Nicotine Addiction: Bio-Psycho-Social Aspects of Addiction

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Nicotine Addiction: Bio-Psycho-Social Aspects of Addiction

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1. Nicotine Addiction: Bio-Psycho-Social Aspects of Addiction Arizona Smokers’ Helpline –

2. What You Should Know by the End of the Presentation Why we should change our thinking and vocabulary related to nicotine Three desirable effects of smoking Three undesirable effects of smoking Three health benefits of smoking cessation Who to contact for assistance with smoking

3. Diary of an Ex-Smoker Jan. 1: my first day as a nonsmoker… | 8 a.m.: Oh, my God! No morning cigarette. Now what do I do? Make Breakfast? Take the dog for a walk? How can I stop thinking about that first cigarette? 10 a.m.: Getting a headache and feeling jittery. Maybe picking a holiday as my Quit Date wasn’t such a good idea. At work I can’t smoke; that might have been easier. Noon: OK, I’ve gone four hours without a cigarette – or 12 hours if you count the time I was asleep last night. Now I know why they say the first few hours are the hardest. 8 p.m.: Should I go to bed early? Maybe this would make the cravings easier to take. Midnight: Can’t sleep. Can’t stop thinking about smoking. Drink some herbal tea. Hope tomorrow will be better.

4. Changing Our Nicotine Vocabulary “Diary of an Ex-Smoker” illustrates difficulty giving up nicotine Smokers are dependent or addicted to nicotine There is a need to change our thinking and subsequently the vocabulary we use to describe nicotine use and abuse

5. Changing Our Nicotine Vocabulary Addiction is a clinical focus Language should reflect the disease – not the symptoms “Alcoholism” is the disease being treated -- not “drinking” “Nicotine addiction” or “dependence” is treated – not “smoking: or “chewing tobacco” (figure 1) Symptoms can be managed medically but will reoccur without intervention addressing the addiction

6. Comprehensive Treatment Treatment is not only about stopping but also about sustaining recovery Comprehensive treatment is necessary: Management of nicotine withdrawal symptoms Use of behavioral modifications to support abstinence and prevent relapse

7. Changing Vocabulary (figure 1)

8. Risk Factors Causes “Risk factor” minimizes casual link between tobacco use and many serious, deadly diseases (figure 2) Preferred term should be tobacco “causes” diseases Many diseases caused by tobacco would be quite rare if there were no tobacco use

9. Changing Vocabulary (figure 2)

10. Dopamine Cycle Dopamine theory: Addicts become accustomed to the high levels of dopamine Dopamine plays an important role in regulation of pleasure Other neurotransmitters also involved in process Dopamine has a central role in nicotine addiction

11. The Brain & Dopamine

12. Signaling Processes (figure 3) Nerve signals from one neuron travel down the axon as electrical impulses They pass to the next cell via neurotrasmitters stored in the nerve endings Nicotine … Enters the body Stimulates dopamine release Produces feelings of pleasure and/or reward

13. Signaling Processes (figure 3)

14. How Drugs Affect Dopamine Levels Nicotine: stimulates release of dopamine; another substance in cigarette smoke blocks the action of MAO Amphetamines: stimulate excess release of dopamine, overwhelming the process of reuptake and enzyme breakdown Cocaine: blocks normal absorption of dopamine; dopamine accumulates in synapse and stimulates the receiver cell

15. Nicotine’s Action in the Brain Nicotine intake stimulates release of dopamine and norepinephrine Dopamine is released from the nucleus accumbens and prefrontal cortex Feelings of pleasure and arousal result from the release of dopamine May increase addictive liability of nicotine. Leads to various physiological effects

16. Desirable Effects of Smoking Muscle Relaxation Normalized mood, decreased anxiety Improved attention span Weight loss, anorexigenic effect, and alteration in brown fat metabolism

17. Undesirable Effects of Smoking Sympathetic activity Arterial constriction Blood pressure Early menopause Osteoporosis Heart rate

18. Evaluating Nicotine Addiction Use of the Fagerstrom questionnaire Use of nicotine blood level test Categories of nicotine use Light Moderate Heavy

19. Fagerstrom Short Form How soon after you wake up do you smoke your first cigarette? Do you find it difficult to refrain from smoking in places where it is forbidden? Which cigarette would you most hate to give up? How many cigarettes per day do you smoke?

20. What You Should Know by the End of the Presentation Why we should change our thinking and vocabulary related to nicotine Three desirable effects of smoking Three undesirable effects of smoking Three health benefits of smoking cessation Who to contact for assistance with smoking

21. What You Should Know by the End of the Presentation Why we should change our thinking and vocabulary related to nicotine Three desirable effects of smoking Three undesirable effects of smoking Three health benefits of smoking cessation Who to contact for assistance with smoking Do you smoke more frequently during the first hours after waking than during the rest of the day? Do you smoke if you are so ill that you are in bed most of the day?

22. Trapped by Nicotine

23. Nicotine Addiction Nicotine is more addictive than heroin Internal sensing system knows when nicotine levels are low Most smokers require a minimum of 10 cigarettes a day to maintain a “comfort zone” First morning cigarettes are often inhaled deeply and to quickly and raise nicotine levels in the blood Nicotine addicts may experience withdrawal symptoms

24. Nicotine Addiction Can Be Intense Craving for nicotine can be so intense that patients continue to smoke despite serious health effects

25. Characteristics of Nicotine Use

26. Characteristics of Nicotine Use

27. Nicotine Habit Some people smoke of chew because of habit Automatic behavior May not realize they are smoking or chewing Habits are linked to other habits Having an alcoholic beverage, putting on make-up, driving in a car, watching TV, or having a cup of coffee may trigger tobacco use People may use cigarettes (or chew) to help them feel more comfortable in social situations People who have a strong smoking habit: Will need to find alternative to tobacco May also have to temporarily avoid situations that are linked to smoking or chewing

28. Nicotine Habit (cont.) People who are emotionally “trapped” by nicotine May feel lonely when they first quit Cigarettes or chew may have been their “best friend” People who feel that tobacco relaxes or comforts them: May use nicotine to help them handle stress May use nicotine when they are lonely, bored, happy or angry

29. Habitual Triggers for Nicotine Use Coffee or tea Alcohol Food Stressful situations Driving Talking on the phone

30. Known Effects of Long-term Smoking Chronic bronchitis Chronic obstructive pulmonary disease (COPD) Cancer of lung and larynx Coronary artery disease

31. Suspected Effects of Long-term Smoking Oral cancer Esophageal cancer Peptic ulcer disease Pancreatic cancer Stomach cancer Renal cancer Bladder cancer Peripheral vascular disease Low birth weight (growth retardation)

32. What Happens to Your Body When You Quit 20 minutes: blood pressure and pulse decrease to normal 8 hours: level of oxygen in blood rises to normal 24 hours: chances of a heart attack decrease 48 hours: sense of taste and smell improve 2 weeks to 3 months: lungs work more efficiently; breathing is easier One to nine months: less coughing, sinus congestion and fatigue

33. Helping Someone Quit Tobacco Behavioral Support: suggest behavioral support such as counseling. The Arizona Smokers’ Helpline offers free telephone counseling and self-help booklets. Call 1-800-556-6222 Cessation Medications: suggest contacting a physician about nicotine replacement (nicotine patch, nasal spray, gum, or inhaler) or a non-nicotine prescription medication Social Support: offer social support during the quitting process

34. Agency for Health Care Policy and Research Recommendations Every person who smokes should be offered cessation treatment at every office visit Clinicians should ask about and record the tobacco-use status of every patient Cessation treatment even as brief as 3 minutes a visit is effective The more intensive the treatment, the more effective it is in producing long-term abstinence from tobacco. Nicotine replacement therapy (nicotine patches or gum), social support, and skills training are effective components of smoking cessation treatment Health care systems should be modified to routinely identify and intervene with all tobacco users at every visit

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