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Tobacco Addiction

Everyone knows that smoking is harmful and addictive, but few people realize just how risky and addictive it is. Addiction means an uncontrollable dependence on tobacco for stimulation, relaxation and stress- relief. Most smokers want to stop and do indeed try, but only one in three succeeds in stopping permanently.

Why is tobacco addictive?

  • Nicotine is a psychoactive drug (chemical component) with stimulant effects on the electrical activity of the brain. This is a habit-forming drug, which has a calming effect, especially in times of stress, reduces sensitivity to pain, causes rise in blood pressure, heart rate and constricts the blood vessels.
  • It is absorbed and enters the bloodstream, through the lungs when smoke is inhaled, and through the lining of the mouth (buccal mucosa) when tobacco is chewed or used as oral snuff or in non- inhaled pipe and cigar smoking. It is also absorbed through the nose from nasal snuff.
  • Nicotine causes activation of "pleasure centers" in the brain (for example, the mesolimbic dopamine system), which explains the pleasure and addictiveness to smoking.

Alarming concern

Addicts develop tolerance to nicotine and need higher doses without feeling sick. More alarming perhaps than the strength of the tobacco addiction is the ease with which it develops. Studies show, that tobacco use usually begins in early adolescence and those who begin intake at an early age are more likely to develop severe nicotine addiction than those who start later.

The worst is that tobacco has the presence of thousands of carcinogens, which has a devastating effect especially in the oral cavity. India has the highest rate of oral cancer in the world, which is directly linked to tobacco intake in its various forms. There are several diseases associated with smoking and chewing tobacco, these are:

  • Leukoplakia is the most common pre- cancerous lesion associated with smoking and/or chewing tobacco. Its prevalence in India varies from 0.2- 5.2 per cent.
  • Erythroplakia represents the most severe oral pre- malignant lesion and carries a much greater risk of cancer than leukoplakia.
  • Oral Sub-mucous Fibrosis (OSMF) a pre-malignant condition,is emerging as a new epidemic, especially among the youth in India. Its dramatic increase is attributed to chewing areca nut\supari present in gutkha and paan masala.

Cancer is the second leading cause of death and among the first diseases that is linked to smoking. Smoking causes about 90 per cent of lung cancer deaths in men and almost 80 per cent in women. The risk of dying from lung cancer is more than 23 times higher among men who smoke, and about 13 times higher among smoker women as compared to non-smokers. Not only are you likely to get lung cancer, tobacco use is also known to cause cancer of the mouth, the voice box (larynx), throat (pharynx), oesophagus, bladder, kidney, pancreas, cervix, stomach. Certain kinds of leukemia are also attributed to tobacco consumption.

Smoker’s palate, smoker’s melanosis and oral candidasis are also more frequent among smokers.

Respiratory disease associated with smoking leads to chronic obstructive pulmonary disease (COPD), which includes emphysema (reduction in elasticity of the lung tissue) and chronic bronchitis (inflammation of the bronchial tree). In such cases the lungs are unable to function to their peak capacity. One gets breathless even after minor exertion and chronic smokers get a hacking cough. Your chances of dying from COPD increases tenfold if you smoke cigarettes and 90 per cent of all deaths from COPD occur due to cigarette smoking.

Heart attack chances are doubled with atherosclerosis, which is narrowing of the blood vessels due to fat deposits. If blood supply to the brain is restricted, there is a risk of paralytic stroke. Smokers are more than 10 times as likely as non-smokers to develop peripheral vascular disease. Tobacco also affects the blood vessels on the arms and legs, leading to a condition called TAO or Thrombo angiitis obliterans, where the limb may need to be amputated in severe cases. Smoking may also cause abdominal aortic aneurysm.

Pregnant mothers using tobacco are at an increased risk of delivering infant with congenital birth defects such as cleft lip and palate in children. Cigarette smoking has many adverse reproductive and early childhood effects, including an increased risk of infertility, pre-term delivery, stillbirth, low birth weight and sudden infant death syndrome (SIDS).

Postmenopausal women who smoke have lower bone density than women who have never smoked. Women who smoke have an increased risk of hip fracture than those who have never smoked.

Periodontal diseases such as bone loss, periodontal attachment loss and periodontal pocket formation are all associated with tobacco use. It also reduces the success rate of periodontal therapy.