Teen Smoking Linked to Substance Abuse, Mental Illness

Because nicotine significantly affects the structural and chemical changes in the developing brains of adolescents, smoking cigarettes makes teens more vulnerable to alcohol and drug addiction and to mental illness, according to research by The National Center on Addiction and Substance Abuse (CASA) at Columbia University.

Analyzing data from the National Survey on Drug Use and Health (NSDUH), CASA researchers found that teens who smoke are nine times more likely to meet the medical criteria for past year alcohol abuse or dependence and 13 times more likely to meet the medical criteria for abuse and dependence on an illegal drug compared with teens who don't smoke.

The report is titled, Tobacco: The Smoking Gun.

"These findings sound an alarm for parents, teachers, pediatricians and others responsible for children's health that smoking by teens may well signal the fire of alcohol and other drug abuse and mental illnesses such as depression and anxiety disorders," said Joseph A. Califano, Jr., chairman and president of CASA in a news release. "We have known for a long time that smoking causes deadly and crippling cancers and cardiovascular and respiratory diseases. Now we see the devastating effects that nicotine can have on the developing brains of our children and teens."

Explaining the Link

The CASA white paper cited more than a dozen scientific studies that may explain the factors that contribute to the relationship between smoking tobacco and drinking alcohol. Some of those factors include:

• Nicotine exposure at an early age may cause neurological changes which can increase teen vulnerability to alcohol abuse.

• Animal studies have shown a "distinct temporal link between nicotine exposure and alcohol consumption" with a clear progression from cigarette use to alcohol use.

• Nicotine increases dopamine levels in the brain which increases a propensity for alcohol and the amount of alcohol consumed.

• Smoking nicotine increases nicotine receptors, also known as upregulation, especially in adolescents. This provides more receptors for alcohol to act upon which increases the urge to drink.

Smoking and Alcohol and Illegal Drugs

Likewise, the CASA research cited dozens of studies, with both animals and humans, that demonstrate that early nicotine use causes complex changes in the brain that make adolescents more vulnerable to marijuana, cocaine and heroin use.

Comparing adolescents age 12-17 who don't smoke, to teens who do, the CASA study found:

• Five times more likely to drink.
  
• 13 times more likely to use marijuana.

Comparing those who started to smoke before age 12 to non-smokers, the study found:

• More than three times more likely to binge drink.
  
• Nearly 15 times more likely to smoke marijuana.
  
• Nearly seven times likelier to use heroin and cocaine.

Smoking and Mental Health Disorders

The CASA study found that among teens who smoke cigarettes:

• Twice as likely to suffer from depression in the past year.
  
• More likely to experience hopelessness, depression and worthlessness.
  
• More likely to report panic attacks and general anxiety disorders.
  
• More likely to report post-traumatic stress disorder.

The CASA report was commissioned by The Citizens' Commission to Protect the Truth, a group of all former U.S. Secretaries of Health, Education, and Welfare and of Health and Human Services, all former U.S. Surgeons General, and all former Directors of the Centers for Disease Control and Prevention.

Tough Changes Recommended

Based on the CASA findings, the commission recommended:

Sharply restricting all tobacco advertising, marketing and promotion.

Stepping up evidence-based prevention and cessation efforts, including counter-advertising programs.

Giving the FDA comprehensive authority to regulate tobacco.

Mandating evidence-based tobacco cessation in substance abuse treatment and mental health care settings.

Enforcing laws restricting sale of tobacco to minors and enacting indoor and outdoor clean air laws to limit children's exposure to second-hand smoke.

Vital to Reach Kids Early

"We have long known that nicotine is extraordinarily addictive and that youth can become addicted extremely quickly," said Cheryl G. Healton, Dr.P.H., president and CEO of the American Legacy Foundation. "This new report underscores what we know about the developing brains of teens who are highly vulnerable to personal, social and media influences to begin smoking and why it is so vital to reach them with information about tobacco before they start to smoke.

"Because 80 percent of smokers begin before age 18, when their young brains and bodies are so susceptible to the effects of nicotine, it is imperative that we stop what for so many will result in lost years and lives to tobacco addiction, disease and death."

Fighting the 'Nicotine Pushers'

"The public health case against tobacco for hiking the chances of damaging our children's developing brains in ways that can increase their risk of alcohol and other drug abuse and mental illness is clear," said Califano. "The time has come to curb cigarette advertisements and promotions by the nicotine pushers and step up campaigns like the American Legacy Foundation's effort to protect our nation's children."

The Citizens' Commission to Protect the Truth was formed to help ensure the continuation of truth, which is a national youth anti-smoking media campaign. More information is available on its web site.

^Sources:

The National Center on Addiction and Substance Abuse. Tobacco: The Smoking Gun (PDF). 23 October 2007.

The National Center on Addiction and Substance Abuse. New CASA Report: Teen Cigarette Smoking Linked to Brain Damage, Alcohol and Illegal Drug Abuse, Mental Illness 23 October 2007.