Youth, The Trajectory of Addictions

December 8, 2008: The Role of Nicotine Addiction in Tobacco Use

Joseph DiFranza, M.D., Professor, Family Medicine and Community Health, University of Massachusetts Medical Center

Key messages:

In his research with young people and addiction, Dr. DiFranza has found that the progression of addiction starts at "wanting" then moves to "craving" and then results in "needing."
At the onset of addiction the latency-to-wanting (the delay between finishing a cigarette and the onset of nicotine withdrawal) may be longer than one week but as tolerance develops, the shortening of the latency to withdrawal drives the progression to daily smoking.
In his study of the development and assessment of nicotine dependence in youth, Dr. DiFranza found that among those who had developed a compulsion to smoke: 10% had symptoms within two days of their first cigarette; 25% had symptoms within 30 days; and 50% had symptoms by the time they were smoking 7 cigarettes per month.
With just one dose of nicotine, the brain is forever changed and does not return to normal even after nicotine is discontinued (in rats).
Successful smoking cessation is not only about will power but may also require remodeling of the brain to restore balance.
Dr. DiFranza's research indicates that preventing the first exposure to nicotine is crucial and prevention programs must incorporate these messages educating young people about the danger of experimenting with tobacco.

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