Debra Smith is craving to break her bondage with cigarettes.
In the morning, after parking her car in front of her workplace, she lights up while listening to spiritual tapes on which ministers preach about breaking any bad habit.
“It’s something you don’t want,” the 36-year-old bookkeeper said of her smoking addiction. “You want to get rid of it. It’s not good for you.”
In her 21 years of puffing, Smith, of Cedar Lake, Ind., has tried to quit seven or eight times. Her most successful attempt lasted three months.
As scientists discover more about nicotine’s powerful hook on the brain, they are better able to explain why the will to quit may not be enough to keep Smith and other smokers away from cigarettes.
The research into nicotine addiction continues even with the recently proposed $368 billion settlement between 29 states and the tobacco industry. Former smokers and their families have also sued tobacco giants, charging that cigarettes caused them to become ill. And while one family last year won a $750,000 judgment against a cigarette company, in May a jury in Jacksonville, Fla., found R.J. Reynolds Tobacco Co. not liable for the death of a 49-year-old woman who died in 1995 after a lifetime of smoking.
Meanwhile, researchers studying the effects of nicotine on health have found that it indeed alters brain chemistry. And that may explain why withdrawal symptoms like headaches, nervousness and irritability make smoking a difficult habit to kick.
“Nicotine is taken up very rapidly in the brain,” said Dr. Edythe London, head of the brain imaging center at the National Institute on Drug Abuse in Bethesda, Md.
Traveling twice as quickly through the bloodstream as mainlined heroin, nicotine reaches the brain “within seven seconds of a drag,” said Susan Adrians, a chemical dependency therapist at St. Margaret Mercy Healthcare Centers South Campus in Dyer, Ind.
Within a half-hour of smoking a cigarette, Adrians said, the nicotine level “drops off slightly and the cravings set in.”
For Smith, reaching for her pack of cigarettes at certain periods of the day has become almost automatic.
“A lot of times, I pick them up without thinking about it,” she said.
Smith arrives shortly after 8 a.m. weekdays at the Lake County Government Center in Crown Point, Ind., then smokes one or two cigarettes in her pickup. She smokes another before walking in the front door by 8:30 a.m. for work in the auditor’s office.
Smith won’t be able to smoke again until two break times and at lunch. In all, she goes through one to 1 1/2 packs a day.
“Sometimes you just need a cigarette,” said Smith as she inhaled during lunch in the center’s cafeteria. “So once you get one, you feel better. You feel relaxed.”
Satisfying the urge to smoke, especially after eating, calms Robert Garza, 21, an employee at the government center.
“To me, nicotine’s like a drug,” he said.
Garza, of East Chicago, has tried to quit twice since he took up smoking at about age 17. But each time, he couldn’t last 24 hours without a cigarette.
“Since I started,” Garza said, “I guess it’s my brain telling me to smoke.”
After a person begins smoking, nicotine binds to specific receptors in the brain, changing its chemistry, experts say.
“A receptor is the equivalent of a biological keyhole (with nicotine being the key),” said Dr. Jack Henningfield, associate professor at Johns Hopkins Medical School in Baltimore, and a tobacco researcher at Pinney Associates, a health-consulting firm in Bethesda, Md.
“Nicotine exposure causes the body to end up with an increased number of nicotine receptors,” Henningfield said.
The brain then becomes accustomed to a continual level of nicotine, and its pleasure-inducing effects contribute to dependence, brain researcher London said.
“Without the nicotine, there’s an imbalance. So there are some behavioral effects,” she said.
The strength of nicotine addiction varies. The Fagerstrom Tolerance Test, commonly used in smoking-cessation programs, measures dependence on a scale of 0 to 11. The score assists a smoker in deciding whether to use the nicotine patch, gum or quitting cold turkey, said Robert Erickson, clinical manager in respiratory care at The Community Hospital in Munster, Ind.
But none of the nicotine-replacement products can deliver “the same kind of high” as a cigarette, said Donald Shopland, coordinator of the smoking and tobacco-control program at the National Cancer Institute in Bethesda.
While uptake of nicotine to the brain occurs within seconds after inhalation, it takes several minutes through the patch or gum. Only after about 20 minutes does nicotine rise to a steady state in the brain. And even then, it never reaches the same high levels in the blood as it would via a cigarette. These factors help explain the high relapse rates among smokers, Shopland said.
