Dr. C. Everett Koop, former Surgeon General of the United States once
stated that “cigarette smoking is clearly identified as the chief, preventable
cause of death in our society” (Reinhold, 1982, para 2). The addictive properties of nicotine can be
felt within the first two days of inhaling a cigarette (n.p., 2007). With symptoms of addiction (e.g., cravings,
irritability, difficulty quitting) seen even in those who smoke only a few
cigarettes per month. Thus, confirming research
“that [indicates] nicotine alters the structure and function of the brain”
(para. 3). Although nicotine is known to
alter brain structure and function, the extrinsic, and intrinsic factors of
nicotine addiction can stem from heredity and environmental factors making it
difficult for someone to quit smoking.
Brain
Structures and Functions
Using magnetic resonance imaging (MRI) to view the effects of
smoking on brain structures and functions suggest a “reduction in volume and
density of frontal gray matter, and cerebral atrophy” (Dodd, Chung, van den
Broek, Barrick, Charlton, & Jones, 2012, p. 241). Furthermore; Dodd, et. al., (2012) indicates
mere exposure to cigarette smoke has been “associated with reduced
microstructural integrity” (242).
Diffusion tensor imaging (DTI) studies reveal decreased molecule motility,
resulting in tissue microstructural damage in aging white matter and cardiovascular
disease. Although researchers know little
about how alterations of brain structure and function relate to smoking, Dodd,
et. al., (2012) suggests the difference in white matter integrity and gray
matter activation may account for the cognitive dysfunction (e.g., short-term
verbal memory, reasoning, semantic fluency) associated with smoking, which increase
with additional respiratory disorders and through increased pack-years of
smoking.
Nicotine’s addictive properties affect mesotelencephalic brain
sites by exerting dopaminergic actions that impede the determination of how
rewarding something is; incentive values (Baker, Brandon, & Chasin,
2004). This may account for the
increased stimulation of the anticipation of smoking but not the smoking
itself.
Extrinsic
and Intrinsic Factors
The motivations for smoking are many: “physical dependence,
ethnicity, impulsivity, affective disorder, and peer influences” are but a few (Baker,
Brandon, & Chassin, 2004, p. 464). Just
as plentiful are the reasons to quit smoking; however, understanding the
underlying causes of intrinsic and extrinsic motivations can enable someone to
change his or her behavior. Intrinsic
behaviors create a positive self-concept, core belief, and enjoyment of an
activity (e.g., smoking) and is developed over time with increased exposure. Intrinsically motived behavior is often shared
with friends and family and is associated with heightened excitement and a
reduction in stress levels. Extrinsic
motivation is external to oneself, often beginning through small rewards, which
gradually increase (e.g., trophies, grades, money, and recognition). Of course, external rewards (or punishments) used
to encourage or dissuade specific behaviors vary from person to person, and
culture to culture. The differences
between intrinsic and extrinsic motivations are the reason or reasons for doing
something.
With smoking, the rewards
for quitting can be difficult to identify.
For example quitting for health reasons can be both an intrinsic
motivator (feeling better) and an extrinsic motivator (reduced illnesses and
expense). However, the level of
addiction and behavioral characteristics of an individual may provide
additional motivations of their own on the success of quitting smoking or
not. According to Lynskey, et. al.,
(1998) as restated by Baker, Brandon, & Chassin (2004), adolescence is a
vulnerable time for tobacco dependency; those who are “‘uncontrolled’ and
impulsive are also more likely to affiliate with substance-using peers” (p. 466). As smokers age, health concerns increase and social
desirability of smoking decrease, stimulating an intrinsic motivation to quit
smoking, thus confirming that a new smokers belief in the negative consequences
of smoking may not surface until years later.
However, tolerance and dependence create their own negative motivation with
discontinuation or reduction of smoking (e.g., “dysphonia, anxiety, inability
to concentrate, increased appetite, weight gain, sleep disruption, etc.” (Hughes,
et. al., 1991; as restated by Baker, et. al., 2004, p. 471)).
Heredity
and Environmental Factors
Researchers have found that some individuals metabolize nicotine
faster than others, which alter the brain’s response to smoking cues; citing
nicotine receptor genes (CHRNA5, CHRNA3, and CHRNB4) that affect nicotine
dependence and level of smoking. Thus, exposure
to cigarettes causes nicotine
concentration surges creating a desire or need, which motivates smoking;
whereas, those with slow metabolizers maintain constant nicotine levels, which
aid in attention, memory, and stress relief (Fitzgerald, 2012). Rattue (2012) references Li-Shiun Chen, M.D.,
Washington University School of Medicine, who states:
“We found that the
effects of smoking cessation medications depend on a person's genes. If smokers have the risk genes, they
don't quit easily on their own and will benefit greatly from
the medications. If smokers don't
have the risk genes, they are likely to quit successfully without the
help of medications such as nicotine replacement or bupropion" (para. 7).
These findings indicate that even the slightest exposure (e.g.,
parental smoking) to nicotine can activate the nicotine receptor genes that
make smoking a rewarding behavior. This
information can enable scientist to fine-tune nicotine blockers, thereby
decreasing these biological traits that increase the desire to smoke. As with any addiction, changing the
environmental cues that engage smoking behaviors is key. Removing temptations by discarding any
smoking related items from the home, vehicle, and work environment (cigarettes,
lighters, and ashtrays), and washing clothing and bedding to remove the smells
of nicotine. Furthermore, avoiding
others who smoke and smoking environments (e.g., pubs, parties, etc.) are
helpful, especially within the first few days.
As indicated in a McGill University (2012) report “Smoking cues, such as
the sight of cigarettes or smokers, affect smoking behavior and are linked to
relapse and cigarette use” (para. 3).
Finding the motivation to quit smoking can offer many benefits;
however, doing so can be a complicated maze of genetic and environmental factors
as nicotine enables changes to brain structure and function creating both
extrinsic and intrinsic motivation to create smoking behavior. Thus as researchers identify which genes
heighten smoking behaviors, biochemical support will enable individuals to quit
smoking with fewer negative effects. By
blocking specific nicotine receptors, altered brain structure and function can
be mitigated. Although finding the
motivation to overcome the negative effects of quitting smoking will require
intrinsic and extrinsic support. The
human body is amazing; when someone quits smoking, the body begins to heal from
the damage nicotine creates, thus the rewards of remaining nicotine free are improved
health and improved quality of life lost because of smoking.
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