Nicotine dependence and psychopathology
Nicotine dependence refers to the compulsive use of nicotine, primarily found in tobacco products, which can create cravings comparable to those seen with other powerful addictive substances. The use of nicotine produces a temporary mood lift, reinforcing its addictive qualities. As individuals continue to use nicotine, dependence tends to increase, leading to withdrawal symptoms such as irritability, anxiety, and difficulty concentrating when not using the substance. Interestingly, the onset of nicotine addiction can be influenced by genetics, though social learning—particularly from observing parental behavior—plays a significant role.
Psychopathology intersects with nicotine dependence, as individuals with certain mental health conditions, such as depression or schizophrenia, are statistically more likely to smoke. This relationship raises concerns about the use of tobacco as a means to self-medicate, despite evidence suggesting that smoking may exacerbate some psychiatric symptoms. The health risks associated with tobacco, including various cancers and respiratory diseases, are well-documented, yet the legal status of tobacco use in many cultures complicates the conversation around addiction and public health. As smoking rates have declined globally, there remains a robust industry focused on cessation products, reflecting the ongoing challenge of nicotine dependence amidst changing societal attitudes toward tobacco use.
Nicotine dependence and psychopathology
- TYPE OF PSYCHOLOGY: Psychopathology; psychotherapy; sensation and perception; stress
- Unlike many damaging addictive pursuits (other than the consumption of alcohol), the use of tobacco is legal in most cultures. Cigars, cigarettes, pipe tobacco, and chewing tobacco contain many chemicals, but the active, addictive ingredient in all of them is nicotine, which can create a craving in many people that is as acute (and as difficult to break) as that for heroin, cocaine, or other drugs.
Introduction
Nicotine produces a temporary mood-altering “lift,” or “buzz,” that encourages continued use and helps produce an addictive craving. The body receives nicotine (and other addictive substances) through in the brain. Dependence increases slightly each time the drug is used, leading to more intense addiction. Thus, although going without the drug is easier for younger people, the addiction becomes more trenchant with age. Going without nicotine causes withdrawal symptoms, including irritability and anxiety, that vary in intensity and duration among individuals.
History and Health Risks
The smoking of tobacco once was deemed healthy. Nicotine was named for the tobacco plant Nicotiana tabacum, which itself was named after Jean Nicot de Villemain, a French ambassador who imported it to Portugal in 1560 as a medicine.
Until the 1950s, university lecture halls were built with ashtrays, and indoor smoking was commonplace. The newsroom of the New York Times, for example, contained so many individuals who chain smoked (people who smoke one cigarette after another) in the 1930s that by the end of the workday, janitors used push brooms to sweep away a carpet of butts an inch or two deep.
In 1963, however, the US Surgeon General issued a report linking smoking with a large number of health problems, including heart disease, stroke, and cancer. Since then, even the inhalation of tobacco effluvia from other people’s lungs, so-called passive (or secondhand) smoking, especially by children and pregnant women, has been associated with significant health risks. The nicotine itself usually does not cause health risks. Other substances in tobacco, including tar and various chemicals, do most of the damage. In 2000, it was estimated that about 33 percent of the global population used tobacco, which decreased to 25 percent by 2015 and 22 percent in 2020. In general, men smoke more often than women, and the rates of nicotine use vary significantly by country.
Physical and Psychological Cues
Nicotine reaches the brain within seven to ten seconds after inhalation. One of the major symptoms of nicotine dependence (addiction) is an inability to go without smoking, even after serious attempts to stop. Other symptoms of addiction include anxiety, irritability, restlessness, difficulty concentrating, depressed mood, frustration or anger, increased hunger, insomnia, and constipation or diarrhea.
The continued use of tobacco, even in the face of serious health problems, is another obvious sign of serious addiction. Some people have been known to continue smoking even after lung cancer surgery. Some people defend their “freedom” to smoke, as if engaging in addictive behavior could be defended as an exercise of free choice. Early studies concerning the correlation of genetics and cigarette smoking found that a propensity to smoke may be related to genetic makeup. In other words, smoking behavior can be inherited to a degree. However, later research indicated that, while a genetic component exists, social learning was more impactful than genetics, meaning that children who grow up watching their parents smoke are more likely to smoke themselves. Some people do not experience pleasure from the use of nicotine and are unlikely to continue its use after experimenting.
Beginning smoking at a young age increases the chances of serious and intense addiction later in life. Nicotine binds to nicotinic acetylcholine receptors in the brain, increasing levels of that play a role in the brain’s regulation of mood and behavior. Nicotine provides many people’s brains with a shot of dopamine, a neurotransmitter, producing a brief sense of euphoria and relaxation that rewards continued use, reinforcing the physiological addiction of the drug. The use of nicotine also increases the flow of the stimulating hormone adrenaline (epinephrine). Nicotine also increases heart rate by about twenty beats per minute and elevates blood pressure because it constricts arteries.
The combustion of tobacco provokes the release of more than sixty cancer-causing chemicals. According to the American Lung Association, smoking plays a role in 90 percent of lung cancer cases among men (70 to 80 percent among women), as well as in cases of emphysema and chronic bronchitis. It also aggravates asthma. Smoking plays a major role in cancers of the mouth, esophagus, larynx, and throat (pharynx). It plays a role in other pathologies in the kidneys, bladder, stomach, pancreas, cervix, stomach, and other parts of the body. It can increase the risk of impotence and infertility.
Tobacco dependence is a physical process that also brings into play psychological cues. A person's desire to increase their nicotine level may be linked to well-established daily rituals, such as morning coffee, drinking alcohol at a bar, or free time between tasks at work. Certain friends may provoke an urge to smoke. Smoking also can be associated with specific locations, such as a particular automobile. Stress can raise anxiety levels and lead to smoking. The smell of burning tobacco can increase the desire to use it. People who experience depression, schizophrenia, and other mental health conditions are, statistically speaking, more likely to smoke tobacco. Individuals who abuse alcohol and illegal drugs also smoke in a higher proportion than the general population.
Tobacco use was once studied as a potential treatment for schizophrenia, attention-deficit hyperactivity disorder (ADHD), and Parkinson’s disease. However, the increased mortality risk associated with smoking far outweighed any marginal benefit seen, and in the case of ADHD, many studies found smoking worsened symptoms. Later epidemiological and experimental studies found some evidence of neuropsychiatric conditions worsening with the use of cigarettes.
Products designed to help individuals who smoke quit using tobacco have become a multibillion-dollar industry worldwide. In some countries, smoking tobacco remains legal for adults, but the places where people can smoke have become limited. In the Netherlands, for example, the smoking of tobacco has become illegal in some cafés where the use of marijuana is allowed. California was the first US state to ban smoking in all enclosed work areas, doing so in 1995.
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