Nicotine Addiction

10 Key excerpts on "Nicotine Addiction"

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  Negative Affective States and Cognitive Impairments in Nicotine Dependence

  • F. Scott Hall, Jared W. Young, Andre Der-Avakian(Authors)
  • 2016(Publication Date)
  • Academic Press

    (Publisher)

  Nicotine dependence describes a substance abuse disorder experienced by individuals who compulsively use tobacco products despite the known health risks. For the purposes of this chapter, dependence will be defined as a “clinical syndrome that can include physical (tolerance and/or withdrawal) and psychological (impaired control of drug/substance use) dependence” (Hughes, 2007). While definitions are debated and definitive criteria continue to evolve, general drug-dependence criteria are helpful in describing nicotine dependence and are generally agreed upon. They include use that is highly controlled or compulsive, psychoactive effects, and drug-reinforced behavior. Additional criteria include stereotypic behaviors and patterns of use, recurrent drug craving, relapse following abstinence, and use despite evidence of harmful effects (Centers for Disease Control and Prevention, 2010). Central to nicotine dependence is nicotine withdrawal. This manifests as a characteristic cluster of symptoms experienced when the key addictive component of tobacco, nicotine, is withheld, either during a quit attempt or during short periods of abstinence. Avoidance of nicotine withdrawal is reported by smokers to be one of the main reasons for maintaining smoking and, consequently, undermines success in quitting. The majority of the withdrawal symptoms experienced are characterized by negative affect, for example feelings of irritability, misery, tension, frustration, anger, and sadness (described in more detail later in the chapter). As such, avoidance of these symptoms and negative states is central to withdrawal-based models of dependence. In seeking to avoid these aversive experiences, and alleviate the negative feelings when they do occur, the dependent smoker re-administers the drug (nicotine) and thereby negatively reinforces continued smoking. This leads to compulsive perseverative use, and the propensity to relapse that characterizes addiction

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  Understanding Nicotine and Tobacco Addiction

  • Gregory R. Bock, Jamie A. Goode, Gregory R. Bock, Jamie A. Goode(Authors)
  • 2006(Publication Date)
  • Wiley

    (Publisher)

  Defining and assessing nicotine dependence in humans Robert West Cancer Research UK Health Behaviour Unit, Department of Epidemiology and Public Health, University College London, Brook House, 2-16 Torrington Place, London WC1E 6BT, UK Abstract. ‘Addiction’ and ‘dependence’ are used synonymously by most researchers and defined as a reward-seeking (usually drug taking) behaviour that has become out of control. The diagnosis has been based on the alcohol dependence syndrome identified 30 years ago by Edwards and Gross and includes tolerance, craving, withdrawal symptoms, difficulty controlling use, important activities given up, and continuation despite harmful conse-quences. A substantial proportion of smokers are addicted by reference to these criteria. However, it is possible to improve on both the definition and its assessment. This paper proposes that addiction is more usefully regarded as a symptom of potentially a range of underlying pathologies involving the ‘motivational system’. Even among smokers there is heterogeneity in the pathology that makes it difficult for them to abstain voluntarily and this has important implications for treatment. For example, there will be smokers for whom the pathology involves a largely reversible effect of nicotine in creating an ‘acquired drive’, others for whom nicotine has induced long-term changes that make life less com-fortable in its absence, and others whose smoking is more situationally driven. Assessment of addiction should first quantify the degree to which the behaviour dominates the indi-vidual’s repertoire and then assess the underlying pathology in the motivational system. A framework for doing this is discussed. 2005 Understanding nicotine and tobacco addiction. Wiley, Chichester (Novartis Foundation Symposium 275) p 36–58 ‘Nicotine as delivered by cigarettes is addictive.’ There are two common interpre-tations of this statement.

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  The Tobacco Epidemic

  • R. Loddenkemper, M. Kreuter, R., Loddenkemper, M., Kreuter, J. J. F. Herth, F.J.F., Herth(Authors)
  • 2015(Publication Date)
  • S. Karger

    (Publisher)

  In the last 2 decades, significant progress has been made towards the development of a comprehensive understanding of various factors that underlie nicotine dependence and its treatment, such as vulnerability to addiction, outcomes of quit attempts, the role of genetics and the assessment of nicotine dependence. In addition, knowledge of the interaction of nicotine with nicotinic acetylcholine receptor (nAChR) subtypes, and the subsequent modulation of neurotransmitter systems that play a role in the addictive effects of nicotine, has further advanced. The elucidation of genetic factors influencing nicotine dependence is already shaping the clinical assessment and design of smoking cessation trials, along with factors underlying successful abstinence. The continued search for neurobiological mechanisms of nicotine dependence has uncovered several new targets for pharmacotherapeutic interventions, including a number of nAChR subtypes other than the predominant α4β2 nAChR, and various neurotransmitter systems. These efforts have revealed several new approaches for the treatment of nicotine dependence, which foreshadow more informed, targeted and effective interventions to curb the impact of the tobacco epidemic on public health and mortality.

  © 2015 S. Karger AG, Basel

  Soon after it was recognized that lung cancer and chronic bronchitis were causally related to cigarette smoking, nicotine and tobacco research concentrated on toxic components in tobacco smoke, as well as on the role of nicotine in tobacco addiction. In the Surgeon General’s Report series on smoking that started in 1964, the 11th report from 1979 defined for the first time smoking as a ‘Nicotine Addiction’, and by that time it became clear that smoking tobacco and inhaling nicotine is a form of nicotine self-administration that is very difficult to stop, leading to the current worldwide nicotine dependence pandemic. Since then, significant progress has been made in our understanding of the factors that determine vulnerability to addiction and the outcome of quit attempts, the role of genetics, the assessment of nicotine dependence and the interaction of nicotine with acetylcholine receptors that underlie nicotine dependence. Together, these advances resulted in the development of more effective treatments and the identification of novel biological targets (see also chapter 17 ). These topics are briefly discussed in this chapter, with references to recent comprehensive reviews and, where appropriate, to primary or recent literature.

  Classification of Nicotine Dependence

  Nicotine dependence consists of three phases, each of which may have a unique neurobiological substrate: acquisition and maintenance of nicotine-taking behavior, withdrawal symptoms upon cessation of nicotine intake and vulnerability to relapse [1

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  Cigarettes, Nicotine, and Health

  A Biobehavioral Approach

  • Lynn T. Kozlowski, Jack E. Henningfield, Janet Brigham(Authors)
  • 2001(Publication Date)
  • SAGE Publications, Inc

    (Publisher)

  Part of the reason that only 2% to 3% of smokers successfully achieve absti-nence each year (Pierce et al., 1989) may be that most people who smoke on a daily basis report that they feel dependent and have experienced withdrawal symptoms (Henningfield et al., 1990; USDHHS, 1988). H Terminology Nomenclature has evolved as our scientific understanding of drug dependence has evolved. We now recognize that a variety of drugs can be labeled addictive and that their effects differ. These effects are described by terms including tolerance, physical dependence, withdrawal, psychoactivity, reinforcement, abuse liability, dependence potential, and intoxication. Table 6.3 provides definitions of these key terms. Summary mÊÊÊxm Nicotine Addiction has now been established as a significant, substantial drug addiction. All drug addictions are the result of complex biobehavioral processes. Tobacco Use as Nicotine Addiction 91 TABLE 6.3 Glossary of Commonly Used Terms to Describe Addictive Drugs Abuse: This refers to maladaptive use of a substance that may or may not pro-duce dependence. Thus, maintaining dependence by medically supervised self-administration of methadone and transdermal nicotine is not consid-ered abuse, even though certain effects of the substances they have re-placed (i.e., street heroin and cigarettes, respectively) could be considered abuse. Abuse liability: A drug meets criteria for abuse liability if it produces effects mediated by the brain that are sufficient to lead a substantial proportion of people and animals to repeatedly self-administer the drug. Abuse liability is confirmed by demonstrating that the drug will serve as a positive reinforcer in animals and humans and that it produces stimulus effects, which overlap with those produced by drugs of abuse, such as amphetamine and morphine.

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  Substance Use Disorders

  A Biopsychosocial Perspective

  • Perry M. Duncan(Author)
  • 2020(Publication Date)
  • Cambridge University Press

    (Publisher)

  Situations, places and activities related to smoking also become associated with nicotine effects (Figure 11.2). The conditioning occurs more frequently, and is associated with more common everyday events, than for any other addictive drug. These almost unavoidable parts of smokers’ daily lives elicit craving for nicotine. Figure 11.2 Smoking becomes associated with many routine situations and behavior, which become conditioned stimuli eliciting the urge to smoke. Photo: vasiliki / E+ / Getty Images. 390 11 Tobacco Use and Nicotine Addiction The question of whether addiction is a disease or a behavioral disorder is of spe- cial relevance to nicotine dependence. Subsequent sections of the current chapter discuss the “disease-like” nature of nicotine dependence (genetic predisposition, changes in brain activity) and the high prevalence of tobacco addiction in psychi- atric populations. However, many individuals who have difficulty in quitting ciga- rette use undoubtedly feel that smoking is an intractable habit that endangers their health, rather than a psychiatric disorder or a disease. The biopsychosocial view of addiction, a major premise of this text, maintains that addiction is a behavioral disorder with disease-like characteristics, partially caused by neurological abnor- malities. Nicotine can definitely produce dependence, but to the public as well as to the chronic smoker, tobacco addiction may not fit the disease model as well as does alcohol, cocaine or heroin addiction. Determining the Incidence of Nicotine Dependence/Addiction Many individuals – but not all – who use tobacco are nicotine dependent. Cigarette smoking is the most addictive method of tobacco use, for reasons described in a later section.

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  Clinical Guide to the Diagnosis and Treatment of Mental Disorders

  • Michael B. First, Allan Tasman(Authors)
  • 2013(Publication Date)
  • Wiley

    (Publisher)

  Nicotine has stimulant and depressive effects on both the central and the peripheral nervous systems. It also affects the cardiovascular system, the gastrointestinal system, and the skeletal motor system. Nicotine stimu- lates the cholinergic nervous system (sympathetic and parasympathetic). Nicotine is a highly addictive substance that causes physical and psychological dependence that is similar to that of opiates and other substances of abuse. Smokers adjust smoking behavior to regulate and maintain the level of nicotine in the blood stream. A withdrawal syndrome develops in response to reduced intake or total abstinence and involves both physiological and psychological symptoms. Withdrawal symptoms over- lap with those of alcohol and other substances of abuse. Psychological dependence on cigarettes involves the perceived benefits/reasons a person smokes, such as a perception that they are able to improve mood and sense of well-being, to satisfy craving, and to provide stimu- lation and relaxation. Through this variety of central and peripheral actions, nicotine improves mood and decreases anxiety; decreases distress in response to stressful stimuli and decreases aggression; improves 212 Chapter 21 . Substance-Related Disorders: Nicotine overall cognitive function and performance (improves reaction time, concentration, vigilance, and stimulus- processing capacity, increases attention, memory and learning, improves the ability to disregard irrelevant stimuli); and decreases the appetite for simple carbohy- drates, decreases stress-induced eating, and increases resting metabolic rate. Many individuals soon become tolerant to these effects so that they smoke not to achieve them, but rather to avoid withdrawal symptoms.

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  Cognition and Addiction

  A Researcher's Guide from Mechanisms Towards Interventions

  • Antonio Verdejo García(Author)
  • 2019(Publication Date)
  • Academic Press

    (Publisher)

  There may be some overlap in the effects of nicotine and tobacco on mood and on cognitive performance. As mood is improved by smoking, there may be increased motivation to concentrate and perform well. Nicotine improves attention, especially in populations with poor baseline performance characteristic of some mental illnesses. Neuroimaging studies suggest that these cognitive effects may relate to enhancement of the executive control network (engaged by externally driven processes, e.g., a cognitive task), suppression of the default mode network (engaged by internally driven processes, e.g., while daydreaming), or a combination of both. Likewise, tobacco withdrawal may change the relationship between these two networks. If true, future research in this area ought to investigate how these networks can be manipulated to support tobacco cessation, via pharmacological or nonpharmacological (e.g., neurofeedback, transcranial magnetic stimulation) methods.

  It is difficult to understand why tobacco is so highly addictive, given its modest acute effects. The extent of classical conditioning (i.e., the number of times cigarette smoking is paired with another stimulus or experience) and the age of initiation play critical roles in the transition from occasional to daily smoking. Nicotine appears to enhance the motivation for other reinforcers as well, which is evident in the amount of effort expended to obtain other reinforcers when nicotine is physiologically present and in DA-rich mesolimbic brain activation when anticipating or receiving other reinforcers. Research in this area is important to understanding withdrawal-related anhedonia and the loss of motivation for nondrug rewards.

  As the smoking rates in the general population decline, there may be less concern or funding for tobacco addiction research. This may leave many vulnerable populations understudied and underserved. As tobacco addiction is a pervasive disease that interacts with and exacerbates other physical and mental illnesses, treatment for tobacco addiction should be an integral part of primary care medicine.

  References

  Abdolahi A, Williams G.C, Benesch C.G, Wang H.Z, Spitzer E.M, et al. Damage to the insula leads to decreased nicotine withdrawal during abstinence . 

  Addiction

  . 2015;110:1994–2003.

  Addicott M.A, Oliver J.A, Joseph McClernon F. Nicotine increases anterior insula activation to expected and unexpected outcomes among nonsmokers . 

  Psychopharmacology (Berl.)

  . 2017;234:1145–1154.

  Addicott M.A, Sweitzer M, McClernon F.J. The effects of nicotine and tobacco use on brain reward function: interaction with nicotine dependence severity . 

  Nicotine Tob. Res.

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  Translation of Addictions Science Into Practice

  • Peter M. Miller, David Kavanagh(Authors)
  • 2011(Publication Date)
  • Pergamon

    (Publisher)

  Neuropsychopharmacology , 22 (2), 200–209. Cognitive, Affective and Motivational Effects of Smoking 255 Piasecki, T. M., Fiore, M. C., & Baker, T. B. (1998). Profiles in discouragement: Two studies of variability in the time course of smoking withdrawal symptoms. Journal of Abnormal Psychology , 107 , 238–251. Piasecki, T. M. (2006). Relapse to smoking. Clinical Psychology Review , 26 , 196–215. Poltavski, D. V., & Petros, T. (2006). Effects of transdermal nicotine on attention in adult non-smokers with and without attentional deficits. Physiology and Behavior , 30 , 614–624. Potter, A. S., & Newhouse, P. A. (2003). The effects of acute nicotine administration on behavioural inhibition in adolescents with attention-deficit/hyperactivity disorder (ADHD). Biological Psychiatry , 53 , 83S. Powell, J. H. (1995). Conditioned responses to drug-related stimuli: Is context crucial? Addiction , 90 , 1089–1095. Powell, J. H., Tait, S., & Lessiter, J. (2002b). Cigarette smoking and attention to pleasure and threat words in the Stroop paradigm. Addiction , 97 , 1163–1170. Powell, J. H., Dawkins, L., & Davis, R. (2002a). Smoking, reward responsivenss, and response inhibition: Tests of an incentive motivational model. Biological Psychiatry , 51 , 151–163. Powell, J. H., Pickering, A. D., Dawkins, L., West, R., & Powell, J. F. (2004). Cognitive and psychological correlates of smoking abstinence and predictors of successful cessation. Addictive Behaviours , 29 , 1407–1426. Royal College of Physicians, Tobacco Advisory Group. (2000). Nicotine Addiction in Britain . London: Royal College of Physicians. Seth, P., Cheeta, S., Tucci, S., & File, S. E. (2002). Nicotinic-serotonergic interactions in brain and behaviour. Pharmacology, biochemistry and behaviour , 71 , 795–805. Shoaib, M., & Bizarro, L. (2004). Deficits in a sustained attention task following nicotine withdrawal in rats. Psychopharmacology , 178 , 211–222. Spilich, G. J., June, L., & Renner, J.

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  Medication Treatments for Nicotine Dependence

  • Tony P. George(Author)
  • 2006(Publication Date)
  • CRC Press

    (Publisher)

  For example, lesions of the VTA reduce nicotine self-administration in rodents, as do local infu-sions of the nAChR antagonist mecamylamine into the VTA [13–15]. In addition, it has been shown that nicotine withdrawal produces a reduction in central DA in rodents and urinary catecholamine excretion in humans who smoke [15–18]. Nicotine modulates the release of other neurotransmitters, including acetylcho-line (ACh), endogenous opioid peptides (EOPs), γ -aminobutyric acid (GABA), glutamate (Glu), norepinephrine (NE), and serotonin (5-HT), all of which are impli-cated in the pathogenesis of PDs and SUDs [14]. Ultimately, an understanding of the neurobiology and pharmacology underlying Nicotine Addiction and PDs and SUDs helps provide a theoretical basis for the treatment of comorbid nicotine dependence in these disorders. 17.3 SMOKING AND PSYCHIATRIC DISORDERS 17.3.1 S CHIZOPHRENIA Compared with the general population, individuals with schizophrenia have mark-edly elevated rates of smoking (45 to 88%) in both clinical [12] and population-based samples [2]. Schizophrenic patients also tend to be heavier smokers [19] and attain higher plasma cotinine levels [20] than nonschizophrenic smokers and extract more nicotine than controls per cigarette [21,22]. Interestingly, several reports have indicated high rates of smoking prior to the onset of psychotic symptoms and antipsychotic treatment [23,24]. These findings suggest a pathophysiological-based vulnerability to Nicotine Addiction in schizophrenic patients rather than a secondary reaction to the presence of clinical symptoms [12,25]. In concert with this hypothesis, nicotine through cigarettes ameliorates psychophysiological deficits in schizophre-nia, including P50 auditory evoked potentials, which are known to be normalized by nicotine administration [26], as well as selected neuropsychological deficits, such as spatial working memory and attentional dysfunction [22,27].

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  Drug Use, Misuse and Abuse

  Psychopharmacology in the 21st Century

  • Cecile A. Marczinski(Author)
  • 2013(Publication Date)
  • Wiley

    (Publisher)

  Use of the CTA task has helped researchers uncover interesting aspects of nicotine, such as genetic differences in the likelihood that CTA for nicotine will develop (Risinger & Brown, 1996). Genotype does seem to be an important factor in propensity to become addicted to nicotine in both animals and humans (USDHHS, 2010). For example, human studies of twins have revealed that identical twins are more likely to have similar smoking habits than fraternal twins, even when not reared together (Hughes, 1986). Results of nicotine studies using the above three paradigms illustrate that nicotine, like other drugs of abuse, can have both rewarding and aversive effects in animals, just like in humans. Moreover, combined use of these various tasks such as CTA and CPP help neuroscientists uncover which brain regions are responsible for the rewarding and aversive effects of nicotine (Sellings, Baharnouri, McQuade, & Clarke, 2008). In better understanding the acute rewarding and aversive effects of nicotine, it is hoped that better methods will be available to prevent the initiation of smoking or improve treatments for Nicotine Addiction. One promising aspect of the reinforcement literature for nicotine is the finding that alternative reinforcers can reduce nicotine use. For example, one study asked smokers to make choices between smoking a cigarette and receiving money. By examining various reinforcement schedules, the researchers observed smokers choosing money over cigarettes, suggesting that even in addicted smokers, nicotine is not so reinforcing that alternative reinforcers couldn’t be substituted (Stoops, Poole, Vansickel, & Rush, 2011). Chronic Effects of Tobacco Use Components of Tobacco Tobacco smoke causes disease. Although that statement is no longer surprising, when the first U.S. Surgeon General’s report was released in 1964, people were shocked to hear it.

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