Tobacco use has widely gone hand and hand with other substance abuse and dependence. When discussing comprehensive alcohol and other drug treatment the integration of tobacco education into the service continuum is beneficial for staff and clients as a way to increase knowledge, skills, attitudes and motivation that contribute to a positive change in substance use behaviors across the board.
Tobacco use harms nearly every organ of the body. It causes many diseases and reduces the health of those who use in general. Smoking tobacco is the leading preventable cause of premature death and a leading cause of illness and mortality.
Despite the well-known health risks of smoking and tobacco use, cessation continues as one of our biggest public health challenges. Approximately 70% of all smokers say they want to quit, but even the most motivated may try to quit 5 or 6 times before they are able to discontinue. 50 million smokers attempt to quit each year; only 6% of these smokers successfully quite cold turkey, or on their own, all at once, without assistance. Whether with cessation aids or on their own, over 3 million Americans do successfully quit smoking every year and in doing so improve their lifespan, quality of life and positively impact the lives of those around them.
Smoking is the most common method of consuming tobacco, and tobacco is the most common substance smoked. The active substances trigger chemical reactions in nerve endings, which heighten heart rate, memory, alertness, and reaction time. Dopamine and later endorphins are released, which are often associated with pleasure.
Most smokers begin during adolescence or early adulthood. Smoking has elements of risk-taking and rebellion for younger users, which often appeals to this age group. The presence of peers that smoke and media featuring tobacco use may also encourage smoking. Because teenagers are influenced more by their peers than by adults, attempts by parents, schools, and health professionals at preventing people from trying cigarettes are frequently unsuccessful.
Children of smoking parents are more likely to smoke than children with non-smoking parents.
Research has suggested that smokers tend to be sociable, impulsive, risk taking, and excitement seeking individuals.Although personality and social factors may make people likely to smoke, the actual habit is a function of operant conditioning. During the early stages, smoking provides pleasurable sensations (because of its action on the dopamine system) and thus serves as a source of positive reinforcement.
After an individual has smoked for many years, the avoidance of withdrawal symptoms and negative reinforcement become the key motivations to continue. Tobacco users report their reasons for continued use as:
- addictive smoking
- pleasure from smoking
- tension reduction/relaxation
- social smoking
- handling (something to do with their hands)
Methods of Tobacco Consumption
Tobacco is an agricultural product processed from the leaves of plants in the genus Nicotiana. It can be consumed, used as an organic pesticide and, in the form of nicotine tartrate, used in some medicines. It is most commonly used as a recreational drug.
Tobacco is most commonly consumed in the forms of smoking, chewing, snuffing, or dipping tobacco, or snus.
Some forms of smokeless tobacco consumed may be categorized as:
- Snus (Scandinavian), a moist Scandinavian form of snuff which is placed under the upper lip which does not result in the need for spitting.
- Snus (American), similar to Scandinavian form of snus. Most American Snus generally have a lower moisture content and lower pH, resulting in lower bioavailablity of nicotine than Swedish varieties
- Chewing tobacco, tobacco furnished as long strands which is placed between the cheek and gum or teeth.
- Nasal snuff (luktsnus in Swedish and luktesnus in Norwegian), a dry form of snuff which is insufflated or “snuffed” through the nose.
- Dipping tobacco a moist and American form of traditional snuff which is placed between the lower lip and the gums and often causes excess saliva while dipping.
Some forms of tobacco consumed in inhalation may be categorized as:
Cigarette is a small roll of finely cut tobacco leaves wrapped in a cylinder of thin paper for smoking.
Beedi is a thin, South Asiancigarette filled with tobacco flake and wrapped in a tendu leaf tied with a string at one end.
Cigarsis a tightly-rolled bundle of dried and fermented tobacco that is ignited so that its smoke may be drawn into the mouth.
Electronic cigaretteare an alternative to tobacco smoking, although no tobacco is consumed. It is a battery-powered device that provides inhaled doses of nicotine by delivering a vaporized propylene glycol/nicotine solution.
Hookahare a single or multi-stemmed (often glass-based) water pipe for smoking. It can be used for smoking herbal fruits, tobacco, or cannabis.
Kretekare cigarettes made with a complex blend of tobacco, cloves and a flavoring “sauce”.
Passive smoking and/or Second-hand smoke and Third-hand smokeis, the usually involuntary, consumption of smoked tobacco. Second-hand smoke (SHS) is the consumption where the burning end is present, environmental tobacco smoke (ETS) or third-hand smoke is the consumption of the smoke that remains after the burning end has been extinguished.
Pipe smokinginvolves placing shredded pieces of tobacco into a chamber of a pipe and igniting it.
Negative Effects of Tobacco Use
Tobacco use leads most commonly to diseases affecting the heart and lungs, with smoking being a major risk factor for heart attacks, strokes, chronic obstructive pulmonary disease (COPD) (including emphysema and chronic bronchitis), and cancer (particularly lung cancer, cancers of the larynx and mouth, and pancreatic cancer). It also causes peripheral vascular disease and hypertension. Cigarette smoke contains more than 4,000 chemicals, including truly nasty things like cyanide, lead, and at least 60 cancer-causing compounds. The effects depend on the number of years that a person smokes and on how much the person smokes. Starting smoking earlier in life and smoking cigarettes higher in tar increases the risk of these diseases.
Tobacco use is responsible for an estimated 7 percent of total U.S. health care costs. It accounts for the 18 percent increase in the incidence of cancer and the 7 percent rise in cancer’s mortality since 1971. Smokers have abnormally high heartbeats, low tolerance for exercise, and an increased risk of damaging arteries from fatty buildups associated with heart disease, according to the American Heart Association’s first report on tobacco-related health problems. In addition, exposure to tobacco smoke exacerbates asthma, decreases lung capacity, and increases the frequency and severity of respiratory infections.
Other consequences of tobacco use include:
- Cataracts in the eyes
- Thyroid disease
- Gum disease
- Chronic bronchitis
- Degenerative disc disease
- Weakend immune system
- Increased risk for stroke
Tobacco use has obvious health issues. Smoking tobacco also has additional hazards. The number one cause of deaths from fire is smoking. Most of these deaths occur when somebody falls asleep and drops a cigarette on a piece of furniture or a mattress.
Smoking During Pregnancy
Smoking during pregnancy is very dangerous. It may cause up to 7.5% of all miscarriages that occur. As many as 26,000 newborns each year are admitted to intensive care units because of low birth weight caused by smoking.
Tobacco Use and Children/Adolescents
The American health foundation has cited increased cigarette smoking as a factor in the deteriorating health of the nation’s children. Roughly 3,000 children in the U.S. become addicted to tobacco every day. Although it’s illegal in all states to sell cigarettes to persons younger than 18 years old, teens are able to buy cigarettes over the counter between 70-80% of the time.
Tobacco Use and Alcohol and Other Drug Recovery
Most alcoholics or other drug addicts have several addictions, and smoking is the most common other addiction by far.
New studies have shed light on cross-addiction between nicotine and alcohol in particular. Nicotine has been shown to increase the craving for alcohol. For many alcohol and other drug users, smoking is also a behavioral trigger for use, and getting clean from cigarettes is a major step toward reducing cravings for other use.
All of this supports the increased prevalence of tobacco use among people receiving treatment or in recovery. Tobacco use among this population is dramatically higher than the general U.S. adult population rate. Approximately 90% of alcoholic inpatients in the U.S. and 85-90% among substance abuse inpatients report tobacco use.
People with a DSM-IV-TR diagnosis (not including nicotine dependence) consume 44% of all tobacco sold in the U.S. and those with a co-occurring mental health and substance use disorder consume 70% of tobacco products.
There are two primary approaches to smoking cessation treatment; the first being the pharmacological approach and the second being a behaviorist approach.
The pharmacological approach includes methods of delivering nicotine to the system without smoking, on the theory that the user will gradually wean off. These nicotine replacement therapies include the nicotine patch, nicotine gum, nicotine nasal spray and the nicotine inhaler. Recent studies show that nicotine replacement therapies can help smokers quit. People using aids are 70% more likely to quit than those using placebos.
The effectiveness of these nicotine replacement tools are improved if done in combination with some kind of behavioral therapy. There are numerous behavioral approaches, often used together. Common ones include tapering or fading, scheduling or timing, motivational enhancements via rewards and punishments of different kinds, relapse prevention, cue exposure, aversion therapy, and others.
New medications for both nicotine addiction and alcoholism are on the way, now that scientists realize that addictions stem from much more than “an addictive personality” or weak will. The remedies being tested actually target the cascade of neurochemical events at the root of addicts’ cravings.
Within two years after people quit smoking, the risk of death from heart disease declines 24 percent. Quitting for 10 to 14 years produces a risk level almost equal with someone who never smoked.
Tobacco use, including cigarette smoking, cigar smoking, and smokeless tobacco use, remains the leading preventable cause of death in the United States.
Tobacco is considered an addictive substance because it contains the chemical nicotine. In addition to nicotine, tobacco also contains more than 19 known cancer-causing chemicals (most are collectively known as “tar”) and more than 4,000 other chemicals.
Because of the addictive properties of nicotine, tolerance and dependence develop. Tolerance can be defined as a state of progressively decreased responsiveness to a drug as a result of which a larger dose of the drug is needed to achieve the effect originally obtained by a smaller dose. Dependence can be defined as a state in which there is a compulsive or chronic need.
Tobacco usage is an activity that is practiced by some 1.1 billion people across the world and up to 1/3 of the adult population.
Quitting tobacco use is not easy, but it can be done. The rewards are immeasurable not only to the tobacco user, but for all of those around them, their family and for generations to come.