This document provides information about substance abuse, with a focus on tobacco and alcohol. It discusses the composition of tobacco and cigarette smoke, noting they contain over 4,000 chemicals including nicotine and carcinogens. The health effects of smoking include increased risk of cancer, cardiovascular and lung diseases. Smoking during pregnancy can also increase lead levels in mothers and impact fetal development. The document also discusses sheesha/hookah smoking and notes it contains high levels of nicotine, carbon monoxide and tar. A section on alcohol discusses low risk drinking guidelines and factors impacting blood alcohol levels.

1. Substance Abuse/Drug Abuse
Editor
Dr.Afsar Karim (PharmD)
TABACCO/ALCOHOL

2. FIRST EDITION 2014/ first series
Publication in collaboration with Aga khan youth & Sports Board /
Aga Khan Social Welfare Board for Skardu/EFHCA.
Thisis greathonor forme to write aninformative literaturecoveringTobaccoandAlcohol onrequesting
AkYSBand ASWB forSkardu. This bookis informative forall Youthwantstoknow about the Tobacco
and Alcohol.Also reliable forthe Medical Studentsfortheirinformation.
For any query mail to akpharm.karim@gmail.com

3. Tobacco
Tobacco isa plantwithinthe genus Nicotianaof the Solanaceae (Nightshade) family.There are more than70
species of tobacco.Productsmanufacturedfromdriedtobacco leaves include cigars,cigarettes, snuff,pipe
tobacco, chewingtobacco(Gutka/Pan) andflavored Shishatobacco.Furtherusesof tobaccoare in plant
bioengineeringandasornamentals,andchemical componentsof tobaccoare usedinsome pesticidesand
medications. Nicotine isthe mainactive ingredientandmostaddictive substance intobacco
The plant isdividedintotwo:
1. Nicotianatabaccum
2. Nicotianarustica- thisisnotusedcommercially
Composition.
Polycyclicaromatichydrocarbons(PAHs) are one class of chemical compoundsthat are presentatlowto trace
levelsinunburnedcigarette filler, andare predominantlygeneratedduringcombustion.Accordingtoa recent
reportof the International AgencyforResearchonCancer,10 carcinogenicPAHstogetherwith53 otherknown
carcinogensare presentincigarette smoke.
Cigarette smoke isacomplex mixture of variousclassesof compounds,includingnumerousPAHs.
The PAH levelsvariedamongthe differentcommercial cigarettebrands,withthe amountof total mainstream
smoke PAHsrangingfrom1 to 1.6 microgper cigarette.Undermachine smokingconditions,the mainstream
smoke fromdomesticcigaretteshadindividual PAHsrangingfrombenzo[k]fluoranthene atlevelsbelow10
ng/cigarette tonaphthaleneatlevelsof around500 ng/cigarette.
solanesol, a45-carbon,trisesquiterpenoidalcohol anaturallyoccurringcomponentintobaccothat isdeposited
duringsmokinginthe cigarette filterbutt.
Nicotine andcarbonmonoxide,whichare only2 of the more than4,000 differentchemicalspresentincigarette
smoke.
Several carcinogenshave beenidentifiedinCigerateSmoke,the tobacco-specificN-nitrosamine (TSNA),N'-
nitrosonornicotine (NNN),and4(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) beingthe mostimportant.
NNN andNNKare formedfromnicotine duringcuring,aging,andespeciallyduringfermentationof tobacco.
Oral swabbingof alowconcentrationof a mixture of NNN plusNNKinwaterinducesoral tumorsinrats. The
concentrationof the stronglycarcinogenicTSNA is higherinsnuff thaninother StreetSmokingproducts.

4. What is'tar'?
Cigarette smoke containstinyparticles,whichcanbe collectedona filterpadina laboratorywhena cigarette is
smokedbya machine. Tar is usuallydefinedasthe weightof particulate mattercollectedinthisway,after
waterand nicotine are subtracted. Tar isa complex mixture of substances,whichincludessubstanceswhichin
sufficientquantitiesare thoughtcapable of initiatingand promotingcancerand Emphysema(Chronic
obstructive pulmonarydisease(COPD) isone of the mostcommonlungdiseases.Itmakesitdifficulttobreathe).
What isnicotine?
Nicotine occursnaturallyinthe tobaccoplantand isa constituentof tobaccosmoke. Nicotine hasunusual
pharmacological properties;ithasbotha mildstimulanteffect,thoughlessthanthatof caffeine,andamild
relaxingeffect. Athighlevels,farhigher thaninthe smoke froma cigarette,nicotineistoxic. . Nicotine isalso
an addictive drug,though,andsmokerscharacteristicallydisplayastrongtendencytorelapse afterhaving
successfullystoppedsmokingforatime.Wheningestedinlargerdoses,nicotine isahighlytoxicpoisonthat
causesvomitingandnausea,headaches,stomachpains,and,insevere cases,convulsions,paralysis,anddeath
Studies show nicotine has powerful side effects on the cardiovascular(Heart and its vessels) system.
Nicotine:
 Increasesepinephrine (adrenaline),whichraisesbloodpressure,heartrate andrespiration,andglucose
levels.
 Narrows(constricts) yourbloodvessels,makingitharderforthe heart to pumpbloodthrough
constrictedarteries.
 May cause yourbodyto release storedfatandcholesterol intothe bloodstream.
 Damagessmoothmuscle cells,promotingthe formationof hardplaqueswhichleadto arthrosclerosis
(hardeningof the arteries).
What iscarbon monoxide?
Carbonmonoxide isagas formedwhenplantmaterialsburn. Itcan combine withhemoglobininblood,
reducingthe blood’scapacitytocarry oxygen. Carbonmonoxide intobaccosmoke isthoughttobe associated
withthe increasedrisk of heartdisease fromsmoking; Highlevelsof carbonmonoxide canleadtobraindamage
and unconsciousness.

5. Effects. Smokers die an average of 14 years soonerthan nonsmokers.
Smokingisa significantindependentriskfactorforcardiovasculardiseaseandisa leadingcause of structural
and functional alterationsof the cardiovascular system.Cigarette smokingcausesinjurytothe vascular
endothelium, producessuperoxideanions,reducesproductionandbioavailabilityof nitricoxide(NO),increases
productionandrelease of endothelin,causesendothelial dysfunction,thrombosis,atherosclerosis,
infarction(localizedDeathof livingCellsresultingfromobstructionof bloodSupply),coronaryarterydisease
(atherosclerosis),stroke(SuddenLossof Consciousness)anddeath
While the effectof cigarette smokingonthe progressionof atheroscleroticdiseasesisestablishedandwell
studied,the role of cigarette smokingoncardiacarrhythmiaislessclearlydefined.Infactthe pathphysiological
mechanismof cigarette smoking-inducedcardiacarrhythmiaisverylikelyacomplex one where the pro-fibrotic
effectof nicotine on myocardial (Heart) tissue withconsequentincreasedsusceptibilitytocatecholaminemight
playa role.Moreover,otherconstituentsof cigarette smoking,suchascarbonmonoxide andoxidative stress,
are likelytocontribute tothe generationof arrhythmias.Finally,cigarette smokingmayinduce coronaryartery
disease andchronicobstructive pulmonarydisease,whichalsomightcause arrhythmia(anabnormal rate of
Muscle contractionsinthe Heart) independently.
Tobacco smokingisa majorrisk factorof the developmentof atherosclerosisandthrombosis.Components of
tobacco smoke induce changesinthe functionof thrombocytes(BloodPlatelets),endothelium, macrophages
(bodyDefenderCells)andsmoothmuscle cellsof bloodvessels.Smokingcauseschangesinactivityof enzymes
of antioxidantsystembyinducingproductionof reactive oxygenspecies.Alterationsof cell functionandenzyme
activitymayaccelerate formationof atheroscleroticplaques.The compoundsof tobaccosmoke alsopromote
atherogenesisbyaffectinggene expression.Nicotine mightpromote aproatheroscleroticstate inhuman
coronary endothelialcells(HCAECs),studyingthe role of 3-hydroxy-3-methylglutaryl coenzymeA (HMG-CoA)
reductase inhibitorsinpreventingthese phenomena:nicotine inducedexpressionof functionallyactive VCAM-
1/ICAM-1, (vascularcellularadhesionmolecule-1(VCAM-1)/intercellularadhesionmolecule-1(ICAM-1)),since
theyincreasedleukocyte adherence toHCAECs.Oxygenfreeradicals,RhoA andnuclearfactor kappaB(NF-
kappaB) playa pivotal role inmodulatingtheseeffects.Indeed,nicotine causedoxygenfreeradical production
as well asactivationof Rho A and NF-kappaBpathways.Superoxide dimutase, RhoA (Y-27639) and NF-kappaB
inhibitors(pyrrolidine dithiocarbamateammonium, Bay11-7082) suppressednicotineeffectsonCAM
expression.HMG-CoA reductase inhibitorspreventedthese nicotine-mediatedeffectsbyinhibitingfree radical
generationandby modulatingactivationof RhoA andNF-kappaBpathways.
Tobacco smokingduringpregnancyincreasedthe concentrationsinmaternal bloodlead.The level of leadin
plasmaand whole bloodcorrelatedwiththe degreeof intensityof cigarette smokinginthe pregnantwomen
studied.Itmaybe a resultof influencingthe mobilizationof calciumfromthe bone withsimultaneousrelease of
leaddepositedinthe bone.Furtherstudiesare requiredtocharacterize the effectof higherleadlevelinthe
bloodof mothersonthe riskof premature labor,low birthweightof newbornsandtheirinferiordevelopment.
Tobacco smokingduringpregnancyreducedserumnitricoxide concentrationsinmothersandtheirchildrenand
correlatedwithnumberof cigarettesdaily consumed. Chewingof tobaccoisassociatedwithanincreasedrisk
for oral (Month) cancer. Snuff dippingiscausallyandspecificallyassociatedwithcancerof the cheek,gum,and
pharynx causescancersof the lung,esophagus,larynx (voice box),mouth,throat,kidney,bladder,pancreas,
stomach,and cervix,aswell asacute myeloidleukemia(Proliferationof white BloodCells).
federal lawisrestrictingthe words“light,”“low,”and“mild”fromtobacco productsnow on the market,as
healthofficialslaunchacampaign to informsmokersthatthere’snosuchthingas a safe cigarette.Studies clearly
showthattheconsumer cangetjustas muchnicotineand tar fromthesecigarettes as‘regular’cigarettes.”

7. Heart and heart vessels showing atherosclerosis causing Heart attack.
SHEESHA
Shisha/Hookah/Waterpipe smoke are more dangerthenthe cigarette
Smoke,containsnicotine, carbonmonoxide,andcarcinogensandmaycontain
evengreateramountsof tar and heavymetalsthancigarette smoke.It
contains11 timesmore Carbonmonoxide thanCigarettes. The WorldHealth
Organizationhassaidthat hookahuse isequivalenttosmoking100 cigarettes
ina 200-puff session. The researcherssay,Waterpipe smoke hasbeenlinked
to oral andlungcancer, heartdisease,infectiousdiseases,and pregnancy-
relatedcomplications.
Increaseschance of gettingtuberculosis
Darkenslips,fingertipsandteeth
Coats the tongue andtaste buds andleadsto lossof appetite.

8. Alcohol
Low risk drinking:
One drinkfor female and2 drinksformale.
One drinkis defined as:as354ml of bear.148ml of wine or 44 ml of 80 proof distilled.
Note:1 literequal to34 oz. 1liter=1000ml. 1 oz = 30ml.
 Livercan process 7.5ml (.25 oz )of alcohol perhour
 BloodAlcohol Content(BAC) decreasesbyabout.015% per hour
***********************************************
Bloodalcohol level (BAL)dependson:
/ Weight
/ Amountof foodand waterin stomach
/ Carbonatedalcoholicbeverages
/ Gender
BloodAlcohol Level Calculations
BAL = (150/bodyweight) x (%alcohol/50)x (ouncesconsumed) x (0.025)

9. For example
/ 175 poundmandrinksfour12-ounce cans of beerwith4% alcohol content
/ BAL = (150/175) x (4/50) x (48) x (0.025)
/ =.86 x .08 x 48 x .025
/ = .08%
Effects :
BAL 0.35 to .50 or BloodAlcohol concentrationGreaterthen400mg/dl can cause respiratory
depressionand cause comaand Death.
Low –Moderate concentration. ApparentStimulant;depressionof cortical functioncauseslossof judgment,
emotional liability,Visual impairment,SlurredSpeech, Ataxia(Uncoordinatedmovementisdue toa muscle
control problemthatcausesan inabilitytocoordinate movements.). Hangovereffectsmayinclude Nausea,
Headache,Dizziness,andtremor.DepressesMedullaryAction; Lethargy,amnesia, Hypothermia(dangerously
lowbodytemperature),hypoglycemia{lowsugarlevel inblood)(Esp.inChildren’s)},Stupor(lackof critical
cognitive functionand level of consciousness),Coma,Respiratory Depression,Cardiomypathy(Heart
Disease),Hypertension(HighBlood Pressure) orhypotension(Low BloodPressure) andcardiovascularcollapse
may occur.
Chronic Excessive Consumption:damage Brain,liver,Braindamage leadstoWernicke-korsakoff Syndrome
(inflammatorydegenerative braindisorderdue tothiamine (vitaminB1) deficiency thatisusuallyassociated
withAlcoholism).Pancreatitis(pancreatitisisswellingandinflammationof the pancreas),increase
CardiovascularRisk. Fatdepositionmayoccurin liverandthere maybe a reductioninvariousBloodCell Counts
and increase Typesof Cancer.
Effect on fetus of Pregnant Human.

11. Conclusive overviewof Alcohol effectsonHumanbody
List of preventable causes of death
Leadingcausesof preventabledeathworldwide asof the year2001, accordingto researchersworkingwiththe
Disease Control PrioritiesNetwork(DCPN) andthe WorldHealthOrganization (WHO).
Cause
Numberof deaths
resulting(millionsper
year)
Hypertension 7.8
Smokingtobacco 5.0
Malnutrition 3.8
Sexuallytransmitteddiseases 3.0
Poordiet 2.8
Overweightandobesity 2.5
Physical inactivity 2.0
Alcohol 1.9
Indoorair pollution fromsolidfuels 1.8
Unsafe waterand poor sanitation 1.6
Sources:
Martindale 33 edition.
Basic & Clinical Pharmacology10EditionbyKatzung.
WWW.pubmed.com
www.fda.gov/consumer
www.wikipedia.com
PREPERED BY Dr.AfsarKarim
Pharmacist(Doctorof Pharmacy)