Psychology
Abstract
Nicotine is an alkaloid existing naturally in tobacco products. It is highly addictive, and intake cessation is often marred by high relapse rates. Multiple sources of literature document the adverse health effects that nicotine dependence has on the body, including cancer, mental illness and coronary diseases. This paper explores the psychological factors behind the prevalence and severity of nicotine addiction. Section one provides an overview of the concept of nicotine addiction and the reason for its pervasiveness. Section two elaborates the psychological development of nicotine dependence, indicating the thought processes and personal motivations behind the use of cigarette. Section three illustrates the psychological mechanisms that reinforce addictive behavior, including operant and classical conditioning, modelling and emotional manipulation by media sources. Section four draws a positive link between mental disorders and nicotine addiction, thereby, reiterating the need for enhancing smoking prevention efforts.
Introduction
Nicotine is one of the most addictive drugs in contemporary societies. It is an alkaloid existing naturally in the tobacco plant. However, cigarette smoking is the most effective channel for delivering nicotine in the human body, producing noticeable effects within the first fifteen seconds. Nicotine dependence triggers compulsive use in individuals, making them go to great lengths to obtain cigarettes regardless of the dangers that the products pose to their health. Despite many smokers expressing a desire to quit the vice, only a few succeed. Of the 70% cigarette smokers who indicate their wish to quit, only 1% achieve this goal (WHO, 2010, p. 143). The reason for the prevalence of nicotine addiction partly stems from the legality and acceptability of cigarette smoking in many social settings (USDHHS, 1988 as cited in Reid, Selzer, & Rotrosen, 2006, p. 2). This scenario has made the fight against cigarette smoking insurmountable, displaying little to negligible victories in some quarters. However, the cause of nicotine dependence is primarily psychological rather than physical. The magnitude of psychological drivers shows in the obsessive cigarette use and disregard of apparent health risks that transcend a person’s wish for treatment. This paper evaluates the interplay of psychological factors driving nicotine addiction.
Understanding Nicotine addiction
An addiction refers to the “repetitive and compulsive use of a drug” (World Health Organization [WHO], 2010, p. 142). To qualify as an addiction, an individual must display key behavioral characteristics: chronic intoxication, obsessive substance use, difficulty in stopping use, high tolerance, and withdrawal symptoms upon cessation attempts (Action on Smoking and Health Organization [ASH], 2013a). Nicotine-dependent individuals exhibit these behaviors to different degrees depending on their duration of smoking. When inhaled, nicotine induces peak brain operation levels within fifteen to twenty seconds, after which the stimulating effects begin to diminish. The transient nature of brain stimulation makes smokers crave for more cigarettes in a bid to recreate this elevated brain activity. On average, a cigarette contains 10 milligrams of nicotine (WHO, 2010, p. 139). Thus, a one-pack cigarette smoker consumes about 200 milligrams of nicotine each day. This makes nicotine the most highly ingested drug compared to other illicit drugs such as heroin and cocaine. As a result, the craving develops into a habit, then into an addiction. Over time, continued intake makes the body tolerant to a repeated dose of nicotine, hence producing a diminished body response. This increasing stimulation moderation necessitates markedly increasing nicotine dosage to achieve the desired effects, thus, creating dependence. Moreover, the perceived positive feelings induced by nicotine inhalation such as depression and anxiety reduction makes hampers the fight against cigarette smoking.
Psychological development of nicotine addiction
Nicotine addiction develops gradually and takes several months to about three years to be established. Several research findings indicate that psychological factors contribute significantly to the experimentation and continued use of cigarette smoking. The transtheoretical model of Intentional Behavior Change identifies five stages of nicotine addiction development: pre-contemplation, contemplation, preparation, action and maintenance (WHO, 2010, p. 144). In the pre-contemplation stage, individuals form attitudes and beliefs regarding cigarette smoking. These beliefs mainly develop during the formative years, when individuals are still susceptible to the teachings and doctrines of their primary guardians and schooling environment. Most of these attitudes about smoking are negative in nature. The deterrence theory holds that the actual or perceived probability and severity of penalties deters bad behavior (Brent, 2011). As such, children grow up with the notion that smoking is immoral and avoid the vice out of fear rather than facts. The psychology of fear prevents them from acting on their curiosity. In the second stage, contemplation, individuals begin to consider cigarette smoking. This impetus chiefly commences at adolescence with the onset of self-discovery and individuality. Usually, the mob psychology triggers such deliberations due to the susceptibility to peer pressure. In the attempts to feel accepted and appear sophisticated, teenagers begin to shape their preconceived beliefs about smoking and increasingly consider experimentation. Available statistics indicates that boys and girls who start smoking in their teenage years continue smoking for about 16 years and 20 years respectively, before they can quit (Piper et al., 2004, p.3).
In the preparation stage, individuals experiment with smoking on an intermittent basis. They are still unsure of whether to take up the vice or abandon it altogether after feeling the initial health effects of nicotine in their bodies. Next, individuals enter the action stage where they establish a regular pattern of cigarette use. Lastly, the maintenance stage entrenches the habit into one’s life, firmly creating nicotine addiction. The habit becomes so ingrained in an individual that lighting a cigarette becomes an involuntary action. Addicts usually develop rigid time or place patterns for smoking.
Psychological nicotine dependence
Conklin and Lee (2008) define psychological dependence as the “compulsive use of a substance to meet a psychological need” (p. 295). Most nicotine addicts use cigarettes as a means of coping with stress, depression, anxiety and pain. As such, they view the smoking habit as self-medication because of its temporary benefits such as increased leading, memory and attention. However, as soon as its effects weaken, depression sets in, making the addicts crave even higher quantities of cigarettes to sustain the substance-induced euphoria for longer durations. As a result, the severity of withdrawal symptoms increases with time, thus hindering cessation efforts. According to the learning theories of addiction, the three principal modes of addiction development include operant conditioning, classical conditioning and observational learning (modelling) (Conklin & Lee, 2008, p. 313). Operant conditioning involves the use of rewards and punishments to reinforce the behavior. In nicotine addiction, the temporary psychological benefits act as rewards for smoking while the severe withdrawal symptoms serve as penalties for cessation attempts. These effects serve to reinforce the smoking habit. Generally, human beings have a penchant for avoiding pain and grief. Since, smoking withdrawal is associated with grief symptoms such as frequent bouts of anger, irritability, sadness, insomnia and nervousness, most addicts prefer resuming the habit.
Classical conditioning involves inculcating a new behavioral response to a new stimulus by repeatedly associating it with a stimulus with a known biological response (Conklin & Lee, 2008, p. 313). In the case of nicotine addiction, the habit becomes integrated into certain aspects of an individual’s social life such as smoking while driving walking, after meals or while hanging out with friends. Such activities trigger cravings for cigarettes, creating a high relapse prevalence among smokers. According to WHO (2010), the majority of smokers who succeed in quitting, usually, make an average of eight to eleven attempts before accomplishing their goal (p. 143). Lastly, observational learning involves aping the behavior of others. In this regard, parents and role models who exhibit the use of cigarettes create fertile grounds for the vice to fester in their children. During the formative years of human development, children idolize their parents and are, therefore, more likely to emulate their smoking habits when they become adults.
The susceptibility of individuals to cigarette smoking and the resulting nicotine addiction also stems from psychological manipulation by the media. The media glamorizes smoking by depicting the habit as being sophisticated. Given the fixation of the younger generation with celebrities and socialites, young adults are increasingly picking inappropriate role models from this social class. Most of these idols engage in maladaptive behaviors such as smoking expensive cigars as a way of asserting their independence and wealth status. As a result, youths emulate these habits without contemplating their adverse long-term effects. Furthermore, movies, films, music videos and cigarette advertisements are usually embedded with hints of emotional appeals that connect with the insecurities of individuals such as fear, need for acceptance and inclusion, low self-esteem and overweightness. For instance, the “Virginia Slim” cigarette pack displays the picture of a slender, sophisticated and independent young woman to appeal to middle-class women (Zamora, n.d.). Moreover, tobacco companies promote smoking by offering promotional incentives such as coupons, free samples and producing branded products such as non-mentholated cigarettes.
Nicotine addiction and mental disorders
Several literature sources attest to the association between cigarette smoking and mental health disorders. According to Koc et al. (2014), the progress of nicotine addiction is very rapid and is most highly expressed by people with mental illness (p. 85). The strength of the dependency increases with the severity of the psychiatric illness (ASH, 2013b). Mental illnesses alter the feelings, thought processes and behavior of individuals to the extent that the shift causes distress to them and others. Existing research evidence indicates that 70% of those suffering from mental illness are more likely to smoke than regular people (ASH, 2013b). The reason for this vulnerability includes the genetic predisposition, greater degree of the effects of pleasure and withdrawal symptoms, the multitude of behavior disorder symptoms and their limited cognitive ability to understand anti-smoking messages. In an experiment to examine the correlation between the level of nicotine addiction and psychological symptoms, Koc et al. (2014), observed a significant positive correlation between nicotine addiction and anorexia, paranoia, psychosis, insomnia, anxiety and obsessive compulsive disorder. Further results showed that smoking triggered psychological disorders in some individuals. Nicotine addicts usually rely on the substance to alleviate their anxiety, depression and stress levels. These mental conditions are felt more acutely by the mentally ill than healthy people. As such, mentally ill individuals rely more heavily on cigarette smoking in order to maintain somewhat normal emotional thresholds. Thus, the knowledge of psychological instability is essential for understanding the prognosis of nicotine dependence.
Conclusion
In conclusion, the role of psychological factors in prompting or exacerbating nicotine addiction should not be overlooked. Nicotine addiction develops over time and ultimately wreaks havoc in the lives of both primary and secondary smokers. This harm is mainly cancer-related. The endemic nature of the smoking and relapse prevalence stems from the reinforcing habits that act as cues for addicts to purchase cigarettes such as meeting former smoking buddies. Furthermore, psychological insecurities such as low self-esteem, poor self-image due to overweightness, and the need for acceptance by peers contribute to the adoption of the vice. Social image is one of the key mechanisms that people, especially teenagers, use to reinforce and sustain social bonds. This quality makes them susceptible to manipulation by others into experimenting with cigarette smoking, thus become hooked before they know it. Therefore, an understanding of the psychological dynamics that mark each stage of nicotine addiction development is essential is actively treating the addiction. Furthermore, stringent regulations regarding cigarette advertisements and promotions should be enacted and enforced to mitigate against loss of lives that occur through continued exposure to nicotine.
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