Confessions of a teenage nicotine addict

John (Gold)
John (Gold)

11:50 PM - Jul 17, 2007 #1

Confessions of a teenage
nicotine addict
by John R. Polito
I'd spent years trying to get mom to quit smoking. But somehow that wasn't important right now. Kimberly was all that mattered. There she was, sitting in the dugout of our neighborhood baseball field, smoking, with a pack of cigarettes beside her. She was fifteen, beautiful, and I yearned to know her better.

Just five bummed cigarettes and three days later, I was alone in my room with no Kimberly to impress and my brain commanded me to find and smoke another. I had already become a hypocrite, and I was about to become a thief, beggar and liar.

Apparently, getting hooked so fast isn't unusual. According to a study published in the July 2007 edition of Archives of Pediatric and Adolescent Medicine, ten percent of youth smokers begin to experience symptoms of addiction after smoking just two cigarettes.

I knew mom kept a carton of cigarettes in the freezer. I recall standing there staring at them, as my conscious and compulsive brains fought over what to do next.

When you become addicted, nicotine or whatever external chemical takes hostage the dopamine reward pathways of your brain. This brain circuitry normally helps us set priorities and pay attention. It generates the mind's most durable memories, memories that should be associated with basic survival needs such as accomplishment, bonding, acceptance, nurturing, nutrition, hydration and reproduction. Instead, this powerful circuitry becomes dedicated to drug seeking and use.

Standing in front of the freezer that day, my compulsive brain prevailed and its victory produced a thief, willing to steal to feed what had now become an endless chemical need. But I wasn't just stealing nicotine from mom. I was using it to steal nerve communication chemicals from my brain.

Some experts contend that nicotine, with its alert high, is the most perfectly designed drug of addiction. Not only does it cause our dopamine pathways to generate a powerful "aaah" sensation, it inhibits normal dopamine cleanup, allowing released dopamine to linger between brain neurons far longer than normal.

About 90% of regular nicotine users at some point discover that they now have a new #1 priority in life: servicing that next mandatory nicotine feeding. But dependency comes with a second hook: tolerance.

Tolerance means that, over time, the drug user needs more of the drug to get the same effect. In a process known as up-regulation, the brain grows millions of extra nicotinic-type acetylcholine receptors in at least eleven different regions of the brain. Tolerance means that any attempt to stop using the drug will leave the addict temporarily de-sensitized to normal neuro-chemical flow, because the brain needs time to down-regulate (work off those extra nicotine-hungry receptors) and restore natural sensitivities.

"Give it time" may sound easy, but the deep inner, compulsive primitive mind controls the body's anxiety alarm circuitry, those pathways that order fight or flight. If not calmed and/or re-schooled, the "lizard brain" may view quitting smoking as akin to attempting to starve yourself to death, setting off powerful anxiety alarms, impossible to ignore.

Clearly I didn't understand the science of nicotine addiction when that first fateful puff caused a massive hit or bolus of nicotine into explode inside my brain. I had no idea that smoking nicotine is as addictive has heroin or cocaine, as Canada's cigarette pack warning labels currently teach Canadian youth.

But I knew it was a bad idea. And watching mom fill ashtray after ashtray while coughing her head off, I at least knew it was difficult to quit.

I also knew a couple of the basic health warnings, at least in regard to cancer. But I would soon discover that engaging in prolonged vigorous physical activity was extremely challenging, if not impossible, depending upon the amount of carbon monoxide then circulating inside my bloodstream.

Yet here I was, a smoker. I found myself in a state of "cognitive dissonance." It's a fancy psychological term that describes the uncomfortable tension that results from having two conflicting thoughts at the same time, or in engaging in behavior contrary to your core beliefs.

So how did I rationalize and explain away the fact that I was now a full-fledged smoker when I didn't want to be, yet found myself continuing to do so, day after day after day after day?

I'd been extremely hard on mom for not quitting. How could I now look in the mirror and not see a total hypocrite looking back? How could I live with the thief and liar I would now become?

Chemical addiction quickly forced me to lie about why I needed to leave the house, family or classroom, and why I was covered in a horrible smell when I returned; I had to find a way to get that next nicotine fix. It compelled me to spend more and more time with other young nicotine addicts, to smoke in the school parking lot and bathroom, to resort to begging for cigarettes, and from time to time actually stealing them from mom. What pack of lies could hide the thief, beggar and liar I'd become?

Like the daily chore of taking out the trash, I now had to find a way to service my brain's rapidly increasing tolerance to nicotine, and replenish a blood-serum nicotine level that was constantly falling by 50% every 120 minutes. I quickly found myself smoking half-a-pack a day, and needing to smoke nicotine before, during and immediately after school. During class I often found myself sitting at my desk thinking about needing to smoke instead of the lesson being taught.

I spent the next thirty years struggling to break free and each time falling flat on my face. I tried every new quitting product that arrived. All the commercials made them sound like quitting with them was easy but nothing could be further from the truth. In fact 93 out of 100 using the nicotine gum or patch will fail and relapse to smoking within six months.

By age 20 I was smoking nicotine at least 20 times a day, by age 30 my brain demanded 40 nicotine fixes a day, and by age 40 I was inhaling nicotine every 15 minutes or so, about 60 times a day. By then, there was no part of my mind, body, life or soul unaffected by the 4,000 hot chemicals arriving with each and every puff.

I repeatedly discovered that attempting to endure nicotine withdrawal in ignorance and darkness, without education or support, can be a frightening experience. Imagine significant panic, anxiety, anger and depression, all seeming to happen at once. Imagine enduring up to 72 hours of nicotine withdrawal before getting all nicotine out of your system and starting to gradually, over time, feel a little bit better.

My health began to fail. I developed chronic bronchitis, recurrent pneumonia, early emphysema and, at three packs-a-day, there wasn't enough oxygen in my bloodstream to keep my teeth alive. After one last failed attempt I swore I'd never try quitting again. I fully accepted my fate. I was a true drug addict, in every sense, and like half of all adult smokers, I would die an addict's death.

And then it happened. Acceptance of the simple truth that I was a failed drug addict freed me from the mountain of lies I'd fed my mind as to why I smoked. It allowed me to no longer be afraid, or run and hide any time smoking or quitting was mentioned. Although still chemically captive, I was somehow now free to listen and learn.

No longer living behind a thick wall of denial, I actually grew curious about my master. I still don't know why but one day I typed "quit smoking" into an Internet search engine and was shocked to discover an entire world of information that I'd previously refused to see. I stumbled upon an Internet quit smoking support group. I told them I'd given up on quitting. They reached through the screen and handed me hope. I cried. Two days later I joined them, and have remained nicotine-free since.

I discovered that the lies I'd told myself were some of the most harmful of all. Flavor, taste? There are zero taste buds inside these lungs. Like or love? It wasn't that I liked smoking but that I didn't like what happened when I didn't smoke - the onset of withdrawal. Relaxation? Nicotine is a central nervous system stimulant that made my heart pound 10 to 20 beats per minute faster.

There is zero pride in revealing how drug addiction fostered changes in my character, beliefs, values, and health. I don't want you to know that by the time I turned 45 that four of my teeth had already died. It's much easier to allow folks to believe that smoking was my only problem or that I remained the same person: a predominately wholesome and mom-loving kid. But truth is, I became a teenage drug addict, compelled to lie, beg, and steal, and to associate with those who understood my need to do so.

On May 15, 1999, I was at last able to arrest by chemical dependency upon nicotine. I have now been free and healing for 8 years, 2 months and 2 days. But I have not killed my addiction, only arrested it. The key to the cell and trading places is just one powerful puff of what may be earth's most captivating chemical.

Nicotine dependency recovery opened my mind to the fact that I'd lived a pack of lies. Quitting exposed those lies to truth. I quickly realized that nicotine didn't give me my spark or edge. That life without it grows better not worse. All the things I once did as a smoker could now be done as well as or better without smoking.

Recovery's rewards are far more than just quitting. It's a journey of readjustment where, one-by-one, we reclaim all the pieces of life. It's like coming home, during a gradual awakening as to how smoked nicotine had totally infected my life and was slowly eating away my brain, lungs and bloodstreams. I never thought I'd be able to say this, but I now like the guy in the mirror. The need for lies is gone. I'm home, and who I always wanted to be. Just me and free.

Related Nicotine Cessation Links
Last edited by John (Gold) on 7:05 PM - Feb 07, 2009, edited 2 times in total.


12:24 AM - Jul 18, 2007 #2

John referred to how he first took up smoking to impress a girl name Kimberly as to his level of maturity. I wrote a letter to John back in February of 2000 that touched on this event. Thought it would be good to attach here.
From the article:
Kids Just Don't Get It!

I wrote a letter to John - WhyQuit's founder - in February 2000, shortly after we met. John and I were discussing presenting youth programs when he said to me that he had started smoking to impress a girl and would have given up his big toe for a chance at a date. In that she smoked, John thought smoking would somehow help in this effort. Much of the following article was part of my response to John. The reasons people give for starting to smoke are not the reason that they continue.

Kids just don't get it! On the surface the preceding sentence explains why kids are smoking at such an alarming rate. Here we have a product that is deadly, so deadly in fact it has been deemed the most preventable cause of premature death in almost all developed nations. Many who don't die from cigarettes will still become impaired or crippled from them. Not only are cigarettes deadly, they're expensive, too. Kids taking up smoking today are likely to spend their entire life dependent upon a product that will end up costing them tens of thousands of dollars. But today, kids are still taking up smoking in record numbers. What is the only logical explanation for this tragedy?

Again, it must be that kids just don't get it. But don't be too quick to interpret my meaning of this phrase. Yes, there are some kids who no matter what you teach them will not listen to any amount of reasoning. But this is not the majority of kids taking up smoking. When I say kids don't get it, I don't mean kids lack the common sense to make a rational decision about smoking. What they don't get is the real information in a manner that helps them understand the magnitude of the danger and the power of the addiction. Without such understanding they are not equipped with the ammunition to overcome peer pressure, as well as tobacco promotion tactics by cigarette manufacturers.

When I try to offer programs to many local schools, free of charge mind you, I often get turned down for the reason that they can't take time out of the busy education schedule required in schools today. Besides this, the school officials often feel kids already are getting the facts about smoking in health classes and DARE presentations. This is all well and good, except the message delivered in these programs is often presented quickly and most truly skim the surface of the depth of the nicotine addiction. I know when I do a school for the first time, the kids are amazed at the stories I relate about the dangers of smoking and the strength of addiction. More important than this though, it almost never fails that the health teacher comes up to me and tells me that he or she never understood the magnitude of the problem.

Recently, I spoke at a conference where representatives from many health organizations were coming to find out how to possibly obtain funding from tobacco settlement monies. The DARE officers present came up to me afterwards shocked about how dangerous smoking actually was. It was apparent that the people who were being relied upon to do the education didn't understand the dangers themselves. The authorities in the schools who should have been responsible for making sure that students were actually being taught the dangers, were not working to make the information available to the students because they were under the false impression that it was being adequately covered by poorly-informed DARE officers.

Kids can get it if it is given to them. It's not only a financial limitation that this material is not disseminated. It is a lack of resolve and commitment by the public that allows this to happen. Parents should be demanding this information for kids. PTA groups should be screaming to increase the educational component of smoking prevention. But unfortunately, most of them don't get it either. How often does a parent react to their child smoking by saying, "Well at least they are not using drugs." There are so many problems faced by kids today such as drugs, alcohol and violence that smoking seems minor in comparison.

What parents and other responsible adults fail to understand is that smoking is going to kill more children than all the other problems combined. Their child has picked up an addiction that is likely going to kill him or her. What do I mean by likely? Well for every thousand 20-year olds who smoke today and don't quit, six of them will eventually die prematurely from being murdered (violence), 12 will eventually die prematurely from accidents, and 500 will die from smoking! "But, at least they are not using drugs." Understand that when parents say this or think this they don't get it either. It is likely that the parents never learned the full extent of the dangers or the addictive properties of nicotine while they were young either.

John, you made the comment that you would have given up your toe for Kimberly back when you were a kid. Think about it though, do you really think you would have given up your toe? If I was there with a chainsaw and made a promise that I would guarantee you a date with Kimberly if you let me lop off your toe, would you have accepted my offer? Probably not, and this analogy is not as farfetched as it may sound on the surface. There are people who end up losing toes, fingers, feet, hands, legs, and arms from peripheral vascular diseases caused by smoking. Their doctors often give them the choice to quit smoking or lose the limb, but they really don't have a choice. They are addicts who lost control. Kids need to understand the extent of that control before they begin smoking. Not just that it smells bad, not that it makes your teeth yellow, and not that it is just "bad" for you. Kids think lots of things are bad for them. But tobacco is in a league by itself. When more kids get this information in its full non-diluted strength, more will have the ammunition needed to say no.

Peer pressure is a real phenomenon. Just telling kids not to give into it isn't enough. Give them the reason not to give into it. Give them the full unadulterated message of the deadly and addictive nature of nicotine. Give them a reason to say no and they will be more likely to say no. Let's make sure kids do get it and I think we will see a turn-around in current trends.


© Joel Spitzer 2000, 2002
Page last updated by Joel Spitzer on August 23, 2003
Last edited by Joel on 6:53 PM - Feb 07, 2009, edited 1 time in total.

John (Gold)
John (Gold)

2:52 AM - Mar 13, 2008 #3

Let the Children Be Heard: Lessons From
Studies of the Early Onset of Tobacco Addiction
[]Joseph R. DiFranza, MD[/url] , Pediatrics 2008;121;623-624
BECAUSE SMOKERS DIE, on average, a decade younger than nonsmokers, and smoking kills between one third and one half of those who start,[1] it is important that all physicians become cognizant of the hazards related to the early onset of smoking.
When one of us (Dr Richmond) assumed the post of Surgeon General in 1977, it was accepted that addiction to nicotine was caused by years of daily smoking. It was assumed that anyone who experienced nicotine withdrawal had to smoke at least 5 times per day to keep it in abeyance. Given this, it was assumed that addiction did not begin until a person smoked 5 cigarettes daily, and anyone smoking less than this did not experience withdrawal and was not addicted.[2] Because novice smokers typically take 2 to 3 years to reach 5 daily cigarettes,[3] it was assumed that prolonged regular daily smoking was a prerequisite for dependence. Through the end of the century, the onset of dependence was envisioned as a creeping, protracted, erosion-like process, the product of tens of thousands of doses of nicotine.[4]

It was intriguing, therefore, when 1 of our (Dr DiFranza's) teenaged pediatric patients volunteered a history of failing at several attempts to quit smoking within a few weeks of trying her first cigarette.[5] Another girl described unpleasant nicotine withdrawal symptoms despite having smoked only 1 or 2 cigarettes a few days a week for 2 months. She, too, had failed in her quit attempts. These initial cases turned out to be quite typical.[3] Among youth who develop dependence, 10% report symptoms after their very first cigarette, and 25% have symptoms within 2 weeks.[3] Through 20,000 individual interviews with adolescents [3,6] and surveys from 100,000 youth,[7] we have documented how dependence develops.[8] Contrary to the perceived wisdom,[4] withdrawal
symptoms typically appear before the onset of daily smoking and almost always before smoking progresses to 5 cigarettes per day.[9] Animal experiments have confirmed that nicotine induces enduring neurophysiologic adaptations in the brain from the first dose.[10]

The history of science is replete with stories of landmark discoveries that initially were disparaged or ignored because they contradicted strongly held beliefs.[11] The data documenting that symptoms of dependence emerge rapidly, and typically when youths are smoking only 1 or 2 cigarettes per week,[3] disproved the universally accepted theory that prolonged daily smoking is a prerequisite for dependence.[2] When these data were presented at the annual meeting of the Society for Research on Nicotine and Tobacco in 2000, those in attendance could not accept what they had heard, suggesting that the children must have been smoking more than they admitted or that they were overreporting symptoms, exaggerating symptoms, espousing culturally derived expectations about symptoms, or responding to
nonverbally communicated performance expectations from the interviewers. Each of these alternate interpretations of the data have been refuted in subsequent studies, and the initial discovery has been replicated independently many times.[6,7,12,13]

Nevertheless, because the data provided by the children contradict the current paradigm, many have suggested that children cannot be trusted to tell the truth about nicotine dependence. Through decades of research, the reliability of symptom accounts obtained from adult smokers had never been questioned, but when the histories obtained from thousands upon thousands of children contradicted the prevailing view, they have been treated as having little scientific value.[14] Some authors have written as if this rapidly expanding body of literature does not exist, claiming that the nature of nicotine dependence in youth is something about which we know nothing.[15] Although we should remain cognizant of the limitations of adolescent self-report data, we also should know when to believe them.

We now understand that nicotine dependence typically develops during childhood or adolescence. However, the official definitions of dependence were all issued at a time when the prevailing belief was that teens were not addicted.[16] Moreover, these definitions were not constructed on an evidence base but, rather, represented proclamations reflecting theoretical assumptions concerning the nature of dependence in adults. In another double standard, these hypothetical constructs of dependence have never been subjected to the scientific skepticism that has been applied so conscientiously to the children's data that contradict them.

Those who ignore the children's data have embarked on their own effort to learn how and when nicotine dependence develops.[17] Their strategy is to determine when young smokers first fit hypothetical adult criteria. We believe this strategy will not produce a description of the natural history of what is primarily a disease of pediatric onset; rather, it will produce a description of how children come to fulfill an adult's vision of what it means to be addicted. We believe that a more promising approach is to take what children teach us about the essential nature of dependence and apply that evidence base to develop an understanding of dependence in adults. This strategy has already borne fruit.[18-20]
Science can only advance if we are willing to discard our beliefs when the facts do not support them. Through the gracious cooperation of the tens of thousands of children who volunteered as research subjects, we now have a basic understanding of how and when nicotine dependence begins. Because 80% of smokers initiate smoking before 18 years of age,[21] we should take this new information and translate it into more effective prevention programs.

1. Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years' observation on male British doctors. BMJ. 2004;328(7455):1519
2. Benowitz NL, Henningfield JE. Establishing a nicotine threshold for addiction. N Engl J Med. 1994;331(2):123-125
3. DiFranza JR, Savageau JA, Fletcher K, et al. The development of symptoms of tobacco dependence in youths: 30-month follow-up data from the DANDY study. Tob Control. 2002;11(3):228-235
4. US Department of Health and Human Services. The Health Consequences of Smoking: Nicotine Addiction-A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Office on Smoking and Health; 1988. DHHS(CDC) publication 88-8406
5. DiFranza JR. Hooked from the first cigarette. J Fam Pract.2007;56(12):1017-1022
6. DiFranza JR, Savageau JA, Fletcher K, et al. Symptoms of tobacco dependence after brief intermittent use: the Development and Assessment of Nicotine Dependence in Youth-2. Arch Pediatr Adolesc Med. 2007;161(7):704-710
7. Scragg R, Wellman RJ, Laugesen M, DiFranza J. Diminished autonomy over tobacco can appear with the first cigarettes. Addict Behav. 2008; In press
8. DiFranza JR, Wellman RJ. A sensitization-homeostasis model of nicotine craving, withdrawal, and tolerance: integrating the clinical and basic science literature. Nicotine Tob Res. 2005;7(1):9-26
9. Wellman RJ, DiFranza JR, Savageau JA, Dussault GF. Shortterm patterns of early smoking acquisition. Tob Control. 2004; 13(3):251-257
10. Smith KM, Mitchell SN, Joseph MH. Effects of chronic and subchronic nicotine on tyrosine hydroxylase activity in noradrenergic and dopaminergic neurones in the rat brain. J Neurochem. 1991;57(5):1750-1756
11. Kuhn TS. The Structure of Scientific Revolutions. 3rd ed. Chicago,IL: University of Chicago Press; 1996
12. Gervais A, O'Loughlin J, Meshefedjian G, Bancej C, Tremblay M. Milestones in the natural course of onset of cigarette use among adolescents. CMAJ. 2006;175(3):255-261
13. Kandel D, Hu MC, Grieisler P, Schaffran C. On the development of nicotine dependence in adolescence. Drug Alcohol Depend. 2007;91(1):26-39
14. Eissenberg T. Measuring the emergence of tobacco dependence: the contribution of negative reinforcement models. Addiction. 2004;99(suppl 1):5-29
15. Costello D, Dierker L, Sledjeski E, Flaherty B, Flay B, Shiffman S; Tobacco Etiology Research Network. Confirmatory factor analysis of the Nicotine Dependence Syndrome Scale in an American college sample of light smokers. Nicotine Tob Res.
16. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994
17. Tiffany ST, Conklin CA, Shiffman S, Clayton RR. What can dependence theories tell us about assessing the emergence of tobacco dependence? Addiction. 2004;99(suppl 1):78-86
18. Wellman RJ, DiFranza JR, Savageau JA, et al. The effect of abstinence on cigarette consumption upon the resumption of smoking. Addict Behav. 2006;31(4):711-716
19. Fernando WWSA, Wellman RJ, DiFranza JR. The relationship between level of cigarette consumption and latency to the onset of retrospectively reported withdrawal symptoms. Psychopharmacology. 2006;188(3):335-342
20. Wellman RJ, DiFranza JR, Wood C. Tobacco chippers report diminished autonomy over tobacco use. Addict Behav. 2006; 31(4):717-721
21. US Department of Health and Human Services. Preventing Tobacco Use Among Young People: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Office on Smoking and Health; 1994
Last edited by John (Gold) on 12:20 PM - Feb 15, 2009, edited 1 time in total.

Joined: 7:22 PM - Nov 11, 2008

4:29 AM - Sep 16, 2009 #4

[font=&AMP]The loss of autonomy over smoking in
relation to lifetime cigarette consumption

[font=&AMP]Addictive Behaviors, [/font] August 10, [font=&AMP]2009. [Epub ahead of print][/font]

[font=&AMP]Ursprung WW[/font][font=&AMP],[/font] [font=&AMP]Difranza JR[/font][font=&AMP].[/font]


[font=&AMP]New Zealand youth who had smoked only one cigarette had diminished autonomy over smoking. We sought to examine this issue in a US sample and examine the early onset of DSM-IV nicotine dependence. A self-administered survey was completed by 367 adolescent smokers in Massachusetts. Diminished autonomy was measured with the Hooked on Nicotine Checklist. Diminished autonomy was present in 5.7% of youth after one cigarette, in 9% after 2, in 26% after 3-4, in 44% after 5-9, in 43% after 10-19, in 67% after 20-99, and in 96% after 100 or more. DSM-IV nicotine dependence was absent in youth who had not smoked 10 cigarettes but was present in 9% after 10-19 cigarettes, in 17% after 20-99, and in 58% after 100 or more. Our data confirm the New Zealand study by showing diminished autonomy among subjects who had smoked only 1 or 2 cigarettes. Diminished autonomy after one or two cigarettes, and DSM-IV nicotine dependence after 10-19, support the sensitization-homeostasis theory of nicotine addiction that the addiction process is initiated by the first few cigarettes.[/font]