Make Nicotine a Controlled Substance

Add Nicotine to the The Controlled Substances Act
Nicotine has been proven to be as addictive as cocaine and heroin and may even be more addictive. Many people who smoke develop nicotine dependence, which makes quitting all the harder, especially when they try to stop smoking on their own. In fact, 70 percent of smokers report wanting to quit, but many wait until they develop a significant tobacco-related disease such as heart disease, cancer or stroke.

The average smoker starts smoking as a teenager, a time of stress and searching for self-identity and general lack of concern about long-term health consequences. Many adults trying to quit have been a smoker longer than a non-smoker, and have not developed healthy ways of managing stress, anxiety or anger. These issues often surface when attempting to quit and interfere with the quitting process.

Quitting represents release from an addictive substance that controls behavior every day and can substantially limit personal growth. People who quit often undergo transformations, accompanied by a new sense of power and feeling that, "If I can do this, I can do anything."

Our Approach to Nicotine Dependence
Quitting tobacco is one of the most important steps people can take for their health, but it is also extremely difficult. The good news is that tobacco addiction is treatable, and tobacco users who receive counseling and medication during their attempts to quit are much more likely to succeed than those who don't get such support.

UCSF is home to a multifaceted tobacco treatment program, staffed by nurses, pharmacists and social workers who are trained in tobacco addiction. We offer one-on-one consultations, interactive classes and a follow-up support group to help class graduates stay or become tobacco free. The follow-up program provides support from peers as well as guidance on tapering tobacco cessation medications. ​Nicotine dependence is an addiction to tobacco products caused by the drug nicotine. It involves physical and psychological factors that make it difficult to stop using tobacco. In the past, it was believed that because nicotine does not cause intoxication or impairment, using tobacco was simply a bad habit, not an addiction. Today, nicotine is recognized as the very addictive drug found in tobacco products.

Nicotine dependence (also called tobacco addiction) involves physical and psychological factors that make it difficult to stop using tobacco, even if the person wants to quit.

Nicotine releases a chemical called dopamine in the same regions of the brain as other addictive drugs. It causes mood-altering changes that make the person temporarily feel good. Inhaled smoke delivers nicotine to the brain within 20 seconds, which makes it very addictive—comparable to opioids, alcohol and cocaine. This "rush" is a major part of the addictive process.

When the person stops using tobacco, nicotine levels in the brain drop. This change triggers processes that contribute to the cycle of cravings and urges that maintains addiction. Long-term changes in the brain caused by continued nicotine exposure result in nicotine dependence, and attempts to stop cause withdrawal symptoms that are relieved with renewed tobacco use.

Signs & Symptoms
Nicotine dependence involves physical and psychological factors.

Signs of physical dependence on nicotine include:

the urge to smoke within 30 minutes of waking
ranking the first cigarette of the day as the most important
smoking at regular intervals throughout the day.
Tobacco use causes feelings of pleasure and alertness, but people with nicotine dependence become tolerant to the desired effects. They may no longer experience pleasure from using tobacco, but they continue to use it because they have cravings and want to avoid nicotine withdrawal.

Signs and symptoms of nicotine withdrawal include:

irritability
restlessness
anxiety
insomnia
difficulty concentrating
fatigue.
These symptoms usually stop within a couple of weeks, but some people continue to have problems concentrating or experience strong nicotine cravings weeks or months after quitting.

In addition to physical factors involved in nicotine dependence, there are psychological factors. People develop conditioned signals, or "triggers," for tobacco use. For example, some people always smoke after a meal or when they feel anxious. These triggers lead to behavior patterns that can be difficult to change.

Causes & Risk Factors
Anyone who smokes or uses other forms of tobacco is at risk of developing nicotine dependence. Various factors influence who is more likely to use tobacco and to develop nicotine dependence:

Genetics: Heredity may determine how receptors in the brain respond to high doses of nicotine delivered by tobacco products.
Family and friends: Children with parents who smoke are more likely to eventually take up smoking themselves. Children with friends who smoke are also more likely to try cigarettes.
Age: The younger a person is when they start using tobacco, the greater the chance that they will continue to smoke and develop nicotine dependence as adults.
Co-existing mental health problems: People with mental health problems, such as depression, anxiety and schizophrenia, have much higher rates of tobacco use.
Other substance use: People who use alcohol, cannabis and illegal drugs have much higher rates of tobacco use.
Diagnosis & Treatment
Diagnosis
Health care providers determine whether a person has nicotine dependence, and how severe it is, by asking certain questions. The most important questions are:

How soon after you wake up do you use tobacco?
How many cigarettes do you smoke per day?
Which is the most important cigarette of the day for you?
Treatment
Quitting tobacco use can take many attempts, so it is important to keep trying.

Medications and behavioral counselling are the two main types of tobacco cessation treatment. Combining these two types of treatment is the most successful way to quit tobacco use.

Medications
Stop-smoking medications reduce withdrawal symptoms and nicotine cravings. The choice of medication, dosage and duration of use depend on each person's needs and preferences.

Two types of medications exist for treating nicotine dependence: over-the-counter products that contain nicotine and prescription medications that do not contain nicotine.

Behavioral counselling teaches the person coping and problem-solving skills they can use to avoid tobacco and prevent relapse. It can also provide social support and encouragement. The more time a person spends in counselling, the more likely that they will succeed in quitting tobacco use. Various types of counselling are used to treat nicotine dependence:
Individual face-to-face counselling: This practical counselling involves meeting with a counsellor to develop a quit plan, learn problem-solving skills to help avoid tobacco use and prevent relapse, and get support during the process. The quit plan may include medication in combination with support. Individual counselling can last from five to 30 minutes and can happen in just one or a few sessions.
Group face-to-face counselling: Meeting as a group to share experiences of trying to quit and to offer one another support can help people stop tobacco use. Trained counsellors often moderate these groups.
Telephone quit lines: Counsellors may provide brief counselling, direct the caller to self-help material and refer them to community resources. Some quit lines only respond to incoming calls, but others call clients and offer counselling and relapse prevention support. Quit lines are free.
Web-based programs: Web-based interventions can help with tobacco cessation, relapse prevention and social support. Websites often provide self-guided quitting activities, interactive online communities moderated by trained staff and downloadable self-help material. Text-messaging services send personalized messages that support the person when they are struggling with cravings, triggers or potential relapse.
Some people don't feel ready to quit but are willing to start by cutting down. Cutting down before quitting can lessen nicotine withdrawal symptoms, and it allows the person to change their tobacco behaviors gradually. Strategies for cutting down include delaying cigarettes, smoking fewer cigarettes and smoking less of each cigarette. Although cutting down may reduce some health risks, there is no safe level of tobacco use.