Nicotine addiction: why does it happen and how to deal with it?

The average Indonesian smokes 12.4 cigarettes per day. Based on the latest data from the 2013 Basic Health Research (Riskesdas), Indonesian active smokers ranging from the age of 10 years and over range up to 66 million people, aka 10 times the total population of Singapore!

What is even more surprising is that the death rate from smoking in Indonesia has so far reached 200 thousand cases per year.

Although most of the toxicity effects of smoking are related to a number of other chemical components contained in a cigarette, cigarette and tobacco addiction is a pharmacological effect of nicotine.

How does nicotine work?

When a person inhales cigarette smoke, nicotine is extracted from tobacco and carried by smoke particles into the lungs which are then rapidly absorbed into the pulmonary veins of the lungs.

Furthermore, the nicotine particles enter the arterial circulation and travel to the brain. Nicotine will easily flow into brain tissue, where these particles will bind to nAChRs receptors, ionotropic receptors (ligand-gated ion channels) that open to allow cations such as sodium and calcium to pass through the membrane in response to more binding of chemical messengers, such as neurotransmitters..

One of these neurotransmitters is dopamine, which can improve your mood and activate feelings of pleasure. The nicotine effect in tobacco is the main reason that makes tobacco and cigarettes so addictive.

Nicotine dependence involves behavioral as well as physiological factors. Behaviors and cues that may be associated with smoking include:

• Certain times of the day, for example, smoking over coffee and breakfast, or during work breaks
• After eating
• Accompanied by drinking alcohol
• Certain places or certain people
• When calling
• Under stress, or when you are feeling sad
• See other people smoking, or smell cigarettes
• When driving

Signs and symptoms of nicotine addiction

In some people, smoking can quickly lead to nicotine dependence even when consumed in small amounts. Here are some signs and symptoms of nicotine addiction:

• Can't stop smoking. Even though you have tried several times to quit smoking.
  
• You experience "withdrawal" when you quit smoking. All of your smoking cessation attempts have caused withdrawal signs and symptoms, both physical and mood changes, such as severe cravings, anxiety and nervousness, irritability or anger, restlessness, difficulty concentrating, feeling depressed, frustrated, anger, increased hunger, insomnia, and constipation or even diarrhea.
  
• Keep smoking even if you have health problems. Even if you have been diagnosed with certain health problems related to the heart or lungs, you cannot and / or are able to stop.
  
• You are more concerned with being able to smoke than doing social or recreational activities. You may prefer not to visit a restaurant altogether because of that restaurant's smoking ban regulations, or prefer not to socialize with non-smokers because you cannot smoke in certain situations or locations.
  

Are there any effective treatments for nicotine addiction?

Apart from initiating healthier lifestyle changes, the following methods are proven to be effective in treating your addiction to nicotine:

Nicotine alternative products

Or better known as NRT (Nicotine Replacement Therapy). For example nicotine gum or nicotine patches. This therapy will support your nicotine needs to alleviate the "withdrawal" effect of quitting smoking. These products produce more tolerable physiological changes than the systemic effects of tobacco-based products, and generally supply the user with a much lower level of nicotine than a cigarette.

These types of therapies have a low potential for nicotine abuse side effects, because they don't produce the pleasant, soothing effects you can get from tobacco products. NRT also does not contain the carcinogenic compounds and pollutants commonly associated with cigarette smoke.

Prescription drugs (bupropion and varenicline)

Bupropion is an antidepressant drug that can also be used to help people quit smoking. Bupropion does not contain nicotine, but it can still overcome the patient's desire to smoke. Bupropion is often used for a period of 7-12 weeks, starting 1-2 weeks before quitting smoking. This medication can be used for maintenance of smoking cessation for up to six months. Side effects that may be experienced are insomnia and dry mouth.

Varenicline is a drug that targets the brain's addiction to nicotine by blocking nicotine intake before it reaches the brain membrane and reducing smoking cravings. Many studies have shown that varenicline is more effective in helping people quit smoking, because this tablet drug successfully stimulates dopamine to intercept nicotine receptors to work. Varenicline reduces the signs and symptoms of nicotine "withdrawal" and cravings, which can help prevent complete relapses. This medication can also block the effects of nicotine even if you return to smoking again.