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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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