From the physical toll of compulsive drug use to the high financial price in terms of lost productivity, law enforcement costs, and spiraling health care to the impact that the behavior has on families, workplaces, and communities, drug addiction continues to wreak havoc on individuals and communities throughout the nation and across the globe.

But the one drug that experts believe is responsible for inflicting the greatest amount of destruction isn’t acquired via shady back-alley deals or illegal transactions on illicit websites. Instead, it is advertised in magazines, purchased in convenience stores, and used in plain sight by millions of Americans every day. This drug is nicotine.

A stimulant that occurs naturally in the leaves of the tobacco plant, nicotine is responsible for both the pleasurable “buzz” that tobacco users enjoy and the habit-forming qualities that make it so difficult for these same people to stop using. And though many people refer to smoking as a “bad habit” (akin to eating too much ice cream or being chronically late), the truth for many smokers and users of smokeless tobacco is that their “habit” is something far more sinister and potentially far more damaging: It is an addiction.

“Nicotine, a component of tobacco, is the primary reason that tobacco is addictive, although cigarette smoke contains many other dangerous chemicals, including tar, carbon monoxide, acetaldehyde, nitrosamines, and more,” Nora Volkow, director of the National Institute on Drug Abuse (NIDA), wrote in a letter that was posted on the agency’s website.

According to NIDA, behaviors that are associated with chronic tobacco use are consistent with the generally accepted characteristics of addiction:

Addiction is characterized by compulsive drug seeking and use, even in the face of negative health consequences. It is well documented that most smokers identify tobacco use as harmful and express a desire to reduce or stop using it, and nearly 35 million of them want to quit each year. Unfortunately, only about six percent of people who try to quit are successful for more than a month

NIDA also notes that, in addition to the compulsion, the continuance in the face of ongoing negative effects, and the difficulty in stopping, tobacco/nicotine dependence is also marked by the onset of withdrawal symptoms in the absence of the drug:

Nicotine withdrawal symptoms include irritability, craving, cognitive, and attentional deficits, sleep disturbances, and increased appetite. These symptoms may begin within a few hours after the last cigarette, quickly driving people back to tobacco use. Symptoms peak within the first few days of smoking cessation and may subside within a few weeks. For some people, however, symptoms may persist for months.

Because of several factors, including the biological reaction of the body to nicotine and the relative ease with which the drug can be acquired and used, ending a dependence upon nicotine can be a particularly challenging endeavor. In fact, the American Heart Association describes nicotine addiction as “historically … one of the hardest addictions to break.”

For individuals who are struggling to overcome alcoholism or an addiction to an illicit substance such as cocaine or heroin, a co-occurring addiction to nicotine can complicate the recovery process.

For example, in his July 18, 2008 article on the HealthDaysection of the U.S. News & World Report website, writer Steven Reinberg reported on a study that found evidence of an association between nicotine and alcohol relapse:

Selena Bartlett, the Sidney R. Baer Jr. Foundation Investigator at the Ernest Gallo Clinic and Research Center of the University of California, San Francisco, thinks that the reliance on cigarettes by most recovering alcoholics has a biological basis and may actually increase the chances of relapse. …

 

In animal experiments, Bartlett found that nicotine can cause relapses to alcohol drinking. "But we don't know how nicotine and alcohol react to keep each other going," she said.

 

Nicotine has its own specific system in the brain, and alcohol may interact with that system, Bartlett said. Recovering alcoholics who continue to smoke may be more likely to relapse than nonsmokers, she added.

"My prediction would be that the relapse rate among smokers is higher," Bartlett said.

 

Ms. Bartlett’s findings echo the conclusions that were reached eight years earlier by Dr. Dzung Anh Le and colleagues at the University of Toronto’s Centre for Addiction and Mental Health.

As reported in a Feb. 15, 2000 article on the website of the BBC News, Dr. Le said that his team’s research on rats had revealed that “nicotine can indeed promote alcohol consumption … [and] it's likely that nicotine and alcohol can act through the same rewarding system in the brain.”

On June 25, 2007, WebMD Health News writer Miranda Hitti reported that a study of 25 recovering alcoholics had determined that the brains of nonsmokers appeared to make more significant progress than did the mental abilities of those who continued to smoke.

“The study shows that while in alcoholism recovery, smokers and nonsmokers both improved their mental skills test scores,” Hitti wrote. “However, nonsmokers showed a bigger improvement in most of the mental skills tests, even in light of other factors, including age and education level.”

 

The researchers who conducted the brain function study believed that their results indicated that individuals who didn’t smoke had a greater chance of having a more successful recovery experience than did those who remained hooked on nicotine, Hitti reported.

 

A similar study that involved brain scans instead of test scores also led researchers to the conclusion that improved brain performance among nonsmokers supported the notion that ending a tobacco addiction can be beneficial (albeit difficult) for individuals who are attempting to achieve and maintain lasting sobriety.

 

“[Quitting smoking] may be a lot to ask from an alcoholic individual going through drastic brain chemical imbalances in early recovery,” researcher Dieter Meyerhoff, professor of radiology at the University of California, San Francisco, said in a release that announced his team’s findings. “But it may lead to faster brain recovery.”