Cigarettes and Other Nicotine Products 

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Nicotine is one of the most heavily used addictive drugs in the United States. Cigarette smoking has been the most 

popular method of taking nicotine since the beginning of the 20th century. In 1998, 60 million Americans were current 

cigarette smokers (28 percent of all Americans aged 12 and older), and 4.1 million were between the ages of 12 and 17 

(18 percent of youth in this age bracket). 

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. 

In addition, the report determined that smoking was a major cause of stroke and the third leading cause of death in the 

United States. 

Health Hazards 

Nicotine is highly addictive. It is both a stimulant and a sedative to the central nervous system. The ingestion of nicotine 

results in 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, 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. Nicotine taken in by cigarette or cigar smoking takes only seconds to reach the brain but has a 

direct effect on the body for up to 30 minutes. 

Research has shown that stress and anxiety affect nicotine tolerance and dependence. The stress hormone 

corticosterone reduces the effects of nicotine; therefore, more nicotine must be consumed to achieve the same effect. 

This increases tolerance to nicotine and leads to increased dependence. Studies in animals have also shown that 

stress can directly cause relapse to nicotine self-administration after a period of abstinence. 

Other studies have shown that animals cannot discriminate between the effects of nicotine and the effects of cocaine. 

Studies have also shown that nicotine self-administration sensitizes animals to self-administer cocaine more readily. 

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. 

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 many kinds of 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 a high expectancy rate 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.

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Promising Research 

Research has shown that nicotine, like cocaine, heroin, and marijuana, increases the level of the neurotransmitter 

dopamine, which affects the brain pathways that control reward and pleasure. Scientists now have pinpointed a 

particular molecule (the beta 2 subunit of the nicotine cholinergic receptor) as a critical component in nicotine addiction. 

Mice that lack this molecule fail to self-administer nicotine, implying that without the b2 molecule, the mice do not 

experience the positive reinforcing properties of nicotine. This new finding identifies a potential site for targeting the 

development of anti-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 the 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 individual's attempts to quit smoking. 

Treatment 

Research suggests that smoking cessation should be a gradual process because withdrawal symptoms are less severe 

in those who quit gradually than in those who quit all at once. Rates of relapse are highest in the first few weeks and 

months and diminish considerably after 3 m-onths. 

Studies have shown that pharmacological treatment combined with psychological treatment, including psychological 

support and skills training to overcome high-risk situations, results in some of the highest long-term abstinence rates. 

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 dependence. Nicotine in this form acts as a nicotine replacement to help smokers quit the smoking habit. 

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 Division of Intramural Research 

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 trademark 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 controllable nicotine craving or thoughts about cigarette use in people trying to quit. 

In the future, a nicotine vaccine may be an effective method for preventing and treating tobacco addiction. The vaccine 

would prevent nicotine from reaching the brain so as to reduce its effects and help keep people from becoming 

addicted. 

Scientists recently developed an experimental nicotine vaccine consisting of a nicotine derivative attached to a large 

protein. The scientists injected a single dose of nicotine into vaccinated rats and found that the amount of nicotine 

reaching the brain was reduced by 64%. Further, the researchers found that administering doses of nicotine antibodies 

similar to those that are ordinarily produced by the vaccine greatly reduced the rise in blood pressure produced by a 

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nicotine injection. The antibodies also completely prevented the increased movements ordinarily seen when rats are 

injected with nicotine. 

The next steps will be to conduct additional safety studies, followed by clinical trials with the vaccine in human 

volunteers. These clinical trials are currently scheduled to begin in early 2002. 

Extent of Use 

Monitoring the Future Study (MTF)*

Prevalence rates for smoking among young people remain high, in spite of the demonstrated health risk associated with 

smoking. Since 1975, cigarettes have consistently been the substance the greatest number of high school students use 

daily. 

Between 1998 and 1999, however, past month smoking decreased significantly among 8th graders, from 19.1 percent 

to 17.5 percent, and rates of use were stable or slightly decreased for 10th graders (25.7 percent) and seniors (34.6 

percent). Lifetime and daily use also leveled off in 1999 among all grades, as did use of smokeless tobacco. 

Cigarette Use by Students, 1999 

Monitoring the Future Study

 

National Household Survey on Drug Abuse (NHSDA)**

Each year, the NHSDA reports on the nature and extent of drug use among the American household population aged 

12 and older. In 1998, an estimated 60 million Americans, or 28 percent of all Americans aged 12 and older, were 

current smokers. Approximately 18 percent (4.1 million) of youths 12 to 17 years old were current smokers in 1998. 

The 1998 survey shows that current smokers are more likely to drink heavily and use illicit drugs than non-smokers. 

# "Lifetime" refers to use at least once during a respondent's lifetime. "Past year" refers to an individual's drug use at 

least once during the year preceding their response to the survey. "Past month" refers to an individual's drug use at 

least once during the month preceding their response to the survey.

* The MTF survey is conducted by the University of Michigan's Institute for Social Research and is funded by National 

Institute on Drug Abuse, National Institutes of Health; it has tracked 12th graders' illicit drug use and related attitudes 

since 1975. In 1991, 8th and 10th graders were added to the study. For the 1999 study, 45,000 students were surveyed 

from a representative sample of 433 public and private schools nationwide. The latest survey data are available at 

NIDA's website, http://www.drugabuse.gov, and at the University of Michigan website, 

http://www.MonitoringTheFuture.org.

** NHSDA is an annual survey conducted by the Substance Abuse and Mental Health Services administration. Copies 

of the latest survey are available from the National Clearinghouse for Alcohol and Drug Information at 1-800-729-6686

This page has been accessed 110492 times since 11/5/99. 

 8th-Graders 10th-Graders 12th-Graders

 Ever Used# 44.1% 57.6% 64.6%

 Used in Past Month# 17.5 25.7 34.6

 Pack + per Day# 3.3 7.6 13.2

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Monday, May 13, 2002. 

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