Cigarettes and Other Nicotine
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.
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
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
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
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
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
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.
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
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 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
|Used in Past Month
|Smoke a Pack or more per Day
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