How do I know if I am addicted to nicotine?

Because of the fact that drug dependence is distinct from physiological dependency and the fact that addiction to nicotine is not the same as addiction to heroin or cocaine, sometimes it is difficult even for those who smoke to know whether or not they are addicted to tobacco. This is particularly true, as the criteria state (see Questions 24 and 27), if a drug does not become a central activity in people's daily lives. How one decides this is largely subjective. As Mark Twain famously said, "Giving up smoking is the easiest thing in the world. I know because I've done it thousands of times."

This quote illustrates the central dilemma regarding addiction to tobacco. How can it be addictive if it is so easy to quit? Then why do you have to quit so many times before you convince yourself you are addicted? Question 32 offers a list of common nicotine withdrawal symptoms to give a clue that, at the very least, physiological dependency has occurred. Of course, as mentioned earlier, these alone are not enough to meet all of the DSM-IV-TR criteria of addiction. But Twain's quote captures at least one other criterion: there is a persistent desire or unsuccessful effort to cut down or control substance use. Of course, you may argue, "but I have neither a desire nor made an effort to cut down so therefore I am not addicted!" Well, aside from the mental gymnastics that addicts go through to convince themselves they are OK, consider one more criterion: the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example, current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption). The physical problems resulting from smoking are by now so well documented that anyone who does not quit despite these facts meets this criterion. Yes, we all know of Grandpa who smoked from the age of 12 until he died at the age of 100. That is always a heartening story. Unfortunately, tobacco use is like Russian roulette or any other risky activity. You can still win, but you are playing against the casino, and while some individuals win, most do not; regardless, the casino always wins.

Here are some simple warning signs that you are addicted: If you smoke within 30 minutes after getting out of bed in the morning, you are probably addicted. If you cannot resist smoking even when you are ill, you are probably addicted. If you are smoking more than one pack each day, smoking more in the morning than at other times of the day, or having difficulty refraining from smoking in places that are assigned as no smoking areas, then you are probably addicted.

Lisa's comment:

When I tried to quit in the past, using the withdrawal process without any medication support, I suffered extreme depression. I kept running to the bathroom at work or out to the parking lot to cry uncontrollably. When I got home, I'd sit on the floor and cry in a fetal position. I thought something was wrong with me and beat myself up even more for not being able to function in any normal mode.

What is "the vicious cycle of addiction to tobacco and nicotine"?

If you smoke within 30 minutes after getting out of bed in the morning, you are probably addicted.

Drug addiction follows a cycle like this: A person experiences discomfort, a sense of distress or pain, whether physical or psychological. This person drinks or tries drugs in order to temporarily relieve the discomfort. It works and the person feels better. He or she realizes he or she can deal with life better and the drugs help toward that end. Use gradually increases as the effectiveness of the drug wears off sooner after each use. As it wears off, a new feeling of discomfort associated with the drug wearing off crowds out the previous discomfort and it fades from memory. At this point, getting and using drugs becomes the primary focus. He or she can no longer control using the drug and ignores any horrible consequences associated with its use. They now have a new problem: addiction. A sense of shame and embarrassment causes the addict to hide his or her drug use from friends and family. This dishonesty and guilt further add to the discomfort, causing a backlash of denial and justification for continued use. In this state of mind, social isolation becomes an easy solution. But this only compounds the discomfort further.

Relationships with friends and family and job performance are impacted. The drugs replace even those outlets and become the most important thing. Ironically, the ability to get relief diminishes as one adapts to the drugs. Ever larger amounts must be taken in order to function at all. An overwhelming obsession with getting and using the drugs now supplants all other interests or activities. One is now caught in an emotional roller- coaster that actually may be mistaken for mental illness. One may seem very "up" and enthusiastic when high, and "down" (depressed) and lethargic when in withdrawal. At this point, the addict is stuck in a cycle of addiction. One faces the problem of having to pursue drugs at any cost and to attempt to appear normal to his friends, family, and employer. By now, the drugs will have changed one both physically and mentally.

While this cycle may seem extreme, particularly when distinguishing the clear differences between nicotine addiction and other addictions, it illustrates why nicotine addiction may actually be far more difficult to quit. When facing the loss of one's entire support system and one's job, it is easier to see why one would want to quit. But when such overtly huge losses are not in jeopardy, the internal justification for continued use becomes all the more powerful, even though one's health is at stake. The impact on health is gradual and insidious, taking years to occur. It does not come in a crescendo-like force the way an alcoholic's or heroin addict's life falls apart. It's easy to rationalize that the physical condition would have occurred anyway even without smoking.

So the cycle of addiction for nicotine is far more subtle, yet because of that fact it is far more powerful and tightly bound.

To read a darkly humorous account of this cycle, I refer you to a chapter called "Smoke" in Italo Svevo's novel, Zeno's Conscience.

Joseph's comment:

In my experience, I truly believe that tobacco and nicotine are a part of a vicious cycle both physically and psychologically. When I first started smoking, it felt like something that worked to relax me and calm me down. At that time it was also a "cool" thing to do. Within a short period of time, I went from wanting a cigarette to needing a cigarette. Even with all the information on TV and what doctors told me, it seemed like it did not matter. What I like to call the phenomena of craving had set in. Every time I tried to not smoke, the physiological and physical draw was so strong, that my self-will could not prevent me from picking up the next one.

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