Did you know that tar is more dangerous than nicotine?

According to statistics, the current number of smokers in China is roughly 350 million. Over the years, Chinese tobacco has maintained seven "world firsts": first in tobacco leaf planting area; first in tobacco leaf purchasing volume; first in cigarette production; first in cigarette consumption; first in the world's number of smokers; first in tobacco profits and taxes; and first in the number of people dying from smoking-related diseases.

Last time, I was pleasantly surprised to find that a video about quitting smoking had more than 700,000 views, proving that many people have indeed begun to pay attention to this issue. However, that video talked more about convincing yourself from a psychological level, and did not fully introduce the physiological level of addiction. Let me add to that today.

01. How to determine tobacco dependence?

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The National Health Commission (formerly known as the National Health and Family Planning Commission), my country's top medical and health agency, has previously issued the "China Clinical Smoking Cessation Guidelines" [1]. This is a professional smoking cessation intervention guideline developed through the joint efforts of many top institutions, including the World Health Organization Collaborating Center for Tobacco or Health, the National Center for Disease Control and Prevention Tobacco Control Office, and the Hospital Tobacco Control Professional Committee of the China Association for Tobacco Control.

This report is written in a very popular way and can be understood without any biomedical background. For example, this self-test form for tobacco dependence is used to determine the physical and psychological dependence of smokers on tobacco.

The content is very simple and does not require professional operation. You can evaluate yourself by referring to the table above. As long as you have experienced the above symptoms three times in the past year, you can be judged as tobacco dependent.

Of course, the above description may make people think that they may also show the above symptoms even if they do not smoke, such as increased appetite and inattention. Then the following tobacco dependence assessment scale is more direct.

According to this table, you can directly judge whether you are addicted to tobacco and the degree of your tobacco dependence based on your smoking habits. Pay special attention to the first cigarette in the morning. The reason for this is that after a night's sleep, it is equivalent to a long-term withdrawal for yourself. If you want to smoke especially in the morning, it means that your tobacco dependence is particularly high.

02. What is withdrawal reaction?

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Having read this far, I believe you have already noticed a very important word here: withdrawal, because it is often followed by a word called withdrawal symptoms. Withdrawal symptoms are a psychological phenomenon, which mainly refers to the strong discomfort or even the opposite of the drug effect after stopping the use of drugs [2]. Of course, this situation is not only applicable to drugs, but also to some of our daily foods such as alcohol, tobacco, and even behaviors such as playing games. It is a result of "addiction". However, withdrawal reaction is not a purely psychological phenomenon, but a phenomenon closely related to physiology. For tobacco, withdrawal reaction also exists, and the main factor behind it is nicotine.

03. Nicotine

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The molecular diagram of nicotine is shown below. It is this simple molecule that is one of the main components of tobacco.

In fact, nicotine itself is nicotine, which is found in all Solanaceae plants, including tobacco. This substance is actually toxic. The secretion of nicotine can be used for sterilization and immunity, etc., which can help tobacco resist the harm of nature and allow itself to survive better. However, tobacco may not have expected that it would be used by humans for smoking, and the result is that nicotine enters the human body.

After nicotine enters the human body, it is transported to the central nervous system and then encounters a key substance, the acetylcholine receptor. This substance is the binding partner of the neurotransmitter acetylcholine and is used to transmit nerve signals. For example, in our neural reward center, the binding of acetylcholine to the receptor leads to the release of dopamine, which makes people excited.

But the emergence of nicotine changed this situation. Nicotine is a competitor of acetylcholine and it can also compete for acetylcholine receptors. In this case, in order to cope with the lack of acetylcholine receptors in the body, more acetylcholine receptors are generated. As a result, when smoking, nicotine will continue to bind to acetylcholine receptors, thus producing continuous excitement in the brain. Once you give up smoking, the excess acetylcholine receptors will remain vacant, resulting in a strong desire for tobacco, which is the withdrawal reaction mentioned above.

It can be seen that nicotine is the core factor of withdrawal reaction, and the current clinical smoking cessation strategies are mainly targeted at nicotine.

04. Tar

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The harm of tobacco is actually mainly tar, not nicotine.

Tar in tobacco is a brown greasy substance from incomplete combustion of tobacco. It contains a variety of chemical substances, including 16 carcinogens alone. It also contains some carcinogenic substances such as acetic acid, ethylene glycol, ketones, hydrogen chloride and other corrosive and toxic gases, which are the main source of tobacco harm. There was once a big man who was committed to reducing the tar of traditional tobacco and was elected as an academician of the Chinese Academy of Engineering, which caused great indignation. Nearly 100 academicians jointly wrote a letter, and the Tobacco Control Association sent seven consecutive letters of protest, because many studies have shown that it is almost impossible to reduce the tar of tobacco. From the public's reaction, it can also be seen that there is an awareness of the harm of tar and resistance to tobacco itself.

Smoking is mainly a chronic effect, that is, long-term smoke invasion. The burning of tobacco will produce a large amount of harmful gases, especially tar, which is a mixture produced by the burning of plants (so the issue of reducing tar is denounced as pseudoscience). These substances will cause long-term damage to the human body, not just the lungs, so they will cause damage to health and increase the incidence of diseases such as lung cancer.

It is worth mentioning that secondhand smoke may be more harmful than firsthand smoke because secondhand smoke, also known as sidestream smoke, burns less completely than the smoke breathed by the smoker himself, and therefore contains more particulate matter.

This is just like the impact of smog we mentioned, which is mainly the impact of particulate matter. Therefore, if you are in close contact with smokers, the impact of second-hand smoke may be greater than first-hand smoke.

Therefore, promoting smoking cessation is beneficial to a certain extent. As for how to quit smoking? In fact, there is a set of medical methods. If you can't solve it by your own will, you might as well try medical methods.

05. How to quit smoking scientifically?

In this "Chinese Clinical Smoking Cessation Guidelines", a total of 3 drugs are recommended, which are also the drugs currently approved by my country's CFDA. They are

1. Nicotine patches and nicotine chewing gum (over-the-counter drugs).

2. Bupropion hydrochloride sustained-release tablets (prescription drug).

3. Varenicline (prescription drug).

These three drugs are actually divided into two types.

The first type: replacement therapy - nicotine patches, nicotine chewing gum

This method of quitting smoking is actually a gradual relief process. Taking into account the strong reactions of tobacco addicts, a gradual reduction in dosage is used to achieve the goal of reducing addiction.

Since nicotine products themselves contain nicotine, they can supplement the smokers' demand for nicotine to satisfy those acetylcholine receptors, acting as a transition and buffer, so smokers who quit smoking will not have a strong withdrawal reaction, which is better than relying solely on willpower to resist. After all, change is a difficult thing for everyone, especially when it involves the central nervous system's need for nicotine, which helps to get through the torment of the stage. But at the same time, the nicotine content is low and will not exceed the nicotine content of tobacco itself, so it is relatively safe and belongs to non-prescription OTC drugs. Therefore, it can be bought on Taobao and JD.

The second type: direct blocking - bupropion hydrochloride sustained-release tablets, varenicline

For patients with severe smoking addiction, neurological drugs may be used. The two prescription drugs recommended in the "Chinese Clinical Smoking Cessation Guidelines" are both psychotropic drugs that act directly on the nervous system. Bupropion hydrochloride sustained-release tablets are well-known antidepressants, and varenicline acts on the acetylcholine receptors mentioned above and is a partial agonist of the nicotinic acetylcholine receptor α4β2. The above two substances have strong psychotropic effects and many toxic side effects. They can cause mental disorders such as depression and may even cause suicide [4]. This is also an important factor in the strict control of such psychotropic drugs in many countries. my country has listed them as prescription drugs, and they must be diagnosed in a hospital, and then prescribed by a doctor and used under the supervision of a doctor.

The above are all drugs mentioned in the official guidelines. They are also official drugs that have been studied and approved by multiple departments. They have undergone many studies and are therefore relatively safe choices in all current channels.

In general, smoking addiction can be quit, and countless people have demonstrated this, so everyone must have confidence. Of course, quitting smoking is painful, not only because it is a test of willpower, but also because of the physiological barrier of acetylcholine receptor binding in our brain, which can be said to be even more difficult. This is also the fundamental factor of withdrawal reaction. Be determined, strengthen your will, and use smoking cessation auxiliary drugs to alleviate withdrawal symptoms, and strive to successfully quit smoking as soon as possible.

1. National Health and Family Planning Commission of the People's Republic of China, Chinese Clinical Smoking Cessation Guidelines (2015 edition).

2. Hughes, John R., and Dorothy Hatsukami. "Signs and symptoms of tobacco withdrawal." Archives of general psychiatry 43.

3. (1986): 289-294. 3 Benowitz, Neal L. "Nicotine addiction." New England Journal of Medicine 362.2

4, (2010): 2295- 2303. 2021/1/27