Nicotine Addiction

What is a Nicotine Addiction?

Nicotine is an addictive substance originating from tobacco plants. Smoking nicotine products causes the release of dopamine in the reward centres of the brain, reinforcing smoking behaviour and making it difficult to stop. When the effect fades, smokers may feel tired or on edge. Over time, the brain adapts to nicotine and builds tolerance.

Long-term smokers eventually find that they need to smoke increasing amounts of nicotine in order to achieve the same high that they once experienced. This further contributes to an addictive cycle.

Types of Nicotine Products

Modern nicotine products include:

  • Cigarettes
  • Cigars
  • Tobacco pipes
  • Vapes (E-Cigarettes)
  • Nicotine gum
  • Nicotine patches

In recent years, vapes (also known as electronic or e-cigarettes) have gained popularity as an alternative source of nicotine. Vaping works by using an electrified coil to vaporise a liquid mix of nicotine and flavouring into a gaseous state that is then inhaled like traditional cigarette smoke. These liquids known as e-liquids or vape juice are appealing amongst youth as they can have a variety of flavours modelled after food and do not leave the same stale smell as burnt tobacco.

Vaping is also often marketed as a healthier alternative to cigarette smoking. However, not enough information is known about the long term effects of vaping. While the flavouring compounds found in e-liquids have been approved for oral consumption, they may react very differently when inhaled into the lungs. Vaping is not currently legal in Singapore.

Social Aspect of Nicotine Addiction

  • Prevalence of Nicotine Addiction: Nicotine addiction has been found to be more prevalent amongst individuals who are facing social difficulties, are of a lower socioeconomic status, or are of a minority group.
  • Environment or recreational activities: Individuals are more likely to smoke when they are exposed to other smokers, such as at parties or bars where such behaviour is common. Alcohol and nicotine are a particularly potent combination and the two often go hand in hand. “Social smokers” may not otherwise smoke one their own, but do so when having a night out with friends.

Physiological Impacts of Nicotine Addiction

Sustained nicotine use can have detrimental effects on every organ in the body. These effects can include:

  • Impaired lung function and worsening of asthma. Smoking is the leading cause of lung cancer deaths and has also been linked to cancer of the mouth, throat, esophagus and kidney amongst others.
  • Increased blood pressure and heart rate while smoking. This increases the risk of heart and cardiovascular diseases such as heart attacks and strokes.
  • Reduced fertility in women and increased impotence in men. Smoking while pregnant is also extremely harmful to the baby and has been linked to an increased risk of Sudden Infant Death Syndrome.
  • Deteriorating oral hygiene. It can lead to stained teeth, increased risk of inflammation and infection of the gums.

When to Seek Help?

A research paper published by the New England Journal of Medicine found that individuals who quit smoking before the age of 40 reduced the risk of death associated with continued smoking by about 90% . However, it is never too early or too late to quit.

Signs and Symptoms of Excessive Nicotine Use

  • Feeling restless, irritable, moody, or anxious when attempting to cut down or stop smoking
  • Having difficulty breathing
  • Elevated blood pressure
  • Sudden changes in heart rate
  • Gastrointestinal disorders
  • Oral infections

Treatment Process

Due to the highly addictive nature of nicotine, it can be very difficult to quit alone. Long-term smokers may have tried to quit multiple times with little to no success. Smoking cessation treatment commonly involves a coordinated team of specialists – a medical practitioner, psychologist, and psychiatrist.

The Intake Assessment (Usually a 1 hour session)

The first visit with the clinical psychologist usually entails a detailed assessment of the presenting issues and relevant background history. For children and adolescents, parents will also be interviewed. At the end of the first session, psychoeducation will be provided and treatment options and plans will be discussed. Depending on the assessment made by your clinician, recommendations on the need to involve other specialists and whether medication is appropriate will be made.

Behavioural & Medical Treatment

Nicotine is often used for stress relief or out of habit, especially in social situations. Behavioural therapy for nicotine cessation typically focuses on developing alternative coping mechanisms to deal with common triggers or stress. Over time, these lifestyle changes help to replace the instinct to reach for a cigarette with something much healthier.

The clinician may also roleplay social situations where one feels pressured to smoke. These could include drinking at a bar or hanging out with friends who smoke. Individuals can practice how to say ‘no’ and diffuse the situation without giving in.

A psychiatrist may also prescribe medical interventions such as Varenicline to help with nicotine cessation. In cases where individuals are unable to quit using nicotine completely, alternative sources such as nicotine patches may be recommended to minimise harm.

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