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https://en.wikipedia.org/w/index.php?title=Nicotine_dependence&oldid=1059876183 04:46, 12 December 2021 Nicotine dependence

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Nicotine dependence
Other names: tobacco dependence;[3] cigarette dependence;[4] tobacco use disorder;[5] nicotine use disorder[6]
Video explanation
SpecialtyFamily medicine[7]
SymptomsThis disorder may involve using for over an extended length of time than was intended, ongoing urge to use, use leading to work or school issues, and not quitting despite physical or physiological issues from such use.[8]
DurationLong-term[9]
Risk factorsRisk factors include family history,[1] being poor, lower education,[10] attention deficit hyperactivity disorder, conduct disorder, depression, anxiety, personality disorders, psychosis, and other substance use disorders.[11] There are genetic risk factors for developing a dependence.[12]
TreatmentCounselling,[13] US Food and Drug Administration (FDA)-approved medications[13]
MedicationNicotine replacement products,[9] bupropion,[9] varenicline,[9] nicotine gum,[14] nicotine patch[14]
FrequencyThere were approximately 1.1 billion smokers globally in 2019.[15]
DeathsTobacco use leads to more than 8 million deaths per year.[16] This number comprises about seven million as a result of direct tobacco use and about 1.2 million passive smokers.[17]

Nicotine dependence is a state of dependence with nicotine use that can result in unwanted effects such as profound motor impairment.[18] This may involve using for over an extended length of time than was intended, ongoing urge to use, use leading to work or school issues, and not quitting despite physical or physiological issues from such use.[8] Drug addiction is a brain disorder involving the reward system.[19] Nicotine dependence is a chronic, relapsing disease defined as a compulsive craving to use the substance, loss of control over substance intake, and emergence of withdrawal symptoms upon discontinuing use,[20] despite harmful social consequences.[21] Nicotine dependence develops over time as a person continues to use nicotine.[22] Greater than 70% of smokers wish to quit, though the majority who try to quit relapse in less than a year.[20] Around 50% of smokers try to stop every year, and of those that make an effort to stop, just 6% maintain long-term smoking abstinence.[9]

In 1610, Francis Bacon noted that the ones who became accustomed to using tobacco, subsequently they rarely stopped using it.[23] Nicotine addiction and dependence is particularly potent in children and young adults.[24] First-time nicotine users develop a dependence reportedly 32% of the time.[25] Higher nicotine dependence is linked with reduced desire to quit, struggling in attempting to quit, and not being able to quit.[26] Risk factors include family history,[1] being poor, lower education,[10] attention deficit hyperactivity disorder, conduct disorder, depression, anxiety, personality disorders, psychosis, and other substance use disorders.[11] There are genetic risk factors for developing a dependence.[12] For instance, genetic markers for a specific type of nicotinic receptor (the 15q25.1 nicotinic receptors) have been linked to increased risk for dependence.[27] There are various diagnostic approaches to identifying nicotine dependence.[3] People with the disorder may smoke within a half hour of waking, may wake up at night to smoke,[11] and most develop cravings when refraining from smoking for several hours.[28]

Evidence-based medicine such as bupropion, nicotine gum, nicotine inhaler, nicotine lozenge, nicotine nasal spray, nicotine patch, and varenicline, can double or triple a smoker's chances of quitting successfully.[14] It is recommended that health care professionals discuss with all adults regarding tobacco use and provide counselling and US Food and Drug Administration (FDA)-approved medications to adults who are not pregnant and use tobacco.[13] First-line medications recommended by the US Department of Health and Human Services are nicotine replacement products, bupropion, and varenicline.[9] For pregnant females using tobacco, it is recommended that health care professionals tell them to quit, and offer them counselling to quit.[13] There is a lack of evidence on the usefulness of electronic cigarettes for quitting tobacco smoking in adults and pregnant females as of 2021.[13] There is insufficient evidence on the efficacy of heated tobacco products for quitting smoking as of 2018.[29] The ability to stop using tobacco following one attempt is under 5%; although, reportedly 50% of tobacco users are able to stop following multiple attempts.[11] Tobacco use leads to more than 8 million deaths per year[16] and kills up to half its users.[30]

There were approximately 1.1 billion smokers globally in 2019.[15] The use of tobacco products, no matter what type, is almost always started and established during adolescence when the developing brain is most vulnerable to nicotine addiction.[31] Nicotine dependence is pervasive among adolescents.[6] Among US adults in 2018, 19.7% (estimated 49.1 million) currently used any tobacco product.[32] Cigarettes were the most commonly used tobacco product (13.7%; 34.2 million) and daily use was reported by 74.6% of cigarette smokers.[32] Adult males and females in the US develop a nicotine dependence at similar rates, but in many developing countries smoking among males is distinctly higher.[11] Of those who smoke daily, about 50% meet the DSM-5 criteria for ​nicotine dependence.[11] People seldom start smoking after the age of 21.[11] Nicotine dependence is a serious public health concern because it is one of the leading causes of deaths worldwide and of avoidable deaths in industrialized countries.[33] An area of concern is the public health consequences of second-hand e-cigarette aerosol on bystanders.[24]

Signs and symptoms

A National Institute on Drug Abuse video entitled Anyone Can Become Addicted to Drugs[34]

Nicotine dependence is defined as a neurobiological adaptation to repeated drug exposure that is manifested behaviorally by highly controlled or compulsive use; psychoactive effects such as tolerance, physical dependence, and pleasant effect; and nicotine-reinforced behavior, including an inability to quit despite harmful effects, a desire to quit, and repeated cessation attempts.[35] Nicotine dependence is a chronic, relapsing disease defined as a compulsive craving to use the substance,[20] despite harmful social consequences;[21] inability to control substance use; and onset of withdrawal-like symptoms when the substance is discontinued.[20] This may involve using for over an extended length of time than was intended, ongoing urge to use, use leading to work or school issues, and not quitting despite physical or physiological issues from such use.[8] People with the disorder may smoke within a half hour of waking, may wake up at night to smoke,[11] and most develop cravings when refraining from smoking for several hours.[28]

"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.[22] Nicotine produces at least two distinct types of tolerance: chronic tolerance, which develops over a period of days and can be observed in experienced smokers even following a period of abstinence, and acute tolerance, which develops over a period of minutes to hours.[30] In clinical studies, it is generally presumed that chronic tolerance has developed in habitual smokers, allowing for comparisons to be made between groups both with (i.e., smokers) and without (i.e., nonsmokers) chronic tolerance to nicotine.[30] Acute tolerance, on the other hand, occurs as rapidly as after one dose of nicotine and clinically can be observed in both experienced smokers as well as nicotine-naïve individuals.[30] Physical dependence on the drug can also occur, and is characterized by a withdrawal syndrome that usually accompanies drug abstinence.[22]

Nicotine in the context of cigarette smoking is typically dosed repeatedly at semiregular intervals over the course of the day.[30] This leads to cycles of receptor activation and desensitization, and accumulating evidence suggests that both states contribute to the reinforcing effects of cigarette smoking.[30] This pattern of behavior is generally disrupted overnight, when sleeping precludes continued nicotine dosing and leads to a period of nighttime abstinence, with subsequent withdrawal symptoms occurring when waking in the morning.[30] Thus, the first cigarette is smoked on a baseline that differs from every other cigarette during the day.[30]

Acute tolerance to the subjective effects of nicotine is thought to be responsible for the finding that smokers report the first cigarette of the day as the most pleasurable.[30] The subjective effects of nicotine in cigarette smokers are influenced by both chronic and acute tolerance to nicotine.[30] By extension, the subjective effects of nicotine differ as a function of duration of abstinence and thus are likely to change over the course of smoking-cessation treatments.[30] For example, both chronic and acute nicotine tolerance can lead to decreases in some subjective measures of smoking.[30]

External video
- 4 months quitting nicotine documented

After cessation of drug use, there is a strong tendency to relapse.[22] Greater than 70% of smokers wish to quit, though the majority who try to quit relapse in less than a year.[20] Around 50% of smokers try to stop every year, and of those that make an effort to stop, just 6% maintain long-term smoking abstinence.[9] Nicotine dependence leads to heavy smoking and causes severe withdrawal symptoms and relapse back to smoking.[22] Stopping of chronic nicotine use causes withdrawal symptoms, and trying to avoid withdrawal symptoms is one reason that contributes to the continuation of smoking and relapse while trying to stop smoking.[20] In tobacco-dependent users of conventional cigarettes, a predictable consequence of short-term abstinence (e.g., for more than a few hours) is the onset of withdrawal symptoms indicated by self-reported behavioral, cognitive, and physiological symptoms and by clinical signs.[35] Subjective withdrawal symptoms are manifested by affective disturbance, including irritability and anger, anxiety, and depressed mood.[35] The behavioral symptoms include restlessness, sleep disturbance, and increased appetite. Cognitive disturbances usually center on difficulty in concentrating.[35] Nicotine dependence develops over time as a person continues to use nicotine.[22] Teenagers do not have to be daily or long-term smokers to show withdrawal symptoms.[36] Relapse should not frustrate the nicotine user from trying to quit again.[14] A 2015 review found "Avoiding withdrawal symptoms is one of the causes of continued smoking or relapses during attempts at cessation, and the severity and duration of nicotine withdrawal symptoms predict relapse."[37] Symptoms of nicotine dependence include irritability, anger, impatience, and problems in concentrating.[38] There is an elevated rate of suicidal thoughts in people who have a nicotine dependence.[2]

Diagnosis

There are different diagnostic methods to identifying nicotine dependence.[3] Common tobacco 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."[39]

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

Biomolecular

Dopamine diagram.
Dopamine

Pre-existing cognitive and mood disorders may influence the development and maintenance of nicotine dependence.[40] Nicotine is a parasympathomimetic stimulant[41] that binds to and activates nicotinic acetylcholine receptors in the brain,[42] which subsequently causes the release of dopamine and other neurotransmitters, such as norepinephrine, acetylcholine, serotonin, gamma-aminobutyric acid, glutamate, endorphins,[43] and several neuropeptides.[44] Nicotine stimulates the sympathetic nervous system.[45] Repeated exposure to nicotine can cause an increase in the number of nicotinic receptors, which is believed to be a result of receptor desensitization and subsequent receptor upregulation.[43] This upregulation or increase in the number of nicotinic receptors significantly alters the functioning of the brain reward system.[46] With constant use of nicotine, tolerance occurs at least partially as a result of the development of new nicotinic acetylcholine receptors in the brain.[43] After several months of nicotine abstinence, the number of receptors go back to normal.[42] Nicotine also stimulates nicotinic acetylcholine receptors in the adrenal medulla, resulting in increased levels of adrenaline and beta-endorphin.[43] Its physiological effects stem from the stimulation of nicotinic acetylcholine receptors, which are located throughout the central and peripheral nervous systems.[47] Chronic nicotinic acetylcholine receptor activation from repeated nicotine exposure can induce strong effects on the brain, including changes in the brain's physiology, that result from the stimulation of regions of the brain associated with reward, pleasure, and anxiety.[48] These complex effects of nicotine on the brain are still not well understood.[48]

When these receptors are not occupied by nicotine, they are believed to produce withdrawal symptoms.[49] These symptoms can include cravings for nicotine, anger, irritability, anxiety, depression, impatience, trouble sleeping, restlessness, hunger, weight gain, and difficulty concentrating.[50]

Neuroplasticity within the brain's reward system occurs as a result of long-term nicotine use which leads to nicotine dependence.[18] There are genetic risk factors for developing dependence.[12] For instance, genetic markers for a specific type of nicotinic receptor (the 15q25.1 nicotinic receptors) have been linked to increased risk for dependence.[27] The most well-known hereditary influence related to nicotine dependence is a mutation at rs16969968 in the nicotinic acetylcholine receptor CHRNA5, resulting in an amino acid alteration from aspartic acid to asparagine.[51] The single-nucleotide polymorphisms rs6474413 and rs10958726 in CHRNB3 are highly correlated with nicotine dependence.[52] Heavy smoking is strongly related to the single-nucleotide polymorphisms rs16969968 and rs1051730 situated in the nicotinic receptor gene group CHRNA5-A3-B4.[53] Many other known variants within the CHRNB3–CHRNA6 nicotinic acetylcholine receptors are also correlated with nicotine dependence in certain ethnic groups.[52] There is a relationship between CHRNA5-CHRNA3-CHRNB4 nicotinic acetylcholine receptors and complete smoking cessation.[54] Increasing evidence indicates that the genetic variant CHRNA5 predicts the response to smoking cessation medicine.[54]

Substance dependence is usually linked to a degeneration of grey matter.[55] However, significantly less is understood regarding the outcome of white matter, which represents more than half of the size of the human brain.[55] The evidence of the effect of nicotine on white matter microstructure of the human brain shows apparently mixed finding.[55] Nicotine use may induce alterations in white matter microstructure.[55] The effect of these alterations is typically unfavorable, such as possibly resulting in decreased fractional anisotropy values.[55]

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.[46]

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., chew, snus, pipes, hookah, e-cigarettes).[citation needed] Evidence-based medicine such as bupropion, nicotine gum, nicotine inhaler, nicotine lozenge, nicotine nasal spray, nicotine patch, and varenicline, can double or triple a smoker's chances of quitting successfully.[14] It is recommended that health care professionals discuss with all adults regarding tobacco use and provide counselling and US Food and Drug Administration (FDA)-approved medications to adults who are not pregnant and use tobacco.[13] For pregnant females using tobacco, it is recommended that health care professionals tell them to quit, and offer them counselling to quit.[13] There is a lack of evidence on the usefulness of electronic cigarettes for quitting tobacco smoking in adults and pregnant females as of 2021.[13] There is insufficient evidence on the efficacy of heated tobacco products for quitting smoking as of 2018.[29] The ability to stop using tobacco following one attempt is under 5%; although, reportedly 50% of tobacco users are able to stop following multiple attempts.[11]

Medication

There are eight major evidence-based medications for treating nicotine dependence: bupropion, cytisine (not approved for use in some countries, including the US), nicotine gum, nicotine inhaler, nicotine lozenge/mini-lozenge, nicotine nasal spray, nicotine patch, and varenicline.[56] These medications have been shown to significantly improve long-term (i.e., 6-months post-quit day) abstinence rates, especially when used in combination with psychosocial treatment.[14] The nicotine replacement products (i.e., patch, lozenge, gum) are dosed based on how dependent a smoker is—people who smoke more cigarettes or who smoke earlier in the morning use higher doses of nicotine replacement products.[citation needed] First-line medications recommended by the US Department of Health and Human Services are nicotine replacement products, bupropion, and varenicline.[9] There is no consensus for remedies for tobacco use disorder among pregnant smokers who also use alcohol and stimulants.[5]

Vaccines

Studies on developing nicotine vaccines have been conducted.[57] Nicotine vaccines may help in treating nicotine addiction, but they have not been approved for use.[57] No country has licensed the use of nicotine vaccines.[58] As of 2011, the nicotine conjugate vaccine has been under development as a way to treat nicotine dependence.[59] There is a lack of proof that nicotine vaccines improve the chances of quitting smoking in the long‐term.[58]

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.[56] 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.[14]

Prevalence

Various types of tobacco products include waterpipe tobacco, smokeless tobacco products, cigars, cigarillos, roll-your-own tobacco, pipe tobacco, bidis, and kreteks.[16] The most commonly used tobacco product is cigarettes.[16] Electronic cigarettes[60] and heated tobacco products are becoming more popular.[61] There were approximately 976 million smokers globally in 2014[62] and approximately 1.1 billion smokers globally in 2019.[15]

Almost 90% of adult daily smokers started smoking by the age of 18, and about 2,000 youth under 18 smoke their first cigarette every day in the US.[31] The use of tobacco products, no matter what type, is almost always started and established during adolescence when the developing brain is most vulnerable to nicotine addiction.[31] Nicotine dependence is pervasive among adolescents.[6] People seldom start smoking after the age of 21.[11]

Among US adults in 2018, 19.7% (estimated 49.1 million) currently used any tobacco product, 16.5% (41.2 million; 83.8% of current tobacco users) used any combustible tobacco product, and 3.7% (9.3 million; 18.8% of current tobacco users) used ≥2 tobacco products.[32] Cigarettes were the most commonly used tobacco product (13.7%; 34.2 million).[32] Among current tobacco product users, daily use was reported by 74.6% of cigarette smokers, 59.1% of smokeless tobacco users, 42.6% of e-cigarette users, and 15.8% of cigar smokers.[32] Adult males and females in the US develop a nicotine dependence at similar rates, but in many developing countries smoking among males is distinctly higher.[11] Of those who smoke daily, about 50% meet the DSM-5 criteria for nicotine dependence.[11]

Historical context of cigarette use and evidence for disease induction

When evaluating the adverse effects associated with acute and chronic exposure to e-cigarette aerosols, reflection on events that led to the rise in cigarette popularity in the last century is warranted.[63] Tobacco consumption in the early 1800s was largely through the use of snuff, chewing tobacco, or cigars.[63] Cigarettes did not gain attention until the early 1900s.[63] The rise in popularity of cigarettes was due to several key events, one of which was the ways in which tobacco was cured.[63] Previous methods to cure tobacco leaves included fire curing, air curing, and sun curing, all of which created a product that was harsh on the lungs when inhaled, thus making smoking a less desirable consumption method.[63] During the 1830s in North Carolina, flue curing was adapted.[63] Here, tobacco leaves are hung on tier-poles that was fed from external fire boxes which slowly increases the temperature indirectly.[63] This curing method increases the sugar content of the tobacco leaves, which makes the tobacco product much more tolerable when inhaled as smoke.[63] Another key hallmark in the rising cigarette popularity was the introduction of safety matches in the 1850s.[63] The next event that led to a rise in cigarette popularity was the invention of an automated cigarette rolling machine by James Bonsack in 1881.[63] This machine could roll 200 cigarettes per minute.[63] Current-day cigarette rolling machines produce in excess of 273 cigarettes every second.[63] American cigarette company Phillip Morris produces in excess of 730 million cigarettes every day.[63] As cigarette smoking was gaining popularity, two notable events played significant roles in facilitating their mass consumption: war rations and mass advertising.[63] Predominantly during World War I, soldiers would have cartons of cigarettes included in their rations.[63] Cigarettes were also the most widely advertised consumer product of the time.[63] Together, these events led to the peak prevalence of cigarette smoking, with approximately 67% of American men smoking cigarettes in the 1950s.[63]

Despite the rapid rise in cigarette use, the health consequences of tobacco smoke were largely unknown.[63] Even before the popular use of cigarettes, one of the first observations of possible adverse health consequences of tobacco use came in 1761, when John Hill associated the use of tobacco snuff as the cause of nasal polyps.[63] Other links between tobacco and adverse health effects emerged in the early 1900s when the German physician Hermann Rottmann noticed a correlation between women who worked at tobacco factories and an increased incidence of lung cancer, which he speculated may be the result of inhaled tobacco dust.[63] It was not until the 1950s that there was an experimental link between tobacco and cancer with a publication led by Ernst Wynder showing that tobacco tars, when applied to the dorsal area of mice, caused tumors.[63] A combination of experimental and epidemiological association led to the US Surgeon General declaration in 1964 that smoking cigarettes is related to cancer.[63] Currently, tobacco smoking is known to cause a wide range of diseases with high mortality.[63] This includes the two most common lung diseases: COPD, which causes an estimated 3.17 million deaths worldwide, and lung cancer, contributing to 1.76 million deaths in 2018 alone.[63]

Epidemiology

Tobacco consumption has been present in the Americas since prehistoric times.[64] After tobacco was introduced from indigenous inhabitants of the Western hemisphere to Europeans through members of Columbus' crew, the effects of tobacco use have been a subject of scientific controversy.[64] In the 16th century, the Spaniard physician and botanist Nicolás Monardes published a book explaining the therapeutic effects of tobacco use for dozens of health problems.[64] Although in the 17th century, King James I of England spoke about the dangerous effects of tobacco, the systematic observations of the negative health effects of tobacco took longer than expected.[64] In the first part of the 20th century, pathologists observed a strong association between lung cancer and cigarette smoking.[64] The rate of smoking peaked in the 1960s, with about 42% of the adult population in the US being tobacco smokers in 1965.[64] By 2019, however, the smoking rate among adults aged 18 years or older went down to 14.0%.[64]

Cigarette smoking is still the leading cause of preventable death, contributing to chronic obstructive pulmonary disease, several types of cancer, diabetes, and cardiovascular disease, and is an additive risk factor in COVID-19.[64] In 1610, Francis Bacon noted that the ones who became accustomed to using tobacco, subsequently they rarely stopped using it.[23] Any tobacco product can be addictive.[65] Nicotine addiction and dependence is particularly potent in children and young adults.[24] Adolescents exhibit symptoms of dependence at reduced amounts of nicotine exposure in comparison to adults, and as a consequence, it is tougher to undo addiction starting in this age group in contrast to adulthood.[66] First-time nicotine users develop a dependence reportedly 32% of the time,[25] while cannabis users develop a dependence about 9% of the time.[67] Risk factors include family history,[1] being poor, lower education,[10] attention deficit hyperactivity disorder, conduct disorder, depression, anxiety, personality disorders, psychosis, and other substance use disorders.[11] 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.[68]

The research suggests 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.[69] 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.[69] Receptive hardcore smokers, who had a more positive view on quitting than ambivalent hardcore smokers, were also more nicotine dependent than ambivalent hardcore smokers.[70] This contradiction could be explained by the association between nicotine dependence and poorer health status.[70] Receptive hardcore smokers may have faced health-related problems (e.g. coughing) and other smoking-related issues (e.g. smoking restrictions) more frequently than ambivalent hardcore smokers.[70] They may have been more aware of the negative consequences of smoking and thus more positive towards quitting.[70]

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.[69][71] There is an increased frequency of nicotine dependence in people with anxiety disorders.[72] Childhood trauma may increase the chance of nicotine dependence.[73] Insular cortex dysfunction is associated with nicotine dependence.[74] 6% of smokers who want to quit smoking each year are successful at quitting.[33] Nicotine withdrawal is the main factor hindering smoking cessation.[75] 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."[26] E-cigarettes may result in starting nicotine dependence again.[76] Greater nicotine dependence may result from dual use of traditional cigarettes and e-cigarettes.[76] 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.[77]

Public health consequences

Nicotine use and addiction

Nicotine addiction impacts millions of lives across the world.[78] Nicotine dependence results in substantial mortality, morbidity, and socio-economic impacts.[33] Nicotine dependence is a serious public health concern because it is one of the leading causes of deaths worldwide and of avoidable deaths in industrialized countries.[33] The tobacco epidemic is one of the largest public health dangers, causing more than 8 million deaths per year.[16] This number comprises about seven million as a result of direct tobacco use and about 1.2 million passive smokers.[17] Tobacco kills up to half its users and is the cause of nearly 90% of all lung cancers.[30] Tobacco smoking is the leading cause of preventable disease, disability, and death in the US.[79] The medical community is concerned that e-cigarettes may escalate global nicotine dependence, particularly among adolescents who are attracted to many of the flavored e-cigarettes.[80] There is strong evidence that vaping induces symptoms of dependence in users.[81] Many organizations such the World Health Organization, American Lung Association, and Australian Medical Association do not approve of vaping for quitting smoking in youth, making reference to concerns about their safety and the potential that experimenting with vaping may result in nicotine dependence and later tobacco use.[82] An area of concern is the public health consequences of second-hand e-cigarette aerosol on bystanders.[24]

As of 2019, global health costs are expected to rise over the next decade, especially with the growing popularity of novel nicotine–delivery devices, such as e‐cigarettes, flavored and unflavored vapor nicotine–containing liquids, etc, which are highly engineered, pleasurable, and rapid in their delivery of the highly addictive nicotine.[83] Tobacco control has been an important issue in most countries across the world.[78] The costs to health care caused by the adverse effects of nicotine are extensive.[78] The entire economic cost of smoking is more than $300 billion per year in the US.[84] The challenge to health care professionals is complicated by the array of new nicotine delivery systems that are being developed and introduced in the marketplace.[22] Some of these products are produced by tobacco manufacturers; others may be marketed as devices to aid in smoking cessation.[22] These new products may be more toxic and more addicting than the products currently on the market.[22] Many children and adolescents who are experimenting with cigarettes and other forms of tobacco state that they do not intend to use tobacco in later years.[22] They are unaware of, or underestimate, the strength of tobacco addiction.[22] This addiction almost always begins during childhood or adolescence.[22] Cigarettes and other forms of tobacco are addicting in the same sense as are drugs such as heroin and cocaine.[22]

Other names

Nicotine dependence[18] is also variously known as cigarette dependence,[4] tobacco dependence,[3] tobacco addiction,[61] tobacco use disorder,[5] nicotine use disorder,[6] or nicotine substance abuse.[55]

See also

Bibliography

  • Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). American Psychiatric Association. 2013. pp. 571–574. doi:10.1176/appi.books.9780890425596.156852. ISBN 978-0-89042-555-8.
  • Stratton, Kathleen; Kwan, Leslie Y.; Eaton, David L. (January 2018). Public Health Consequences of E-Cigarettes (PDF). National Academies of Sciences, Engineering, and Medicine. National Academies Press. pp. 1–774. doi:10.17226/24952. ISBN 978-0-309-46834-3. PMID 29894118.

References

  1. ↑ 1.0 1.1 1.2 1.3 Kendler, Kenneth S; Edwards, Alexis; Myers, John; Cho, Seung Bin; Adkins, Amy; Dick, Danielle (May 2015). "The predictive power of family history measures of alcohol and drug problems and internalizing disorders in a college population". American Journal of Medical Genetics Part B: Neuropsychiatric Genetics. 168 (5): 337–346. doi:10.1002/ajmg.b.32320. ISSN 1552-4841. PMC 4466079. PMID 25946510.
  2. ↑ 2.0 2.1 Wilhelm, Kay; Wilhelm, Kay; Arnold, Karen; Niven, Heather; Richmond, Robyn (2004). "Grey Lungs and Blue Moods: Smoking Cessation in the Context of Lifetime Depression History". Australian & New Zealand Journal of Psychiatry. 38 (11–12): 896–905. doi:10.1080/j.1440-1614.2004.01489.x. ISSN 0004-8674. PMID 15555023.
  3. ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 Piper, Megan; McCarthy, Danielle; Baker, Timothy (2006). "Assessing tobacco dependence: A guide to measure evaluation and selection". Nicotine & Tobacco Research. 8 (3): 339–351. doi:10.1080/14622200600672765. ISSN 1462-2203. PMID 16801292. S2CID 22437505.
  4. ↑ 4.0 4.1 Stratton 2018, p. Dependence and Abuse Liability, 256.
  5. ↑ 5.0 5.1 5.2 Akerman, Sarah C.; Brunette, Mary F.; Green, Alan I.; Goodman, Daisy J.; Blunt, Heather B.; Heil, Sarah H. (2015). "Treating Tobacco Use Disorder in Pregnant Women in Medication-Assisted Treatment for an Opioid Use Disorder: A Systematic Review". Journal of Substance Abuse Treatment. 52: 40–47. doi:10.1016/j.jsat.2014.12.002. ISSN 0740-5472. PMC 4382443. PMID 25592332.
  6. ↑ 6.0 6.1 6.2 6.3 Cavallo, Dana A.; Krishnan-Sarin, Suchitra (2019). "Nicotine Use Disorders in Adolescents". Pediatric Clinics of North America. 66 (6): 1053–1062. doi:10.1016/j.pcl.2019.08.002. ISSN 0031-3955. PMID 31679596.
  7. ↑ Rustin, TA (1 August 2020). "Assessing nicotine dependence". Am Fam Physician. 62 (3): 579–84, 591–2. PMID 10950214.
  8. ↑ 9.0 9.1 9.2 9.3 9.4 9.5 9.6 9.7 Little, Melissa A.; Ebbert, Jon O. (2015). "The safety of treatments for tobacco use disorder". Expert Opinion on Drug Safety. 15 (3): 333–341. doi:10.1517/14740338.2016.1131817. ISSN 1474-0338. PMID 26715118.
  9. ↑ 12.0 12.1 12.2 Wittenberg, Ruthie E.; Wolfman, Shannon L.; De Biasi, Mariella; Dani, John A. (2020). "Nicotinic acetylcholine receptors and nicotine addiction: A brief introduction". Neuropharmacology. 177: 108256. doi:10.1016/j.neuropharm.2020.108256. ISSN 0028-3908. PMC 7554201. PMID 32738308.
  10. ↑ 13.0 13.1 13.2 13.3 13.4 13.5 13.6 13.7 Krist, Alex H.; Davidson, Karina W.; Mangione, Carol M.; Barry, Michael J.; Cabana, Michael; Caughey, Aaron B.; Donahue, Katrina; Doubeni, Chyke A.; Epling, John W.; Kubik, Martha; Ogedegbe, Gbenga; Pbert, Lori; Silverstein, Michael; Simon, Melissa A.; Tseng, Chien-Wen; Wong, John B. (2021). "Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Persons". JAMA. 325 (3): 265. doi:10.1001/jama.2020.25019. ISSN 0098-7484. PMID 33464343.
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  17. ↑ 20.0 20.1 20.2 20.3 20.4 20.5 Falcone, Mary; Lee, Bridgin; Lerman, Caryn; Blendy, Julie A. (2015). "Translational Research on Nicotine Dependence". Translational Neuropsychopharmacology. Current Topics in Behavioral Neurosciences. Vol. 28. pp. 121–150. doi:10.1007/7854_2015_5005. ISBN 978-3-319-33911-5. ISSN 1866-3370. PMC 3579204. PMID 26873019.
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  19. ↑ 22.00 22.01 22.02 22.03 22.04 22.05 22.06 22.07 22.08 22.09 22.10 22.11 22.12 U.S. Department of Health and Human Services (1988). The health consequences of smoking: Nicotine addiction: A report of the Surgeon General. 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.Public Domain This article incorporates text from this source, which is in the public domain.
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