Cigarette smoking damages nearly every organ of the body and is the leading preventable cause of morbidity and mortality in the U.S. and New York State.1 Smoking causes about 28,000 deaths in adult New Yorkers annually, and an estimated 750,000 New Yorker adults live with serious smoking-attributable disease.2,3
Tobacco dependence is a chronic relapsing disease caused by nicotine addiction.1 About 80-90% of people who smoke are addicted to nicotine.4 Deliberate changes in the design and composition of cigarettes over the past 50 years make them more addictive than ever before.1Today's cigarettes deliver more nicotine from the lungs to the heart and brain more quickly.1
Nicotine affects the body as soon as it enters the bloodstream:
- Nicotine stimulates the adrenal glands to release adrenaline, which stimulates the central nervous system and increases blood pressure, respiration, and heart rate.
- Nicotine increases dopamine levels, which affect the brain pathways that control reward and pleasure.
- Continued nicotine exposure results in long-term brain changes, including addiction to the drug and increased susceptibility to addiction to other substances.5
Nearly 70% of adults who smoke want to quit, but only about 7% who make a quit attempt each year succeed.6 Nicotine withdrawal can lead to relapse for those who try.
Symptoms of nicotine withdrawal include:
- irritability
- feelings of anger and/or frustration
- anxiety
- depressed mood
- difficulty concentrating
- insomnia
- increased appetite
- restlessness
- nicotine cravings
People who smoke can and do quit although it can be difficult and may require multiple attempts before they succeed in quitting for good.7 As with any addiction, relapse is common.7
You can assist your patients in managing nicotine withdrawal by treating their tobacco dependence with evidence-based medication and brief motivational counseling that improves their ability to sustain cessation.
For more information on treating nicotine withdrawal, see:
- Identifying and Treating Patients Who Use Tobacco – Action Steps for Clinicians
- Treating Tobacco Use and Dependence – Quick Reference Guide for Clinicians
Although nicotine interacts with some medications, cigarette smoke is responsible for most drug interactions.8 For patients not ready to quit, you may need to adjust the doses of other medications you prescribe. See Drug Interactions with Tobacco Smoke for more information.
“The reality is that smoking is not … a choice. For most smokers, tobacco use is an addiction, and nicotine is the primary drug of choice.” – Let’s Make the Next Generation Tobacco-Free, Your Guide to the 50th Anniversary Surgeon General’s Report on Smoking and Health
References:
- U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: 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, 2014.
- Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Control Programs — 2014. Atlanta: 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, 2014.
- Estimated smoking-attributable morbidity in NYS calculated from estimated smoking-attributable morbidity in the U.S., sourced from The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General and the annual smoking-attributable deaths in NYS statistic, sourced from Best Practices for Comprehensive Tobacco Control Programs — 2014.
- U.S. Department of Health and Human Services. Understanding Withdrawal. Smokefree.gov.
- National Institute on Drug Abuse. Drug Facts – Cigarettes and Other Tobacco Products. Revised June 2018.
- Centers for Disease Control and Prevention. Quitting Smoking Among Adults—United States, 2000–2015. Morbidity and Mortality Weekly Report 2017;65(52):1457-64.
- Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update—Clinical Practice Guidelines. Rockville (MD): U.S. Department of Health and Human Services, Public Health Service, Agency for Healthcare Research and Quality, 2008.
- The Regents of the University of California. Drug Interactions with Tobacco Smoke. 1999-2016.
