Understanding nicotine addiction and physical withdrawal process

Article Abstract:

Drug addiction or drug dependence refers to a condition in which a psychoactive substance (one that affects the mind) is repeatedly and voluntarily consumed. Psychoactivity of a substance is determined by its capacity to affect the central nervous system and induce sensations of pleasure or pain. Addictive drugs are pleasurable to use because they lead to such consequences as mood elevation or prevention of withdrawal reactions. Tolerance is a phenomenon that often accompanies frequent drug use, whereby previously effective doses become insufficient to produce the same positive effect. As a result, the addict needs to consume ever-larger quantities of the substance. Nicotine addiction meets all the above criteria for classification as drug addiction. Although most cigarettes contain about 10 mg of nicotine, variations in smoking style result in an actual nicotine intake of less than one mg to several mg per cigarette. It is an ideal addictive drug, since the smoker can thereby control the quantity of nicotine ingested. Nicotine content as determined in laboratory studies that use smoking machines is almost meaningless for estimating the amount of drug a person actually uses. Tobacco is toxic and has been shown to be as addictive as heroin. Nicotine addiction is treated increasingly often with programs that are similar to other drug addiction programs. The suggestion has been made by some that nicotine is not addictive but, rather, the act of smoking is behaviorally rewarding. This has been disproven by studies demonstrating the psychoactive power of nicotine. It is five to ten times more powerful than cocaine and a thousand times more powerful than alcohol in its ability to alter mood and behavior. Nicotine is a 'euphoriant', a drug that elevates mood, alleviates anxiety and boredom, and can function as a reward in animal studies. Tolerance to nicotine is maintained by constant intake of large amounts that could not have been tolerated by the body during early use. Withdrawal reactions such as craving, mood change, and altered heart rate may begin after abstinence of six to 10 hours. Nicotine gum relieves many symptoms of withdrawal but is not 'liked' by many patients, highlighting the importance of the behavioral component of this addiction. Use of nicotine polacrilex gum must be guided by awareness of all the symptoms of nicotine addition, including the psychological ones. This gum provides less nicotine than many people receive in cigarettes, but it can prevent the symptoms of withdrawal. Its dose should be carefully determined to avoid precipitating a relapse. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Physiological aspects, Nicotine, Drug abuse, Tobacco

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Psychopharmacologic treatment of cigarette smoking

Article Abstract:

The development of drugs that help people stop smoking has enabled dentists as well as physicians to treat this addictive disorder. Most treatments such as group therapy, hypnosis, or aversive conditioning (in which an unpleasant event is associated with smoking) have a success rate of between 15 and 30 percent after one year. The only drug currently approved by the Food and Drug Administration (FDA) for treating nicotine addiction is nicotine polacrilex gum, which must be properly administered. Dentists are ideally situated to instruct patients in correct use of the gum, since its effectiveness depends on proper chewing. To help patients, clinicians must be aware of the reinforcing (rewarding) aspects of smoking, including its physiological and social aspects, as well as the sense of deprivation that accompanies giving it up. Treatment usually focuses on helping patients handle withdrawal symptoms and their cravings for cigarettes. Since the only nicotine obtained from nicotine gum is that which is absorbed through the mucous membranes of the cheek, the user must be taught to chew slowly for maximum absorption. The gum is intended to supply a constant, low level of nicotine, instead of the rapid rises associated with cigarette smoking; therefore, new pieces should be rationed accordingly. It is not intended for use with cigarettes; the patient must stop smoking entirely. Treatment should last several months, since behavioral change may take this long. Polacrilex gum costs $10 to $30 per box but is ultimately cheaper than cigarettes, which may cost a smoker $30 to $90 per month. Patients enrolled in a gum program may blame the gum if they develop mouth sores, but these seem to develop anyway when people stop smoking. The success of a smoking-cessation program depends on following recommendations and willingness to change life-style elements that encourage smoking. It is especially important that smokers not believe they can smoke if they need to. Dentists are encouraged to advise all smokers to quit and to help the most highly motivated patients by offering nicotine polacrilex gum and a supportive treatment program. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Nicotine reduction therapy and relapse prevention for heavy smokers: 3-year follow-up

Article Abstract:

Nicotine polacrilex is a drug designed for use with behavior modification therapy to help people stop smoking. It has proven superior to placebo (inactive) drugs in several published studies. The 1988 report of the Surgeon General contained several conclusions relevant to this product. These include the following: nicotine is addictive; many smokers are now heavy smokers; nicotine replacement therapy has been shown to be successful; nicotine polacrilex therapy is best when used with behavior modification techniques; and prevention of relapse is essential for successful nicotine withdrawal treatment. The Cooper/Clayton method of smoking cessation for heavy smokers (25 cigarettes or more per day) is discussed. This program replaces cigarettes with nicotine polacrilex, then gradually eliminates nicotine polacrilex, and provides support groups during the treatment program. The three-year success rate for this program was 36 percent, an encouraging figure. Patients' individual nicotine habits must be taken into account in designing their treatment. Suggestions are provided for proper use of nicotine polacrilex. (Consumer Summary produced by Reliance Medical Information, Inc.)

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