Despite what tobacco companies tried to sell in the early days of the smoking boon in America, the primary ingredient in cigarettes, nicotine, is highly addictive. Approximately 17.8 percent, or 42.1 million American adults aged 18 and older, smoked cigarettes in 2013.[1] Addiction is defined as the use and abuse of a substance regardless of any negative health consequences, compulsive drug-seeking behavior, and the inability to quit even when desired. Most people who smoke cigarettes understand the potential dangers and side effects that smoking causes, and around 35 million each year admit that they want to quit and aren’t able to on their own.[2] Smoking costs the American society close to $289 billion a year in lost workplace productivity and health care costs, and more than 70 percent of all smokers wish they could quit.[3]
The Centers for Disease Control and Prevention (CDC) names cigarette smoking as the leading cause of preventable death in America, reducing life expectancy by at least 10 years. The mortality rate among smokers is three times higher than those who never smoked.[4]
In 2006, in the wake of many states banning smoking in public areas due to the dangers of secondhand smoke, a new product hit the market in the United States called an e-cigarette, or e-cig for short. These products are electronic and don’t contain tobacco; instead, they use nicotine cartridges that are often replaceable and can even be flavored, heating the “juice” with a rechargeable battery, producing no ash, and resulting in a vapor instead of smoke.
These e-cigs may resemble actual cigarettes and be disposable, or they can be refilled, recharged, and used over and over again. They may look like fountain pens or small silver tubes, and they are lit with an LED light when turned on and used.
The percentage of Americans smoking traditional cigarettes is at an all-time low, while e-cigarette use is on the rise. In fact, the percentage of adults in the United States trying e-cigarettes more than doubled from 2010 to 2013.[5] There is a raging ongoing argument as to the safety of e-cigarettes as compared to traditional cigarettes, but one thing is certain: both contain nicotine, which can cause dependency and addiction.
Nicotine Addiction
Around one-third of those who try smoking become daily smokers, less than 5 percent of smokers who attempt to quit do so successfully at any one time, and more people are diagnosed as nicotine-dependent than with any other substance abuse disorder.[6] Cigarettes contain more than 600 ingredients that are burned when a cigarette is lit, creating more than 7,000 chemicals, many of which are toxic and 69 of which are known carcinogens, or cancer-causing substances.[7]
Nicotine, derived from the tobacco plant, activates the production of the neurotransmitter dopamine in the brain, which is responsible for feelings of pleasure. Nicotine may also stimulate the production of the inhibitory neurotransmitter gamma-aminobutyric acid, or GABA, which depresses the stress reaction and leaves the individual feeling more relaxed and calm. When a user burns and inhales the resulting smoke from a cigarette, the nicotine reaches the brain in about 10 seconds, creating pleasant feelings and shortcutting natural reward pathways.[8] Nicotine also leaves the bloodstream rather quickly, which may encourage smokers to light up again in order to feel the same effects.
Over time, the brain and body can become physically dependent on nicotine and rely on it in order to feel the same good feelings as the brain will produce less “happy cells” on its own, instead expecting the artificial stimulation. The act of smoking itself may become a ritual, hooking the smoker psychologically as well as he comes to correlate feeling good with the places, sensations, or acts related to smoking. He may experience withdrawal symptoms that may intensify in the first few days and last a few weeks if he tries to stop smoking. These withdrawal side effects may include trouble sleeping, difficulties concentrating, irritability, depression, anxiety, and intense cravings.
Nicotine also depresses the appetite and often smokers are hesitant to quit as they fear weight gain associated with an increased appetite that is commonly a side effect of nicotine withdrawal. It can be hard to quit smoking without addressing both the physical and psychological aspects of nicotine dependency and addiction. An estimated 85 percent of smokers who attempt to quit on their own relapse within a week.[9]
The age of initiation has been shown to greatly influence future substance abuse and dependency. Nicotine can affect young brains that are not fully developed, prompting them to a potential addiction later in life by damaging the prefrontal cortex, which is responsible for regulating moods and making sound decisions. This region of the brain is underdeveloped in children and adolescents, which may predispose them to substance abuse and other risky behaviors. Around half of all new smokers in 2013 began smoking before age 18.[10]
E-cigarette trends are disturbing as well; the rates of middle and high school students using e-cigs tripled in 2014.[11] Many marketing campaigns for both cigarettes and e-cigs have targeted children and young adults over the years.
The Ebb and Flow of Smoking Through the Years
Smoking rates began to be recorded in 1965 for adults and in 1991 for high school students. [23] The following includes the rate fluctuations of the overall percentage of smokers in the American population throughout the recorded years:
Year |
Percent American Adult Smokers |
Percent of High School Student Smokers |
1965 |
42.4 | N/A |
1970 |
37.4 | N/A |
1985 |
30.1 | N/A |
1990 |
25.5 | N/A |
1991 |
27.5 | |
1995 |
34.8 | 24.7 |
1997 |
36.4 | 24.7 |
1999 |
34.8 | 23.5 |
2001 |
28.5 | 22.8 |
2002 |
22.5 | |
2003 |
21.9 | 21.6 |
2004 |
20.9 | |
2005 |
23 | 20.9 |
2006 |
20.8 | |
2007 |
20 | 19.8 |
2008 |
20.6 | |
2009 |
19.5 | 20.6 |
2010 |
19.3 | |
2011 |
18.1 | 19.0 |
2013 |
17.8[24] | 15.7[25] |
Smoking was once considered “cool” and very commonplace among men especially. In the 1940s, cigarette smoking among American males peaked, with 67 percent smoking.[12] Big tobacco companies marketed and promoted cigarettes with celebrity sponsors, on billboards, television, in the movies, and on the radio. By the 1960s, the gap between female and male smokers began to close, and women smoking rates peaked, with 44 percent of women smoking.[13]
Tobacco companies failed to inform the public about the dangers of smoking even though they were aware that smoking could cause cancer. The American Cancer Society’s National Board of Directors announced the link between cancer and smoking in 1954, but tobacco companies may have worked to keep this knowledge out of the public eye for another 10 years, as it wasn’t until 1964 that the Surgeon General’s report formally recognized smoking as a cause of cancer.[14]
In 1969, tobacco ads were banned from radio and TV, and smoking prevention and education campaigns flooded the American market, attempting to educate the public, especially adolescents and children, on the potential dangers of smoking.[15] Smoking rates rose steadily until about the mid-1970s, when health care professionals began recognizing and publishing the dangers of smoking. The number of smokers began to slowly decline as the public finally started taking notice.
Student smoking rates, on the other hand, kept increasing until about the end of the 1990s when the number of teen smokers finally began to decline. Tobacco companies took a hit in the 1990s, and much of the publicity surrounding them was negative, possibly influencing attitudes of young potential smokers. Disapproval rates among adolescents rose through the late 1990s and into the early 2000s while adolescents’ perceived risk of the dangers of smoking did as well.[16]
Tobacco companies were not ready to give up the ghost, however. Even though they were banned in the early 1990s from marketing directly to kids, they still managed to find ways to hit this target audience. The five largest tobacco companies spent $9.94 billion dollars on promotions and advertising in 2008, with over 70 percent of this money going toward pricing strategies and retailer discounts; cigarette pricing strategies may increase the number of teens and young adults trying cigarettes and becoming smokers.[17]
E-cigs are increasing popular among this age group too, and many companies market flavors that appeal to kids. In 2014, the number of 8th and 10th graders smoking e-cigarettes was more than double the number of those smoking traditional cigarettes.[18] Perceived risk of e-cigs among teens is relatively low also, around 14 percent, and it is the lowest perceived risk of any other drug of abuse surveyed, even alcohol.[19]
Cigarette pricing plays a big role in smoking rates. In 2009, a 62-cent federal tax per pack went into effect, effectively making cigarettes more expensive.[20] At the state level, as of 2011, all 50 states also impose excise taxes on cigarettes that are as high as more than $4 a pack in some states.[21] The CDC began extensive ad campaigns in 2012 highlighting the dangers of smoking as relayed by former smokers, and most states also allocate big money to tobacco prevention and control programs each year. In recent years, laws have gone into effect banning smoking in public places, such as parks, workplaces, restaurants, casinos, and bars. Currently, 36 states and 700 municipalities, including New York City and New Orleans, have smoking bans in place regulating where you can light up, and making smoking less accessible, and therefore potentially less appealing. This has helped to decrease the number of smokers and new smokers each year.[22]
Rise of Vaping
With an e-cigarette, a vapor is exhaled, and use is often termed “vaping.” E-cigarettes and starter kits are commonly sold in vape shops, and there an estimated 8,500 of them in the United States doing a booming business of $1.2 billion a year.[26] Many of these vape shops even host contests with cash prizes for the person who can blow the biggest cloud of vapor.
As traditional cigarette smoking grows more expensive, less easily accessible, and less “cool,” many smokers are turning to the e-cig alternative. In 2013, over 36 percent of smokers had at least tried an e-cigarette.[27] Tobacco companies are jumping on board with e-cigs as well. Marketing campaigns are exploding, as e-cigarettes are heavily marketed on television; unlike with traditional cigarettes, marketing on this platform is still open for e-cigs.
Awareness of e-cigarettes has doubled from 2010-2013, as close to 80 percent of American adults became aware of them, and one in 10 had tried an e-cigarette at least once by 2013.[28] E-cig use among adolescents is climbing at alarming rates as well. In just one year, from 2013-2014, the percentage of high school students using e-cigarettes jumped from 4.5 percent to 13.4 percent.[29] The popularity of conventional cigarettes seems to be waning, while e-cigarettes are trending.
Safety Debate of E-Cigarettes
E-cigarettes are fairly new; therefore, not as much scientific research exists as to their safety and long-term potential side effects. Many smokers may turn to e-cigs with the belief that they are somehow a safer alternative; however, they may not actually be safer. Federal regulations are expected to be released by the U.S. Food and Drug Administration (FDA) this year, but as of yet, e-cigarettes are not as tightly controlled as tobacco products. Currently, the only e-cigs controlled by the FDA are those that are marketed for therapeutic purposes.
The FDA has also instructed manufacturers to cease proclaiming that e-cigarettes can help people stop smoking, since there is no evidence supporting this. New legislation is expected to regulate the sale of e-cigs to minors, potentially ban kid-friendly flavors, and stop manufacturers from making health claims that are unsubstantiated, in addition to requiring warning labels on packaging.
Several states and cities have already banned the usage of e-cigarettes indoors, attempting to stop smokers who are thwarted by indoor smoking bans from merely switching to e-cigs as an alternative. More than 40 states also currently ban the sale of e-cigarettes and other electronic nicotine delivery systems to minors.[30]
So are e-cigs safer than conventional cigarettes? Research is divided at this point. One study found that cigarette smoke contained 9-450 more hazardous toxins than e-cig vapor, although e-cigarettes may release inconsistent amounts of nicotine with each puff.[31] On the other side of the argument, researchers have also found that e-cigs heat up to 1,000 degrees Fahrenheit, releasing the carcinogenic toxin formaldehyde, which is commonly used as an embalming fluid. E-cig users are exposed to 5-15 times more of this toxin than regular cigarette smokers.[32]
While the debate rages on about the safety of e-cigarettes versus conventional ones, it is important to understand that both cigarettes and e-cigs deliver nicotine to the brain, and nicotine is an addictive chemical that is not easy to break free from. Candy flavoring and marketing campaigns may increase the popularity of e-cigs in a younger crowd, potentially creating a younger crop of nicotine addicts.
Additionally, there is a correlation between cigarette smoking and the use of other illicit drugs and alcohol. The NSDUH found that cigarette smokers aged 12 and older in the United States also used other illicit drugs 24.1 percent of the time in 2013, as opposed to their peers who used illicit drugs only 5.4 percent of the time.[33] In youth aged 12 to 17, these figures are even higher with 53.9 percent of those smoking in the past month also using illicit drugs in contrast with 6.1 percent of nonsmokers.[34] Alcohol use, binge drinking, and heavy alcohol use are also higher in cigarette smokers versus nonsmokers.
E-cigarettes are not considered any more effective than other nicotine replacement devices, such as the nicotine patch, in helping smokers quit smoking as they often do not have the same “feel” that smokers have come to crave and rely on. Instead, behavioral therapies may be the best, and safest, way to effectively quit smoking and increase life expectancy and quality of life. Damage to the heart, respiratory system, and lungs can heal over time, and smokers who stop before age 40 are likely to be able erase smoking damage and regain potential years that may be lost with continued smoking.[35]
Highly credentialed staff members at Axis can help you develop a comprehensive treatment plan that is right for you and assist you in kicking the nicotine habit for good. Contact us today to learn more.
Citations
[1] (Nov. 2014). “Current Cigarette Smoking Among Adults- United States 2005-2013.” Centers for Disease Control and Prevention (CDC). Mortality and Morbidity Weekly Report (MMWR). Accessed April 22, 2015.
[2] (July 2012). “Is Nicotine Addictive?” National Institute on Drug Abuse (NIDA). Accessed April 22, 2015.
[3] Sifferlin, A. (Nov. 2014). “U.S. Smoking Rate Hits Historic Low.” Time. Accessed April 23, 2015.
[4] (Nov. 2014). “Tobacco-Related Mortality.” Centers for Disease Control and Prevention (CDC). Accessed April 22, 2015.
[5] (Sept. 2014). “Electronic Cigarettes.” Centers for Disease Control and Prevention (CDC). Accessed April 22, 2015.
[6] (2010). “Nicotine Addiction: Past and Present - How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General.” Centers for Disease Control and Prevention (CDC). Accessed April 22, 2015.
[7] (2015). “What’s in a Cigarette?” American Lung Association. Accessed April 22, 2015.
[8] (July 2012). “Is Nicotine Addictive?” National Institute on Drug Abuse (NIDA). Accessed April 22, 2015.
[9] Ibid.
[10] (2014). “Results from the 2013 National Survey on Drug Use and Health (NSDUH): Summary of National Findings.” Substance Abuse and Mental Health Services Administration (SAMHSA). Accessed April 22, 2015.
[11] Clark, T. (April 2015). “E-Cig Use Soared, Cigarette Use Among U.S. Youth Fell in 2014: CDC.” Reuters. Accessed April 22, 2015.
[12] (July 2007). “Trends in Tobacco Use.” American Lung Association. Accessed April 22, 2015.
[13] Ibid.
[14] Proctor, R. (2012). “The History of the Discovery of the Cigarette-Lung Cancer Link: Evidentiary Traditions, Corporate Denial, Global Toll.” Tobacco Control. Accessed April 22, 2015.
[15] Layton, L. (Mar. 2010). “New FDA Rules Will Greatly Restrict Tobacco Advertising and Sales.” Washington Post. Accessed April 22, 2015.
[16] Bacman, J., Johnston, L., Miech, R., O’Malley, P., Schulenberg, J. (2014). “Monitoring the Future. National Survey Results on Drug Use 1975-2014.” National Institute on Drug Abuse (NIDA). Accessed April 23, 2015.
[17] (July 2007). “Trends in Tobacco Use.” American Lung Association. Accessed April 23, 2015.
[18] Bacman, J., Johnston, L., Miech, R., O’Malley, P., Schulenberg, J. (2014). “Monitoring the Future. National Survey Results on Drug Use 1975-2014.” National Institute on Drug Abuse (NIDA). Accessed April 23, 2015.
[19] Ibid.
[20] Egan, S. (June 2013). “Why Smoking Rates are at New Lows.” New York Times. Accessed April 23, 2015.
[21] (July 2007). “Trends in Tobacco Use.” American Lung Association. Accessed April 23, 2015.
[22] Berman, M. (April 2015). “New Orleans is Going Smoke-Free in Bars and Casinos. Here are 32 Questions You May Have About How the Ban Works.” Washington Post. Accessed April 23, 2015.
[23] (Nov. 2014). “Trends in Cigarette Smoking Among High School Students and Adults, United States 1965-2011.” Centers for Disease Control and Prevention (CDC). Accessed April 23, 2015.
[24] (Jan 2015). “Current Cigarette Smoking Among Adults in the United States.” Centers for Disease Control and Prevention (CDC). Accessed April 23, 2015.
[25] (2013). “National Youth Risk Behavior Surveys, 1991-2013.” Centers for Disease Control and Prevention (CDC). Accessed April 23, 2015.
[26] Mickle, T. (April 2015). “Take a Deep Breath if You Want to Try Competitive Vaping.” Wall Street Journal. Accessed April 23, 2015.
[27] (Sept. 2014). “Electronic Cigarettes.” Centers for Disease Control and Prevention (CDC). Accessed April 23, 2015.
[28] Ibid.
[29] Clark, T. (April 2015). “E-Cig Use Soared, Cigarette Use Among U.S. Youth Fell in 2014: CDC.” Reuters. Accessed April 23, 2015.
[30] (Dec. 2014.) “State Laws Prohibiting Sales to Minors and Indoor Use of Electronic Nicotine Delivery Systems - United States November 2014.” Centers for Disease Control and Prevention (CDC). Morbidity and Mortality Weekly Report (MMWR). Accessed April 23, 2014.
[31] Wellness Team (Aug. 2014). “New Research: E Cigs Safer Alternative to Regular Cigarettes.” Cleveland Clinic. Accessed April 23, 2015.
[32] (Jan. 2015). “Before You Vape: High Levels of Formaldehyde Hidden in E Cigs.” NBC News. Accessed April 23, 2015.
[33] (2014). “Results from the 2013 National Survey on Drug Use and Health (NSDUH): Summary of National Findings.” Substance Abuse and Mental Health Services Administration (SAMHSA). Accessed April 23, 2015.
[34] Ibid.
[35] Vastag, B. (Jan. 2013). “Quitting Smoking by Age 40 Erases Most of the Risk of an Early Death.” Washington Post. Accessed April 23, 2015.
