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Nicotine Addiction: Philippine College of Chest Physicians Council On Tobacco or Health & Air Pollution

This document discusses nicotine addiction through cigarettes. It states that cigarettes are the most efficient delivery device for nicotine, better than intravenous administration. Nicotine causes biological and psychological dependence through its effects on the brain, including increasing nicotinic receptors and releasing chemicals like dopamine. Withdrawal symptoms occur when nicotine levels drop, maintaining the addiction. Both positive and negative reinforcement perpetuate regular smoking behavior and nicotine intake. To overcome addiction, interventions must address biological, psychological, and socio-cultural factors.

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73 views16 pages

Nicotine Addiction: Philippine College of Chest Physicians Council On Tobacco or Health & Air Pollution

This document discusses nicotine addiction through cigarettes. It states that cigarettes are the most efficient delivery device for nicotine, better than intravenous administration. Nicotine causes biological and psychological dependence through its effects on the brain, including increasing nicotinic receptors and releasing chemicals like dopamine. Withdrawal symptoms occur when nicotine levels drop, maintaining the addiction. Both positive and negative reinforcement perpetuate regular smoking behavior and nicotine intake. To overcome addiction, interventions must address biological, psychological, and socio-cultural factors.

Uploaded by

eijneb nasihub
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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1

Nicotine Addiction
PHILIPPINE COLLEGE OF CHEST PHYSICIANS
Council on Tobacco or Health & Air
Pollution
2

Three-Link Chain of Tobacco Dependence


Biological Dependence
(Physically)
Psychological Dependence
(Mentally)
Socio-cultural Factors
(Peers, curiosity)
Substance Dependence
DSM-IV
 Tolerance
 Withdrawal
 Substance taken in larger amounts or over a longer period than
intended
 Persistent desire or unsuccessful efforts to cut down or control
 Great deal of time spent in activities necessary to obtain or use
 Important social, occupational or recreational given up or
reduced because of use
 Continued use despite having had a persistent or recurrent
physical or psychological problem caused or exacerbated by
substance

Ref: Koh JS. Int J Dermatol 41:21-27, 2002


Cigarettes and Nicotine Dependence
 Most efficient delivery device for
nicotine that exists – better than
intravenous

 Cigarette manufacturers have


modified cigarettes over the past
decades to maximize nicotine
delivery to the brain

 High doses of arterial nicotine


cause up regulation of the nicotine
acetylcholine receptors

 Genetic factors influence tobacco


dependence

 Left untreated 60% of smokers die


from a tobacco-caused disease
Ref: RD, Robertson CR JAMA 260:1173, 1998
NICOTINE
Not a carcinogen

Liquid in its native state

Distilled from burning tobacco and carried on tar


droplets
Inhalation – peak arterial concentration 2-4x venous
concentrations (faster absorption than intravenous)
Half life of 120 minutes (2 hours)
Nicotine changes the brain chemistry
Nicotine increases the number of nicotinic receptors in the
brain
Nicotine receptors are triggered by cues to desire smoking
When the receptors are empty, cravings and urges arise
With 1-2 puffs of a cigarette, 50% occupancy of the
nicotinic receptors in the brain that may last for 3 hours
after smoking
One cigarette may fill 88% receptor and reduces the
craving
Nicotine Withdrawal
DSM-IV

Dysphoric or depressed mood


Insomnia
Irritability, frustration or anger
Anxiety
Difficulty concentrating
Restlessness
Decreased heart rate
Increased appetite or weight gain
Nicotine:
CNS Actions

10 seconds to
reach the
brain!
Nicotine:
CNS Actions

2 2
4 2 4

42
Nicotinic
Receptor

 Nicotine binds preferentially to nicotinic acetylcholinergic (nACh) receptors


in the central nervous system; the primary is the 42 nicotinic receptor in
the Ventral Tegmental Area (VTA)
 Results in a release of dopamine in the Nucleus Accumbens (nAcc) which is
believed to be linked to reward
Nicotine Releases Chemicals in
the Brain
Dopamine Pleasure, calmness,
appetite suppression
Norepinephrine Arousal, appetite
suppression
Acetylcholine Arousal, cognitive
enhancement
Nicotine
Vasopressin Memory improvement

Serotonin Mood modulation,


appetite suppression
Beta-endorphin Reduction of anxiety
and tension
Benowitz, 1999
Smoking Saturates 42 Nicotinic
Receptors (PET scan)
PET scan 2-FA radioligand visualization of brain 42
(nAChRs)
MRI

kBq/mL
9

0.0 0.1 Cigarette 0.3 1.0 3.0 Nondisplaceable


Cigarette (1-2 puffs) Cigarette Cigarette Cigarette
50% occupancy 88% R occup
of R x 3.1 hr Reduced
craving
Blood Nicotine Concentrations
in Smokers
10-30% of 10 mgs of nicotine in a cigarette is absorbed
Blood nicotine concentration (ng/mL) n = 10

50 •Nicotine’s half-life is 2
hours
•Nicotine levels persist for 6
40 to 8 hours after cessation of
smoking*
(3–4 half-lives)
3
0
2
0
1
00 0800 1200 1600 2000 2400 0400 0800
Clock time Benowitz et al, 1983
*Serum level decreases by 75%;
Accounts for severe physiologic withdrawal commonly accompanied awakening
Pharmacokinetics of Nicotine
Pulse Doses Serve as Re-inforcer
Peak is due to rapid delivery from smoke into arterial blood,
Related to psychoactive effect* and addiction potential
Nicotine blood level (µg/ml)

Threshold level
InitiaFall in bloodfor
l fallLevel duewithdrawal
to
in metabolism
symptoms
blood
level
Cigarette Smoked Cigarette Smoked Cigarette Smoked

Time
* due to
Means to control mood, appetite, body weight
J Respir Dis 1998

sustain cognitive performance on which smokers rely


Nicotine Tolerance & Increased Addiction
Dopamine
Dopamine
 Self regulated nicotine intake
 frequency of cigarette consumption
 the intensity of inhalation
Nicotine
Nicotine
 Tolerance to long-term nicotine
 desensitization of nicotine receptors in
the VTA1
 the up-regulation (increased number) of
nicotine receptors

 Withdrawal symptoms and cravings


 A drop in nicotine level
 Decreased sensitivity of the nicotinic Satisfacti
receptor
on
1. Schroeder SA. JAMA. 2005;294:482. 2.
Jarvis MJ. BMJ. 2004; 328:277
Nicotine Maintains Addiction
Positive reinforcement (Direct receptor
stimulation)
Powerful reinforcement effect of 1st cigarette
of the day

Negative reinforcement (Avoidance of


withdrawal signs and symptoms)
200-300 discrete boluses of nicotine to the brain
per day
16

3-Link Chain must be cut-off!


Brief Intervention
Intensive Intervention
 Medical treatment –
addresses withdrawal
ADDICTION symptoms
 Intensive Counseling –
addresses the psychological
and behavioral (socio-cultural)
component of the addiction

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