Brief overview
- Description: physical and psychological dependence on nicotine effects
- Symptoms: strong craving for nicotine, loss of control, continued use despite harmful consequences, withdrawal symptoms (e.g. restlessness and irritability)
- Causes: Conditioning of the reward center in the brain, stress, possibly genetically determined response to nicotine
- Diagnosis: Criteria include strong craving, high consumption, difficulty giving up nicotine when smoking is banned, quickly reaching for a cigarette in the morning
- Treatment: motivational treatment, behavioral therapy support, nicotine replacement therapy
- Prognosis: high risk of relapse without professional support, high motivation is crucial for success
Nicotine addiction: Description
For decades, advertising has presented smokers as attractive, free and open-minded people. Despite intensive efforts to educate people, this image is still in many people’s minds today. In fact, most tobacco users are simply addicted to nicotine. The chemical from the tobacco plant affects both the body and the psyche of the smoker. Cigarettes can have a calming but also an invigorating effect. The risk of smoking becoming an addiction is high.
Nicotine addiction: passive smoking
Smoke is not only dangerous for smokers themselves. People who inhale the smoke passively can also suffer damage. It is particularly dangerous when women smoke during pregnancy. This increases the risk of premature birth, newborns often have a lower weight at birth and are more likely to suffer sudden infant death syndrome. Nicotine also enters the baby’s body through the mother’s milk. The more a mother smokes, the higher the concentration in breast milk. Children who are passively exposed to smoke are also harmed. They suffer more frequently than other children from respiratory diseases, pneumonia and middle ear infections.
Nicotine addiction: How many are affected?
Around 29 percent of adults in Germany smoke. That’s around 20 million people. Among men, around 31 percent take up a cigarette, among women it is around 26 percent.
Among young people between the ages of 12 and 17, the number of smokers has fallen significantly since 2001: Back then it was still at 28 percent. According to the latest surveys in 2014, it has now fallen to just under 10 percent. Boys were slightly more likely to smoke than girls (11 versus 9 percent).
Most of the tobacco consumed in Germany is in cigarettes – with or without filters, ready-made from a packet or rolled or stuffed by the smoker. Cigarillos, cigars, pipes, snuff, chewing tobacco and water pipes play a subordinate role.
Nicotine addiction: Toxic fumes
The raw material for raw tobacco is the dried leaves of the tobacco plant. The plant can only be consumed – as a smoking agent, chewing tobacco or snuff – after industrial processing. Tobacco smoke contains more than 4,000 ingredients. The most important active ingredient is nicotine. Depending on the origin of the plants and the preparation of the tobacco, the smoker, snuffer or chewer gets different amounts of the toxic chemical compound. In addition to nicotine, tobacco smoke contains numerous other chemicals and heavy metals, such as hydrogen cyanide, benzene, formaldehyde, hydrazine, vinyl chloride, cadmium, lead, nickel, chromium, aluminum and carbon monoxide. More than 40 of these substances have been proven to be carcinogenic.
Nicotine addiction: symptoms
According to the ICD-10 classification of mental disorders (ICD in short: International Classification of Diseases), at least three of the following criteria must apply over a period of one month or repeatedly within one year for a diagnosis of nicotine addiction:
- Limited control over the start, end and amount of consumption.
- Occurrence of physical withdrawal symptoms when consumption is reduced.
- Development of tolerance: consumption must be increased in order to achieve a constant effect.
- Abandonment or neglect of interests due to substance use.
- Continued tobacco use despite obviously harmful consequences.
As the body becomes accustomed to nicotine, the person concerned must initially consume more and more in order to feel the same effect. Typical withdrawal symptoms are increased excitability and restlessness. Many smokers believe that nicotine reduces their inner restlessness, but it actually increases in the long term. Other withdrawal symptoms include a reduced ability to concentrate, feelings of hunger, sleep disorders and anxiety.
Smoking: Consequences for health
While nicotine is responsible for the effects and addiction, the other chemicals in tobacco smoke are primarily harmful to health. The consequences of smoking affect the health of the entire body. In many cases, tobacco consumption is even responsible for premature death.
Smoking also increases blood pressure and thus promotes heart and vascular diseases. The feared long-term consequences of nicotine addiction include coronary heart disease (CHD), heart attacks and circulatory disorders of the leg arteries (“smoker’s leg”). Other consequences include diabetes (type 2 diabetes) as well as skin and tooth damage.
Last but not least, smoking also increases the risk of cancer. This applies in particular to lung cancer, laryngeal cancer, oesophageal cancer and oral cavity cancer. Nicotine consumption also plays a role in the development of other malignant tumors, such as pancreatic cancer, kidney cancer, stomach cancer and leukemia. Around 25 to 30 percent of cancer deaths are attributable to smoking.
Nicotine addiction: Causes and risk factors
Nicotine addiction is caused by the influence of various psychological and biological factors. Nicotine causes both physical and psychological dependence.
Nicotine addiction: smoking as a learned behavior
Most of those affected started smoking in childhood or adolescence. They pick up a cigarette out of curiosity or due to peer pressure. Many also cover up their insecurities with a cigarette in their hand.
Even in adulthood, cigarettes smoked together fulfill a social purpose. Smoking during work breaks and after meals links nicotine consumption with a feeling of relaxation and enjoyment. As soon as the connection between smoking and certain situations is learned, the reach for a cigarette after a meal or when going out is almost automatic.
Nicotine addiction: Biological factors
Nicotine addiction occurs when our natural reward system in the brain is manipulated. The reward system is essential for survival. For example, it rewards us for eating when we are hungry. To do this, it releases the neurotransmitter dopamine, which makes us feel good. When we consume nicotine, more dopamine is released. Reaching for a cigarette is therefore just as rewarding as eating, drinking and sex. However, regular smokers overstimulate the system. The previous amount of nicotine is no longer sufficient for a positive effect. This development of tolerance and the associated withdrawal symptoms characterize the physical dependence of nicotine addiction. The body increasingly demands more nicotine.
If there is a physical and psychological dependency, it is almost impossible for those affected to control their consumption. The unpleasant withdrawal symptoms of nicotine addiction, which occur as soon as the nicotine level decreases, determine when the next cigarette is smoked.
Nicotine addiction: Examinations and diagnosis
If you suspect a tobacco addiction, you can first consult your family doctor. To diagnose nicotine addiction, he or she will ask questions about your tobacco consumption. The Fagerström questionnaire, which can be used to assess the severity of nicotine addiction, has proved very successful. The Fagerström test contains the following questions, among others:
- How many cigarettes do you smoke a day?
- Do you find it difficult not to smoke when you are in places where smoking is prohibited?
- How soon after waking up do you smoke your first cigarette?
The doctor will also check your physical state of health to determine whether the nicotine addiction has already caused any consequential damage. If necessary, this must be treated.
If the nicotine addiction is severe, the doctor will recommend therapeutic treatment. If the person concerned is motivated, less intensive support measures may also be effective. The doctor will inform you about the various smoking cessation programs available for nicotine addiction.
Nicotine addiction: Treatment
Nicotine addiction: Motivational treatment and brief interventions
A brief intervention to treat nicotine addiction is usually carried out by doctors or in addiction counseling centers. Smoking behavior is first recorded and then the motivation to quit is determined. The smoker is supported in giving up nicotine through short motivational talks. Telephone counseling and self-help groups also offer effective help in combating nicotine addiction.
Nicotine addiction: therapeutic treatment
Behavioral therapy group and individual interventions have proven particularly effective in smoking cessation. In behavioral therapy, the affected person’s behavior is analyzed and alternative behaviors are developed. For example, the therapist will ask which conditions and situations tempt the person concerned to smoke. There is often a connection with stress, which the cigarette is intended to reduce. The therapist helps the patient to find other ways of dealing with stress. Relaxation techniques and strengthening the social network play an important role in this.
Nicotine addiction: Nicotine replacement therapy
Nicotine gum and nicotine mouth sprays do not have a continuous effect, but a slightly delayed effect after ingestion. Nicotine nasal sprays best imitate the effect of a cigarette, but for this reason have a higher risk of addiction.
The physical dependence of nicotine addiction is over after about two weeks. However, the psychological dependence remains and must be treated to prevent relapses. How long the strong desire (craving) persists varies greatly. In many cases, however, nicotine replacement therapy is an effective method of helping people to give up tobacco permanently.
Nicotine addiction: Further measures
Anyone starting to quit smoking should consider a plan for structuring their day. Distracting activities are an important support. Sport in particular makes abstinence easier. On the one hand, those affected notice an improvement in their physical condition and breathing becomes easier. Secondly, sport triggers the release of neurotransmitters that create a feeling of happiness. Friends and family can also make an important contribution. People should be informed about smoking cessation so that they can support the person affected.
Nicotine addiction: Progression and prognosis
An important prerequisite for the success of smoking cessation is the motivation of the person concerned. After a longer period of abstinence, the risk of relapsing is reduced. Nevertheless, vigilance is still necessary even after years. Certain smells or situations can bring back the memory of the good feeling with the cigarette. The decision against nicotine addiction must therefore be made again and again.
