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Are Tobacco and Nicotine Addictive?
A current theory in the history of the use of tobacco is that its use is compulsive and similar to other forms of drug abuse. In the Americas the inability of the Indians to abstain from tobacco raised problems for the Catholic Church. The Indians insisted on smoking even in church, as they had been accustomed to doing in their own places of worship. In 1575 a church council issued an order forbidding the use of tobacco in churches throughout the whole of Spanish America.
Soon, however, the missionary priests themselves were using tobacco so frequently that it was necessary to make laws to prevent even them from using tobacco during worship.
As tobacco smoking spread through England the demand often exceeded the supply and prices soared. London tobacco shops were equipped with balances; the buyer placed silver coins in one pan and might receive in the other pan, ounce for ounce, only as much tobacco as he gave silver. The high price, however, did not curb demand.
In 1610 an English observer noted: “Many a young nobleman’s estate is altogether spent and scattered to nothing in smoke. This befalls in a shameful and beastly fashion, in that a man’s estate runs out through his nose, and he wastes whole days, even years, in drinking of tobacco; men smoke even in bed.” A failure of a local tobacco crop could make men desperate. Sailors approaching the island of Niacin the Malay Archipelago were greeted with cries: “Tobacco, strong tobacco. We die, sir, if we have no tobacco!”
The addictive nature of tobacco was noted at about the same time by Sir Francis Bacon, who wrote: “The use of tobacco is growing greatly and conquers men with a certain secret pleasure, so that those who have once become accustomed thereto can later hardly be restrained there from.”
The invention of cigarette-rolling machines made the availability of tobacco even easier and was seen by some as an additional cause for alarm. The following editorial in the Boston Medical and Surgical Journal (1882) states the case well:
Our greatest danger now seems to be from an excess of cigarette smoking. The numbers of young men who smoke cigarettes is almost startling. It is not only students, but even school boys in their teens, who vigorously and openly indulge in this dangerous habit. . . . A little cigarette, filled with mild tobacco which lasts for only a few minutes, appears harmless enough. But the very ease with which these bits of paper can be lighted and smoked adds considerably to the tendency to indulge to excess . . . One of the pernicious fashions connected with cigarette smoking is “inhaling”. The ideal cigarette smoker is never as happy as when he inhales the smoke, holds it in his air passages for some time, and then blows it out in volume through the nose and mouth. If he realized that “the smoker who draws the greatest amount of smoke and keeps it longest in contact with the living membrane of the air passages undoubtedly takes the largest dose of the oil”, he might at least endeavor to modify his smoking in this respect. These are dangers super-added to those attendant on the ordinary use of tobacco [other than machine rolled cigarettes], and should be considered by all medical men.
Current Controversy and Theory
It has long been suspected that tobacco was a drug of high abuse potential and that nicotine was the critical substance. However, the controversy has remained until recently. Some have held that nicotine was simply a toxin delivered by tobacco smoke and that it had little to do with behaviour. Others felt that nicotine actually was a noxious or aversive element in cigarette smoke and limited how much a person smoked. Still others were convinced that nicotine itself was an abusable drug and the key to compulsive tobacco use.
Which theory was correct had implications for the understanding and treatment of cigarette smoking, as well as for government policy. For instance, should treatment remodeled after that used for people who bite their fingernails, or after that for people who abuse drugs? Should the government support the tobacco industry as it does other forms of agricultural industry, or should it regulate tobaccos a drug?
Although these are critical issues, they have not had much consideration in parliaments around the world. But in the United States the issues have been debated in both houses of Congress. Expert witnesses were found to support every conceivable position. One testified that the high incidence of cancer in cigarette smokers was due to personality traits in smokers. Representatives of the tobacco lobby argued that any regulation on cigarette smoking would be an attack on the free will of Americans to engage in voluntary pleasurable acts.
The National Institute on Drug Abuse and the United States Public Health Service testified that cigarette smoking was an instance of drug abuse. Their spokesmen insisted that cigarette smoking is not a voluntary pleasure but rather compulsively driven behavior.
The National Institute on Drug Abuse (NIDA) was one of the last major national or international health-related organizations to take the official position that cigarette smoking was a form of drug abuse. The consequences of its position were potentially so widespread that NIDA had the certain of the findings. The evidence that convinced IDA to take this position can him summarized as follows.
Similarities in the Use of Tobacco and Known Drugs of Abuse
The most obvious similarity is that, by and large, non-nutritive plant products are not widely consumed unless they contain drug that affects the way people think or feel (psycho-activity). These substances are used in such a way that the drug gets into the blood stream and ultimately to the brain. Opium poppies are reduced and refined to yield the potent extract morphine; further processing results in heroin. Cocanine is extracted from coca leaves and processed in ways that maximize its effects.
Nicotine is made available, following an elaborate pro-cuss of harvesting and manufacturing, in a very convenient and effective delivery system-the tobacco cigarette. Nice-tine reaches the brain even more efficiently when inhaled in tobacco smoke than when given intravenously. It is well absorbed through the thin membranes of the mouth and nose and is, therefore, well absorbed when taken in the form of chewing tobacco or snuff.
Developing patterns of the behavior of tobacco or drogues are also similar. With tobacco, alcohol, heroin, and many other drugs, initial use (experimentation) is usually with the support or even encouragement of friends or relatives. One of the best predictors of smoking, in fact, is that both parents are cigarette smokers. Similarly, a common finding among people who have recently stopped smoking is that either their friends or relatives have also stopped. These patterns of peer and social pressure are shared with most drugs of abuse.
Patterns of use also are similar. As with the opiate drugs(morphine and heroin), initial build up of tolerance leads to increased use, which then remains stable over long periods of time. Removing the drug for short period’s results in discomfort and an increased desire to take the drug.
In a study and treatment programmed for smokers, heroin addicts, and alcoholics, people were required to abstain from the use of the drug. Over the next year, their rate of relapse was studied. Patterns of relapse were similar for all three drugs. This suggests similar biological factors.
Other points of similarity between cigarette smoking and drug abuse are tolerance and physiological dependence. As noted earlier, tolerance to tobacco and nicotine is well documented. This effect is shared by most drugs of abuse.
The issue of physiological dependence is more complex, however. Drugs are often abused when no physiological dependence can be detected. However, many drugs are associated with discomfort and a heightened desire (“craving”) to take the drug during abstinence. Cigarettes are no exception. Indeed many people will travel a fair distance to get a cigarette when they have exhausted their supply.
Nicotine is a Drug
There was considerable evidence that cigarette smoking was a behavior pattern and a form of drug abuse in which the critical drug was nicotine. However, much of this evidence was circumstantial and not considered sufficient for an agency of the United States Govern-mint to officially label cigarette smoking as a form of drug abuse. It had to be determined if nicotine itself met the criteria for being defined as a drug of abuse.
Over the years, standardized procedures were developed to discover if new drugs were likely to be abused. Two different kinds of studies were critical. One type is called “the single dose study”, which compares the effects of one dose of the test drug to the effects of single doses of standard drugs of abuse. Morphine, cocaine, alcohol, and pentobarbital are all highly abused drugs that served as good standards. The other study is called the “self-administration study”. This makes the drug available to both animal and human subjects to determine if they will take it voluntarily (i.e., self-administer it).
The single dose studies compared nicotine in cigarettes to nicotine given intravenously. Volunteers were given re-search cigarettes to smoke on some test days and were given intravenous nicotine injections on other test days. The subjects were never told what nicotine dose level they were given, or even whether the injection or cigarette contained any nicotine at all. Physiological and psychological measures were taken before and after injections or cigarettes were given.
Several critical findings were made in this study. Firstly, nicotine produced similar effects whether given intravenously or in the form of cigarette smoke. This proved that nicotine is responsible for many of the physiological and psychological effects of tobacco. Secondly, nicotine pro-diced effects in the brain that allowed volunteers to accurately report when they had been given nicotine and when they had been given a “blank” (placebo). They were also able to rate accurately the strength of the dose. This showed that nicotine was psychoactive. Thirdly, nicotine produced psychological effects of euphoria that were similar to those produced by the standard drugs of abuse. This indicated that nicotine itself was an abusable drug that could produce compulsive behavior. Fourthly, subjects with a wide range of experience with drugs of abuse reported that certain effects of nicotine were similar to the effects of cocaine or amphetamine.
To discover if the psychological effects of nicotine had to do with social and critical factors, certain studies with animals were cloned. Certain animals are useful for testing abusable drugs since they usually respond to the drugs as do humans.
With animals, however, it is generally assumed that the responses are due to the biological effects of the drugs and not to socio-cultural factors such as advertising or peer pressure. White rats were trained to press one lever when they received a stimulant and another lever when they received a sedative. When the animals were given nicotine, they pressed the stimulant lever. The larger the dose, the more they pressed the lever. Thus, like humans, the animals were reporting that they could “feel” the injections, that the injections “felt like stimulants”, and they could accurately “rate” the size of the dose.
In the “self-administration studies” human volunteers and animal subjects were permitted to take nicotine intra-venous using automatic injection systems. These studies also helped determine whether the drug is important by itself, or if various social and other factors are necessary forth drug to be taken. Both the human volunteers and animals voluntarily took nicotine, and nicotine was found to function as a reinforce (reward). The pattern of nicotine self-administration by human volunteers. The pat-terns are interesting since they are similar to those found when people smoke cigarettes.
The self-administration studies were important in show-in that nicotine could serve as a reinforcer without the other factors that accompany cigarette smoking (taste, oral satisfaction, and peer approval). The results of studies on both human and animal subjects indicate that the biological effects of nicotine are sufficient for it to serve as a reinforcer. In other words, factors unique to humans-television advertising, peer pressure, attempts to prove masculinity or independence-probably have little to do with why nice-tine is a reinforcer.
Such studies do not mean that socio-cultural factors are not important. They clearly are. Rather, the studies show that nicotine’s biological effects make it an ideal drug to be abused and to cause addiction, particularly when it is so widely available.
The results of these studies led the director of the National Institute on Drug Abuse (Dr. William Pollen) to testify to both the United States Senate and the House of Representatives that cigarette smoking is a form of drug abuse in which persons become dependent on the drug nicotine. In its Triennial Report to the United States Congress, the National Institute on Drug Abuse concluded the following:
In answer to the question, “what are the mechanic-isms that underlie the compulsive use of tobacco?” the National Institute on Drug Abuse is in agreement with other organizations (e.g., the American Psychiatric Association, and the World Health Organization) that tobacco use can be an addictive form of behavior. In addition to this conclusion, an appraisal of data collected biennia’s intramural [Addiction Research Center] and extramural [e.g. Johns Hopkins and Harvard] research programs indicates that the behavior is a form of drug abuse in which nicotine is critical. Specifically, it is evident that the role of nicotine in cigarette smoking is similar to the role of cocaine in coca leaf use, of THC in marijuana smoking, and of ethanol in alcoholic beverage consumption.
The results of these studies and of the policy statements by the National Institute on Drug Abuse and the United States Public Health Service (which adopted NIDA’s policy) will take time to implement fully. However, changes of medical and political importance are already occurring. New bills have been passed in Congress that strengthens warning son cigarette packets, and treatments for cigarette smoking are being developed based on drug abuse models.
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