Adolescents, Mental Health, and Cigarette Smoking

Biology 202
2002 First Paper
On Serendip

Adolescents, Mental Health, and Cigarette Smoking

Biz Martin

I began this research interested in looking at mental health and its relationship to cigarette smoking. By searching the Internet, I found myself being drawn into the discourse surrounding cigarette smoking, mental health and adolescents/adolescence. By seeing nicotine as addictive, and therefore an abuseable substance, and understanding the neurological effects nicotine has on the brain, we can see how cigarette smoking is connected to mental health. In adolescents the effect is even more pronounced because their relationships to peers and parents create situations where their mental health is compromised.

Nicotine is one of the many chemicals found in cigarettes, and is the "primary component in tobacco that acts on the brain." (1). You would think that after two hundred years of studying nicotine we would have a relatively sound understanding of it, and yet it still produces unexpected side effects on the brain and body.(1). Nicotine addiction in America is most commonly expressed and seen through cigarette smoking. "Most cigarettes in the U.S. market today contain 10 milligrams (mg) or more of nicotine. Through inhaling smoke, the average smoker takes in 1 to 2 mg nicotine per cigarette." (1).

How does nicotine enter a person’s body and where does it go once it’s inside? "Nicotine is absorbed through the skin and mucosal lining of the mouth and nose or by inhalation in the lungs. Depending on how tobacco is taken, nicotine can reach peak levels in the bloodstream and brain rapidly. Cigarette smoking, for example, results in rapid distribution of nicotine throughout the body, reaching the brain within 10 seconds of inhalation". (1).

How nicotine interacts with the brain significantly affects behavior. "Of primary importance to its addictive nature is the finding that nicotine activates the brain circuitry that regulates feelings of pleasure, the so-called reward pathways...nicotine increases the levels of dopamine in the reward circuits." (1). Smoking increases dopamine, which in turn increases pleasurable feelings. The enjoyable effects of nicotine are even more enhanced by the subsequent feelings of craving and withdrawal. This positive reinforcement from needing to sustain increased dopamine levels by smoking, while coping with the addictive qualities of smoking, make this a hard habit to quit. Generally speaking, a smoker will take about 10 puffs on a cigarette in a five-minute period. If one smoked 30 cigarettes a day (1.5 packs), that person would get 300 hits of nicotine a day. "These factors contribute considerably to nicotine's highly addictive nature." (1).

Even though most smokers would "identify tobacco as harmful and express a desire to reduce or stop using it," most smokers, who try, fail to quit. "Addiction is characterized by compulsive drug-seeking and use, even in the face of negative health consequences, and tobacco use certainly fits the description." (1). This makes it all the more significant when you learn that "three-quarters of the adults who currently smoke started their habit before the age of 21." (2). If adults are already addicted by age 21, when did they start? It turns out that "teenage years are critical ones in the habituation of cigarette smokers." (2). Cigarette companies know that if they can hook a young consumer in their early years, they will have a customer for life, as long as they can keep them addicted. Since the adolescent years are among the most tumultuous ones, it is important to look at the effects cigarette smoking might have on this population.

It is easy to think of cigarette smoking and nicotine addiction as occurring in a vacuum. Seeing it as just a habit, though, will rule out any connection to mental health. The NIMH and NIDA have both found that "chronic cigarette smoking during adolescence may increase the likelihood that these teens will develop a variety of anxiety disorders in early adulthood." (3). Since there are strong connections between panic disorders and breathing problems, researchers hypothesized that "smoking might also relate to risk for panic disorder in children and adolescents through an effect on respiration." (3). This type of correlation is useful aside from empirical research if one wanted a more applied approach when studying this population. Because it "highlights how cigarette smoking may rapidly and negatively affect a teen's emotional health-perhaps even before any of the widely known physical effects such as cancer may occur," (3). it is able to appeal to something within their realm of imagining. The risk of cancer is in the distant future, but teen’s think with their emotions. Emotional health is something they can understand, relate to and actually want to protect, perhaps by altering their smoking habits.

The National Comorbidity Survey found that "thirty-one percent of those adolescents who smoked 20 or more cigarettes per day had anxiety disorders during early adulthood. Among those who smoked every day and had an anxiety disorder during adolescence, 42 percent began smoking prior to being diagnosed with an anxiety disorder and only 19 percent were diagnosed with anxiety disorders before they reported daily smoking." (3). The NCS found that mood, anxiety, antisocial personality disorder, and substance use disorders were highly comorbid in a general population sample aged 15 to 54. (4). At the same time, the life span of mental disorders co-existing with addictive disorders was estimated at 50 percent, and in 83.5 percent of these cases, the mental disorder developed during adolescence and before the addiction. (4). The theories concerned with the relationship between substance use and mental disorders have emphasized the interaction between the symptoms of the mental disorder and the mood-altering characteristics of specific substances. (4). In the case of cigarettes and nicotine, the mood altering characteristics would be first and foremost, pleasurable feelings. Don’t underestimate the feelings of irritability and crankiness that occur as dopamine levels fall during withdrawal. This results in a positive feeling when a cigarette is smoked, and a negative feeling when cigarettes are not around: a very obvious reinforcement of cigarette smoking behavior, which is only compounded with the addictive quality of nicotine.

"It has been proposed that substance use is an attempt to self-medicate for difficult feeling states such as depression and anxiety...Adolescence is a difficult developmental period that may precipitate the onset of emotional problems or substance use. Self-medication and using substances to forget unpleasant experiences, or to fulfill a need state that cannot be otherwise gratified have been identified as motivations for adolescent substance use." (4). It has also been shown that at any one time "between 10% and 15% of the child and adolescent population has some symptoms of depression. The prevalence of the full-fledged diagnosis of major depression among all children ages 9 to 17 has been estimated at 5%." (5). These aren’t flat out correlations between depression and cigarette smoking, but they do offer reasonable implications on the relationship between the two. Adolescence is a time when depressing thoughts crowd the mind; it’s reasonable to believe that much of smoking begins due to depression and the need to self medicate the dopamine levels in the brain.

Adolescent onset smoking is only now being recognized as a problem. "Although an estimated 1 million adolescents begin smoking annually, and although cigarette smoking continues to be the largest cause of preventable illness and death in the United States, the number of studies dedicated to smoking cessation interventions was woefully small." (6). Complying with the realization that the risk of emotional instability over the risk of cancer would cause greater reactions in adolescents, is Hurt’s conclusion that, "the nicotine patch therapy plus minimal behavioral intervention does not appear to be effective for treatment of adolescent smokers." (6). More effort needs to be placed into creating a more effective smoking cessation program aimed at adolescents, as well as making the treatment available to them.

One source of prevention is, of course, the parents. "Children living with nonsmoking parents-and particularly those youngsters who also have mothers with a strong antismoking attitude--are 50% less likely to take up the tobacco habit compared with their peers," researchers report. (7). One study, supported by the NIH, was concerned primarily with the role of the mother’s attitude about smoking. They found that "children in households where neither parent smoked and the mother had strong antismoking beliefs were 50% less likely to take up the habit than other children." (7). When compared to houses where either parent smoked, there was "no reduction in adolescent smoking associated with mothers' antismoking attitude. This joint effect of parental attitudes and behaviors suggests that mothers' attitudes have a substantial influence on children and adolescents, but that this influence occurs only when the attitudes are strongly held and both parents behave in a manner consistent with those attitudes and do not smoke." (7)."Do as I say, not as I do," has rarely carried much weight though. Kids will often mimic their parents behavior even when they are told not to.

The concern lies in keeping teenagers from starting smoking, so they will have less chances of
starting this habit as they grow up. Because mental health is tied into cigarette smoking, there are even
more levels on which to appeal to someone’s sensibilities. It’s hard to explain to someone who is so young, that their health in old age depends on choices they make when they are young. It might be more relevant to talk with an adolescent about their emotional state and to correlate that with any cigarette smoking behavior. Cigarette smoking creates changes in brain neurology by heightening activity in the pleasure zone. It is important to realize what the interactions are that occur between cigarettes and the brain, because they have implications for mental health and behavior.

References

1) National Institute of Drug Abuse page on nicotine, describes nictotine’s addictive qualities

2) Division of Alcohol and Drug Abuse smoking fact sheet, good source for smoking fact sheet

3) National Institute of Health paper, good paper linking adolescent cigarette smoking to anxiety disorders

4) Substance Abuse and Mental Heatlh Services Administration, paper explaining comorbidity of smoking and mental health

5) American Medical Association, mental health and adolescents

6) Archives of Pediatric and Adolescent Medicine, paper about promoting adolescent smoking cessation

7) Medline Plus Health Information, relating a parents expectation to whether or not a kid will smoke