A middle-aged woman who I’ll call Martha came to see me concerned about a neck mass and given her long smoking history, she admitted to being worried about lung cancer. This woman was  thoughtful and articluate and admitted that despite her anxiety about developing lung cancer, she couldn’t quit smoking. So what makes nicotine such a powerful, addictive drug?

Nicotine is a highly toxic alkaloid that closely resemble acetylcholine, a powerful neurotransmitter in the brain which directs  over 200  chemical processes in the body. Because of this resemblance, it can lock on to many receptor sites in the brain triggering a series of chemical reactions.

One of the most powerful reactions occurs with dopamine. Dopamine regulates the pleasure center of the brain and levels rise with nicotine – in the same way that levels increase with cocaine, heroin or marijuana.

Because dopamine levels quickly wear off, the smoker is compelled to have another cigarette. There is a certain amount of desensitization that occurs so that more of the drug is needed to satisfy the addiction.

It doesn’t take long for a person to become addicted to nicotine with some estimates suggesting that smoking even as little as 4 cigarettes could lead to addiction. Martha had been smoking since age 17 and she was now in her late 50s. She looked pretty dejected and without prompting said she understood how odd it must have seemed that despite her fears of lung cancer, she still couldn’t quit. There was something about the way she said it  - a certain resignation in her tone – that brought home to me how powerfully addicting nicotine is.

I finished examining Martha and sent her off for a chest xray, CT scan of the neck and lab work. The xray was negative and she’s scheduled for her CT scan. I truly hope that no matter what the results, she stops smoking.

For those interested in finding out more about tobacco addiction, there are some very informative (and passionate) websites devoted to breaking the tobacco habit. Here they are:

• http://whyquit.com/whyquit/LinksAAddiction.html
• http://www.drugabuse.gov/tib/tobacco.html
• http://quitsmoking.about.com/od/nicotine/a/nicotineeffects.htm

Readers are invited to submit their own recommendations.

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