Smoking is the inhalation of the smoke of burning tobacco encased in cigarettes, pipes, and cigars. Casual smoking is the act of smoking only occasionally, usually in a social situation or to relieve stress. A smoking habit is a physical addiction to tobacco products. Many health experts now regard habitual smoking as a psychological addiction, too, and one with serious health consequences.
The U.S. Food and Drug Administration has asserted that cigarettes and smokeless tobacco should be considered nicotine delivery devices. Nicotine, the active ingredient in tobacco, is inhaled into the lungs, where most of it stays. The rest passes into the bloodstream, reaching the brain in about 10 seconds and dispersing throughout the body in about 20 seconds.
Depending on the circumstances and the amount consumed, nicotine can act as either a stimulant or tranquilizer. This can explain why some people report that smoking gives them energy and stimulates their mental activity, while others note that smoking relieves anxiety and relaxes them. The initial "kick" results in part from the drug's stimulation of the adrenal glands and resulting release of epinephrine into the blood. Epinephrine causes several physiological changes—it temporarily narrows the arteries, raises the blood pressure, raises the levels of fat in the blood, and increases the heart rate and flow of blood Page 3470 | Top of Articlefrom the heart. Some researchers think epinephrine contributes to smokers' increased risk of high blood pressure.
Nicotine, by itself, increases the risk of heart disease. However, when a person smokes, he or she is ingesting a lot more than nicotine. Smoke from a cigarette, pipe, or cigar is made up of many additional toxic chemicals, including tar and carbon monoxide. Tar is a sticky substance that forms into deposits in the lungs, causing lung cancer and respiratory distress. Carbon monoxide limits the amount of oxygen that the red blood cells can convey throughout your body. Also, it may damage the inner walls of the arteries, which allows fat to build up in them.
Besides tar, nicotine, and carbon monoxide, tobacco smoke contains 4,000 different chemicals. More than 200 of these chemicals are known be toxic. Nonsmokers who are exposed to tobacco smoke also take in these toxic chemicals. They inhale the smoke exhaled by the smoker as well as the more toxic sidestream smoke—the smoke from the end of the burning cigarette, cigar, or pipe.
Here's why sidestream smoke is more toxic than exhaled smoke: When a person smokes, the smoke he or she inhales and then breathes out leaves harmful deposits inside the body. But because lungs partially cleanse the smoke, exhaled smoke contains fewer poisonous chemicals. That's why exposure to tobacco smoke is dangerous even for a nonsmoker.
Causes and symptoms
No one starts smoking to become addicted to nicotine. It isn't known how much nicotine may be consumed before the body becomes addicted. However, once smoking becomes a habit, the smoker faces a lifetime of health risks associated with one of the strongest addictions known to man.
About 70% of smokers in the United States would like to quit; in any given year, however, only about 3.6% of the country's 47 million smokers quit successfully.
Although specific genes have not yet been identified as of 2003, researchers think that genetic factors contribute substantially to developing a smoking habit. Several twin studies have led to estimates of 46-84% heritability for smoking. It is thought that some genetic variations affect the speed of nicotine metabolism in the body and the activity level of nicotinic receptors in the brain.
|Symptoms That Occur After Quitting Smoking|
|Craving for cigarette||nicotine craving||first week can linger for months||distract yourself with other activity|
|Irritability, impatience||nicotine craving||2 to 4 weeks||Exercise, relaxation techniques, avoid caffeine|
|Insomnia||nicotine craving temporarily reduces deep sleep||2 to 4 weeks||Avoid caffeine after 6 PM relaxation techniques; exercise|
|Fatigue||lack of nicotine stimulation||2 to 4 weeks||Nap|
|Lack of concentration||lack of nicotine stimulation||A few weeks||Reduce workload; avoid stress|
|Hunger||cigarettes craving confused hunger pangs||Up to several weeks||Drink water or low calorie drinks; eat low-calorie snacks|
|Coughing, dry throat, nasal drip||Body ridding itself of mucus in lungs and airways||Several weeks||Drink plenty of fluids; use cough drops|
|Constipation, gas||Intestinal movement decreases with lack of nicotine||1 to 2 weeks||Drink plenty of fluids; add fiber to diet; exercise|
Smoking is recognized as the leading preventable cause of death, causing or contributing to the deaths of approximately 430,700 Americans each year. Anyone with a smoking habit has an increased chance of lung, cervical, and other types of cancer; respiratory diseases such as emphysema, asthma, and chronic bronchitis; and cardiovascular disease, such as heart attack, high blood pressure, stroke, and atherosclerosis (narrowing and hardening of the arteries). The risk of stroke is especially high in women who take birth control pills.
Smoking can damage fertility, making it harder to conceive, and it can interfere with the growth of the fetus during pregnancy. It accounts for an estimated 14% of premature births and 10% of infant deaths. There is some evidence that smoking may cause impotence in some men.
Because smoking affects so many of the body's systems, smokers often have vitamin deficiencies and suffer oxidative damage caused by free radicals. Free radicals are molecules that steal electrons from other Page 3471 | Top of Articlemolecules, turning the other molecules into free radicals and destabilizing the molecules in the body's cells.
Smoking is recognized as one of several factors that might be related to a higher risk of hip fractures in older adults.
Studies reveal that the more a person smokes, the more likely he is to sustain illnesses such as cancer, chronic bronchitis, and emphysema. But even smokers who indulge in the habit only occasionally are more prone to these diseases.
Some brands of cigarettes are advertised as "low tar," but no cigarette is truly safe. If a smoker switches to a low-tar cigarette, he is likely to inhale longer and more deeply to get the chemicals his body craves. A smoker has to quit the habit entirely in order to improve his health and decrease the chance of disease.
Though some people believe chewing tobacco is safer, it also carries health risks. People who chew tobacco have an increased risk of heart disease and mouth and throat cancer. Pipe and cigar smokers have increased health risks as well, even though these smokers generally do not inhale as deeply as cigarette smokers do. These groups haven't been studied as extensively as cigarette smokers, but there is evidence that they may be at a slightly lower risk of cardiovascular problems but a higher risk of cancer and various types of circulatory conditions.
Recent research reveals that passive smokers, or those who unavoidably breathe in second-hand tobacco smoke, have an increased chance of many health problems such as lung cancer and asthma, and in children, sudden infant death syndrome.
Smokers are likely to exhibit a variety of symptoms that reveal the damage caused by smoking. A nagging morning cough may be one sign of a tobacco habit. Other symptoms include shortness of breath, wheezing, and frequent occurrences of respiratory illness, such as bronchitis. Smoking also increases fatigue and decreases the smoker's sense of smell and taste. Smokers are more likely to develop poor circulation, with cold hands and feet and premature wrinkles.
Sometimes the illnesses that result from smoking come on silently with little warning. For instance, coronary artery disease may exhibit few or no symptoms. At other times, there will be warning signs, such as bloody discharge from a woman's vagina, a sign of cancer of the cervix. Another warning sign is a hacking cough, worse than the usual smoker's cough, that brings up phlegm or blood—a sign of lung cancer.
A smoker who tries to quit may expect one or more of these withdrawal symptoms: nausea, constipation or diarrhea, drowsiness, loss of concentration, insomnia, headache, nausea, and irritability.
It's not easy to quit smoking. That's why it may be wise for a smoker to turn to his physician for help. For the greatest success in quitting and to help with the withdrawal symptoms, the smoker should talk over a treatment plan with his doctor or alternative practitioner. He should have a general physical examination to gauge his general health and uncover any deficiencies. He should also have a thorough evaluation for some of the serious diseases that smoking can cause.
Research shows that most smokers who want to quit benefit from the support of other people. It helps to quit with a friend or to join a group such as those organized by the American Cancer Society. These groups provide support and teach behavior modification methods that can help the smoker quit. The smoker's physician can often refer him to such groups.
Other alternatives to help with the withdrawal symptoms of kicking the habit include nicotine replacement therapy in the form of gum, patches, nasal sprays, and oral inhalers. These are available by prescription or over the counter. A physician can provide advice on how to use them. They slowly release a small amount of nicotine into the bloodstream, satisfying the smoker's physical craving. Over time, the amount of gum the smoker chews is decreased and the amount of time between applying the patches is increased. This helps wean the smoker from nicotine slowly, eventually beating his addiction to the drug. But there's one important caution: If the smoker lights up while taking a nicotine replacement, a nicotine overdose may cause serious health problems.
The prescription drug Zyban (bupropion hydrochloride) has shown some success in helping smokers quit. This drug contains no nicotine, and was originally developed as an antidepressant. It isn't known exactly how bupropion works to suppress the desire for nicotine. A five-year study of bupropion reported in 2003 that the drug has a very good record for safety and effectiveness in treating tobacco dependence. Its most common side effect is insomnia, which can also result from nicotine withdrawal.
Researchers are investigating two new types of drugs as possible treatments for tobacco dependence as of 2003. The first is an alkaloid known as 18-methoxycoronaridine (18-MC), which selectively blocks the nicotinic receptors in brain tissue. Another approach involves developing drugs that inhibit the activity of cytochrome P450 2A6 (CYP2A6), which controls the metabolism of nicotine.
Research on smoking shows that most smokers desire to quit. But smoking is so addictive that fewer than 20% of the people who try ever successfully kick the habit. Still, many people attempt to quit smoking over and over again, despite the difficulties—the cravings and withdrawal symptoms, such as irritability and restlessness.
For those who do quit, the benefits to health are well worth the effort. The good news is that once a smoker quits the health effects are immediate and dramatic. After the first day, oxygen and carbon monoxide levels in the blood return to normal. At two days, nerve endings begin to grow back and the senses of taste and smell revive. Within two weeks to three months, circulation and breathing improve. After one year of not smoking, the risk of heart disease is reduced by 50%. After 15 years of abstinence, the risks of health problems from smoking virtually vanish. A smoker who quits for good often feels a lot better too, with less fatigue and fewer respiratory illnesses.
There are a wide range of alternative treatments that can help a smoker quit the habit, including hypnotherapy, herbs, acupuncture, and meditation. For example, a controlled trial demonstrated that self-massage can help smokers crave less intensely, smoke fewer cigarettes, and in some cases completely give them up.
Hypnotherapy helps the smoker achieve a trance-like state, during which the deepest levels of the mind are accessed. A session with a hypnotherapist may begin with a discussion of whether the smoker really wants to and truly has the motivation to stop smoking. The therapist will explain how hypnosis can reduce the stress-related symptoms that sometimes come with kicking the habit.
Often the therapist will discuss the dangers of smoking with the patient and begin to "reframe" the patient's thinking about smoking. Many smokers are convinced they can't quit, and the therapist can help persuade them that they can change this behavior. These suggestions are then repeated while the smoker is under hypnosis. The therapist may also suggest while the smoker is under hypnosis that his feelings of worry, anxiety, and irritability will decrease.
In a review of 17 studies of the effectiveness of hypnotherapy, the percentage of people treated by hypnosis who still were not smoking after six months ranged from 4-8%. In programs that included several hours of treatment, intense interpersonal interaction, individualized suggestions, and follow-up treatment, success rates were above 50%.
One study demonstrated that inhaling the vapor from black pepper extract can reduce symptoms associated with smoking withdrawal. Other essential oils can be used for relieving the anxiety a smoker often experiences while quitting.
A variety of herbs can help smokers reduce their cravings for nicotine, calm their irritability, and even reverse the oxidative cellular damage done by smoking. Lobelia, sometimes called Indian tobacco, has historically been used as a substitute for tobacco. It contains a substance called lobeline, which decreases the craving for nicotine by bolstering the nervous system and calming the smoker. In high doses, lobelia can cause vomiting, but the average dose—about 10 drops per day—should pose no problems.
Herbs that can help relax a smoker during withdrawal include wild oats and kava kava.
To reduce the oral fixation supplied by a nicotine habit, a smoker can chew on licorice root—the plant, not the candy. Licorice is good for the liver, which is a major player in the body's detoxification process. Licorice also acts as a tonic for the adrenal system, which helps reduce stress. And there's an added benefit: If a smoker tries to light up after chewing on licorice root, the cigarette tastes like burned cardboard.
Other botanicals that can help repair free-radical damage to the lungs and cardiovascular system are those high in flavonoids, such as hawthorn, gingko biloba, and bilberry, as well as antioxidants such as vitamin A, vitamin C, zinc, and selenium.
This ancient Chinese method of healing is used commonly to help beat addictions, including smoking. The acupuncturist will use hair-thin needles to stimulate the body's qi, or healthy energy. Acupuncture is a sophisticated treatment system based on revitalizing qi, which supposedly flows through the body in defined pathways called meridians. During an addiction like smoking, qi isn't flowing smoothly or gets stuck, the theory goes.
Points in the ear and feet are stimulated to help the smoker overcome his addiction. Often the acupuncturist will recommend keeping the needles in for five to seven days to calm the smoker and keep him balanced.
Smoking seriously depletes vitamin C in the body and leaves it more susceptible to infections. Vitamin C can prevent or reduce free-radical damage by acting as an antioxidant in the lungs. Smokers need additional C, in higher dosage than nonsmokers. Fish in the diet supplies Omega-3 fatty acids, which are associated with a reduced risk of chronic obstructive pulmonary disease (emphysema or chronic bronchitis) in smokers. Omega-3 fats also provide cardiovascular benefits as well as an anti-depressive effect. Vitamin therapy doesn't reduce craving but it can help beat some of the damage created by smoking. Vitamin B12 and folic acid may help protect against smoking-induced cancer.
How do you give up your cigarettes for good and never go back to them again?
Here are a few tips from the experts:
- Have a plan and set a definite quit date.
- Get rid of all the cigarettes and ashtrays at home or in your desk at work.
- Don't allow others to smoke in your house.
- Tell your friends and neighbors that you're quitting. Doing so helps make quitting a matter of pride.
- Chew sugarless gum or eat sugar-free hard candy to redirect the oral fixation that comes with smoking. This will prevent weight gain, too.
- Eat as much as you want, but only low-calorie foods and drinks. Drink plenty of water. This may help with the feelings of tension and restlessness that quitting can bring. After eight weeks, you'll lose your craving for tobacco, so it's safe then to return to your usual eating habits.
- Stay away from social situations that prompt you to smoke. Dine in the nonsmoking section of restaurants.
- Spend the money you save not smoking on an occasional treat for yourself.
"AAAAI, EPA Mount Effort to Raise Awareness to Dangers of Secondhand Smoke." Immunotherapy Weekly November 30, 2001: 30.
Batra, V., A. A. Patkar, W. H. Berrettini, et al. "The Genetic Determinants of Smoking." Chest 123 (May 2003): 1338-1340.
Ferry, L., and J. A. Johnston. "Efficacy and Safety of Bupropion SR for Smoking Cessation: Data from Clinical Trials and Five Years of Postmarketing Experience." International Journal of Clinical Practice 57 (April 2003): 224-230.
Janson, Christer, Susan Chinn, Deborah Jarvis, et al. "Effect of Passive Smoking on Respiratory Symptoms, Bronchial Responsiveness, Lung Function, and Total Serum IgE in the European Community Respiratory Health Survey: A Cross-Sectional Study." Lancet 358 (December 22, 2001): 2103.
Lerman, C., and W. Berrettini. "Elucidating the Role of Genetic Factors in Smoking Behavior and Nicotine Dependence." American Journal of Medical Genetics 118-B (April 1, 2003): 48-54.
Maisonneuve, I. M., and S. D. Glick. "Anti-Addictive Actions of an Iboga Alkaloid Congener: A Novel Mechanism for a Novel Treatment." Pharmacology, Biochemistry, and Behavior 75 (June 2003): 607-618.
Richmomd, R., and N. Zwar. "Review of Bupropion for Smoking Cessation." Drug and Alcohol Review 22 (June 2003): 203-220.
Sellers, E. M., R. F. Tyndale, and L. C. Fernandes. "Decreasing Smoking Behaviour and Risk through CYP2A6 Inhibition." Drug Discovery Today 8 (June 1, 2003): 487-493.
"Study Shows Link Between Asthma and Childhood Exposure to Smoking." Immunotherapy Weekly October 10, 2001: np.
Yochum, L., L. H. Kushi, and A. R. Folsom. "Dietary Flavonoid Intake and Risk of Cardiovascular Disease in Postmenopausal Women." American Journal of Epidemiology 149, no. 10 (May 1999): 943-9.
American Association of Oriental Medicine. 5530 Wisconsin Avenue, Suite 1210, Chevy Chase, MD 20815. (301) 941-1064 or (888) 500-7999. 〈http://www.aaom.org〉 .
American Cancer Society. Contact the local organization or call (800) 227-2345. 〈http://www.cancer.org〉 .
American Lung Association. 1740 Broadway, New York, NY 10019. (800) 586-4872 or (212) 315-8700. 〈http://www.lungusa.org〉 .
Herb Research Foundation. 1007 Pearl St., Suite 200, Boulder CO 80302. (303) 449-2265. 〈http://www.herbs.org〉 .
National Heart, Lung, and Blood Institute (NHLBI). Building 31, Room 5A52, 31 Center Drive, MSC 2486, Bethesda, MD 20892. (301) 592-8573. 〈http://www.nhlbi.nih.gov〉 .
Smoking, Tobacco, and Health Information Line. Centers for Disease Control and Prevention. Mailstop K-50, 4770 Buford Highway NE, Atlanta, GA 30341-3724. (800) 232-1311. 〈http://www.cdc.gov/tobacco〉 .
Virtual Office of the Surgeon General: Tobacco Cessation Guideline. 〈http://www.surgeongeneral.gov/tobacco〉 .