Dr. Frank Bures: Nicotine addiction is powerful, dangerous.

 

Nicotine is an addicting chemical or drug or substance — or whatever category you choose to call it. It’s likely the most addicting chemical in common human exposure. It is said to be 1,000 times more addictive than alcohol, 10 to 100 more times than barbiturates (rarely used today), and 5 to 10 more times than morphine or cocaine.

Addiction is a repetitive, compulsive behavior that seeks and gets a reward, no matter what the consequences, even when the person is well aware the consequences are bad. Dependence is the state of tissue function that the chemical creates as normal, which then produces a withdrawal syndrome when the chemical is removed.

The feeling of reward induced by any addictive thing happens in our brain in the areas that produce the neurotransmitter between nerves called dopamine. Those areas become sensitized to the chemical, and the dopamine production is increased and sustained. This prods us to want more, especially after a “crash” without it.

Nicotine stimulates a host of brain neurotransmitters, which amplify the behavioral, psychological and physical effects of the drug. First is dopamine, which gives pleasure and suppresses appetite. Then there is acetylcholine, which produces an arousal and enhanced thinking. (I know another dermatologist who said he thought his IQ rose many points when he smoked.)

Next is Vasopressin, which also improves memory. There also are Norepinephrine and serotonin that adds more stimulation. Their interactions are really complex. It only takes seven to eight seconds for inhaled nicotine to reach your brain and react, which is a quick hit.

The withdrawal symptoms from nicotine are familiar to many who have and are trying to quit. The list can include irritability, anger, hostility, anxiety, nervousness, panic, poor concentration, disorientation, lightheadedness, sleep disturbances, constipation, mouth ulcers, dry mouth, sore throat or gums or tongue, limb pain, sweating, depression, fatigue, fearfulness, sense of loss, tobacco craving, hunger, and coughing from the long-term phlegm in damaged airways to name just a few.

These can last a few weeks or several months. I know former smokers who, years after quitting, say they could light up a cigarette just like that, if they think about it. The deleterious medical effects from nicotine are not as many as tobacco but are still many, especially on heart and blood vessels. It increases blood pressure and pulse rate, and saliva and phlegm. If your cardiovascular system is already compromised, nicotine compounds any malfunction.

Nicotine addiction is the second leading cause of death worldwide. It, as well as most other addictions from alcohol or drugs, can be a marker for additional brain disease in the form of a range of mental illnesses. One estimate is that perhaps as many as 60 percent of addicted people have an underlying or secondary disease, from depression to schizophrenia to obsessive-compulsive disorder. Treating more than the addiction might be of far greater benefit and success.

Nicotine has long been felt to be what is called a gateway drug. This means it lowers the threshold for addiction to other chemicals. A new summary in the Sept. 4 New England Journal of Medicine, by one of the originators of the concept, presented the mind-boggling molecular basis for nicotine priming the reward pathways for cocaine specifically, and other drugs by inference. Many people studies have followed nicotine smokers going to marijuana and cocaine, and using both to get a much larger reward effect.

So is there anything good to said about nicotine addiction?

Nope, it sure doesn’t seem so.

One website for nicotine addicts by addicts themselves speaks of nicotine in precisely the same vein as alcohol, as taught by Alcoholics Anonymous and others. Once addicted, your brain tissue is altered for life. Once an addict, always an addict. Try telling that to a teen under peer pressure.

To me, it’s the same problem as advising them about acquiring a tattoo. Once the mark is there, it lasts for your personal eternity. At least brain tissue is not seen by everyone else.

Frank Bures is a semi-retired dermatologist in Winona.