In Adolescents, Addiction to Tobacco Comes Easy

Huh? I don’t get it. This finding really challenges a lot of assumptions about addiction. It will be interesting to see follow-up studies. I’ll take it more seriously once it’s replicated. Could it be that there is some switch flipped in the limbic system that responds to environmental cues, even id they only occur once a week?

In the report that follows, Dr. Joseph R. DiFranza, a family health and community medicine specialist at the University of Massachusetts Medical School in Worcester, states that “very soon after that first cigarette, adolescents can experience a loss of autonomy over tobacco.”

Dr. DiFranza, who studies tobacco dependence, described a typical teenage smoker — a 14-year-old girl who smokes only occasionally, about three cigarettes a week. She admitted to having failed at several efforts to quit. Each time she tried, cravings and feelings of irritability drove her back to smoking.

“We have long assumed that kids got addicted because they were smoking 5 or 10 cigarettes a day,” Dr. DiFranza said in an interview. “Now we know that they risk addiction after trying a cigarette just once.”

Even occasional teenage smokers can experience the same symptoms of nicotine withdrawal that prompt adult smokers to light up again and again.

Robin J. Mermelstein, director of the Center for Health Behavior Research at the University of Illinois in Chicago and a longtime researcher on smoking behavior, said in an interview that Dr. DiFranza’s message was important. But, Dr. Mermelstein added, “the vast majority of teenagers who try one or two cigarettes don’t go on to become smokers.”

“Some kids experience withdrawal symptoms earlier than others,” she continued. “We still need to know how to predict who’s going to get hooked.”

Dr. DiFranza explained that a phenomenon called “dependence-related tolerance — how long after smoking a cigarette you can go before you need to smoke another one” — was long thought to be the same for adolescents and adults. But recent studies have shown that the brains of adolescents can become tolerant to nicotine after smoking fewer cigarettes than one a day, and it is tolerance that then drives them to smoke more often.

“The typical adult smoker begins to crave the next cigarette in 45 minutes to an hour after smoking,” he said. “But kids can be addicted and not need to smoke again for days, even weeks.”

Some adult smokers are no different from teenagers. One study found that adults who smoked only a few cigarettes a week found it hard to quit. “They experienced withdrawal symptoms, which some rated as unbearable,” Dr. DiFranza reported. “Most of these self-described ‘social smokers’ were addicted to tobacco.”