Is nicotine addictive?

In February 2000, the Royal College of Physicians published a report on nicotine addiction which concluded that “Cigarettes are highly efficient nicotine delivery devices and are as addictive as drugs such as heroin or cocaine.” [1] Two years earlier, the report of the Government’s Scientific Committee on Tobacco and Health stated that: “Over the past decade there has been increasing recognition that underlying smoking behaviour and its remarkable intractability to change is addiction to the drug nicotine. Nicotine has been shown to have effects on brain dopamine systems similar to those of drugs such as heroin and cocaine”. [2] Both the RCP and SCOTH reports confirmed the findings of the landmark review by the US Surgeon General in 1988 on nicotine which also concluded that cigarettes and other forms of tobacco are addicting and that nicotine is the drug in tobacco that causes addiction. [3]

Despite these authoritative reviews, there has been some debate about the extent to which the smoking habit is controlled by physiological addiction. The debate has arisen because there is no universally accepted definition of addiction although the World Health Organization has defined addiction as: “A state, psychic and sometimes also physical, resulting in the interaction between a living organism and a drug, characterised by behavioural and other responses that always include a compulsion to take the drug on a continuous or periodic basis in order to experience its psychic effects, and sometimes to avoid the discomfort of its absences. Tolerance may or may not be present.” [4] On the basis of this definition, it is possible to demonstrate a scientific basis for defining nicotine as an addictive substance.

Can you use nicotine patches when on Tamoxifen?

I've had breast cancer and am on tamoxifen. I want to give up smoking – is it safe for me to use nicotine patches?

We cannot find any published research about the use of nicotine patches for women who are taking tamoxifen. We contacted the pharmaceutical company, Pharmacia, who produce one of the nicotine patches called Nicorette to find out more information. Their medical information service searched their information database and through published studies to see if there was any reason not to take the two together.

They tell us that taking tamoxifen and using Nicorette will “have no adverse effects that they know of”. So, they do not have any records of people taking these drugs together and having any problems.

Do bear in mind that this is only one company’s advice and we would suggest that you talk to your GP or cancer specialist about this. They may want to monitor you for a while when you first use the patches. It is important that you read the information leaflet enclosed in the nicotine patches before you start. This will tell you when you shouldn't use them. Nicotine patches can have side effects and it is important that you use the correct dose in relation to how much you usually smoke. If you begin to use nicotine patches and start to feel unwell in anyway, you should remove the patch and arrange to see your doctor.

We've checked the product information for tamoxifen and there is no mention of nicotine in any of the leaflets (as of March 2005).

It is great that you have decided to give up smoking. It is not an easy thing to do, especially if you have smoked for many years. But the benefits that you will gain will make it well worth it. Your GP and consultant are both likely to be very supportive of your decision. We have some useful tips on giving up smoking on the Cancer Research UK website. This also gives details of the NHS quitline (freephone 0800 002200). The people who work on this phone line are all experienced at helping people who are trying to give up smoking. So if you find that you are struggling at times, which is very natural, you may find it useful to give them a call for some extra encouragement. Good luck.

The Twelve Steps of Nicotine Anonymous

We admitted we were powerless over nicotine – that our lives had become unmanageable. Came to believe that a Power greater than ourselves could restore us to sanity. Made a decision to turn our will and our lives over to the care of God as we understood Him. Made a searching and fearless moral inventory of ourselves. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs. Were entirely ready to have God remove all these defects of character. Humbly asked Him to remove our shortcomings. Made a list of all persons we had harmed, and became willing to make amends to them all. Made direct amends to such people wherever possible, except when to do so would injure them or others. Continued to take personal inventory and when we were wrong promptly admitted it. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out. Having had a spiritual awakening as the result of these steps, we tried to carry this message to nicotine users and to practice these principles in all our affairs.

Copyright 1990, 1992, 1999 by Nicotine Anonymous®
The Twelve Steps reprinted and adapted with permission of Alcoholics Anonymous World Services, Inc. Permission to reprint and adapt the Twelve Steps does not mean that AA is affiliated with this program. AA is a program of recovery from alcoholism - use of the Twelve Steps in connection with programs and activities which are patterned after AA, but which address other problems, does not imply otherwise. See Alcoholics Anonymous' Twelve Steps below.

1. We admitted we were powerless over alcohol - that our lives had become unmanageable. 2. Came to believe that a Power greater than ourselves could restore us to sanity. 3. Made a decision to turn our will and our lives over to the care of God as we understood Him. 4. Made a searching and fearless moral inventory of ourselves. 5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs. 6. Were entirely ready to have God remove all these defects of character. 7. Humbly asked Him to remove our shortcomings. 8. Made a list of all persons we had harmed, and became willing to make amends to them all. 9. Made direct amends to such people wherever possible, except when to do so would injure them or others. 10. Continued to take personal inventory and when we were wrong promptly admitted it. 11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out. 12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics and to practice these principles in all our affairs. Copyright 1939, 1955, 1976 by Alcoholics Anonymous World Services, Inc.

How can I find out more about Nicotine Anonymous?
In cities across the United States and Canada check the white pages of your local book. If you cannot find a meeting, please write the World Services Office. An up-to-date Worldwide Meeting List is also published annually in SevenMinutes (the Nicotine Anonymous quarterly newsletter) as well as being posted on our website.

Nicotine - Smoking statistics

Action on Smoking and Health – January 2005

· Tobacco was introduced to Europe from the New World at the end of the fifteenth century. Smoking spread rapidly and was long regarded as having medicinal value. It was not until the 20th century, however, that smoking became a mass habit and not until the 1950’s that the dangers of smoking were firmly established. · About 12 million adults in the UK smoke cigarettes - 28% of men and 24% of women. In 1974, 51% of men and 41% of women smoked cigarettes - nearly half the adult population of the UK. Now just over one-quarter smoke, but the decline in recent years has been heavily concentrated in older age groups: i.e., almost as many young people are taking up smoking but more established smokers are quitting. · Adult smoking rates vary only slightly between different parts of the country, as defined by the Government Office Regions. For example, in the East of England 25% of people smoke, in the North West, 30%. In Scotland 31% of the population smokes; in Wales the prevalence is 27%. · Smoking is highest among those aged 20-24: 38% of men and 34% women in this age group smoke. Among older age groups prevalence gradually declines with the lowest smoking rate among people aged 60 and over: 15% smoke in this age group. This reflects the fact that many former smokers will have stopped in middle age and around one quarter of smokers die before reaching retirement age. · More than 80% of smokers take up the habit as teenagers. · In the United Kingdom about 450 children start smoking every day. · About one fifth of Britain's 15 year-olds – 18% of boys and 26% of girls - are regular smokers - despite the fact that it is illegal to sell cigarettes to children aged under16. · Men and women in manual socio-economic groups are more likely to smoke than people in non-manual occupations. 20% of men and 17% of women in the professional and managerial groups smoke compared with 34% of men and 30% of women in routine and manual groups. · People do give up - 21% of women and 27% of men are ex-smokers. Surveys show that about 70% of current smokers would like to give up altogether. · Tobacco is the only legally available consumer product which kills people when it is used entirely as intended. · Every year, around 114,000 smokers in the UK die as a result of their habit. · Deaths caused by smoking are five times higher than the 22,833 deaths arising from: road traffic accidents (3,439), other accidents (8,579), poisoning and overdose (881), alcoholic liver disease (5,121), murder and manslaughter (513), suicide (4,066), and HIV infection (234) in the UK during 2002. · About half of all regular cigarette smokers will eventually be killed by their habit. · Smoking causes about thirty per cent of all cancer deaths (including around 84% of lung cancer deaths), 17% of all heart disease deaths and at least 80% of deaths from bronchitis and emphysema. · Polls show that people underestimate the health risks of smoking and the effects of passive smoking. · Tobacco smoke contains over 4,000 chemical compounds, which are present either as gases or as tiny particles. These include: nicotine This is what is addictive. It stimulates the central nervous system, increasing the heartbeat rate and blood pressure. In large quantities nicotine is extremely poisonous. tar Brown and treacly in appearance, tar consists of tiny particles and is formed when tobacco smoke condenses. Tar is deposited in the lungs and respiratory system and gradually absorbed. It is a mixture of many different chemicals, including: formaldehyde, arsenic, cyanide, benzo[a]pyrene, benzene, toluene, acrolein. carbon monoxide This binds to haemoglobin in the bloodstream more easily than oxygen does, thus making the blood carry less oxygen round the body. · The UK government earned £8,093 million in revenue from tobacco duty excluding VAT in the financial year 2003-04. · A law to ban tobacco advertising and sponsorship came into effect in February 2003. During the period September 2001-August 2002 tobacco companies spent £25 million on advertising, excluding sponsorship and indirect advertising. · The Government currently spends around £30m on anti-smoking education campaigns. A further £41m is spent on measures to help people stop smoking. · ASH was established in 1971 by the Royal College of Physicians following the failure of the Government to act on the College's request for effective laws to reduce tobacco use.