Tobacco addiction

A treatable chronic relapsing disorder characterized by cravings and compulsive use of tobacco. 

Estimated, currently, 47.1 million US adults or 19% of that population, currently use tobacco mostly in the form of cigarettes: accounting for 12.5% of the population.

More than 480,000 adults in the US die annually from cigarette smoking effects, and approximately 16 million have a smoking related illness.

Smoking prevalence is highest among adults 25 to 64 years of age. 

Smoking is more common in people of color, low income individuals, low education individuals, and those who are divorced, separated, or widowed and those who are non-cis gender or non-heterosexual, those who receive Medicaid, disability benefits, or are uninsured, and in those having anxiety and depression.

In the US individuals with mental illness are 2 to 4 times more likely than the general population to smoke.

Nicotine is the primary addictive compound in tobacco, but the byproducts of combustion drive tobacco related disease and death.

Inhaling cigarette smoke delivers an arterial bolus of nicotine to the brain in 7 to 30 seconds at an  average of 1 mg of nicotine per cigarette, which activates the nicotinic receptors that mediate the release of dopamine in the reward pathways of the brain.

Smoking allows for the most rapid delivery of high concentration of nicotine and makes it the most addictive form of nicotine delivery.

Risk factors for the onset of smoking and subsequent tobacco addiction are both genetic and environmental.

The age a person initiates smoking, and the number of cigarette smoked per day, and cessation have been associated with 566 genetic variants in 406 loci.

Parental smoking, influence of peers, and personality traits related to impulsivity and risk-taking and sensation seeking behaviors are associated with the beginning of and experimentation with smoking.

Adverse childhood experiences are associated with twice the risk of a person becoming an adult smoker.

Recent decrease in smoking among adolescents has occurred but an increase in the proportion of smokers initiating smoking has occurred in early adulthood: attributed to smoking prevention efforts in middle school and high school students.

The person who smokes me make 30 or more attempts to quit for having permanent remission.

Only 3 to 5% of smokers will be abstinent 6 to 12 months after a given quit attempt, with most relapsees occurring within the first eight days after quitting, and this is related to acute withdrawal symptoms with difficulty concentrating, increased anxiety, sadness, anger, frustration, irritability, insomnia, and hunger with subsequent urge to smoke, that is cravings.

Tobacco withdrawal symptoms peak within two days after a person quits smoking and is greatly diminished within a week, the cravings can persist and lead to relapse.

The incidence of relapse is as high as 10% in the year after one year of abstinence, decreasing to 2 to 4% after two years.

Late relapses may occur, often triggered by a stressful life event.

Smoking even a single cigarette can lead to a full relapse.

Evidence-based treatments suggest 10 to 30% of smokers have long-term abstinence.

Management: all persons who smoke should be advised to stop as soon as possible and should be treated with medications and provided behavioral counseling if they smoke five or more cigarettes per day.

Treating with Varenicline or combination of nicotine patch plus short acting nicotine replacement formulations is the first choice for smokers.

See nicotine replacement therapy

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