8:2 - Treating Tobacco Dependence: Addiction & Tobacco Effects

What is third hand smoke?

"Third-hand" smoke refers to the cigarette byproducts that cling to smokers' hair and clothing as well as to fabrics, carpets and surfaces — even after secondhand smoke has cleared. Ever take a whiff of a smoker's hair and feel sick from the strong scent of cigarette smoke? Welcome to the world of third-hand smoke. Third hand smoke refers to the cigarette by-products that cling to smokers' hair and clothes, furniture, carpets and surfaces — even after secondhand smoke has cleared. This term was coined to raise awareness about the danger these invisible tobacco toxins pose to small children, who are especially susceptible because they breathe near, crawl on, play on, touch and mouth contaminated surfaces. It's important to remember that smoke exposure in the home can't be eliminated by opening a window, using air conditioning or a fan, or allowing smoking in some rooms but not others. If you can smell tobacco smoke — even if you can't see it — you're breathing in toxins, including more than 60 known carcinogens. The only way to fully protect people, especially kids — is to make the home and car smoke-free. Initial studies have suggested that third hand smoke may pose health risks, especially to kids who are more susceptible to carcinogenic agents in the residue of tobacco smoke. Expect to see more research in this area in the future.

What is a light smoker?

A light smoker or "chipper" consumes a daily amount of tobacco that is less than ½ pack per day, and often smokers in this category can consume as little as 4-6 cigarettes per day for example.

Smoking has been linked to the buildup of fatty substances, or plaque, in the carotid artery, the main neck artery supplying blood to the brain. What does this cause?

Blockage of this artery is the leading cause of stroke. Nicotine raises blood pressure; carbon monoxide reduces the amount of oxygen the blood can carry to the brain; and smoking makes the blood thicker and more likely to clot.

T/F: Cigarette smoking accounts for about one-third of all cancers, including 90 percent of lung cancer cases.

TRUE - Although nicotine is addictive and can be toxic if ingested in high doses, it does not appear to cause cancer—other chemicals are responsible for most of the severe health consequences of tobacco use. Tobacco smoke is a complex mixture of chemicals such as carbon monoxide, tar, formaldehyde, cyanide, and ammonia—many of which are known carcinogens. Tar exposes the user to an increased risk of lung cancer, emphysema, and bronchial disorders. Smokeless tobacco (such as chewing tobacco and snuff) also increases the risk of cancer, especially oral cancers.

What is the wheel of ingestive and process addictions?

The hub represents the core problem, the addiction susceptible person and the addiction-oriented family system. The spokes depict a variety of substance and process addictions——symptoms of the core problem which can occur separately or in constellations. The relative narrowness of the spokes at the hub illustrate the addiction's initial pliability and amenability to alteration and reversal. The widening spokes represent expansion and fusion with the rim of adverse consequences.

What is the effect of pH on nictotine?

The tobacco industry has long appreciated the importance of smoke pH for boosting nicotine's impact the freebase form of nicotine in smoke increases with increasing alkalinity. Although pH is a good indicator of relative freebase availability, it tends to underestimate the actual amount available. Other industry methods for measuring free nicotine−such as oil versus water partitioning or studies of nicotine volatility−reveal free nicotine levels much higher than those predicted from pH alone.

What is the alpha4 beta2 receptor?

The α4 β2 Receptor is an ion channel on the cell membrane. It consists of two α4 and three β2 subunits. Nicotine binds between alpha and beta subunits. (Nicotinic Acetylcholine Receptors −− nACHRs) This produces a release of Dopamine.

Nicotine changes what in the brain?

chemistry: Nicotine increases the number of nicotinic receptors. Nicotinic receptors are triggered by cues that make a user want to smoke. When receptors are empty, they make a smoker feel uncomfortable and increase the user's desire to smoke. Smokers have many more nicotine receptors than nonsmokers. When bound to nicotine (red cones), these receptors will produce cravings for nicotine. When a person quits smoking, many nicotinic receptors will disappear, but those that remain have "memory" and can be triggered by cues. This is often referred to as euphoric recall.

Where are the most well known effects of smoking?

the most well known adverse effects are on the respiratory and cardiovascular systems. Smoking causes lung diseases, and increases the risk of heart diseases. Smoking has also been linked to leukemia, cataracts, and pneumonia. On average, adults who smoke die 14 years earlier than nonsmokers.

What are 4 key points about nicotine addiction?

1. Addiction leads to compulsive use, despite adverse consequences. 2. Addiction involves a psychoactive substance with reinforcing properties: DOPAMINE, released in the nucleus ACUMBENS, triggers CNS effects such as pleasure, anxiety relief, better task performance, improved memory 3. The addicted subject develops tolerance. 4. An addictive substance causes physical dependence, withdrawal and relapse.

What does ETS do to adults, children?

Adults: Heart disease Lung cancer Children: Respiratory / lung diseases; asthma Middle ear disease According to CDC, approximately 38,000 deaths per year can be attributed to secondhand smoke. Nonsmokers exposed to secondhand smoke increase their risk of developing heart disease by 25 - 30 % and lung cancer by 20 - 30 % In addition, secondhand smoke causes respiratory problems in nonsmokers, such as coughing, phlegm, and reduced lung function. Children exposed to secondhand smoke are at an increased risk for sudden infant death syndrome, acute respiratory infections, ear problems, and more severe asthma. Based on the weight of the available scientific evidence, EPA has concluded that the widespread exposure to ETS in the U.S. presents a serious and substantial public health risk. In kids, ETS increases the risk of lower respiratory tract infections such as bronchitis and pneumonia. EPA estimates that between 150,000 and 300,000 of these cases annually in infants and young children up to 18 months of age are attributable to exposure to ETS. Of these, between 7,500 and 15,000 will result in hospitalization.ETS exposure increases the prevalence of fluid in the middle ear, a sign of chronic middle ear disease. ETS exposure in children irritates the upper respiratory tract and is associated with a small but significant reduction in lung function. ETS exposure increases the frequency of episodes and severity of symptoms in asthmatic children. The report estimates that 200,000 to 1,000,000 asthmatic children have their condition worsened by ETS and it is a risk factor for new asthma cases.

Why is smokeless tobacco not harmless?

Adverse oral health effects Cardiac effects Damages DNA And Key Enzymes (animal models) So far we have been focusing on the systemic effects of smoking tobacco, principally because it is the most widely used and the effects are well established. However, smokeless tobacco is far from harmless. According to a report in the journal Chemical Research in Toxicology , far from having adverse effects limited to the mouth, smokeless tobacco affects the normal function of a key family of enzymes found in almost every organ in the body. The enzymes play important roles in production of hormones, including the sex hormones estrogen and testosterone; production of cholesterol and vitamin D; and help the body breakdown prescription drugs and potentially toxic substances. Smokeless tobacco also damages genetic material in the liver, kidney and lungs. The study noted widespread recognition of smokeless tobacco's harmful effects on the mouth, which include an increased risk of gum disease and oral cancer. The potential carcinogens and other chemicals in chewing tobacco and other smokeless products are absorbed into the blood and travel throughout the body. However, there is less information on smokeless tobacco's effects there. We do know that it exerts some cardiovascular effects similar to smoking tobacco. However, the latest study evaluated changes in enzymes and genetic material in animals using extracts of smokeless tobacco. In addition to damage to the genetic material DNA, researchers found that smokeless tobacco extracts alter the function of the so-called CYP-450 family of enzymes. No doubt, research will continue in this area.

What must be done with the chain of addiction?

All 3 pieces of the chain must be addressed in tobacco dependence treatment in order for the addiction to be managed.

What are the withdraws and craving associated with nicotine?

Almost everyone experiences some symptoms of withdrawal when they stop smoking. For most smokers, withdrawal symptoms, such as those shown here, last for several weeks, becoming less intense and less frequent over time. WITHDRAWAL symptoms (yellow) peak in their intensity within the first few days of stopping smoking. After a few intense days, they become milder and then resolve. URGES, also called CRAVINGS (red lines) occur even when smoking. They can be frequent (lines close together) and intense (taller lines) soon after quitting - but typically they are brief, lasting only a few minutes. As time goes on, urges occur less often, are less intense and don't last as long. However, you can still experience urges even months after you've stopped smoking.

What are the withdraw and craving symptoms associated with nicotine?

Anger Anxiety Craving Depression Difficulty concentrating Fatigue Nausea Frustration Hunger Irritability Impatience Restlessness Nervousness Shakiness

What patterns develop in tobacco use?

Circadian Rhythmic repetition of tobacco use at about the same time each day

What are the systemic effects of smoking - on the heart?

Coronary heart disease Peripheral vascular disease Abdominal aortic aneurysm

What is the link between smoking and impotence?

For 30-40 yr old men, smoking increases risk of erectile dysfunction (ED) by 50% For men in their 30s and 40s, smoking increases the risk of erectile dysfunction (ED) by about 50%.The British Medical Association estimates that up to 120,000 men have ED because of smoking. Erection can't occur unless blood can flow freely into the penis, so these blood vessels have to be in good condition. Smoking can damage the blood vessels and cause them to degenerate: nicotine narrows the arteries that lead to the penis, reducing blood flow and the localized blood pressure. Over time, the narrowing effect worsens. Erection problems in smokers may be an early warning signal that cigarettes are already damaging other areas of the body - such as the blood vessels that supply the heart.

What is freebasing?

Freebasing is a chemical process used to increase the stimulating effect of [illicit] drugs, such as cocaine, by converting the salt of the drug into its noncharged base form that can more readily enter the brain. The resulting product is smoked. Freebasing may also describe the use of ammonia in cigarettes, which helps convert bound nicotine molecules in tobacco smoke into free nicotine molecules, therefore, boosting the effect of the nicotine on the smoker.

What effect does smoking have on the youth?

Heart and lung effects Poorer physical fitness, endurance Increased lung cancer risk Emotional/psych disorders High risk behaviors; addictive potential Smoking during childhood and adolescents can pose some additional risks. Short-term health consequences include: respiratory and non respiratory effects, nicotine addiction, and a higher risk for experimenting with other drugs. Long-term health consequences of youth smoking are reinforced by the fact that most young people who smoke regularly continue to smoke throughout adulthood. Smoking reduces the rate of lung growth in kids and hurts fitness in terms of both performance and endurance—even for young people trained in competitive running. The resting heart rates of young adult smokers are two to three beats per minute faster than nonsmokers. Smoking at an early age increases the risk of lung cancer. For most smoking-related cancers, the risk rises as the individual continues to smoke. Teenage smokers suffer from shortness of breath (SOB) almost 3x as often as nonsmoking teens, and produce more phlegm. Teen smokers are more likely to have emotional or psychological problems, such as depression. Teens who smoke are 3x more likely than nonsmokers to use alcohol, 8x more likely to use marijuana, and 22 x more likely to use cocaine. Smoking is associated with other risky behaviors, such as fighting and engaging in unprotected sex. People who start smoking at an earlier age also appear to have a higher potential for nicotine addiction

What effects does smoking have on the digestive system?

Heartburn GI disease (ulcers, Crohn's disease) Pancreatic cancer: Polycyclic aromatic hydrocarbons (PAH) from tobacco smoke

What is a heavy smoker?

Heavy smokers are defined as smoking a pack or more per day (e.g. >20-25 cig/day).

What is the link between infertility and pregnancy with smoking?

Infertility Pregnancy Miscarriage, premature or low birth wt babies Increased risk of nicotine addiction in child Sudden infant death syndrome (SIDS). Behavioral / learning problems in kids As already mentioned, tobacco use can contribute to infertility problems among couples. Pregnant women who smoke cigarettes run an increased risk of miscarriage, stillborn or premature infants, or infants with low birth weight. Smoking more than one pack of cigarettes per day during pregnancy nearly doubles the risk that the affected child will become addicted to tobacco if that child starts smoking. Maternal smoking may also be associated with learning and behavioral problems in children.

What are the respiratory effects of smoking?

Lung Cancer Emphysema Chronic bronchitis

What is the information on women and smoking?

More difficulty in quitting Postmenopausal women who smoke have lower bone density than female never smokers. Female smokers have an increased risk for hip fracture than female never smokers. Higher risk for some cancers than male smokers. It has been noted that women tend to have more difficulty in quitting tobacco. This may be due in part to the hormonal effects of tobacco, some of which were just mentioned. Also, because of these effects women smokers are at greater risk for osteoporosis, especially as they age. Women also appear to have higher risks for some cancer, such as bladder cancer, than comparable smoking males. It has been suggested that women may process the metabolites of tobacco differently than men. Research in this area is ongoing.

How does nicotine addiction cause lung cancer?

Most of what is known about the association of smoking and cancer concerns lung cancer. This slide describes the mechanism of lung cancer development from smoking. Cigarette smoke carcinogens form the link between nicotine addiction and lung cancer. Collectively, the evidence favoring the sequence of steps shown in this slide is very strong. Nicotine addiction is the reason that people continue to smoke. While nicotine itself is not considered to be carcinogenic, each cigarette contains a mixture of carcinogens, including a small dose of polycyclic aromatic hydrocarbons (PAHs) and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) among other lung carcinogens, tumor promoters, and co-carcinogens. Carcinogens like NNK and PAHs require metabolic activation to exert their carcinogenic effects; there are competing detoxification pathways, and the balance between metabolic activation and detoxification differs among individuals and will affect cancer risk. The metabolic activation process leads to the formation of DNA adducts, which are carcinogen metabolites bound to DNA. If DNA adducts escape cellular repair mechanisms and persist, they may lead to miscoding, resulting in a permanent mutation. Cells with damaged DNA may be removed by apoptosis, or programmed cell death. If a permanent mutation occurs in a critical region of an oncogene or tumor suppressor gene, it can lead to activation of the oncogene or deactivation of the tumor suppressor gene. Multiple events of this type lead to damaged cells with loss of normal growth control and, ultimately, to lung cancer. The long-term exposure of smokers to the genotoxic intermediates formed from these carcinogens is consistent with our present understanding of cancer induction as a process which requires multiple genetic changes. It's very plausible that the continual barrage of DNA damage produced by tobacco smoke carcinogens causes the multiple genetic changes that are associated with lung cancer. While each dose of carcinogen from a cigarette is small, the cumulative damage produced in years of smoking will be substantial.

What type of smokers exist?

Nonsmoker:Never smoker or Former smoker Social smoker / nondaily smoker Light smoker / Chipper Regular daily smoker Heavy smoker

What does smoking do to the lungs?

One of the first established links between smoking and disease was on the respiratory system. Smoking causes lung cancer, the most common cancer in the U.S. In addition, smoking causes other lung diseases like emphysema, and chronic bronchitis by damaging the airways and alveoli (i.e., small air sacs) of the lungs. For example, cigarette smoke is by far the most common cause of emphysema. The damage begins when tobacco smoke temporarily paralyzes the microscopic hairs (cilia) that line bronchial tubes. Normally, these hairs sweep irritants and germs out of the airways. But when smoke interferes with this sweeping movement, irritants remain in the bronchial tubes and infiltrate the alveoli, inflaming the tissue and eventually breaking down elastic fibers. In emphysema, many of these elastic fibers have been destroyed, and patients must consciously force air out of their lungs. The forced exhalation compresses many of the small airways, making breathing and expelling air even more difficult.

What is addiction?

PATHOLOGICAL RELATIONSHIP WITH AN OBJECT OR EVENT

What are the different types of ETS?

Passive smoke Second-hand smoke ---Mainstream smoke - what the smoker exhales ---Sidestream smoke- what comes directly from the burning tobacco product = Extremely potent

What does nicotine do in the body?

People smoke for many reasons. One main reason is because the nicotine in tobacco is so addictive. Inhalation is the quickest way for a drug to reach the brain. When smoking, high levels of nicotine enter the lungs and are quickly absorbed into the bloodstream. Nicotine reaches the brain in about 8-10 seconds stimulating feelings of pleasure and the desire for more tobacco. Nicotine goes into the circulation from the lungs. Then the heart pumps it immediately to the brain and the rest of the body at high concentrations. It's these high levels delivered so rapidly that make nicotine so addictive.

Explain 20 pack years.

Plateau #1 20 Pack Years Significance: Systemic health is breaking down and smoker begins to feel it. Physical body changes can be detected (measured). HOW TO REACH 20 PACK YEARS 1.0 Pack/Day X 20 Years Smoking 2.0 Packs/Day X 10 Years Smoking

Explain 30 pack years.

Plateau #2 30 Pack Years Significance: The quality of one's life is going downhill fast and the smoker knows it! Physical, mental and social limitations have set in and tobacco-related conditions are popping up. A key time for action! HOW TO REACH 30 PACK YEARS 1.0 Pack/Day X 30 Years Smoking 2.0 Packs/Day X 15 Years Smoking 3.0 Packs/Day X 10 Years Smoking

What does smoking do to the skin and hair?

Poor wound healing Premature Wrinkling= Smoker's face Brittle, dry hair; hair loss Benign skin lesions Cancerous skin lesions

What is a daily smoker?

Regular daily smokers are what we usually think of when we think of smokers. They consume moderate amounts of tobacco on a daily basis

What does smoking do to the digestive system?

Smoking contributes to heartburn, because tobacco smoke irritates the entire digestive tract, stimulating a higher acid production. Smoking also negatively affects the pancreas, which secretes hormones, like insulin, which help the body digest most food sources. Smoking can contribute to ulcers and Crohn's disease. Crohn's disease is an inflammatory bowel disorder often striking people in their 20s-30s. Tobacco smoke is also one of the biggest risk factors for developing pancreatic cancer. For example, smoking during the college years has been associated with a 2-3 fold increased risk of pancreatic cancer. Research has implicated polycyclic aromatic hydrocarbon (PAH) compounds in tobacco smoke as being promoters of pancreatic cancer.

How does smoking effect the skin and hair?

Smoking has been associated with poor wound healing in the epithelium. The mechanism of these harmful effects is likely multifactorial. The nicotine in cigarettes causes vasoconstriction of cutaneous blood vessels which results in less oxygen to the tissues. Smoking also increases carboxyhemoglobin, increases platelet aggregation, increases blood viscosity, decreases collagen deposition, and decreases prostacyclin formation, which all negatively affect wound healing. In addition, vasoconstriction associated with smoking is not so short lived. Smoking a single cigarette may cause cutaneous vasoconstriction for up to 90 minutes - a pack-a-day smoker remains tissue hypoxic for most of each day. Although no official guidelines have been established, many dermatologists advise patients to quit smoking for at least 1 week before and after surgical procedures. The skin of a long-term smoker may become dry, discolored, spotted and more easily prone to wrinkles. The image on the slide shows the typical wrinkling pattern observed in smokers. Smoking also makes the hair become thin, brittle and hard to manage. Hair may eventually fall out. Smokers have triple the risk of skin cancer and smoking is associated with several benign skin conditions such as eczema and acne.

What are the health effects of smoking on the brain?

Smoking is one of the major causes of strokes in adults. There are ~600,000 strokes / yr related to smoking ( ~30% are fatal). Strokes are the 3rd leading cause of death in the U.S. Recent studies have also shown that smoking may reduce memory and cognitive abilities.

What does smoking do to the heart?

Smoking is well known to cause coronary heart disease, the leading cause of death in the U.S. The effects of nicotine and carbon monoxide from smoking increase the chance of cardiovascular diseases. Carbon monoxide impedes the ability of red blood cells (rbcs) to carry oxygen to tissues, including heart and brain tissue. The lack of oxygen causes the heart to work harder and can lead to a thickening of the walls and heart failure. Smoking causes reduced circulation by narrowing the blood vessels (arteries) and puts smokers at risk for developing peripheral vascular disease in which there is an obstruction of the large arteries in the arms and legs. This can cause a range of problems from pain to tissue death or gangrene. Smoking can also cause the formation of a swelling or weakening of the body's main artery, the aorta, where it runs through the abdomen, referred to as an abdominal aortic aneurysm.

What are the oral effects of tobacco use?

Stained teeth, restorations & dentures Reduced taste and smell; Halitosis Hairy Tongue, Smokers' Melanosis, Nicotine Stomatitis Candidiasis, Leukoplakia, Carcinomas; Periodontal disease, Dental caries Increased risk of surgical complications, poor wound healing, increased risk of implant failure

What are strokes caused by?

Stroke occurs when blood to the brain fails to circulate properly. Brain cells can die from decreased blood flow and the resulting lack of oxygen. Most strokes are caused by a blockage of blood flow to the brain which stems from 3 conditions : the formation of a clot within a blood vessel of the brain or neck, (i.e. thrombosis); the movement of a clot from another part of the body (embolism); or a severe narrowing of an artery in or leading to the brain (stenosis).

T/F: Smoking harms nearly every organ of the body. Smoking causes many diseases and reduces the overall health of smokers.

TRUE

T/F: The harms of tobacco use have been known for many years and are dose related -that is, the longer a person smokes and the more a person smokes, the greater the risks.

TRUE

What effect does smoking have on hormones?

Thyroid disease (e.g. Grave's hyperthyroidism) Stimulates release of some pituitary hormones and adrenal gland hormones Sex hormones (anti-estrogen effects) Insulin Parathyroid hormone & Vitamin D Smoking can modify the activity of many human hormones. Smoking has been implicated as a risk factor for some thyroid diseases, even affecting thyroid function of kids whose parents smoke. Smoking stimulates the release of adrenal gland hormones and several anterior and posterior pituitary hormones. This may then influence many bodily functions. For example fertility and blood pressure through actions on prolactin, and anti-diuretic hormone, respectively. Smoking has major effects on human reproductive potential, and in women, produces an anti-estrogen effect. The activity of insulin is antagonized by smoking as is Parathyroid Hormone (PTH) and vitamin D. These changes make the smoker more susceptible to elevated blood glucose, and lowered calcium absorption. NOTE: a hormone agonist are chemicals that bind to the hormone receptors on target cells and exert the same effect as the hormone; a hormone antagonist blocks binding of the hormone to the receptor on target cells which has the effect of inhibiting the activity of the hormone.

What is the link between tobacco and diabetes mellitus?

Tobacco is of particular danger to people with diabetes. All complications of diabetes such as cardiovascular disease, foot problems, kidney and eye disease are worsened by smoking. There is growing evidence that cigarette smokers are more prone to developing type 2 diabetes than the rest of the population. Smoking is associated with insulin resistance. While smoking, insulin absorption is delayed and if taking insulin, the effects of smoking will hinder the action of insulin administration. When diabetes is already present, smoking increases the incidence, mortality and morbidity from cardio- and cerebrovascular complications (MI and stroke), diabetic foot problems, eye disease and kidney disease.

What is the summary for this tobacco lecture?

Tobacco use adversely affects every body system Tobacco use particularly harmful during pregnancy, youth, and women of all ages. Smokeless tobacco has systemic and oral health risks ETS has smoking increase health risks Third hand smoke may also pose risks esp. to kids

What is the brain's response to nicotine?

When a NEUROTRANSMITTER finds its RECEPTOR, it activates the receptor's nerve cell. The nicotine molecule is shaped like a neurotransmitter, acetylcholine, whose receptors are involved in many functions: muscle movement, breathing, heart rate, learning, mood, appetite and memory. When nicotine gets into the brain, it attaches to acetylcholine receptors and mimics its actions. Nicotine activates areas of the brain which produce feelings of pleasure and reward by producing dopamine, a powerful neurotransmitter.

What is the environmental effect of smoking (ETS) = environmental tobacco smoke?

While we often think of medical consequences that result from direct use of tobacco products, but Passive or the involuntary inhaling o tobacco smoke also increases health risks. Secondhand smoke, also known as environmental tobacco smoke, is a form of passive smoking. It consists of "mainstream smoke" which is the smoke that the smoker exhales and "sidestream smoke"—the smoke that smolders off the end of a cigarette, cigar, or pipe. Sidestream smoke has neither passed through a filter nor through the lungs of a smoker and is therefore extremely potent, containing more tar, nicotine, particles, and gases than inhaled smoke. Sidestream smoke can cause respiratory distress and allergic reactions, as well as lung cancer. Secondhand smoke contains thousands of toxic chemicals (e.g. Benzene, Carbon monoxide, Chromium, Cyanide, Formaldehyde, Lead, Nickel, Polonium). The dangerous particles in secondhand smoke can linger in the air for hours. Breathing secondhand smoke for a short time can irritate the lungs and reduce the amount of oxygen in the blood.