An Addiction Specialist Explains Nicotine's Powerful Hold Over Cigarette Smokers

"Nicotine grabs people very strongly."
Michael M. Miller, MD, an addiction medicine specialist, is the medical director of the NewStart Alcohol/Drug Treatment Program at Meriter Hospital in Madison, Wis. He is also the president of the American Society of Addiction Medicine and an associate clinical professor at the University of Wisconsin School of Medicine and Public Health.

Q: Why is it so hard to quit smoking?

A: The hardest part about quitting drugs is the physical withdrawal symptoms—and it's especially hard to “establish abstinence” when the symptoms hit right away. Nicotine's withdrawal symptoms are powerful and hit the fastest of all drugs. People experience agitation, insomnia, irritability, and strong cravings within two to four hours of their last cigarette.

Q: Is smoking more addictive than alcohol?

A: Yes, the drugs that seem to be the most addictive are nicotine, cocaine, and methamphetamine. Those three are different from all other drugs. Among those who drink alcohol on a regular basis, around 15% develop an addiction. About 45% of those who smoke on a regular basis get addicted.

Q: Is nicotine addiction inherited, like alcoholism can be?

A: Genetics are the biggest factor in determining whether you will be among the 10% of the population to develop an addiction. Perhaps 50% to 60% of ones likelihood of developing alcohol addiction is genetic, for instance. Many people thought that phenomenon was limited to alcohol. But the genetic contribution to drug addiction, including nicotine addiction, is at least as strong as it is for alcohol, and probably greater than 60%.

Q: How are the effects of nicotine addiction different from other drugs?

A: People using injection drugs will develop physical problems a few years after they start shooting up. People who use alcohol can go 10 or 20 years before developing significant health problems from drinking. But people who use tobacco can easily go 20 to 30 years without developing health consequences. During all those years, the risk for harm is accumulating, but they dont see it yet. So people think theyre getting a free pass. They think it isnt harming them, or that theyll be able to escape the harm.

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Lead Writer: Dr. Michael M. Miller
Last Updated: July 09, 2008

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