Nicotine dependence
Nicotine dependence | |
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Other names | tobacco dependence; tobacco use disorder |
Video explanation |
Nicotine dependence[notes 1] is a state of dependence upon nicotine.[1] Nicotine dependence is a chronic, relapsing disease defined as a compulsive craving to use the drug, despite social consequences, loss of control over drug intake, and emergence of withdrawal symptoms.[5] Tolerance is another component of drug dependence.[6] Nicotine dependence develops over time as a person continues to use nicotine.[6] The most commonly used tobacco product is cigarettes, but all forms of tobacco use and e-cigarette use can cause dependence.[7][8] Nicotine dependence is a serious public health problem because it leads to continued tobacco use, which is one of the leading preventable causes of death worldwide, causing more than 8 million deaths per year.[7]
According to the World Health Organization, "Greater nicotine dependence has been shown to be associated with lower motivation to quit, difficulty in trying to quit, and failure to quit, as well as with smoking the first cigarette earlier in the day and smoking more cigarettes per day."[9] The WHO estimates that there are 1.1 billion smokers globally.[10] Of the 34 million smokers in the US in 2018, 74.6% smoked every day, indicating the potential for some level of nicotine dependence.[11] There is an increased frequency of nicotine dependence in people with anxiety disorders.[12]
There are different ways of measuring nicotine dependence.[3] Common dependence assessment scales for cigarette smokers are the Fagerström Test for Nicotine Dependence, the Diagnostic and Statistical Manual of Mental Disorders, the Cigarette Dependence Scale, the Nicotine Dependence Syndrome Scale, and the Wisconsin Inventory of Smoking Dependence Motives (WISDM).[3]
Nicotine is a
Definition
Nicotine dependence is defined as a neurobiological adaptation to repeated drug exposure that is manifested by highly controlled or compulsive use, the development of tolerance, experiencing withdrawal symptoms upon cessation including cravings, and an inability to quit despite harmful effects.[6] Nicotine dependence has also been conceptualized as a chronic, relapsing disease.[17] A 1988 Surgeon General report states, "Tolerance" is another aspect of drug addiction [dependence] whereby a given dose of a drug produces less effect or increasing doses are required to achieve a specified intensity of response. Physical dependence on the drug can also occur, and is characterized by a withdrawal syndrome that usually accompanies drug abstinence. After cessation of drug use, there is a strong tendency to relapse."[6]
Nicotine dependence leads to heavy smoking and causes severe
Diagnosis
There are different ways of measuring nicotine dependence.[3] The five common dependence assessment scales are the Fagerström Test for Nicotine Dependence, the Diagnostic and Statistical Manual of Mental Disorders, the Cigarette Dependence Scale, the Nicotine Dependence Syndrome Scale, and the Wisconsin Inventory of Smoking Dependence Motives.[3]
The Fagerström Test for Nicotine Dependence focuses on measuring physical dependence which is defined "as a state produced by chronic drug administration, which is revealed by the occurrence of signs of physiological dysfunction when the drug is withdrawn; further, this dysfunction can be reversed by the administration of drug".[3] The long use of Fagerström Test for Nicotine Dependence is supported by the existence of significant preexisting research, and its conciseness.[3]
The 4th edition of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorder (DSM-IV) had a nicotine dependence diagnosis which was defines as "...a cluster of cognitive, behavioral, and physiological symptoms..."[3] In the updated DSM-5 there is no nicotine dependence diagnosis, but rather Tobacco Use Disorder, which is defined as, "A problematic pattern of tobacco use leading to clinically significant impairment or distress, as manifested by at least 2 of the following [11 symptoms], occurring within a 12-month period."[22]
The Cigarette Dependence Scale was developed "to index dependence outcomes and not dependence mechanisms".[3] The Nicotine Dependence Syndrome Scale, "a 19-item self-report measure, was developed as a multidimensional scale to assess nicotine dependence".[3] The Wisconsin Inventory of Smoking Dependence Motives "is a 68-item measure developed to assess dependence as a motivational state".[3]
Mechanisms
Traditional cigarettes are the most common delivery device for nicotine.[23] However, electronic cigarettes are becoming more popular.[24] Nicotine can also be delivered via other tobacco products such as chewing tobacco, snus, pipe tobacco, hookah, all of which can produce nicotine dependence.[25]
Biomolecular
Pre-existing cognitive and mood disorders may influence the development and maintenance of nicotine dependence.
When these receptors are not occupied by nicotine, they are believed to produce withdrawal symptoms.[32] These symptoms can include cravings for nicotine, anger, irritability, anxiety, depression, impatience, trouble sleeping, restlessness, hunger, weight gain, and difficulty concentrating.[33]
Psychosocial
In addition to the specific neurological changes in nicotinic receptors, there are other changes that occur as dependence develops.[citation needed] Through various conditioning mechanisms (operant and cue/classical), smoking comes to be associated with different mood and cognitive states as well as external contexts and cues.[29]
Treatment
There are treatments for nicotine dependence, although the majority of the evidence focuses on treatments for cigarette smokers rather than people who use other forms of tobacco (e.g.,
Medication
There are eight major evidence-based medications for treating nicotine dependence:
Vaccine
TA-NIC is a proprietary vaccine in development similar to TA-CD but being used to create human anti-nicotine antibodies in a person to destroy nicotine in the human body so that it is no longer effective.[39]
Psychosocial
Psychosocial interventions delivered in-person (individually or in a group) or over the phone (including mobile phone interventions) have been shown to effectively treat nicotine dependence.[38] These interventions focus on providing support for quitting and helping with smokers with problem-solving and developing healthy responses for coping with cravings, negative moods, and other situations that typically lead to relapse.[citation needed] The combination of pharmacotherapy and psychosocial interventions has been shown to be especially effective.[17]
Epidemiology
First-time nicotine users develop a dependence about 32% of the time.[40] There are approximately 976 million smokers in the world.[41] Estimates are that half of smokers (and one-third of former smokers) are dependent based on DSM criteria, regardless of age, gender or country of origin, but this could be higher if different definitions of dependence were used.[42] Recent data suggest that, in the United States, the rates of daily smoking and the number of cigarettes smoked per day are declining, suggesting a reduction in population-wide dependence among current smokers.[43] However, there are different groups of people who are more likely to smoke than the average population, such as those with low education or low socio-economic status and those with mental illness.[43] There is also evidence that among smokers, some subgroups may be more dependent than other groups.[citation needed] Men smoke at higher rates than do women and score higher on dependence indices; however, women may be less likely to be successful in quitting, suggesting that women may be more dependent by that criterion.[43][44] There is an increased frequency of nicotine dependence in people with anxiety disorders.[12] 6% of smokers who want to quit smoking each year are successful at quitting.[45] Nicotine withdrawal is the main factor hindering smoking cessation.[46] A 2010 World Health Organization report states, "Greater nicotine dependence has been shown to be associated with lower motivation to quit, difficulty in trying to quit, and failure to quit, as well as with smoking the first cigarette earlier in the day and smoking more cigarettes per day."[47] E-cigarettes may result in starting nicotine dependence again.[48] Greater nicotine dependence may result from dual use of traditional cigarettes and e-cigarettes.[48] Like tobacco companies did in the last century, there is a possibility that e-cigarettes could result in a new form of dependency on nicotine across the world.[49]
Concerns
Nicotine dependence results in substantial mortality, morbidity, and socio-economic impacts.
See also
Notes
Bibliography
- Stratton, Kathleen; Kwan, Leslie Y.; Eaton, David L. (January 2018). Public Health Consequences of E-Cigarettes (PDF). )
References
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- ^ a b c d e f U.S. Department of Health and Human Services (1988). The health consequences of smoking: Nicotine addiction: A report of the Surgeon General (PDF). U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Health Promotion and Education, Office on Smoking and Health. DHHS Publication No. (CDC) 88-8406.
- ^ a b "Tobacco". www.who.int. Retrieved 2021-04-17.
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- ^ "WHO | Gender, women, and the tobacco epidemic". WHO. Archived from the original on June 4, 2014. Retrieved 2021-04-17.
- ^ WHO global report on trends in prevalence of tobacco smoking 2000–2025, second edition. Geneva: World Health Organization. http://apps.who.int/iris/bitstream/handle/10665/272694/9789241514170-eng.pdf
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Heavy nicotine use in the form of smoking tobacco has been linked to neuropathy (Brody, 2006), often manifesting as prefrontal gray matter atrophy (Gallinat et al., 2006; Zhang et al., 2011). Conversely, consumption of nicotine via smoking has been associated with higher white matter volume (Gazdzinski et al., 2005; Yu et al., 2011). Studies examining nicotine use via DTI have found similarly conflicting results. In chronic nicotine users, heavy consumption has been associated with lower FA (Lin et al., 2013) and higher FA (Paul et al., 2008), as well has both lower RD (Wang et al., 2017) and higher RD (Lin et al., 2013). The results of studies examining non-chronic, regular nicotine use are similarly split. Regular nicotine use has been associated with lower FA (Huang et al., 2013; Liao et al., 2011; Zhang et al., 2011) and higher FA (Hudkins et al., 2012; Wang et al., 2017). These seemingly conflicting nicotine results may be partly accounted for by the developmental stage in which it is consumed, with higher FA more commonly observed in younger nicotine users (Hudkins et al., 2012; Jacobsen et al., 2007). Alternatively, it maybe that the association between nicotine use and higher FA in adolescents is temporary, eventually leading to microstructural declines with chronic use. Future longitudinal studies could formally address this theory.
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- ^ a b c d e f Fiore, MC; Jaen, CR; Baker, TB; et al. (2008). Treating tobacco use and dependence: 2008 update (PDF). Rockville, MD: U.S. Department of Health and Human Services, U.S. Public Health Service. Archived from the original (PDF) on 2016-03-27. Retrieved 2016-09-02.
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- ^ "CelticPharma: TA-NIC Nicotine Dependence". Archived from the original on 2009-12-06. Retrieved 2009-10-27.
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- ^ a b c "Current Cigarette Smoking Among Adults — United States, 2005–2013". Morbidity and Mortality Weekly Report (63). Centers for Disease Control and Prevention: 1108–1112. 2014.
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External links
- Fagerstrom Test of Nicotine Dependence (Heatherton et al., 1991)
- Heaviness of Smoking Index (Heatherton et al., 1989) Archived 2017-02-02 at the Wayback Machine
- Diagnostic and Statistical Manual of Mental Disorders V (DSM-V)
- Tobacco Dependence Screener (Kawakami et al., 1999) Archived 2016-09-27 at the Wayback Machine
- Nicotine Dependence Syndrome Scale (NDSS; Shiffman, Waters & Hickcox, 2004)
- Cigarette Dependence Scale (Etter et al., 2003)
- Wisconsin Inventory of Smoking Dependence Motives (Piper et al., 2004)