Tobacco and Nicotine

Page last updated June 11, 2020 by Doug McVay, Editor/Senior Policy Analyst.

16. Tobacco and Nicotine Addiction

"Long-term exposure to nicotine produces biologic adaptations leading to reduced sensitivity to some of the effects of nicotine (tolerance) and symptoms of distress soon after cessation of drug use (withdrawal). Tolerance of nicotine in adolescent smokers may be related to onset of drug dependence, even though tolerance in adult smokers does not appear to be related to different indices of nicotine addiction. Withdrawal symptoms, especially self-reported cravings and negative affect, are related to some indices of addiction. A narrower focus on the individual withdrawal symptoms most strongly related to relapse, such as negative affect (e.g., depressed mood), may increase understanding of the underlying mechanisms associated with the maintenance of nicotine addiction and requires further study.
"Positive reinforcement from nicotine may play a more significant role in the initiation of smoking, and negative reinforcement, particularly relief from withdrawal, is an important contributor to the persistence of smoking and relapse. Measures of nicotine’s reinforcing effects, especially the most common measure—self-reported number of cigarettes smoked per day—are consistently related to other indices of addiction, including the risk of relapse. However, other objective measures of nicotine’s reinforcing effects, especially those reflecting persistence in smoking behavior, may provide even stronger markers of addiction for predicting clinical outcomes and for testing the efficacy of new treatments or tobacco products. Such measures may also be useful as endophenotypes of dependence for future research into the etiology of addiction, including the influence of a person’s genetic composition. Therefore, the development of these validated markers and measures for nicotine and smoking reinforcement is critical for future research examining the etiology and treatments for nicotine addiction and for tobacco product testing."

US Department of Health and Human Services. "How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General." Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010, p. 124.
http://www.cdc.gov/tobacco/dat...

17. Nicotine Dependence, Co-Occurring Substance Use Disorders, and Psychiatric Comorbidity

"It is estimated that nearly one-half of all cigarettes sold in the United States (44 percent) are consumed by people with mental illnesses or substance abuse disorders. In addition, the prevalence of tobacco use among those with either addictions and/or mental illness is between 38 to 98 percent, as opposed to 19.8 percent for the general population (Schroeder 2009). Breslau and colleagues (1991) have conducted several studies. One earlier population-based study in Michigan observed that young adults with a diagnosis of nicotine dependence reported higher prevalence of alcohol and drug dependence and major depression and anxiety disorders than did persons who had never experienced nicotine dependence (Breslau et al. 1991). The relationships between each disorder and nicotine dependence were observed even when adjustments were made for confounding comorbidities. These findings are similar to those observed for adolescent smokers described earlier (Dierker et al. 2001) (see 'Determinants of Nicotine Addiction' earlier in this chapter). However, the results were contrary to other findings among adolescents (Clark and Cornelius 2004; Rohde et al. 2004). Other population-based research and clinical studies have also pointed to the strong relationship between daily smokers or nicotine-dependent smokers (as opposed to lifetime nonsmokers or non-dependent smokers) and substance use disorders, anxiety disorders, and depression, with higher prevalence of comorbid psychiatric disorders among nicotine-dependent smokers and higher prevalence of nicotine-dependent smokers among persons with comorbid disorders. For example, in a U.S. population-based survey, Grant and colleagues (2004) observed that the prevalence of alcohol use disorders, current mood disorders, or current anxiety disorders among adult respondents with diagnoses of nicotine dependence during the past year ranged from 21 to 23 percent compared with 9 to 11 percent in the general population. Conversely, other studies have shown the percentage of persons with nicotine dependence among respondents with these comorbid disorders ranging from 25 to 35 percent and as high as 52 percent among respondents with drug use disorders compared with 12.8 percent in the general population (Glassman et al. 1990; Breslau et al. 1994, 2004b; Lasser et al. 2000; Degenhardt and Hall 2001; Kandel et al. 2001; Isensee et al. 2003; Schmitz et al. 2003; Grant et al. 2004; John et al. 2004)."

US Department of Health and Human Services. "How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General." Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010, pp. 167-168.
http://www.cdc.gov/tobacco/dat...

18. Nicotine Dependence and Psychiatric Disorders

"Comorbidity between ND and psychiatric disorders characterized these adolescent smokers. Nicotine dependent adolescents had higher rates of anxiety, mood, disruptive, and multiple disorders than non-dependent smokers. The study elucidates these associations. Foremost, comorbidity between ND and psychiatric disorders in adolescence results from the fact that psychiatric disorders increase the risk of ND, controlling for common underlying factors. ND increases the risk of psychiatric disorders to a much weaker extent. This partially is due to the fact that, on average, psychiatric disorders onset ND by at least two and a half years, as reported by others [32,50], and in most cases psychiatric disorders precede ND. With control for covariates, we demonstrated a bidirectional association between disruptive disorder and ND, a unidirectional association between anxiety and ND, and no association between mood disorder and ND. Comorbidity of ND with mood disorders is explained by a common etiology."

Pamela C. Griesler, Mei-Chen Hu, Christine Schaffran, and Denise B. Kandel, "Comorbid Psychiatric Disorders and Nicotine Dependence in Adolescence," Addiction, 2011 May; 106(5); 1010-1020. doi:10.1111/j.1360-0443.2011.03403.x
http://www.ncbi.nlm.nih.gov/pm...

19. Tobacco and Cancer

"Although cigarette smoke contains diverse carcinogens, PAH, N-nitrosamines, aromatic amines, 1,3-butadiene, benzene, aldehydes, and ethylene oxide are among the most important carcinogens because of their carcinogenic potency and levels in cigarette smoke. Moreover, the major pathways of metabolic activation and detoxification of some of the principal carcinogens in cigarette smoke are well established. Reactive intermediate agents critical in forming DNA adducts include diol epoxides of PAH, diazonium ions generated by ?-hydroxylation of nitrosamines, nitrenium ions formed from esters of N-hydroxylated aromatic amines, and epoxides such as ethylene oxide. Glutathione and glucuronide conjugation play major roles in detoxification of carcinogens in cigarette smoke.
"Familial predisposition and genetic polymorphisms may play a role in tobacco-related neoplasms. Researchers have established cigarette smoking as a major cause of lung cancer; more than 85 percent of lung cancers are attributable to smoking. However, not all smokers develop lung cancer, and lung cancer can arise in lifetime non-smokers. This variation in disease has stimulated interest in molecular epidemiology of genetic polymorphisms, including genes that regulate the cell cycle and genes for carcinogen-metabolizing enzymes that may lead to variations in susceptibility to the carcinogens in tobacco smoke. Studies to date suggest a role for these genetic polymorphisms in the risk of lung and bladder cancer in smokers, and they support the possibility of interactions between genes and smoking status."

US Department of Health and Human Services. "How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General." Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010, p. 302.
http://www.cdc.gov/tobacco/dat...

20. Tobacco Use, Cardiovascular Disease, and CVD Mortality

"Cigarette smoking is a major cause of CVD, and past reports of the Surgeon General extensively reviewed the relevant evidence (U.S. Department of Health, Education, and Welfare [USDHEW] 1971, 1979; USDHHS 1983, 2001, 2004). Cigarette smoking has been responsible for approximately 140,000 premature deaths annually from CVD (USDHHS 2004). More than 1 in 10 deaths worldwide from CVD in 2000 were attributed to smoking (Ezzati et al. 2005). In the United States, smoking accounted for 33 percent of all deaths from CVD and 20 percent of deaths from ischemic heart disease in persons older than 35 years of age (Centers for Disease Control and Prevention 2008). Cigarette smoking also influences other cardiovascular risk factors, such as glucose intolerance and low serum levels of high-density lipoprotein cholesterol (HDLc). However, studies have reported that smoking increases the risk of CVD beyond the effects of smoking on other risk factors. In other words, the risk attributable to smoking persisted even when adjustments were made for differences between persons who smoke and nonsmokers in levels of these other risk factors (Friedman et al. 1979; USDHHS 1983, 2001, 2004; Shaper et al. 1985; Criqui et al. 1987; Ragland and Brand 1988; Shaten et al. 1991; Neaton and Wentworth 1992; Freund et al. 1993; Cremer et al. 1997; Gartside et al. 1998; Wannamethee et al. 1998; Jacobs et al. 1999a). For example, in one study, the effect of cigarette smoking on the risk of coronary heart disease (CHD) was evident even among persons with low serum levels of cholesterol (Blanco-Cedres et al. 2002)."

US Department of Health and Human Services. "How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General." Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010, p. 355.
http://www.cdc.gov/tobacco/dat...

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