Tobacco was first introduced into European society by Hernandez de Toledo in the sixteenth century. Cigarette smoking is a major preventable cause of disease worldwide.Tobacco addiction, the second-leading cause of death in the world, is a culprit for approximately 5 million deaths each year or 1 in 10 adult deaths.
Nicotine meets the criteria of a highly addictive drug. Nicotine is a potent psychoactive drug that induces euphoria, serves as a reinforcer of its use, and leads to nicotine withdrawal syndrome when it is absent. As an addictive drug, nicotine has 2 very potent issues: it is a stimulant and it is also a depressant.Nicotine in cigarette smoke affects mood and performance and is the source of addiction to tobacco.
Nicotine addiction is classified as nicotine use disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). The criteria for this diagnosis include any 3 of the following within a 1-year time span:
- Tolerance to nicotine with decreased effect and increasing dose to obtain same effect
- Withdrawal symptoms after cessation
- Smoking more than usual
- Persistent desire to smoke despite efforts to decrease intake
- Extensive time spent smoking or purchasing tobacco
- Postponing work, social, or recreational events in order to smoke
- Continuing to smoke despite health hazards
Nicotine withdrawal is classified as a nicotine-induced disorder according to the DSM-IV-TR. Symptoms include difficulty concentrating, nervousness, headaches, weight gain due to increased appetite, decreased heart rate, insomnia, irritability, and depression. These symptoms peak in the first few days but eventually disappear within a month.
Symptoms of nicotine toxicity, otherwise known as acute nicotine poisoning, include nausea, vomiting, salivation, pallor, abdominal pain, diarrhea, and cold sweat.
A previous history of depression, use of antidepressants in the past, and onset of depression during previous quit attempts should be obtained.
Physical effects of nicotine use include increased heart rate, accelerated blood pressure, and