The use of tobacco leaf to create and satisfy nicotine addiction was introduced to Columbus by Native Americans and spread rapidly to Europe. The use of tobacco as cigarettes, however, is predominantly a twentieth century phenomenon, as is the epidemic of disease caused by this form of tobacco.

Nicotine is the principal constituent of tobacco responsible for its addictive character. Addicted smokers regulate their nicotine intake and blood levels by adjusting the frequency and intensity of their tobacco use both to obtain the desired psychoactive effects and avoid withdrawal.

Unburned cured tobacco contains nicotine, carcinogens, and other toxins capable of causing gum disease and oral cancer. When tobacco is burned, the resultant smoke contains, in addition to nicotine, carbon monoxide and 4000 other compounds that result from volatilization, pyrolysis, and pyrosynthesis of tobacco and various chemical additives used in making different tobacco products. The smoke is composed of a fine aerosol, with a particle size distribution predominantly in the range to deposit in the airways and alveolar surfaces of the lungs, and a vapor phase.

The bulk of the toxicity and carcinogenicity of the smoke resides in the aerosolized particulate phase, which contains a large number of toxic constituents and carcinogenic compounds. The aggregate of particulate matter, after subtracting nicotine and moisture, is referred to as tar. The vapor phase contains carbon monoxide, respiratory irritants, and ciliotoxins as well as many of the volatile compounds responsible for the distinctive smell of cigarette smoke.

The alkaline pH of smoke from blends of tobacco utilized for pipes and cigars allows sufficient absorption of nicotine across the oral mucosa to satisfy the smoker’s need for this drug. Therefore, smokers of pipes and cigars tend not to inhale the smoke into the lung, confining the toxic and carcinogenic exposure (and the increased rates of disease) largely to the upper airway for most users of these products. The acidic pH of smoke generated by the tobacco used in cigarettes dramatically reduces absorption of nicotine in the mouth, necessitating inhalation of the smoke into the larger surface of the lungs in order to absorb quantities of nicotine sufficient to satisfy the smoker’s addiction. The shift to using tobacco as cigarettes, with resultant increased deposition of smoke in the lung, has created the epidemic of heart disease, lung disease, and lung cancer that dominates the current disease manifestations of tobacco use.

Genetic Considerations
Several genes have been associated with nicotine addiction. Some reduce the clearance of nicotine, and others have been associated with an increased likelihood of becoming dependent on tobacco and other drugs as well as a higher incidence of depression. It is unlikely that genetic factors are the principal determinants of addiction. Rates of smoking initiation among males, and corresponding rates of nicotine addiction, have dropped by almost 50% since the mid-1950s, suggesting that factors other than genetics are important. It is more likely that genetic susceptibility influences the probability that experimentation with tobacco as an adolescent will lead to addiction as an adult.

Nicotine Addiction

• Disease Manifestations of Cigarette Smoking
• Lower Tar and Nicotine Cigarettes
• Nicotine Addiction: Cessation
• Nicotine Addiction: Introduction
• Nicotine Addiction: Other Forms of Tobacco Use
• Nicotine Addiction: Pharmacologic Interactions
• Nicotine Addiction: Physician Intervention
• Nicotine Addiction: Prevention