Giving up cigarette smoking is one of the most difficult things a person can do. Nicotine, a chemical found in tobacco, is a highly addictive drug. Smokers and those who use other forms of tobacco become addicted to the feelings of pleasure they get from nicotine. And it’s the nicotine that makes it so very difficult to quit this habit.

Although I’ve never used tobacco, I understand well how nicotine can become an incredibly important part of a person’s life. As a hospital nurse, I had patients dying of lung cancer and emphysema sneak out to the stairwell to smoke. As a nurse practitioner, I’ve had young patients with serious asthma explain they would rather live with coughing and wheezing than live without cigarettes.

Non-smokers often see smokers as weak. It’s not that they are weak; it’s that the urge to feel the effect of nicotine is so incredibly strong. Just a few seconds after taking the first puff of a cigarette, a feeling of well being begins. This is often compared to the pleasurable feeling heroin users experience when they inject their drug.

Non-smokers often think smokers don’t care about their health or the health of others. However, I’ve met plenty of smokers who eat very healthy diets and get regular exercise. And there are some health care providers – nurses, doctors and even respiratory therapists – who definitely care about the health of others, yet they smoke.

Smoking just doesn’t make sense, non-smokers say. It’s expensive, it’s smelly, it’s unhealthy, it’s socially undesirable.

But to smokers, smoking does make sense. Every time they smoke they get another hit of nicotine and they feel better because of it. Nicotine helps them feel both relaxed and alert.

When a smoker inhales, nicotine in the smoke is delivered to the lungs. In the lungs, nicotine is absorbed into the bloodstream and is rapidly carried to the brain. If chewing tobacco is used, the nicotine is absorbed into the bloodstream through the mucous membranes of the mouth.

In the brain, nicotine stimulates the release of a neurotransmitter called dopamine. (Nicotine is not the only drug to stimulate dopamine release; this happens with cocaine, heroin and other drugs of abuse.) When levels of dopamine increase in the brain, people experience pleasurable sensations.

When the effects of a cigarette begin to fade and dopamine levels in the brain drop, smokers experience a desire for another cigarette, which will once again allow them to experience that pleasurable feeling.

Tobacco users gradually become tolerant to nicotine’s effects, so over time they may have to smoke more frequently to get the same effect.Various forms of tobacco – cigarettes, cigars, pipes, snuff and chewing tobacco – differ in how they are used, how they taste and how they smell. What they have in common is they all contain nicotine. Researchers who study nicotine’s effects often refer to these products as “nicotine delivery systems.”

Although nicotine is the most well-known ingredient in tobacco, there are about 4,000 other identified chemicals in tobacco and tobacco smoke; 60 of these are known to cause cancer. Nicotine’s positive effects on the brain are so strong, intelligent and rational people are willing to risk lung disease and cancer in order to continue to get those good feelings.

Every tobacco user who has tried to quit knows the strong pull of nicotine addiction. Going without tobacco makes people feel depressed, anxious, irritable; they crave nicotine. The urge to smoke – because of nicotine’s effect on the brain – is so strong, only a small percentage of smokers are able to quit on their first attempt.

Next week: Hints to help tobacco users overcome the power of nicotine.

Kathryn B. Brown is a family nurse practitioner with a master’s degree in nursing from OHSU. Is there a health topic you would like to read about? Send ideas to kbbrown@eastoregonian.com. You can find more local health news and information in the Health section at www.bluemountaineagle.info