Nicotine’s Effects on the Brain & Body & How to Quit Smoking or Vaping

Introduction

• Nicotine is one of the most commonly consumed substances globally
• Billions of people ingest nicotine daily, mostly through smoking tobacco
• Other sources of nicotine include dip, snuff, patches, gum, pills, and toothpicks
• This discussion will focus on nicotine, not smoking or vaping

Nicotine’s Effects on the Brain and Body

• Increases focus, motivation, working memory, and cognitive capacity
• Can lead to addiction for other substances related to vaping and vaping-​​associated behaviors

Tools for Focus

13-​​minute daily meditation
1. Increases focus ability, mood, and other positive aspects of mental health and performance
2. Simple practice: sit or lie down, close eyes, direct attention to a place just between and above the eyes 

Alpha GPC
1. 300mg taken 10–30 minutes before cognitive or physical work can increase focus
2. Increases acetylcholine and epinephrine (adrenaline) levels
3. Dopamine increase achieved through cognitive processing or other pro-​​dopamine protocols
4. Some people take 600mg of a garlic capsule to offset potential TMAO increase related to cardiovascular health

Prescription Compounds for Focus

• Ritalin, Adderall, Modafinil, Armodafinil, and Vivance may be prescribed by a board-​​certified physician for individuals with ADHD or other focus-​​related issues

Nicotine: Overview and Effects

Nicotine and the Brain

• Nicotine binds to nicotinic receptors in the brain and body 
  • These receptors exist for acetylcholine, not because of tobacco or other external sources of nicotine
• Acetylcholine and nicotine play important roles in normal brain and body function 
  • Activation of nicotinic receptors can trigger directed rewiring of the brain (neuroplasticity)

Nicotine Use and Addiction

• Separating nicotine from its delivery device (e.g., smoking, vaping) is crucial when discussing its effects
• Some people use nicotine-​​containing products (e.g., gum) to enhance focus and motivation 
  • This is not a recommendation for everyone to consume nicotine products
• Nicotine can be powerful as a mood modulator 
  • Quitting nicotine, especially through smoking, can cause a significant drop in mood
• Nicotine can have both positive and negative effects on cognitive function, depending on dosage and individual factors

Considerations for Nicotine Use

• Children, pregnant individuals, and those with addictive tendencies or mood disorders should be cautious with nicotine use
• Nicotine’s effects on mood and cognitive function can vary widely among individuals
• Further research and understanding of nicotine’s effects on the brain and body are needed to make informed decisions about its use
  Effects of Nicotine on Humans
• Nicotine does not cause infertility in humans 
  • Can reduce penile girth and lead to sexual dysfunction due to changes in blood flow and endothelial cell function
• Nicotine found in plants like tobacco 
  • Can enter the bloodstream through inhalation or contact with mucosal tissues
• Nicotine binds to nicotinic acetylcholine receptors in the brain and body 
  • Different receptors dictate different effects of nicotine on tissues

Nicotine’s Effects on the Brain and Body

• Ingesting nicotine takes 2–15 minutes to enter the bloodstream 
  • Smoking and vaping are faster than direct contact with mucosal lining
• Four major categories of neurochemical effects of nicotine: 
  1. Mesolimbic reward pathway (dopamine reward pathway) 
     • Nicotine triggers the release of dopamine from the nucleus accumbens, increasing motivation, well-​​being, and alertness
     • Also decreases activity of GABA, an inhibitory neurotransmitter
  2. Increase in acetylcholine 
     • Neuromodulator that exists in humans
• Nicotine suppresses appetite and increases metabolism 
  • Binds to the alpha‑4 beta‑2 receptor in the brain
• Difficult to quit nicotine due to its potent increase in dopamine and decrease in GABA 
• Nicotine can be used as an antidepressant in certain cases
  Effects of Nicotine on the Brain and Body
• Nicotine binds to nicotinic alpha four, beta two containing nicotinic receptors 
  • Increases electrical activity in POMC neurons
  • Suppresses appetite and limits impulse to chew
• Direct effects of nicotine on metabolism 
  • Transient increases in metabolism (2% to 5%)
• Nicotine increases dopamine, reinforcing and rewarding 
  • Younger females may use nicotine for appetite suppressing effects
• Nicotine is fat soluble 
  • Can move freely through the brain and body
  • Can pass through cell membranes
• Effects of nicotine on the body 
  • Increases heart rate, blood pressure, and contractility of the heart
  • Increases sympathetic tone (alertness and physical readiness)
  • Constricts blood vessels, reducing blood flow to various tissues
  • Acute nicotine use can reduce penile girth
  • Chronic nicotine use can impair blood flow to various organs
• Nicotine can relax skeletal muscle 
  • Counterintuitive due to acetylcholine’s role in muscle contraction
  • Related to neural circuits upstream of muscles and autonomic nervous system arrangement
• Overall effects of nicotine 
  • Activates reward pathways
  • Increases attention, alertness, and mood
  • Raises blood pressure and heart rate
  • Enhances preparedness for thinking
  • Relaxes the body
  • Creates an ideal state for cognitive work
    Nicotine and Cognitive Enhancement
• Nicotine can enhance cognitive ability and focus 
  • Useful for mental work, not physical performance
  • Nobel Prize-​​winning colleague uses nicotine gum for cognitive focus
• Negative side effects of nicotine 
  • Dipping or chewing tobacco increases risk of oral cancer
  • Not recommended for people under 25 years old 
    • Can create nicotine dependence and negatively impact brain development
• Nicotine can increase acetylcholine and dopamine levels 
  • May be beneficial for adults with slowed brain development
  • Should not be ingested through smoking, vaping, or direct contact with tobacco

Negative Effects of Smoking, Vaping, Dipping, and Snuffing

• Damages endothelial cells, which make up the vasculature 
  • Negatively impacts blood and nutrient delivery to all cells, organs, and tissues
• Cigarettes contain thousands of toxins and carcinogens 
  • Ammonia, tar, formaldehyde, and carbon dioxide are potent carcinogens
  • Carbon dioxide depletes oxygen delivery to tissues
• Smoking, vaping, dipping, and snuffing all negatively impact health 
  • Estimated 14-​​year reduction in lifespan for every pack of cigarettes smoked per day
    Nicotine Consumption and Effects
• Over 1 billion people consume tobacco for nicotine 
• 70% of cigarette smokers want to quit but find it difficult due to brain neurochemistry
• Negative health effects of nicotine consumption:
• Increased probability of cancer, stroke, heart attack, peripheral neuropathies
• Cognitive dysfunction, memory impairment, sexual dysfunction
• Minor increases in cortisol, decreases in growth hormone
• Nicotine is not the cause of cancer, but other substances in tobacco and nicotine delivery devices are

Withdrawal Symptoms

• Occur as soon as 4 hours after the last ingestion of nicotine
• Symptoms include agitation, craving for nicotine, stomach aches, nausea, irritability
• Craving is due to a drop in dopamine below baseline levels

Quitting Smoking, Vaping, Snuffing, or Dipping

• There are effective ways to quit, including single event treatments
• Nicotine is not the carcinogen, but other substances in tobacco and nicotine delivery devices cause negative health impacts
  Vaping and Its Effects
• Vaping pens designed to vaporize nicotine quickly without burning tobacco 
  • Constantly updated engineering for low heat or non-​​heating approaches
• Vaping resembles crack cocaine in terms of speed of entry of nicotine into the bloodstream 
  • Speed of onset determines how habit-​​forming and addictive a substance is
  • Faster dopamine release in mesolimbic reward pathway makes vaping more addictive than cigarette smoking
• Young people’s brains getting wired to expect rapid, dramatic dopamine increases 
  • Leads to a progressive narrowing of the things that bring pleasure
  • Vaping associated with increased levels of depression, especially when use drops off

Cocaine and Nicotine Delivery Mechanisms

• Delivery mechanisms for cocaine parallel those for nicotine 
  • Snorting, injecting, and vaporizing (crack cocaine) all lead to rapid increases in psychoactive substances and dopamine release
• Vaping causes a very rapid increase in blood concentrations of nicotine, faster than other modes of delivery 
  • This makes it more habit-​​forming and addictive

Dopamine and Addiction

• Dopamine reward pathway is the only pathway for achieving satisfaction from any endeavor 
  • Initially, a substance causes a high increase in dopamine, but with repeated use, the increase becomes lower and lower
  • System can be recovered by abstinence from nicotine consumption, but withdrawal is difficult and miserable
• Vaping is harder to quit than cigarette smoking for most people 
  • Only 5% of people who try to quit smoking cold turkey succeed, and 65% of those relapse within a year
    Behavioral and Pharmacologic Methods for Quitting Nicotine
• Behavioral methods:
  • Clinical hypnosis
    • Developed by Dr. David Spiegel at Stanford School of Medicine
    • 23% success rate in quitting smoking after one session
    • Available through the Reverie app (Reverie​.com)
• Pharmacologic methods:
  • Bupropion (Wellbutrin)
    • Increases dopamine release, used for depression and smoking cessation
    • Typical dosage: 300 mg/​​day divided into two doses of 150 mg each
    • Increased seizure risk, use caution in patients with liver or renal disease
    • 20% success rate in overcoming smoking or vaping addiction
  • Nicotine replacement therapy (NRT)
    • Using nicotine patches, gum, or other delivery methods to maintain nicotine levels
    • Gradually reducing nicotine intake over time
    • Reasonably successful, but specific success rates

Resources

• Reverie app for clinical hypnosis: Reverie​.com
• Review article on pharmacologic approaches to smoking cessation: “Pharmacologic Approach to Smoking Cessation: An updated review for daily clinical practice” (2020)
  Smoking Cessation and Vaping Addiction
• Vaping is a rapidly increasing behavior, especially in the young population 
• Need for an all-​​out campaign to counter vaping addiction
• Combination of approaches for smoking cessation is most effective 
  • Using nicotine patches, then switching to gum, and then nasal spray
  • Changing the kinetics of nicotine absorption and dopamine release
  • Keeping the system intentionally off balance
• Homeostasis: the tendency for biological systems to reach equilibrium 
  • Baseline drops to compensate for peaks in arousal from nicotine
  • Withdrawal phase: baseline is lower than normal, making quitting more difficult
  • 75% of people relapse within one week; overall failure rates are 95%
• Getting through the first week is critical 
  • Use healthy methods to increase dopamine (e.g., cold showers, exercise, positive social interactions)
  • Hypnosis and bupropion can also assist in smoking cessation 
    • Bupropion increases dopamine pharmacologically
    • Hypnosis involves changes in neural circuitry and remapping of default networks
      Clinical Hypnosis and Quitting Smoking/​​Vaping
• Clinical hypnosis can help treat nicotine addiction 
• Understanding homeostasis process and time course of nicotine can help develop a quitting protocol
• First week of quitting is particularly hard due to decrease in autonomic arousal and dopamine
• Routine hypnosis can help reinforce neural circuits to stay away from nicotine
• Consuming alcohol increases the probability of relapse after quitting nicotine

Biology of Nicotine

• Nicotine is not what causes cancer, but the delivery device (smoking, vaping, etc.) does
• Ingesting nicotine for cognitive boost not recommended, but other methods like Alpha GPC can be used for cognitive enhancement
• Nicotine is an immensely powerful substance and understanding its biology can help in quitting