Tobacco Addiction

Tobacco addiction (a-DIK-shun) is a strong craving for nicotine (NICK-o-teen), a chemical in tobacco that makes it hard for people to quit smoking despite the many health risks.


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Nicotine dependence

Smoking cessation

Cigarette smoking can be hazardous not only to your physical health but also to your social health. Contrary to popular belief, most young people do not smoke. In fact, 9 of 10 middle school students and 7 of 10 high school students reported that they were not currently smoking, according to the 1999 National Youth Tobacco Survey. Other research has found that two-thirds of teenagers say that seeing someone smoke turns them off, and more than four-fifths say they would rather date nonsmokers.

What Is Tobacco Addiction?

As encouraging as these figures are, though, they still mean that 1 of 10 middle school students and 3 of 10 high school students smoke cigarettes. Once they get started, most find it hard to stop. They quickly develop tobacco addiction, which means that they have a strong, uncontrollable craving for nicotine, a chemical in tobacco. Nicotine is an easy drug to get hooked on, as highly addictive as heroin or cocaine for some people.

One hallmark of any addiction is tolerance (TAH-le-rans), which means that over time people start to need more and more of a substance to feel its effects. Another effect is withdrawal symptoms, which means that people who are addicted to a substance have physical symptoms and feel sick if they stop using it. Tobacco addiction causes both effects. When people first start smoking, one cigarette may be enough to make them queasy and dizzy. Soon they can smoke several cigarettes without any symptoms, however, and most smokers are up to a pack or more each day by age 25. When people are forced to stop smoking even for a short time, they have unpleasant symptoms. Many rush to light up as soon as they leave a place where smoking is not allowed.

What Is Tobacco Withdrawal?

Most smokers say they do not plan to be smoking in 5 years. But, in fact, more than 70 percent of smokers continue to do so. The main reason it is so tough for them to quit is the discomfort of withdrawal. When smokers suddenly stop or sharply cut back on their tobacco use, a host of distressing symptoms quickly set in. People are tempted to start smoking again to relieve the distress. Common symptoms of tobacco withdrawal include:

  • bad mood
  • depression
  • trouble sleeping
  • irritability
  • anger
  • anxiety
  • short attention span
  • increased appetite
  • weight gain

What Forms of Tobacco Are Used?

There is no such thing as a safe tobacco product. The use of any tobacco product, even ones that are labeled "low tar," "naturally grown," or "additive free," can cause addiction and health problems. Likewise, the use of tobacco in any form, including cigarettes, cigars, pipes, and smokeless tobacco (chewing tobacco or snuff), is harmful. Although cigarettes are the most popular form of tobacco, others are common too. The 1999 National Youth Tobacco Survey was the first study to look at the use of all kinds of tobacco products by young people nationwide. Of the high school students in the study, about 15 percent sometimes smoked cigars, and sizable numbers also used smokeless tobacco (chewing tobacco or snuff), kreteks (clove cigarettes), or bidis (small, flavored cigarettes from India).

What Are the Short-Term Effects of Nicotine?

Nicotine narrows the blood vessels and puts added strain on the heart. Smoking also causes shortness of breath and reduces the amount of oxygen that is available for the muscles and other body tissues to use. These changes can limit people's ability to do the things they want to do. In young people, sports performance can suffer as a result. For example, many smokers cannot run as far or as fast as nonsmokers. Tobacco use also makes people less attractive. It stains teeth and causes bad breath, yellowed fingers, and smelly clothes. In addition, even brief use of smokeless tobacco can cause cracked lips and white spots, sores, and bleeding in the mouth.

* larynx (LAYR-inks) is a structure in the throat, composed of muscle and cartilage (KAR-ti-lij) and lined with a mucous (MYOO-kus) membrane, that guards the entrance to the windpipe and serves as the voice organ.

* esophagus (eh-SOF-a-gus) is the tube connecting the stomach and the throat.

What Are the Health Risks of Tobacco Use?

Tobacco use is the primary cause of preventable death in the United States, leading to more than 400,000 deaths each year. It kills more people than AIDS, alcohol, drug abuse, car crashes, murders, suicides, and fires combined. The health risks include:

  • Cancer: Smoking is a leading cause of cancer of the lungs, larynx * , mouth, throat, and esophagus * , and it plays a role in many other cancers. This is not surprising, since 60 of the more than 4,000 chemical compounds in tobacco and tobacco smoke are known to cause cancer, cell changes, or tumor growth.
  • Lung disease: Smoking is a major cause of chronic bronchitis (KRO-nik brong-KY-tis), long-lasting inflammation of the breathing tubes or passages that connect the windpipe to the lungs, and emphysema (em-fi-SEE-ma), a long-lasting disease in which the air sacs of the lungs become overly large and don't empty normally. It also worsens colds and pneumonia (noo-MO-nya), an inflammation of the lungs usually caused by infection.
  • Heart disease and stroke: Smokers are twice as likely as nonsmokers to have a heart attack, in which the heart is damaged when the blood supply to part of the heart muscle is decreased or blocked. Smoking also raises the risk of having a stroke, in which a blood vessel to the brain is blocked or bursts, resulting in injury to brain tissue.
  • Pregnancy problems: Smoking by pregnant women is linked to miscarriage * , stillbirth * , premature birth * , low birth weight * , and infant death. Women who smoke also are more likely to have trouble getting pregnant.
  • Dental problems: Use of smokeless tobacco can lead to gum problems and tooth loss.

* miscarriage (MIS-kare-ij) is the loss of a pregnancy before birth.

* stillbirth is the birth of a dead infant.

* premature (pre-ma-CHUR) birth means born too early. In humans, it means being born after a pregnancy term lasting less than 37 weeks.

* low birth weight means born weighing less than normal. In humans, it refers to a full-term (pregnancy lasting 37 weeks or longer) baby weighing less than 5.5 pounds.

What Causes Tobacco Addiction?

Nicotine is absorbed easily from tobacco smoke in the lungs. It also is absorbed from smokeless tobacco through the inner lining of the mouth. Within seconds, it travels through the bloodstream to the brain. There it signals the brain to release chemicals that make people want to smoke more. The effect is very powerful. Some people find it especially hard to kick tobacco addiction. The younger people are when they start smoking, the harder it is to quit and the greater the risk to their health.

On April 14, 1994, top executives from Philip Morris, RJ Reynolds, and other major cigarette companies testified before a federal court about the addictive nature of nicotine. The tobacco industry also came under attack for targeting children and teens in their ad campaigns. In response, anti-smoking regulations have restricted cigarette sales and the ways in which cigarette companies can market their product. AP/Associated Press
On April 14, 1994, top executives from Philip Morris, RJ Reynolds, and other major cigarette companies testified before a federal court about the addictive nature of nicotine. The tobacco industry also came under attack for targeting children and teens in their ad campaigns. In response, anti-smoking regulations have restricted cigarette sales and the ways in which cigarette companies can market their product.
AP/Associated Press

How Is Tobacco Addiction Treated?

There are three proven ways of treating tobacco addition: using medications, getting support and encouragement, and learning new skills to resist the urge to smoke and to handle stress better.


The nicotine patch and nicotine gum are sold without a prescription. The nicotine in these products passes through the skin or membranes lining the mouth and reduces the craving for tobacco. It is important to follow label directions carefully. In particular, people should not smoke while using one of these products. Young people under age 18 should check with a physician before trying the patch or gum. A nicotine inhaler * and nicotine nasal spray * are also available by prescription. Bupropion (Wellbutrin, Zyban) is another prescription drug that has been approved for use in smoking cessation. Using any of these products doubles a person's chances of success.


Counseling can give people support, and it can help them learn the skills they need to give up tobacco and handle stress without smoking. The more counseling people get, whether individually, in a group, or over the phone, the better their chances of quitting. Programs to help people quit smoking are offered at many health care centers and hospitals.

How Well Does Treatment Work?

Giving up tobacco is hard. Most people make two or more attempts before they lick the problem for good. Each time people try to quit, though, they learn more about what helps and what hurts. Half of all people who have ever smoked have been able to stop eventually.

* inhaler (in-HAY-ler) is a handheld device that produces a mist that Is breathed in through the mouth.

* nasal (NA-zal) spray is a mist that Is sprayed into the nose.

No Butts About It

Here are some quick tips for people who are trying to quit using tobacco:

  • Pick a quit date. Write it down. Make a commitment to yourself and stick to your quit date.
  • Tell your friends and family that you plan to quit. Ask them not to smoke around you or leave cigarettes around.
  • Change your daily routine when you first stop smoking. Eat different foods, or take a different route to school.
  • Plan something fun to do each day as a reward for not smoking.
  • Try to distract yourself from the urge to smoke. Call a friend, go for a walk, or take up a new hobby.
  • Do something other than smoking to reduce stress. Exercise, take a hot bath, or listen to soothing music.
  • Drink a lot of water and other nonalcoholic fluids.



Izenberg, Neil, with Robert P. Libbon. How to Raise Non-Smoking Kids. New York: Byron Preiss Multimedia Company, 1997. A guide for parents that may also be useful for teen readers.

Kranz, Rachel. Straight Talk About Smoking. New York: Facts on File, 1999.


American Lung Association, 1740 Broadway, New York, NY 10019. The ALA sponsors program to help people quit smoking and provides information and training about tobacco addiction and smoking cessation.
Telephone 212-315-8700

American Academy of Family Physicians (AAFP), 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. AAFP sponsors "Tar Wars," a smoking-prevention program designed for fifth-grade students.
Telephone 913-906-6000

Stop Teenage Addiction to Tobacco, Northeastern University, 360 Huntington Avenue, 241 Cushing Hall, Boston, MA 02115. This organization's goal is to end childhood and teenage addiction to tobacco.
Telephone 617-373-7828


Campaign for Tobacco-Free Kids. This site, run by the National Center for Tobacco-Free Kids, aims to protect children from tobacco addiction and secondhand smoke.

Quitnet. This site, a project of the Boston University School of Public Health, offers helpful tips and tools for people who are trying to quit using tobacco. , a site run by the medical experts of the Nemours Foundation and the A. I. duPont Hospital for Children, posts information and artides on smoking, smoking prevention, and quitting for kids, teens, and parents.

See also
Substance Abuse

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