Solving the Case of How to Quit: Identifying the Criminal

 There was a lot of laughter in the room, but the group's focus was noticeable to an observer.

Twelve members of Gulf County's law enforcement family were gathered around a table in late May to do one thing: solve the mystery of how to quit smoking and dipping.

Sheriff Joe Nugent, himself a smoker, along with his wife, some of his investigators, deputies and office support personnel were all there at Nugent's insistence. Joining them were members of the Port St. Joe Police Department and volunteer fire department, and one or two others with city and county ties.

In all 16 people were in class that afternoon. It was the first of six classes to be presented to eight groups in the Tobacco Cessation/Chronic Diseases program currently being conducted by the Gulf County Health Department in conjunction with several area organizations.

The program is under the direction of Rosa Feltrop, the health department's tobacco prevention health educator.

For six weeks in May and June, a total of 64 people will band together to learn the best techniques to quit smoking. It will not be easy, but it will be well worth the effort, or multiple efforts, necessary.

It's a mind thing," Nugent said. "It all comes down to your attitude about it."

The reasons for this group's wanting to quit were all pretty similar: they did not have the stamina to do their jobs as well as they used to.

They were concerned for their families. They hated the constant, deep coughing. It was time.

"We're all in our 40s and 50s," said Nugent. "We need to be doing what we can for our health."

"It's time," agreed John Ford, fire chief of the Port St. Joe Volunteer Fire Department. He appeared to want to say something else, then shook his head and repeated, "It's just time."

So what do they face, in solving the mystery of how to kick the habit of nicotine addiction?

First, the facts.

Nicotine is a chemical in tobacco leaves, a naturally occurring, colorless liquid that turns brown when burned, and smells like tobacco when exposed to air.

In its natural state - in the tobacco plant - it serves as the plant's natural defense against insects.

Since nicotine naturally occurs in tobacco plants, cigars and smokeless tobacco products contain nicotine as well as cigarettes.

Nicotine is also what makes tobacco products so addictive.

It is a deadly drug, as addictive as anything so far identified. It currently has no beneficial uses except as an insecticide. But it is legally sold in a recognized drug-delivery system (tobacco products), on the open retail market.

What makes nicotine so insidious, especially in the form of cigarettes, is that science has repeatedly proven that nicotine activates the reward centers of the brain - the brain circuits that regulate feelings of pleasure.

Nicotine is a natural liquid alkaloid that acts on the central and peripheral nervous systems. For those who chew and dip tobacco, nicotine reaches the central nervous system in about three to five minutes. A cigarette cuts it down to seconds.

Here's the crime.

With each puff of a cigarette, a smoker pulls nicotine into his or her lungs, where it is immediately absorbed into the blood.

As soon as nicotine hits the blood stream, it stimulates the body's adrenal gland, which releases a dose of epinephrine (adrenaline). That rush of adrenaline stimulates the entire body and raises the heart rate, breathing rate and blood pressure. It causes the arteries to narrow and contributes to hardening of the arteries over time.

Nicotine also causes glucose (blood sugar) to be released into the blood, which is why smokers feel more alert after smoking a cigarette.

Simultaneously, the nicotine suppresses insulin production in the pancreas, which is why smokers are always slightly hyperglycemic.

In seven to ten seconds from the first puff, nicotine hits the brain, changing the way the brain works.

This happens so fast for two reasons. The ammonia which tobacco companies have added to cigarettes actually increases the amount of nicotine delivered to the body.

And nicotine is literally shaped like the natural brain chemical acetylcholine. Acetylcholine is one of many chemicals called neurotransmitters (think of them as messengers), which carry "messages" between brain cells (neurons).

Neurons have special spaces in them called receptors, into which specific neurotransmitters (messengers) can fit, just like a key into a lock.

Nicotine, because it is shaped like something already in the brain, locks into acetylcholine receptors, causing rapid changes in both the body and brain.

Nicotine also attaches to the particular brain cells that release a neurotransmitter (messenger) called dopamine.

Nicotine stimulates the brain cells to release unusually large amounts of dopamine, which in turn stimulates the brain's pleasure and reward center, a group of brain structures involved in appetite, learning, memory and pleasurable feelings.

Normally, feelings of pleasure come from things like food, comfort and the company of people you love. But smoking cigarettes also causes a flood of dopamine in the smoker's brain, giving the smoker that intense "ahhh..." feeling. Result? Immediate addiction.

Depending on the dosage of nicotine absorbed and the person's mood, smoking can be stimulating or relaxing.

But the nasty effects of nicotine don't end there.

Normal brain cells reabsorb neurotransmitters after they've done their work and delivered their "message." But cigarette smoke causes dopamine to stay in the spaces (synapses) between brain cells.

After repeated doses of nicotine, the brain actually changes. To adjust to the constant overload of dopamine, the brain cuts production of the neurotransmitters and reduces the number of receptors. Now the smoker needs nicotine just to create normal levels of dopamine in his or her brain. Without nicotine, the smoker feels irritable and depressed. So, the solution is to light up again...and again...and again.

As far back as 1988, the U.S. Surgeon General reported that cigarettes were addictive, using the same scientific standards that were applied to other addictive drugs like cocaine and heroin, which cause the same changes in the brain. But those drugs are illegal.

Internal documents from the tobacco companies, made public by the 1998 master settlement agreement, proved that tobacco executives knew years before the Surgeon General that nicotine was addictive.

According to the scientific analysis of nicotine by the International Program on Chemical Safety (IPCS), "Nicotine is one of the most toxic of all poisons and has a rapid onset of action... Nicotine is also a powerfully addictive drug...It is a substance of abuse."

The analysis also states, several times, that there is no known antidote to nicotine.

According to the analysis, nicotine occurs naturally in the tobacco plant in concentrations of 0.5 to eight percent, and common blends of cigarette tobacco, although variable, contain nicotine concentrations of 15 to 25 milligrams per cigarette.

Other scientific data state that American cigarettes contain about 9 milligrams of nicotine per cigarette, but a smoker only inhales one to two milligrams of the drug (in the smoke) from every cigarette.

The IPCS analysis determined the mean lethal dose of nicotine for adults was 30 to 60 milligrams at one time; in children the lethal dose was considered to be about 10 milligrams of nicotine consumed in one very short time frame.

Dizziness, nausea and even vomiting are common problems experienced by people trying their first cigarette. These are the first symptoms of nicotine poisoning. However, cigarette smokers very quickly develop a tolerance to the nicotine, according to the IPCS analysis.

The analysis also stated that nicotine inhaled in tobacco smoke enters the blood almost as rapidly as something injected through an I.V. (intravenous) injection.

And because nicotine that is inhaled through cigarette smoke enters the bloodstream through the vast area of the lungs, peak nicotine levels may be higher and take less time between smoking and when nicotine hits the brain, than after an I.V. injection.

Even though nicotine is metabolized fairly rapidly in the body, with repetitive dosing it still accumulates in the body.

According to the IPCS document, the half-life of nicotine averages two hours, meaning that over a six to eight hour period of consistent smoking, there are significant levels of nicotine in the blood after you stop puffing.

So if you smoke until you go to sleep, you are still exposed to significant concentrations and possible drug effects of nicotine even in your sleep - basically 24 hours a day.

When pregnant women smoke, the carbon monoxide and high doses of nicotine they inhale interfere with the baby's oxygen supply.

Nicotine readily crosses the placenta into the fetus, and nicotine concentrations in the fetus can be as much as 15 percent higher than the smoking mother's.

Newborns of smoking mothers, especially women who smoke during pregnancy, often show signs of drug withdrawal comparable to infants exposed to other addictive drugs.

Yet the IPCS states in its scientific analysis of nicotine that "preventative measures for occupational exposure to nicotine include: adequate ventilation, chemical goggles, mechanical filter respirator, rubber gloves, aprons and boots."

So why, one could reasonably ask, is nicotine legal?

Recently, researchers funded by the National Institute on Drug Abuse (NIDA) have shown through animal testing that acetaldehyde, another chemical compound in tobacco smoke, dramatically increases the reinforcing properties of nicotine and may also contribute to tobacco addiction.

The researchers also reported that this effect is age-related, suggesting that the brains of adolescents may be more vulnerable to tobacco addiction than adult brains.

Research is beginning to suggest that there may be biological reasons for this increased vulnerability in adolescents.

Adolescent rats have proven more susceptible to the reinforcing effects of nicotine than adult rats, and take more nicotine when it is available than do adult animals.

Adolescents may also be more sensitive to the reinforcing effects of nicotine in combination with other chemicals found in cigarettes, thus increasing nicotine's addictive properties in adolescent, but not adult, animals.

Nugent, who began smoking in college 35 years ago, watched his father die of lung cancer, "but even that wasn't enough to make me stop," he said.

Now the type of research coming out of places like NIDA colors Nugent's thoughts on smoking a totally different shade.

"The best thing in the world is for kids to not start smoking or chewing at all," he said. "I think if anybody who didn't smoke talked about it with somebody who did, they'd never start."