CIGARETTE smoking is a public health concern in Malaysia. According to the Health Ministry, up to one in five Malaysian adults are current smokers. It is estimated that 4.8 million Malaysians aged 15 years and above currently smoke; so are they experiencing nicotine addiction?
Cigarette smoking remains the leading cause of preventable diseases and premature death worldwide. The annual global death toll due to smoking is four million, and is expected to rise to a staggering 10 million by 2030.
In Malaysia, almost one in two of current smokers made an attempt to quit smoking in the past 12 months. Among smokers who try to quit smoking, less than 5% quit successfully at any one time.
Heavy smokers who make serious attempts to quit smoking are only able to do so for a few hours. In addition, many of those who attempt to quit on their own return to smoking within a month.
This raises the question: What makes smoking so addictive?
The answer lies in nicotine. Hence, any effort made to address this public health concern must take into account the nicotine addiction aspect in cigarette smoking.
Nicotine is a compound found in plants, specifically the Solanaceae family, which includes tobacco, tomato, potato and eggplant.
Nicotine is predominantly found in tobacco leaves, and in smaller amounts in tomatoes, potatoes and eggplants.
It acts as a stimulant and is responsible for the addiction and dependency of cigarette smoking. It is the most important active ingredient in cigarettes that not only maintains the addiction in smoking, but also the tobacco industry.
However, it must be noted that while nicotine is addictive, it is not the primary cause of smoking-related diseases like lung cancer.
Nicotine is inhaled through cigarette smoke and moves quickly from the lungs to the brain through the bloodstream. It then stimulates and speeds up the transmission of neurotransmitters in the brain.
One of these neurotransmitters – dopamine – produces a pleasurable and rewarding response which serves to reinforce the effects of nicotine. The rewarding effects create a compelling drive to continue smoking.
Nicotine is psychologically and physiologically addictive. Take caffeine for instance. Like nicotine, caffeine use is reinforced by the taste and smell of coffee, and its psychoactive effects. Most of us swear by a cup of coffee before we start our day.
Caffeine is a stimulant that releases neurotransmitters and induces pleasure, and increases alertness, concentration and performance. Nicotine in cigarette smoking provides the same buzz that a good cup of coffee brings.
Alternatives to smoking such as vapes and e-cigarettes have also gained popularity over the last few years, mainly due to their ability to deliver a dose of nicotine to the user without having to go through the combustion process of smoking.
In my years of dealing with patients, I’ve learned that people smoke for several reasons – mostly to control their moods, concentrate, and reduce stress and anxiety. This is all thanks to the psychoactive, stimulant effects of nicotine.
There is a common misconception that nicotine is the cause of many smoking-related diseases. However, diseases caused by smoking are due to the toxins found in tobacco smoke. Nicotine plays a very minor role, if any, in causing diseases from smoking.
Tobacco smoke from cigarettes is a complex and dynamic mixture of more than 7,000 chemicals, with more than 60 being well-established cancer-causing agents (carcinogens). These carcinogens include polycyclic aromatic hydrocarbons, volatile compounds (carbon monoxide, nitrogen dioxide) and metals among many others.
On the other hand, chemicals such as cyanide and arsenic in cigarettes increase the risk of cardiovascular disease. The toxic effects of components such as nitrogen dioxide and carbon monoxide can injure the airways and cause lung diseases such as chronic bronchitis and emphysema. These chemicals are the real killers in conventional cigarettes.
Trapped by nicotine addiction, smokers continue to subject themselves to a variety of smoking-related diseases with every puff, which eventually culminates and leads to death by smoking.
While being dependent on caffeine is not seen as problematic, the view is very much different with nicotine. This is probably due to the well-known negative health consequences associated with nicotine from cigarette smoking.
However, as much as nicotine causes addiction to cigarette smoking, it can also be used therapeutically to help in smoking cessation. For anyone who has tried to quit smoking, it would be described as a difficult and uncomfortable process due to the withdrawal symptoms.
Nicotine can be used as a form of pharmacotherapy to provide relief and ease the process of quitting. In fact, from my experience in treating addictions, incorporating nicotine into an individual’s quit plan can have positive psychological impacts in their journey to quit smoking.
Nicotine replacement therapy (NRT) can be used to assist smokers who find it difficult to quit on their own. In Malaysia, NRT is available in the form of gum, transdermal patches, lozenges and inhalers – all of which are effective in reducing the severity of withdrawal symptoms.
All forms of NRT have been shown to double the success rate of quitting, and is generally well tolerated by most patients. The use of NRT products is, without a doubt, a rational harm reduction strategy to reduce the adverse health effects of tobacco and to move towards quitting.
Malaysia has achieved amazing success in substitution maintenance therapy managing opiod dependence and HIV/AIDS prevention. We will have similar progress by recommending and offering nicotine replacement therapies for all smokers in their endeavour to quit smoking.
Incorporating nicotine in alternative devices and products is the next step to take for successful switching and quitting. By removing the stigma associated with nicotine, new treatment approaches can be adopted to help people move forward from the clutches of smoking and the harms that come with it.