Addiction

Definition of Addiction

The American Psychiatric Association defines addiction using five criteria, tolerance, withdrawal, loss of control, preoccupation, and continuation despite adverse consequences. An addict will display three or more of the criteria.

1. Tolerance is either a need for markedly increased amounts of the substance to achieve the desired effect, or markedly diminished effect with continued use of the same amount of the substance. Many tobacco users rapidly go from "one now and then," to buying a pack or a can a day.
2. Withdrawal consists of uncomfortable or dangerous symptoms when the user stops taking the substance for a time. Tobacco users experience irritability, restlessness, lack of concentration, fatigue, hunger, nervousness, and other symptoms when they go without nicotine.
3. Loss of control is when the user takes larger amounts or takes the substance over a longer period than was intended. The user usually has a persistent desire or makes unsuccessful efforts to cut down or control substance use. Remember, 48% of current smokers wish they could quit, but feel that they can’t.
4. Preoccupation means that the user spends a great deal of time obtaining and using the substance and/or recovering from its effects. Smokers may panic if they have few or no cigarettes left or if they are out of matches.
5. Continuation despite adverse consequences means that the user gives up or reduces important social, occupational, or recreational activities because of substance use. For example, he or she may stand in the winter cold to smoke or stop visiting friends or family members who won’t allow smoking in their homes. It may also mean that the person continues using even though he or she knowingly has a persistent or recurrent physical or psychological problem caused or made worse by the substance. For example, someone may continue chewing tobacco even after losing gums or teeth or continue smoking despite a daily cough.

Mechanisms of Addiction

Nicotine stimulates the release of the brain's neurotransmitters (messenger chemicals.) An increase in neurotransmitters creates a heightened alertness and aids short-term memory. The first rush of nicotine hits the brain within a few seconds. The amount of nicotine in the blood begins falling rapidly as soon as the user stops smoking or chewing. Within 45 minutes of using, the concentration of nicotine in the blood is at about half of its peak. The user begins to feel withdrawal symptoms, like irritability and restlessness. The withdrawal drive the user to smoke or chew again.

Over time, the tobacco user’s brain becomes accustomed to a certain concentration of nicotine in the blood, and tolerance builds. Users’ brains actually trick them into maintaining a set level of nicotine. Studies have shown that smokers who switch to lower nicotine cigarettes subconsciously smoke more cigarettes, inhale more deeply, hold the smoke longer, or cover the tiny holes in the filter. All of these strategies, conscious or not, increase the amount of nicotine the smoker absorbs.

The tobacco industry insisted in public for decades that nicotine was not addictive, but was "flavoring" agent. However, internal industry documents reveal the truth. Tobacco company Brown & Williamson’s general counsel wrote in 1963, "…nicotine is addictive. We are, then, in the business of selling nicotine, an addictive drug effective in the release of stress mechanisms."