The History of Tobacco
One of the first known uses of tobacco are from Native
Americans in the Northern American regions they smoked tobacco as part of their
spiritual ceremonies and for medicinal reasons.
“Tobacco is a green, leafy
plant that is grown in warm climates. After it is picked, it is dried, ground
up, and used in different ways. It can be smoked in a cigarette, pipe, or
cigar. It can be chewed (called smokeless tobacco or chewing tobacco) or
sniffed through the nose (called snuff).
(Jacobs, 1997, p 6)” In 1612 the North American settlers began selling
their tobacco crops. (Jacobs, 1997)
By 1881 a guy
named James Bonsack “. . . invented the cigarette-making machine. . .” and went
into business with another guy named James “Buck” Duke, together they formed
the American Tobacco Company and sold Duke Durham cigarettes. (Jacobs, 1997, p 8) By 1902 Phillip Morris formed a company and
made his own brand of cigarettes he called, Marlboro. “Since WW II, there have
been six giant cigarette companies in the U.S. They are Philip Morris, R.J.
Reynolds, American Brands, Lorillard, Brown & Williamson, and Liggett &
Meyers (now called the Brooke Group).”
(Jacobs, 1997, p 9)
Prior to the
1950s science had demonstrated that “. . . smoking caused lung cancer as well
as other serious respiratory and cardiac diseases, leading to death.” (Brandt, 2012, p 65) In 1953 the cigarette companies started being
accused of being the purveyors of lung cancer.
On, January 11, 1964,the U.S. Surgeon General, Luther L. Terry, released
a statement to the public regarding the strong relationship, if not causal
relationship, between smoking, lung cancer and other cardiovascular diseases. (Terry, 1964)
One year later, the United States Congress passed the Cigarette Labeling
and Advertising Act of 1965 (‘Act’). The
Act required that all tobacco companies include a label on their cigarette
packaging that stated “Cigarettes may be hazardous to your health.” (Jacobs, 1997) In 1980, the American
Psychiatric Association included Nicotine Dependence as part of the Substance
Disorders in the Diagnostic and Statistical Manual’s third edition. (Coszi, 2011)
And, by 1988 Dr. C. Everrett Koop, the United States Surgeon General,
released a statement to the public that likened the dangers of nicotine addiction
to cocaine and heroine addiction (Tolchin, 1988)
Diagnosis
of Nicotine Dependence
The Diagnostic and Statistical Manual of Mental
Disorders Fourth Edition Text Revision (DSM IV) sets out the criterion for
substance dependence as “A Maladaptive pattern of substance use leading to
clinically significant impairment or distress, as manifested by three (or more)
of the following, occurring at any time in the same 12-month period:
1. Tolerance,
. . . [ingest more of the substance to obtain the needed effect or the effects
are lessened with continued use of same amount]
2. Withdrawal . . . [the body does not feel
normal unless the substance or similar substance is present so the person may
experience headaches, nausea, shaking, etc… ]
3. the
substance is often taken in larger amounts or over longer period than was
intended
there
is a persistent or unsuccessful efforts to cut down or control substance use
4. A
great deal of time is spent in activities necessary to obtain the substance . .
.
important
social, occupational, or recreational activities are given up or reduced
because of substance use
5. the substance use is continued despite
knowledge of having a persistent or recurrent physical or psychological problem
that is likely to have been caused or exacerbated by the substance . . .” (APA, 2000, p197)
The DSM IV then sets out specific criterion to be met
for Nicotine Dependence. Because some of
the criterion for Substance Dependence would not apply to Nicotine Dependence
clarification of some of the criterion is needed. For example there is no need for a nicotine
dependent person to spend a great deal of time trying to obtain nicotine, as
nicotine is readily available to the general public, as opposed to say, someone
who is dependent on prescription medication who would have to go to see a
doctor or several doctor before they were able to obtain the medication needed.
(APA, 2000) “Tolerance to nicotine is
manifested by a more intense effect of nicotine the first tie it is used during
the day and the absence of nausea and dizziness with repeated intake, despite
regular use of substantial amounts of nicotine.” (APA, 2000, p 264)
Also, smokers smoke so that they don’t feel withdrawal
symptoms, chain smoking could be considered “spending a great deal of time” with the substance,
people who don’t go places because they can’t smoke could be considered to be
“Giving-up important social, occupational, recreational activities. . .” and “Continued use despite the knowledge of
medical problems related to smoking. . .”
(APA, 2000 p 265) Someone is in
Nicotine withdrawal if they are manifesting four of the following six criterion
after “. . . the abrupt cessation or disruption of use of nicotine containing
products . . .” 1.) dysphoric or depressed mood; 2.) insomnia; 3.) irritability, 4.) restlessness or impatience, 5.) decreased
heart rate; 6.) increased appetite or weight gain. (APA, 2000, p 265)
When making a diagnosis of nicotine dependence a
clinician can use the specifiers for a diagnosis of Substance dependence to note
whether the nicotine diagnosis is “With Physiological Dependence. This specifier should be used when Substance
Dependence is accompanied by evidence of tolerance (Criterion 1) or withdrawal
(Criterion 2). [or] Without Physiological Dependence. This specifier should be used when there is
no evidence of tolerance (Criterion 1) or withdrawal (Criterion 2). In these individuals substance dependence is
characterized by a pattern of compulsive use (at least three items from
Criteria 3-7).” (APA, 2000, 195) Common
features of a nicotine dependent individual are “tobacco odor, cough, evidence
of chronic obstructive pulmonary disease, and excessive skin wrinkling.” (APA, 2000, p 267)
There are several tests that can assist with the
diagnosis of Nicotine Dependence. One of
the diagnostic tests is the Core International Diagnostic Interview (CIDI)
developed by the World Health Organization (WHO) in 1997 as an international
assessment tool for the diagnosis of mental disorders. (World Health Organization, 1997) Another test that is used to assess an
individual’s level of dependence to nicotine is the Fagerstrom Test for
Nicotine Dependence (FTND). The
shortened version of the FTND asks six
questions which focus on when a smoker smokes and the intensity of discomfort
if he doesn’t. There is a point scale
given to each answer and the smoker is assessed as having a very low
dependence, moderate dependence or high dependence on cigarettes. (Balfour, 2000)
Treatment
for Nicotine Dependence
There are many types of treatment for Nicotine
Dependence. Some of the treatments available for Nicotine Dependence are: Pharmacological, Nicotine Replacement Therapy,
Cognitive Behavioral Therapy, Motivational Interviewing, Smoking Cessation,
Hypnosis, Acupuncture, Diet & Exercise and quitting Cold Turkey. The most commonly used and proven effective
treatments are pharmacological, nicotine replacement therapy (a type of smoking
cessation) and cognitive behavioral therapy.
(Mayo Clinic Staff, 2010)
One of the most effective medications for
pharmacological treatment of nicotine dependence is “Bupropion (Zyban®,
Wellbutrin®,
or Aplenzin®)
[it] is a prescription anti-depressant in an extended-release form that reduces
symptoms of nicotine withdrawal” (American Cancer Society, 2013, p 1) Another
popular medication to stop smoking is “Varenicline
(Chantix®)
[it] is a prescription medicine developed to help people stop smoking. It works
by interfering with nicotine receptors in the brain.” (American Cancer Society,
2013, p 1) Neither of these medications
contain nicotine but they assist an individual in quitting smoking Bupropion by
alleviating some of the depression that may occur during the withdrawal from
nicotine and Varenicline by minimizing the any sense of pleasure the smoker may
think he gains from smoking. (American
Cancer Society, 2013)
Nicotine Replacement Therapy are gums, inhalers,
patches, lozenges and nasal sprays that contain nicotine. (National Institute of Health, 2013)
“Available trials indicate that nicotine replacement therapy is an effective
intervention in achieving sustained smoking abstinence for smokers who have no
intention or are unable to attempt an abrupt quit” (BMJ, 2009, p 1) The BMJ research also found that counseling together
with Nicotine Replacement Therapy was the most effective way to treat Nicotine
Dependence. (BMJ, 2009)
Cognitive Behavioral Therapy and Motivational
Interviewing are two of the counseling methods used for most substance
dependence treatment. “Developed by Dr. Aaron T. Beck, Cognitive Therapy (CT), or Cognitive Behavior Therapy
(CBT), is a form of psychotherapy in which the therapist and the client
work together as a team to identify and solve problems.” (Beck Institute
Website) Studies have shown that group
therapy sessions using Cognitive Behavioral Therapy have doubled the chances of
individuals quitting smoking and effectively achieving their treatment goals.
(Stead, 2009) Motivational Interviewing
Therapy “MI is a collaborative method that elicits from patients their own
motivation or reasons for changing their behavior.” (Bisono, 2006, p72) Motivational Interviewing is considered a
form of effective listening to and questioning of the client in order to elicit
the client’s own motivations for behavior change and defeat the idealization of
negative consequences of the disorder as benefits to the client. (Miller, 2009)
Most of the treatments for
Nicotine Dependence recommend a change in diet and exercise to help reduce the
cravings for nicotine. The research
suggests that the best treatment is a combination of treatment that combines
individual or group counseling with medication or nicotine replacement therapy
and some other lifestyle changes. (American Cancer Society, 2013)
References
American Psychiatric Association.
(2000). Diagnostic and
statistical manual of mental disorders (4th
ed., text rev.). Washington, DC: Author.
Balfour, D., Benowitz,
N., Fagerstrom, K., Kunze, M. and Keil U. (2000) Diagnosis and treatment of
nicotine dependence with emphasis on nicotine replacement therapy: A status
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Bisonó,
A., Manuel, J., & Forcehimes, A. (2006). Promoting treatment adherence
through motivational interviewing. In W. O'Donohue, & E. Levensky (Eds.), Promoting treatment adherence: A
practical handbook for health
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CA: SAGE Publications, Inc. doi: 10.4135/9781452225975.n5
Coszi,
F., Pistelli, F. and Carrozzi, L. (2011). Tobacco smoking: Why do physicians
not make diagnosis?. European Respiratory Review, 20,
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Jacobs,
M. (1997). From the first to the last ash: The history, economics & hazards
of tobacco. Mass. Department of Public Health grant to The Cambridge Tobacco Education
Program, Cambridge Department of Human Service Programs. Tobacco Control
Activities are supported by the Health Protection Fund, established upon
passage of voter referendum Question 1 (Tobacco Excise tax). Retrieved from: http://healthliteracy.worlded.org/docs/tobacco/Tobacco.pdf
Moore,
D., Aveyard, P., Connock, M., Wang, D., Fry-Smith, A., and Barton, P.,( 2009). Effectiveness
and safety of nicotine replacement therapy assisted reduction to stop smoking:
systematic review and meta-analysis. BMJ 2009;338:b1024 doi:10.1136/bmj.b1024
Stead,
L. & Lancaster, T. (2013). Group
behaviour therapy programmes for smoking cessation. National Institute of Health. DOI: 10.1002/14651858.CD001007.pub2
Terry,
L., (1964). History of the surgeon
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for disease control and prevention. Retrieved from: http://www.cdc.gov/tobacco/data_statistics/sgr/history/index.htm
Tolchin,
M. (1988) Surgeon general asserts smoking is an addiction. New York Times Retrieved from: http://www.nytimes.com/1988/05/17/us/surgeon-general-asserts-smoking-is-an-addiction.html
