THREE. Risk, Prevention, and Epidemiology


If I am addicted to tobacco, will I be predisposed to other addictions?

Smokers are far more likely to develop an addiction to tobacco and far less likely to successfully quit than people who use other addictive drugs. It is harder to break a smoking addiction than a heroin addiction. And while the majority of smokers are not addicted to other drugs, the majority of drug and alcohol addicts are also addicted to smoking. It appears that all addictions—whether they are street drugs, alcohol, tobacco, or certain behaviors such as gambling, sex, or even shopping—are mediated at some level via the brain's reward system and its principal neurotransmitter, dopamine (see Question 7). We know this from a variety of sources both direct and indirect. Laboratory research has found an overlap between the effects of nicotine and opiates on dopamine signaling. Additionally, certain drugs known as dopamine agonists prescribed for Parkinson's disease have unusual side effects, including an increase in sexual behavior, gambling, and shopping. The dopamine reuptake inhibitor bupropion[1], which increases the amount of dopamine in the brain, has aided patients in smoking cessation. Nicotine and alcohol also influence the body's internal opiate system, known collectively as endorphins, which cause analgesia[2] and euphoria, which also affects the dopamine system. One of three medications approved for the treatment of alcoholism is naltrexone, which blocks the opiate receptors and thereby reduces craving for alcohol. Finally, brain imaging studies have demonstrated that various drugs of abuse activate the same areas of the brain in addition to their own individual actions. These overlapping areas are pathways regarded to be part of the brain's reward system.

All in all, the susceptibility to develop any addiction is general. But the odds of becoming addicted vary not only with one's own genetic susceptibility but also with the type of drug one is using, because some drugs are more prone to cause addiction than others. Given that nicotine has a greater addictive potential than other drugs, more people will become addicted to it, including those who are not generally susceptible to addiction. Individuals who are more highly susceptible to addiction will very quickly become addicted to nicotine along with a variety of other drugs they might use on a regular basis. Thus, becoming addicted to tobacco does not necessarily predict that one is more susceptible to other addictions. What does predict susceptibility, however, is the speed with which one becomes addicted, and this is often determined by the age of first use and the age when one begins to use regularly. Early use of tobacco and early heavy use of tobacco especially, is a strong predictor for the susceptibility of becoming addicted to other drugs (see Question 16).

What risk factors contribute to people smoking?

Risk factors are the characteristics that increase the chances of developing a disease or disorder. Epidemiology is the study of disease or disorder rates in large populations, and the various circumstances both biologically and environmentally that are common among individuals who develop a particular disease or disorder under study. It is through these studies that risk factors for a particular condition are discovered. Some risk factors are modifiable, which means the individual can lower his or her risk for developing a particular condition by making changes in his or her life, such as modifying diet, activity, or exposure. Some risk factors are non-modifiable, which means that the individual has no ability to lower or modify the risk, such as gender or other heritable traits.

The following is a list of risk factors associated with the development of nicotine dependency:

Age: It appears that teens become addicted more quickly because of developmental and biological factors.

It appears that teens become addicted more quickly because of developmental and biological factors.

Gender: A higher percentage of teen smokers are males. More white females smoke than other ethnic groups.

Adult males were more likely to smoke, but that has changed now that more women are joining the workforce and are exposed to other smokers. Females have more difficulty quitting than males.

Ethnicity: Higher rates of smoking are found among Caucasians and Native Americans; lower rates of smoking are found among African Americans, Latino Americans, and Asian Americans.

Geographical area in the United States: Higher rates of smoking are found in the southern tobacco-growing states and the Midwest as well as Nevada; the lowest rates of tobacco use are in the West, namely Utah (The Mormon religion forbids smoking).

Mental illness: A higher percentage of the mentally ill are heavy smokers.

Children and adolescents with neuropsychiatric disorders: Higher rates of smoking are seen in young people diagnosed with attention deficit hyperactivity disorder (ADHD)[3] and conduct disorders.

Alcoholism: There is a strong association between the two addictions. If you attend an Alcoholics Anonymous meeting, most likely you will find yourself in a smoke- filled room.

Poor education or lower socio-economic class: Today, there are more smokers among the poor and uneducated than among the middle class, the wealthy, and the well- educated.

Living in a developing country: Smoking rates are higher in the developing nations.

Parental and peer smoking: Role modeling is a powerful learning tool. Rates of smoking increase in families where the parents smoke. An even stronger influence is the peer group. Teens are far more likely to smoke if their teenage peers smoke than if their parents smoke.

  • [1] Generic name for the drugs Wellbutrin, marketed as an antidepressant, and Zyban, marketed as a smoking cessation medication.
  • [2] A type of drug that relieves pain. Analgesics include nonsteroidal anti-inflammatory (NSAIDs) agents such as aspirin and opiates such as morphine.
  • [3] A persistent pattern of inattention and/ or hyperactivity, impulsivity that is seen more frequently in children with ADHD than in children at comparable developmental levels.
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