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Date: Oct. 1, 2016
Publisher: Gale, a Cengage Company
Document Type: Drug overview; Topic overview
Length: 6,446 words
Content Level: (Level 4)
Lexile Measure: 1190L

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Official Names: Nicotine (beta-pyridyl-alpha-N-methylpyrrolidine), tobacco
Street Names: Bidis (BEE-deez), chew, chewing tobacco, cigars, cigarettes, coffin nails, fags, kreteks, snuff, spit, smokes
Drug Classification: Not scheduled, illegal for purchase by persons under eighteen years of age; stimulant

What Kind of Drug Is It?

Nicotine is one of the ingredients in tobacco that causes changes to the brain and behavior. Tobacco, a broad-leafed plant that originated in the Americas, is one of the most widely abused psychoactive, or mind-altering, substances in the world. In the United States alone, one in four men and one in five women smoke cigarettes, cigars, pipes, or use oral products such as chewing tobacco or snuff. In other parts of the world the percentage of users is even higher.

Nicotine use typically begins among Americans between the ages of eleven and eighteen--an age group too young to buy the product legally. Young users soon discover that nicotine is habit-forming, that all the ways of taking it pose great health risks, and that it can lead to troubles on the job and sometimes an early death.

Tobacco advertisements and many movies present nicotine use as a glamorous, rebellious, adult activity. And adults can smoke legally. What tobacco advertisements do not note, however, is the fact that one-third of all smokers live below the poverty level; that the more educated a person is, the less likely he or she is to use tobacco; and that an estimated one billion people will die from tobacco-related illnesses worldwide in the twenty-first century. Tobacco use is one of the leading causes of preventable death. Its link to cancer, emphysema and asthma (lung disorders), and depression (a mood disorder), has been clearly established. Smokers can expect to live seven to ten years less than people who do not use tobacco products.

Popularity Decreases

At the height of tobacco's popularity in the United States in the 1960s, more than half of all adult men and about one in three adult women smoked cigarettes. People smoked in movie theaters and on buses and planes. They smoked at their desks in office buildings and in their beds at night. Famous film and television stars, and even some doctors, promoted certain brands of cigarettes in commercials and on billboards. Nonetheless, in those times, people knew that smoking could ruin their health.

A half-century later, in the early 2000s, smokers can find it difficult to get a job if they reveal a tobacco habit. Smoking is not permitted on planes, in theaters, in many office buildings, or on public transportation. Many cities have enacted bans on smoking in restaurants and bars.

Studies have proven that secondhand smoke, or "passive" smoke, can cause many health problems for the nonsmoker. Pregnant women who smoke endanger the health of their unborn babies. Most Americans are less tolerant of smoking than they used to be. Yet, the "2003 National Survey on Drug Use and Health (NSDUH)" reported that 40 percent of young adults age eighteen to twenty-five admitted to smoking cigarettes at least once in their lives.

No country that has learned to use tobacco has ever given it up. Nicotine addiction, a physical dependence on the drug due to repeated drug use, continues to be a global public health issue. It is one of the leading causes of preventable illness in adults. The U.S. government keeps a watchful eye on tobacco companies to ensure they do not target cigarette advertisements to teens for several reasons. First, teens are not allowed to smoke legally. Second, adults over the age of twenty-five rarely begin smoking after never having smoked before.


The first European to record seeing tobacco use was the explorer Christopher Columbus (1451-1506) in 1492. On his initial voyage to the New World, Columbus wrote in his diary that the native peoples he encountered "drank" smoke from the burning leaves of a certain plant. Even without understanding their language, Columbus could see that the people he met highly valued their tobacco.

Use Originated in the Americas

Archaeologists are not sure where or when tobacco use began in the Americas. More than sixty varieties of tobacco grew all over North and South America. Even the garden flower known as the petunia is related to tobacco. The earliest documented use of tobacco among Native Americans occurred with the Mayan culture, a civilization from Central America that peaked about 2,000 years ago. A carving on a Mayan temple shows an elaborately dressed man smoking a long-stemmed pipe. Other historians of ancient America believe that pipe smoking may have begun in North America and spread south. Whatever the case, by 1000 ce, most Native American cultures used tobacco in religious and political rituals. The plant did not grow in Europe.

Columbus and his crew were baffled and disturbed by the sight of people smoking tobacco. Nevertheless, they collected specimens of the plant, as well as pipes, and took them back to Spain. As the Spanish and Portuguese began to explore and settle the Americas, they began "drinking smoke" themselves. Sailors who moved between Europe and America were among the first to discover that once they began smoking tobacco, they could not stop.

By 1535, Spanish colonists in the New World were planting tobacco for their own use. At around the same time, farmers in Europe began to cultivate the plant. In 1559, the French ambassador to Portugal, Jean Nicot (1530-1600), became interested in tobacco. He thought it might be useful as a medicine. He introduced powdered tobacco--snuff--at the French court and made the substance fashionable. It is from his name, "Nicot," that the word nicotine is derived.

Tobacco in the American Colonies

Tobacco was one of the first crops planted when English colonists arrived in Jamestown, Virginia. Ships filled with tobacco sailed from America to Europe, where the tobacco was traded for items the colonists could not make or buy in the New World, including tea, furniture, and high-quality cloth. In some parts of America, tobacco could be used instead of money. The need for new fields to grow tobacco--a plant that uses up the rich nutrients in the ground--pushed settlers westward, into territories occupied by Native Americans. By the time the Declaration of Independence was signed in 1776, tobacco smoking was common among Anglo Americans. Every tavern kept a supply of clay pipes for use by visitors. When smokers were finished with their pipes, they broke off the part of the stems their lips had touched and passed the pipe to a new user.

By the nineteenth century, different classes of people used tobacco in different ways. The upper classes tended to "take snuff," inhaling powdered tobacco through the nose. The middle classes preferred pipes, and the lower classes held wads of tobacco between their gums and teeth, a practice known as "chewing." Within 300 years of its discovery by Columbus, tobacco had spread to all parts of the world. Many cultures considered it a beneficial medicine. The Native Americans had wrapped shredded tobacco in larger leaves, and "cigars" became popular by the turn of the twentieth century. "Cigarettes" were invented by people who gathered the shredded cigar tobacco that had gone to waste and wrapped it in small papers to smoke it.

The popularity of cigarettes skyrocketed during World War I (1914-1918), because they were easy to transport into battle. Many young soldiers brought the cigarette habit home with them, and factories stood ready to create the product on assembly lines. By the 1920s, whole industries built on tobacco advertised in print, on billboards, and through movies and radio. Women were encouraged to smoke, and they took up the habit as well. The "Jazz Era" generation was the first to embrace tobacco in great numbers. The era's great athletes smoked when not on the playing field and chewed tobacco during games. During the Great Depression (1929-1941), U.S. President Franklin Delano Roosevelt (1882-1945) was sometimes photographed with a cigarette, in a holder, in his mouth.

Tobacco-Related Illness Begin to Surface

Americans who had been young in the 1920s were entering their sixties by the 1960s. At that time, tobacco use began to show its downside. Even as new generations became hooked on nicotine, older Americans suffered increasing numbers of lung, throat, and mouth cancers. Others died of emphysema, a disorder that affects the lungs' ability to process oxygen. In 1961, the U.S. surgeon general requested a report on the effects of tobacco use on health. Facing opposition from tobacco companies--who claimed to have done their own research--a panel of experts met to study the problem.

In 1964, the panel submitted a report to the surgeon general that linked tobacco use to lung cancer, mouth and throat cancer, heart attacks, strokes, emphysema, and other diseases of the stomach and liver. The report, to no one's surprise, declared that nicotine was habit-forming. At the time the report was issued, 40 percent of adult Americans used some form of tobacco.

By the late 1960s, nonprofit groups from many sectors were uniting to stop tobacco use in the United States. Groups such as the American Heart Association, the American Lung Association, and the American Cancer Society launched advertisements to counter the popular characters featured in cigarette ads, including Joe Camel and the Marlboro Man. Perhaps just as effective for younger people was the personal experience of a loved one--a parent, a grandparent, or an older sibling--suffering the ill effects of tobacco use. Smoking declined among Americans as a result.

The terms passive smoking and "secondhand smoke" had not been invented in the 1960s. However, by the 1990s, people had become aware that tobacco smoke posed a threat not only to the smoker, but also to those exposed to the smoldering cigarette or cigar and the exhaled smoke. Private companies began to ban smoking in office buildings, and a whole series of laws followed, banning smoking in public transportation, on airplanes, in health care facilities, and in government buildings. People who had once puffed at their desks were forced to smoke on their breaks, huddled outside in all sorts of weather. At the same time, states began to levy higher taxes on cigarettes to help pay for Medicaid and other social welfare programs.

Tighter Laws Cut Down on Nicotine Abuse

On November 16, 1998, forty-seven states and the District of Columbia came to an out-of-court settlement with four major American tobacco companies. (The other three states had previously come to agreements.) The states had sued the tobacco companies for the costs of providing health care to poor people suffering from tobacco-related illnesses. The cigarette companies agreed to pay the states $206 billion for health care. The companies also agreed not to market their product to adolescents through advertisements or promotional items. They further agreed to fund a program to discourage teenage smoking. One consequence of this settlement: The average price of a pack of cigarettes rose fifty cents in one year, from $2.20 in 1998 to $2.70 in 1999. By 2005, cigarettes were selling for about $4.00 per pack. As of 2009, the average cost ranged between $4.50 and $5.00. For heavy smokers, many of them poor already, this was a difficult increase to manage.

Despite the successes made in the anti-tobacco campaign, smoking still appealed to youth who wanted to rebel against authority. In fact, by suggesting that tobacco was something that only adults should use just made it more popular with rebellious youth who wanted to seem hip and mature. Smoking was also glamorized in various movies as something that cool people do. As of the early twenty-first century, a large number of teens still take up smoking. The National Center for Chronic Disease Prevention and Health Promotion estimates that about 4,000 people under the age of eighteen begin smoking each day in the United States.

More recently, the healthcare industry has focused on smoking in films. "Product placement" is very important in movies. When a character in a film uses a particular brand of food or beverage, sales of that product often climb. In 2005, the American Medical Association recommended that the film industry adopt a policy that would automatically give an "R" rating to any movie in which a character uses tobacco. (People under seventeen are not supposed to be admitted to "R" rated movies without a parent or adult.) Whether the film industry will honor that request is uncertain.

On June 22, 2009, President Barack Obama signed the Family Smoking Prevention and Tobacco Control Act. This historic legislation grants authority to regulate tobacco products to the U.S. Food and Drug Administration. One July 10, 2009, the Food and Drug Administration inserted into the Federal Register a Request for Comments regarding regulation of tobacco products. The due date for comments was set for September 29, 2009.

What Is It Made Of?

Nicotine is a poisonous alkaloid that occurs naturally in the leaves of the tobacco plant. While still in the leaves of the plant, it is a colorless liquid. Sixty milligrams of nicotine, about the amount a bottle cap would hold, can kill a human being. It is used as a pesticide to kill insects on plants and internal parasites in animals.

The chemical formula for nicotine is C10H14N2. The average cigarette contains 8 to 10 milligrams of nicotine, but much of this is lost in the process of burning. Typically, a smoker receives about 1 milligram of nicotine per cigarette. A pinch of chewing tobacco contains between 4.5 and 6.5 milligrams of nicotine. Since chewing tobacco enters the body more slowly than smoked tobacco, more of the dose is absorbed, but over a longer period of time.

In addition to nicotine, a smoking leaf of tobacco releases more than 4,000 different chemicals. Four hundred of these are known to be poisonous, and forty-three have been shown to cause cancer. A lit cigarette releases, among other things, carbon monoxide, ammonia, hydrogen cyanide, benzene, formaldehyde, acetone, methanol, and vinyl chloride. Tobacco companies add other ingredients to cigarettes as well, including menthol. Menthol numbs the throat to the irritating effects of the smoke. It also widens the pathways in the lungs, allowing more smoke to penetrate the tissues.

When smoke is exhaled from the lungs, a substance called tar remains in the body. As its name suggests, tar is a sticky residue that clings to lung tissue. Tar contains cancer-causing compounds. Receiving nicotine through the mouth by chewing reduces some of the dangerous chemicals from tar, but it also exposes the tissues in the mouth to cancer-causing agents and compounds that cause tooth decay and gum disease. The same compounds in tar simply cling to the mouth tissues and are absorbed by the gums, cheeks, and throat.

How Is It Taken?

Nicotine is taken in several ways. The most common and quick-acting manner is smoking. The user lights a cigarette, draws the smoke into the lungs, and exhales it. The effects of the nicotine can be felt within ten seconds, and they usually last between fifteen minutes and an hour.

People who smoke cigars and pipes generally "puff" them and do not inhale the smoke into the lungs. Even so, the soft tissues in the mouth absorb the nicotine and send it through the bloodstream to the brain. Smoking pipes or cigars is, indeed, habit-forming. Puffing is just another way to deliver nicotine to the brain. The presence of the smoke in the mouth and throat can lead to cancers in those body parts, and to cancer of the esophagus, the tube leading into the stomach.

With chewing tobacco, the user takes a wad of moist tobacco and presses it between the cheek and the gum. As the mouth fills with saliva, the user must spit, because swallowing tobacco-laced saliva could be deadly and certainly causes stomach upset. Users of chewing tobacco generally keep a wad in the mouth for about thirty minutes, during which time about 2 milligrams of nicotine enter the bloodstream through the cheek and gum tissue.

Few people snort snuff anymore, but it was once a popular way to use nicotine. Snuff, finely-ground tobacco, was snorted up the nose and usually removed by sneezing. A "pinch of snuff" was thought to ward off colds and other infectious diseases.

Are There Any Medical Reasons for Taking This Substance?

Some small studies have been performed to see if nicotine patches help reduce memory loss in Alzheimer's disease patients and muscle tremors in Parkinson's disease patients. Since nicotine is so highly addictive, however, its valid medical uses are considered very minimal.

The only acceptable medical use for nicotine is to help people overcome addiction to nicotine. "Nicotine delivery systems" include skin patches, gum, inhalers, and nasal sprays. Tobacco users trying to quit the habit can curb nicotine's withdrawal symptoms with these products. The products become very dangerous if a person smokes while using them. In that case, nicotine overdose is possible. Although some nicotine replacement products are available over the counter, most encourage nicotine addicts to seek the advice and counsel of a medical doctor while attempting to curb nicotine use.

Usage Trends

Data about smoking trends in the United States are available from a number of sources. In 2014, for example, the Surgeon General of the United States issued a report on smoking, "The Health Consequences of Smoking--50 Years of Progress," noting that 480,000 Americans die annually from smoking-related conditions, the most common preventable cause of death in the United States. About 41,000 of these deaths resulted from secondhand smoke, smoke that is inhaled not by the smoker himself or herself, but by someone who is exposed to another person's smoking. The report estimated that smoking--related illnesses costs the nation more than $300 billion per year, of which $170 billion is direct medical care and $156 is a result of lost productivity. Other government report, published in the Morbidity and Mortality Weekly Report, produced by the Centers for Disease Control and Prevention (CDC) reported that 42.1 million U.S. adults (17.8 percent of the nation's population) were current smokers, of whom 32.4 million (76.9 percent) smoked every day. The report also said that the group with the largest fraction of smokers was American Indians and Alaska Natives (26.1 percent), followed by non--Hispanic whites (19.4 percent), non--Hispanic blacks (18.3 percent), and non--Hispanic Asians (9.6 percent). Men were slightly more likely to be smokers (20.5 percent) than were women (15.3 percent). Those in the age group 25 to 44 years were also the most likely of all age groups to be smokers (20.1 percent), followed by those between the ages of 45 and 64 (19.9 percent), those 18 to 24 (18.7 percent), and those 65 years and older (8.8 percent).

In the 2014 edition of its annual report, National Survey on Drug Use and Health (NSDUH), the Substance Abuse and Mental Health Services Administration (SAMHSA) noted that cigarette smoking had decreased significantly in all ages between 2002 and 2014, from 13.0 percent to 4.9 percent among the age group 12 to 17, from 40.8 percent to 28.4 percent in the 18 to 25 age group, and from 25.2 percent to 21.5 percent in the age group 26 and older. Similar trends were also reported for the use of other tobacco products, such as chewing tobacco, snuff, cigars, and pipe tobacco.

More specific data about smoking trends among high school students are available from the Monitoring the Future (MTF) study conducted by the Institute for Social Research at the University of Michigan. The percentage of eighth graders who reported smoking at least once during the 30--day period preceding the survey in 2014 was 4.0 percent, down from 14.3 percent in 1991, the first year that question was asked by researchers. Comparable data for tenth grades were 7.2 percent in 2015 compared to 20.8 percent in 1991, and for twelfth graders, 13.6 percent in 2014 compared to 28.3 percent in 1991. These usage numbers reflected to at least some extent students' changing attitudes about the risk posed by smoking. The number of eighth graders who said that there was "great risk" associated with smoking one to five cigarettes a day rose from 26.9 percent in 1999 to 41.9 percent in 2014. Tenth followed a similar trend, the number saying that this practice was very risky rising from 28.4 percent to 52.0 percent over the same period. (Twelfth graders were not asked a comparable question.)

Ties to Social Problems?

The various surveys show another fact as well. According to the American Heart Association, people with a high school education or less are three times more likely to be smokers than those with a college education. The prevalence of cigarette smoking is highest among people living below the poverty level, with one in three reporting tobacco use.

A study of more than 4,000 students in Oregon and California linked early smoking with problem behaviors. Kids who start smoking around age twelve are considered "early smokers." In an article published in the Journal of Adolescent Health, Phyllis L. Ellickson and her coauthors reached the following conclusion: "Compared with nonsmokers, early smokers were at least three times more likely by grade twelve to regularly use tobacco and marijuana, use hard drugs, [and] drop out of school." In addition, these adolescents were "at higher risk for low academic achievement and behavioral problems at school."

Effects on the Body

Nicotine is the addictive compound in tobacco. When it enters the bloodstream, either through the lungs, the skin inside the mouth, or the nasal passages, it moves to the brain. There it binds with acetylcholine receptors, triggering the release of other neurotransmitters and hormones. Basically, nicotine causes two sensations: stimulation in the thought processes, and general relaxation in the user.

The Need for a Cigarette

The quick-acting nicotine increases the amount of dopamine in the brain. This causes pleasure and relaxation of muscles. At the same time, it enhances norepinephrine and acetylcholine levels, increasing mental stimulation and suppressing appetite. Nicotine also enhances memory and promotes a feeling of well-being. In other words, the drug stimulates the brain's reward system, making the user "feel good."

When people say that cigarettes help them to concentrate, they are not exaggerating. Nicotine does have that effect. However, the effect wears off quickly unless another dose of nicotine enters the brain. Likewise, nicotine does cause a feeling of relaxation, but this too passes quickly, leading to a craving for more of the drug. Many behaviors are related to the addicting qualities of nicotine. The user, taking a puff on a cigarette, might just feel more relaxed because withdrawal symptoms have been held at bay for another hour.

A Dangerous Habit

Nicotine causes a release of epinephrine, leading to a faster heartbeat, higher blood pressure, quickened breathing, and higher blood sugar. So while the user may feel relaxed, the body is actually working harder to pump blood and take in oxygen. Over a long period of time, this strain on the heart and elevated blood pressure can lead to heart attack and stroke. The drug also complicates the chemistry of the blood, causing blood vessels to become smaller and blood cells to stick together in clots. This can increase the risk of organ damage and stroke. Over time, nicotine contributes to the build-up of plaque in the arteries, a leading cause of heart disease. The chemicals in cigarette smoke also irritate the throat, interfere with the lung's ability to clear debris and bacteria, and promote nausea and other digestive disturbances.

Most scientists agree that nicotine is the most addictive substance used by people--worse than cocaine, although it works in a similar way on the brain's reward centers. (An entry for cocaine is available in this encyclopedia.) Because nicotine works so quickly and exits the brain just as quickly, it begins to induce cravings in most users within days or weeks of first use. Its effects are particularly strong on those with attention-deficit/hyperactivity disorder (ADHD), for whom it may be calming, and those with depression or a tendency to become depressed. People with those problems have a harder time freeing themselves from a nicotine addiction, so they are advised not to use tobacco at all.

Getting Hooked

Regular tobacco use causes tolerance, a condition that can lead to heavy smoking or chewing, and to lifestyle changes based on that heavy use. People find themselves spending a great deal of money on tobacco products, using them recklessly (smoking in bed, smoking while driving), and endangering the health of others with secondhand smoke.

At overdose levels, nicotine causes dizziness, vomiting, muscle tremors, convulsions, and paralysis of the lungs leading to an inability to breathe. All of these symptoms can develop within minutes. Tobacco products should be kept out of reach of children and pets. Those using nicotine replacement products should never smoke or chew tobacco at the same time. In addition, great care should be taken with any insecticide or other product containing pure nicotine.

The immediate effects of nicotine are generally mild and pleasurable; the long-term effects of tobacco use are not. Smokers accumulate a huge buildup of tar in the lungs, promoting cancer and clogging the air sacs that transfer oxygen into the bloodstream. The cancer-causing chemicals in tobacco promote growth of tumors in the mouth, on the lips, in the throat, in the lungs, in the esophagus, and elsewhere in the body. Nearly one in five deaths due to heart disease can be blamed on tobacco, and the overall death rate from cancer is twice as high among smokers as among nonsmokers.

More Dangers

People who smoke damage tiny, hair-like structures called cilia that lead to the lungs. Cilia help to remove germs and dirt from the lungs. This leads to an accumulation of mucus in the lungs and bronchial tubes--the famous "smoker's cough." Smokers also suffer more frequent and more serious cases of flu and pneumonia. Heavy tobacco use can cause men to become impotent and their sperm counts to decrease. Tobacco use has also been linked to cancers in the female reproductive organs.

Perhaps the most dangerous aspect of nicotine is the time it takes for the deadly side effects to develop. Most people begin using tobacco as teenagers, a time when they are most vulnerable to peer pressure and subtle advertising techniques. The vast majority of teenagers are enjoying the best health they will ever have in their lives. They cannot imagine growing old, developing health problems, or being at risk for fatal diseases. By the time they begin to understand how fragile the body is, they can already be deeply dependent on nicotine.

Becoming free of nicotine addiction causes immediate and long-term health benefits, including improved breathing, better sensation of taste, healthier teeth and skin, and improved strength. Quitting smoking also lessens the risks of cancer--but not entirely. Sometimes people who have not smoked in years discover that they have lung cancer. The disease is difficult to diagnose in its early stages. The very best way to avoid nicotine-related illnesses is to avoid any use of nicotine at any stage of life. If nicotine use has begun, the sooner it ends, the better the chances of living a long and healthy life.

Reactions with Other Drugs or Substances

Tobacco use causes the liver to produce more enzymes that can lower the blood levels of other medicines. Doctors should alter the doses of prescription drugs and monitor patients more carefully if those patients are using tobacco or nicotine replacement products. Nicotine should not be combined with certain asthma drugs, blood thinners, antipsychotic drugs, drugs for migraine headaches, and some antidepressants. Nicotine also interferes with some blood pressure medications such as Procardia and Tenormin. Women who are using birth control pills are urged not to smoke, because the combination of the pills and the tobacco can increase the likelihood of blood clots.

Any combination of nicotine and cocaine, opiates, hallucinogens, or marijuana can heighten the effects of the illegal drugs and possibly lead to irregular heartbeat or breathing problems. Heavy use of tobacco and alcohol further increases cancer risks. (Entries on alcohol and marijuana are available in this encyclopedia.)

Treatment for Habitual Users

Giving up the nicotine habit can be very difficult. Within hours of the last cigarette or chew, the body begins to respond to the lack of the drug. People become irritable and anxious, they overeat, they cannot sleep, and they can experience muscle tremors and a craving for tobacco. Many times, it is just easier to get another cigarette rather than to face the withdrawal symptoms.

Many self-help groups, including Nicotine Anonymous, the American Lung Association, the American Cancer Society, and the National Cancer Institute, have smoking cessation, or stopping, programs. Local- and state-funded programs also provide counselors and various treatment methods to the motivated addict who wants to quit using tobacco. These treatment programs may use hypnosis, group therapy, or behavior modification to encourage alternate behavior and help individuals combat the many facets of nicotine addiction. In many cases, health insurance companies will help pay for nicotine treatment programs.

Probably the most successful treatment methods involve nicotine replacement products such as gum (Nicorette) and skin patches (NicoDerm CQ, Nicotrol, Habitrol, and ProStep). These products recommend that the user work closely with a doctor or therapist to taper the doses of nicotine slowly. People using nicotine replacement therapies must take care not to use tobacco products at the same time, since this may lead to nicotine overdose. They must also be aware that these therapies can be habit-forming themselves, so they must be motivated not to exceed the recommended dose on the label of the package.

Other prescription drugs used to curb nicotine abuse include buproprion (Zyban), an antidepressant, and Clonidine (Catapres), a medicine to reduce high blood pressure. Both of these products block nicotine's pleasurable effects and help a recovering user avoid tobacco products.

For most, the best way to treat a tobacco habit is to combine a nicotine replacement therapy with counseling, education, group support, and the encouragement of family and friends. A heavy tobacco user must expect that the process will not always go smoothly and must have strategies in place for times of stress. Recovering nicotine addicts usually need to alter their lifestyles in order to avoid the people and places associated with smoking. If other family members smoke in the home, this can be very challenging.

In 2006, Pfizer Laboratories gained FDA approval to market varenicline under the brand name Chantix. This smoking cessation drug occupies nicotine receptors, and reduces the craving for nicotine, but in February 2008, the FDA issued an advisory warning that varenicline may cause serious behavioral and mood problems. The drug may also cause vivid or strange dreams.

The least effective way to attempt to quit nicotine is to depend on will power or to attempt to cut back on smoking by using low-tar cigarettes or by smoking less. People who try to quit in this way usually compensate by drawing more deeply on the cigarettes they do smoke. The relapse rate for this type of cessation is very high.


Nicotine erodes health slowly at first. Most people begin smoking early in life, when they are enjoying the best health they will ever have. Gradually, however, the consequences of long-term tobacco use become evident. People suffer from bad breath, discolored teeth, cravings, and dryness and thinning of the skin. They may develop a "smoker's cough" or a gravelly voice from damage to the larynx, the organ that produces sound in the throat. They may develop lesions--sores that do not heal or that heal very slowly--on their lips or inside the mouth. All of these are early warning signs of trouble to come.

Increased Risk of Cancer and Other Illnesses

It is estimated that one-third of all cancers and 87 percent of lung cancer in the United States can be traced directly to tobacco use. Cancer is an illness in which cells grow and reproduce too quickly, causing tumors inside the body. The tumors can be small at first and then grow rapidly. If the cancer reaches the lymph glands that send hormones throughout the body, the cancer can spread through the body as well. Cancer treatment generally involves surgery to remove tumors. Surgery is often followed by chemotherapy, a process that shrinks tumors but also causes nausea, weakness, hair loss, and malfunction of the immune system. Some tumors are treated with radiation to stem their growth. Radiation can cause pain and burning of the skin.

Cancer is treatable, but smokers are twice as likely to die of it as nonsmokers diagnosed with the same illness. Heavy smokers are four times more likely to die of their cancers as nonsmokers diagnosed with similar cancers.

Long-term tobacco use is directly linked to heart attack, various lung illnesses, high blood pressure, and stomach ulcers. It also reduces the body's ability to heal broken bones, promotes arthritis, and causes bad breath and yellowing of the teeth. All of these effects stem from a product that is legal for use in the American adult population. However, the U.S. Surgeon General's warning about the various health consequences of smoking appears on all packs of cigarettes sold in the United States.

The Law

In most states, people must be 18 years old to purchase tobacco products legally. In Alabama, Alaska, New Jersey, and Utah, the minimum age for purchase of tobacco is 18, and in Hawaii, it is 21. Individual localities sometimes have other age restrictions. In New York state, for example, the age limit for the purchase of cigarettes in Nassau and Onondaga counties is 19. The burden of keeping underage persons from buying cigarettes or smokeless tobacco falls on the stores that sell it.

Shopkeepers risk prosecution if they are caught selling tobacco to minors. Most stores require that younger buyers produce valid identification showing date of birth. Occasionally, young undercover police officers will attempt to buy tobacco without proper identification to see if the shopkeepers are abiding by the law. A store owner who sells tobacco to a minor risks losing his or her license to sell the product, as well as fines or closure of the business.

People under the age of eighteen who get caught with tobacco products do not face criminal prosecution. However, they can be suspended from school if caught with tobacco on school grounds. Most authorities contact parents or legal guardians to report the situation. For teens who smoke, secrecy rarely lasts very long. The telltale smell of tobacco clinging to clothing and hair is hard to disguise.

Discrimination against Smokers

In some states, private companies have introduced policies that deny jobs to smokers. The companies cite the extra burden of health care costs for their smoking employees, as well as loss of work time due to smoking breaks. Many smokers claim that this is discrimination and should not be a factor deciding employment, especially since smoking is legal. As of 2015, 30 states prohibit discrimination against smokers in the workplace, while the remaining states allow such actions.

Key Terms

mind-altering; a psychoactive substance alters the user's mental state or changes one's behavior
out-of-control cell growth leading to tumors in the body's organs or tissues
secondhand smoke
the smoke exhaled from a cigarette user and breathed in by someone nearby
loss of feeling, consciousness, or movement caused by the breaking or blocking of blood vessels in the brain
passive smoking
inhaling smoke from someone else's burning cigarette
a nitrogen-containing substance found in plants
carbon monoxide
a poisonous gas with no odor; carbon monoxide is released when cigarettes burn
Alzheimer's disease
a brain disease that usually strikes older individuals and results in memory loss, impaired thinking, and personality changes; symptoms worsen over time
Parkinson's disease
an incurable nervous disorder that worsens with time and occurs most often after the age of fifty; it is generally caused by a loss of dopamine-producing brain cells; symptoms include overall weakness, partial paralysis of the face, trembling hands, and a slowed, shuffling walk
the process of gradually cutting back on the amount of a drug being taken until it is discontinued entirely; also the accompanying physiological effects of terminating use of an addictive drug
pronounced uh-settle-KOH-leen; a neurotransmitter that forms from a substance called choline, which is released by the liver
a substance that helps spread nerve impulses from one nerve cell to another
pronounced DOPE-uh-meen; a combination of carbon, hydrogen, nitrogen, and oxygen that acts as a neurotransmitter in the brain
pronounced nor-epp-ih-NEFF-run; a natural stimulant produced by the human body
pronounced epp-ih-NEFF-run; a hormone that increases heart rate and breathing; also called adrenaline
a condition in which higher and higher doses of a drug are needed to produce the original effect or high experienced

Tobacco Statistics

Did you know that...

  • As of 2005, tobacco use was considered to be the leading preventable cause of death in the United States. Nearly 500,000 deaths are related to tobacco use each year.
  • The Centers for Disease Control and Prevention estimates that smoking takes 5.6 million years of potential life away each year in the United States.
  • In the United States each day, some 4,000 people under age 18 smoke their first cigarette.
  • Most adult smokers started using tobacco before their 18th birthday--nearly 80 percent of them, in fact.

Charley, the Addicted Chimp

According to First Coast News in April of 2005, Charley, a resident of the Bloemfontein Zoo in South Africa, picked up a smoking habit after finding a pack of cigarettes thrown into his cage. Helpful zoo visitors lit his cigarettes for him. Charley learned to hide his cigarettes from the zookeepers, who would take them from him. The zoo staff feared he had become addicted. They posted signs asking visitors not to give Charley any more tobacco for fear that it was damaging his health.

Nicotine Withdrawal Symptoms

Nicotine withdrawal causes a variety of symptoms, including:

  • restlessness
  • anxiety
  • impatience
  • anger
  • difficulty concentrating
  • increased appetite and weight gain
  • depression
  • loss of energy and interest in life
  • dizziness
  • headache
  • sweating
  • insomnia, the inability to sleep
  • tremors, shaking of limbs
  • tightening of muscles
  • cravings for tobacco.

Kreteks and Bidis

Kreteks are clove-spiced cigarettes from Indonesia. Bidis are small, flavored cigarettes from India. Both are available on the American market, and both contain high concentrations of nicotine--higher, even, than American cigarettes. These items are tobacco products, and they are habit-forming.

Source Citation

Source Citation   

Gale Document Number: GALE|CV2646400040