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Nicotine is one of the most heavily used

addictive drugs in the United States. In

2003, 29.8 percent of the U.S. population 12 and older—70.8 million people—

used tobacco at least once in the month

prior to being interviewed.* This figure

includes 3.6 million young people age 12

to 17. There were no statistically significant changes in past-month rates of the

different tobacco products among this

age group between 2002 and 2003.

However, there were significant declines

in past-year and lifetime cigarette use

between 2002 and 2003. In addition,

the rate of past-month cigarette use

decreased among 13 year-olds. Young

adults aged 18 to 25 reported the highest

rate of current use of any tobacco products (44.8 percent). 

Cigarette smoking has been the most popular method of taking nicotine since the

beginning of the 20th century. In 1989,

the U.S. Surgeon General issued a report

that concluded that cigarettes and other

forms of tobacco, such as cigars, pipe

tobacco, and chewing tobacco, are

addictive and that nicotine is the drug

in tobacco that causes addiction. The

report also determined that smoking was

a major cause of stroke and the third

leading cause of death in the United

States. Statistics from the Centers for

Disease Control and Prevention indicate

that tobacco use remains the leading preventable cause of death in the United

States, causing approximately 440,000

premature deaths each year and resulting

in an annual cost of more than $75 billion in direct medical costs. (See

www.cdc.gov/tobacco/issue.htm).

Health Hazards ———–

Nicotine is highly addictive. Nicotine provides an almost immediate “kick” because

it causes a discharge of epinephrine from

the adrenal cortex. This stimulates the

central nervous system and other endocrine glands, which causes a sudden

release of glucose. Stimulation is then

followed by depression and fatigue, leading the abuser to seek more nicotine. 

Nicotine is absorbed readily from tobacco

smoke in the lungs, and it does not matter

whether the tobacco smoke is from cigarettes, cigars, or pipes. Nicotine also

is absorbed readily when tobacco is

chewed. With regular use of tobacco,

Cigarettes and Other

Nicotine Products
levels of nicotine accumulate in the body

during the day and persist overnight.

Thus, daily smokers or chewers are

exposed to the effects of nicotine for

24 hours each day. 

Addiction to nicotine results in withdrawal

symptoms when a person tries to stop

smoking. For example, a study found

that when chronic smokers were deprived

of cigarettes for 24 hours, they had increased anger, hostility, and aggression,

and loss of social cooperation. Persons

suffering from withdrawal also take

longer to regain emotional equilibrium

following stress. During periods of abstinence and/or craving, smokers have

shown impairment across a wide range

of psychomotor and cognitive functions,

such as language comprehension.

Women who smoke generally have earlier

menopause. If women smoke cigarettes

and also take oral contraceptives, they

are more prone to cardiovascular and

cerebrovascular diseases than are other

smokers; this is especially true for women

older than 30.

Pregnant women who smoke cigarettes

run an increased risk of having stillborn

or premature infants or infants with low

birthweight. Children of women who

smoked while pregnant have an increased

risk for developing conduct disorders.

National studies of mothers and daughters have also found that maternal

smoking during pregnancy increased

the probability that female children would

smoke and would persist in smoking.

Adolescent smokeless tobacco users are

more likely than nonusers to become cigarette smokers. Behavioral research is

beginning to explain how social influences, such as observing adults or other

peers smoking, affect whether adolescents

begin to smoke cigarettes. Research has

shown that teens are generally resistant

to antismoking messages. 

In addition to nicotine, cigarette smoke

is primarily composed of a dozen gases

(mainly carbon monoxide) and tar. The

tar in a cigarette, which varies from about

15 mg for a regular cigarette to 7 mg in

a low-tar cigarette, exposes the user to an

increased risk of lung cancer, emphysema, and bronchial disorders.

The carbon monoxide in the smoke

increases the chance of cardiovascular

diseases. The Environmental Protection

Agency has concluded that secondhand

smoke causes lung cancer in adults and

greatly increases the risk of respiratory

illnesses in children and sudden infant

death.

Promising

Research ———–

Research has shown that nicotine, like

cocaine, heroin, and marijuana, increases

the level of the neurotransmitter dopamine,

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which affects the brain pathways that control reward and pleasure. Scientists now

have pinpointed a particular molecule

[the beta 2 (b2)] subunit of the nicotine

cholinergic receptor) as a critical component in nicotine addiction. Mice that lack

this subunit fail to self-administer nicotine,

implying that without the b2 subunit, the

mice do not experience the positive reinforcing properties of nicotine. This new

finding identifies a potential site for targeting the development of nicotine addiction

medications.

Other new research found that individuals

have greater resistance to nicotine addiction if they have a genetic variant that

decreases the function of the enzyme

CYP2A6. The decrease in CYP2A6 slows

the breakdown of nicotine and protects

individuals against nicotine addiction.

Understanding the role of this enzyme in

nicotine addiction gives a new target for

developing more effective medications to

help people stop smoking. Medications

might be developed that can inhibit the

function of CYP2A6, thus providing a

new approach to preventing and treating

nicotine addiction.

Another study found dramatic changes in

the brain’s pleasure circuits during withdrawal from chronic nicotine use. These

changes are comparable in magnitude

and duration to similar changes observed

during withdrawal from other abused

drugs such as cocaine, opiates, amphetamines, and alcohol. Scientists found

significant decreases in the sensitivity of

the brains of laboratory rats to pleasurable stimulation after nicotine administration was abruptly stopped. These changes

lasted several days and may correspond

to the anxiety and depression experienced by humans for several days after

quitting smoking “cold turkey.” The results

of this research may help in the development of better treatments for the withdrawal symptoms that may interfere with

individuals’ attempts to quit smoking.

Treatment ———–

Studies have shown that pharmacological

treatment combined with behavioral treatment, including psychological support

and skills training to overcome high-risk

situations, results in some of the highest

long-term abstinence rates. Generally,

rates of relapse for smoking cessation are

highest in the first few weeks and months

and diminish considerably after about 3

months.

Behavioral economic studies find that

alternative rewards and reinforcers can

reduce cigarette use. One study found

that the greatest reductions in cigarette

use were achieved when smoking cost

was increased in combination with the

presence of alternative recreational

activities.

Nicotine chewing gum is one medication

approved by the Food and Drug Administration (FDA) for the treatment of nicotine
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dependence. Nicotine in this form acts as

a nicotine replacement to help smokers

quit smoking.

The success rates for smoking cessation

treatment with nicotine chewing gum vary

considerably across studies, but evidence

suggests that it is a safe means of facilitating smoking cessation if chewed according to instructions and restricted to patients who are under medical supervision.

Another approach to smoking cessation

is the nicotine transdermal patch, a skin

patch that delivers a relatively constant

amount of nicotine to the person wearing

it. A research team at NIDA’s Intramural

Research Program studied the safety,

mechanism of action, and abuse liability

of the patch that was consequently

approved by FDA. Both nicotine gum and

the nicotine patch, as well as other nicotine replacements such as sprays and

inhalers, are used to help people fully quit

smoking by reducing withdrawal symptoms and preventing relapse while undergoing behavioral treatment.

Another tool in treating nicotine addiction

is a medication that goes by the trade

name Zyban. This is not a nicotine

replacement, as are the gum and patch.

Rather, this works on other areas of the

brain, and its effectiveness is in helping to

make nicotine craving, or thoughts about

cigarette use, more controllable in people

who are trying to quit.

Extent of Use ———–

2004 Monitoring the Future (MTF)

Survey**

Despite the demonstrated health risk associated with cigarette smoking, young

Americans continue to smoke. However,

30-day smoking rates among high school

students are declining from peaks reached

in 1996 for 8th-graders (21.0 percent)

and 10th-graders (30.4 percent) and in

1997 for seniors (36.5 percent). In 2004,

30-day*** rates reached the lowest levels

ever reported by MTF for 8th-graders (9.2

percent) and 10th-graders (16.0 percent).

Twenty-five percent of high school seniors

reported smoking during the month preceding their responses to the survey. 

Lifetime cigarette use among 10th-graders

decreased significantly, from 43.0 percent

in 2003 to 40.7 percent in 2004. Among

10th-graders, there was a significant decrease in the number of students reporting

that they smoke one-half pack or more

cigarettes per day.

The decrease in smoking rates among

young Americans corresponds to several

years in which increased proportions of

teens said they believe there is a “great”

health risk associated with cigarette smoking and expressed disapproval of smoking one or more packs of cigarettes a

day. Students’ personal disapproval of

smoking had risen for some years, but

showed no further increase in 2004.
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In 2004, 85.7 percent of 8th-graders,

82.7 percent of 10th-graders, and 76.2

percent of 12th-graders stated that they

“disapprove” or “strongly disapprove” of

people smoking one or more packs of

cigarettes per day. In addition, 8th- and

10th-graders reported significant increases in the perceived harmfulness of smoking one or more packs of cigarettes per

day.

Other Information

Sources ———–

For additional information on nicotine

abuse and addiction, please visit

www.smoking.drugabuse.gov.

For more information on how to quit

smoking, please visit www.cdc.gov/

tobacco.

National Institutes of Health – U.S. Department of Health and Human Services

This material may be used or reproduced without permission from NIDA. Citation of the source is appreciated.

* NSDUH (formerly known as the National Household Survey on Drug Abuse) is an annual survey of Americans age

12 and older conducted by the Substance Abuse and Mental Health Services Administration. Copies of the latest

survey are available at www.samhsa.gov and from the National Clearinghouse for Alcohol and Drug Information at

1-800-729-6686.

** These data are from the 2004 Monitoring the Future Survey, funded by the National Institute on Drug Abuse, National

Institutes of Health, DHHS, and conducted by the University of Michigan’s Institute for Social Research. The survey has

tracked 12th-graders’ illicit drug use and related attitudes since 1975; in 1991, 8th- and 10th-graders were added to

the study. The latest data are online at www.drugabuse.gov. 

*** “Lifetime” refers to use at least once during a respondent's lifetime. “Annual” refers to an individual's drug use at least

once during the year preceding their response to the survey. “30-day” refers to an individual's drug use at least once during the month preceding their response to the survey.