give the individual any more willpower. It does let the person focus on breaking the habit of smoking as the body adjusts to lower levels of nicotine.

    Some of the types of nicotine replacement therapy are as follows:

  • nicotine gum, which is available over-the-counter or by prescription
  • nicotine inhalers, which are available by prescription
  • nicotine nasal spray, which is given by prescription
  • nicotine patches, which are available over-the-counter in various strengths
  • Since these products replace the nicotine the person would have gotten from a cigarette, nothing new is being introduced into the body. The direct effect from nicotine is the same.

    A person using nicotine replacement products should not continue to smoke. Nicotine can cause serious medical problems, including death, if it is abused. Nicotine replacement products are not recommended for people in the following situations:

  • people who have had a heart attack within the past 2 weeks
  • people who have serious arrhythmias, or irregular heartbeats
  • people who have angina, the chest pain associated with heart disease
  • women who are pregnant, unless their healthcare provider recommends it
  • Zyban, or bupropion, has been approved by the FDA for smoking cessation. How Zyban works is largely unknown. It is thought to act on certain pathways in the brain that are involved in nicotine addiction and withdrawal. The person feels less of an urge to smoke. Zyban also helps reduce some of the more bothersome nicotine withdrawal symptoms associated with smoking cessation. For example, it can reduce anxiety, irritability, frustration, difficulty concentrating, and restlessness.

    What are the side effects of the treatments?

    The most-reported side effect from the nicotine patch is skin irritation. Those who use a 24-hour patch sometimes report having vivid dreams. The patch may also cause headache or joint pain.

    Nicotine gum can cause some minor mouth, tongue, and throat irritation. It may also cause an arrhythmia and palpitations. Swallowing the gum can cause nausea or vomiting.

    The most common side effects from the nasal spray are irritation of the nose and throat, watering eyes, sneezing, and cough. These side effects may lessen in intensity after the first week of use.

    The most common side effect of the nicotine inhaler is irritation of the lining of the mouth and throat. Some people may experience cough, runny nose, or nausea.

    The most common side effects of Zyban include dry mouth and insomnia. If side effects occur, they are generally mild and disappear after a few weeks. Other side effects include shakiness, skin rash, dizziness, and anxiety.

    What happens after treatment for the condition?

    Withdrawal symptoms are temporary. They usually last only 1 to 2 weeks. The person can derail smoking triggers by using counteractions. Counteraction involves actively responding to the trigger, but not in the usual way. Instead of smoking, the individual comes up with a different and healthier response. There are three main ways to cope with triggers.

  • Avoid the situation. Someone who smoked while driving a car can choose a different route that requires more concentration.
  • Change the situation. The person may choose to sit in the nonsmoking section of restaurants.
  • Find a substitute for a cigarette. Pens, small toys, or rubber bands are good options. Chew sugarless gum or hard candy, or try carrot sticks.
  • A relapse occurs when a person who has stopped smoking slips and has a cigarette. Following are some keys to dealing with a relapse.

  • Learn from the relapse and move on.
  • Figure out the details that led to the slip.
  • Review the Quit Plan and reasons to stop smoking.
  • Revise the Quit Plan and set a new quit date.
  • How is the condition monitored?

    To remain nicotine free, smokers should avoid tempting situations and do something else when the urge to smoke arises.

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