Hooked on Hookah

Nicotine addiction

Although, as mentioned earlier, the effects of smoking hookah are considerably worse than those of smoking cigarettes, the mechanism for addiction is the same. Nicotine from the smoked tobacco in the base of the hookah binds to nicotinic acetylcholine receptors (nAChRs) of neurons in a specific part of the midbrain called the ventral tegmental area (VTA). This binding subsequently activates VTA neurons to release dopamine, a hormone which positively regulates reward centers of the brain and gives hookah smokers the feeling of pleasure associated with smoking. nAChRs have important functional properties that contribute to their physiological effects, including activation, desensitization, and upregulation following nicotine exposure.

There are three main neurons in the VTA that express nAChRs and induce these physiological effects: dopamine neurons, GABA neurons, and glutaminergic presynaptic terminals. Most important to the regulation of nicotine exposure are the GABA neurons, which are inhibitory neurotransmitters that exercise inhibition of VTA neurons. However, nicotine is an inhibitor of GABA neurons that causes smoking addictions to arise because other VTA neurons will continue to release dopamine with little regulation. Thus, GABA neuron desensitization by nicotine causes hookah smokers to continue smoking until they achieve a desirable level of pleasure, eventually limiting their own ability to produce dopamine. This causes hookah and tobacco smokers to become increasingly reliant on their smoking habits to activate their reward centers and “feel good.”

Necessary prevention

Al-Delaimy is in disbelief at the speed with which hookah use has risen, making him a steadfast advocate for hookah prevention: “Not many Americans were doing it 10 years ago. Now, it’s picking up interest amongst people who haven’t even smoked!”

Because hookah is a relatively new phenomenon, hookah prevention and education are still in their early stages. According to California law codes, currently any establishment posing as a tobacco shop may allow customers to smoke their purchases on-site legally. Hookah lounges have proliferated for precisely this reason.

“What hookah lounges have done is use a loophole in the law that says that selling tobacco in a tobacco shop allows customers to smoke their purchase right there after buying it. This has given the impression that it’s ok to smoke it because the lounges are right there,” says Al-Delaimy.

He believes the best solution to reversing the trend in hookah use is to close this loophole.

“Once we ban smoking even in places that sell it, that would close the loophole and make it less appealing for people to go out and smoke. It would send the message that hookah is not allowed because it is dangerous. We need legislation passed sooner rather than later.”

In the meantime, Al-Delaimy is continuing to work towards the formation of a tobacco-free society.

“My ultimate goal is to stop this trend and make it be something of the past…to have a day where there is no tobacco use, eliminating all preventable diseases associated with [tobacco].”

WRITTEN BY JOSEPH ALESHAKI. Joseph Aleshaki is a Human Biology major from Thurgood Marshall College. He will graduate in 2013.

References

  1. Aljarrah, K., Zaid Q.A., Al-Delaimy, W.K. (2009). Perceptions of Hookah Smoking Harmfulness: Predictors and Characteristics among Current Hookah Users. Tobacco Induced Diseases, 5(1), 16.
  2. Hookah History. (2012, January 17). Hookah History.  Retrieved from http://www.hookahcompany.com/hookah_history.htm
  3. Mansvelder, H.D., McGehee, D. (2002). Cellular and Synaptic Mechanisms of Nicotine Addiction. Journal of Neurobiology, 53(4), 606-17.
  4. Messer, K., Trinidad, D.R., Al-Delaimy, W.K., Pierce, J.P. (2008). Smoking Cessation Rates in the United States: A Comparison of Young Adult and Older Smokers. American Journal of Public Health, 98(2), 317-22.
  5. Smith, J.R., Edland, E.D., Novotny, T.E., Hofstetter, C.R., White, M.M, Lindsay, S.P., Al-Delaimy, W.K. (2011). Increasing Hookah Use in California. American Journal of Public Health, 101(10), 1876-879.
  6. Smith, J.R.,  Novotny, T.E., Edland, S.D.,  Hofstetter, C.R., Lindsay, S.P., Al-Delaimy, W.K. (2011). Determinants of Hookah Use among High School Students. Nicotine Tob Res, 13(7), 565-572.
  7. Adolescents’ perceptions about quitting and nicotine replacement therapy: findings from the California Tobacco Survey. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16549315