Abstract
Nicotine sustains addictive tobacco use, which in turn causes much premature disability
and death. The essence of drug addiction is loss of control of drug use. Molecular
biology studies suggest that the α4β2 nicotinic acetylcholine receptor subtype is the main receptor mediating nicotine
dependence. Nicotine acts on these brain nicotinic cholinergic receptors to facilitate
neurotransmitter release (dopamine and others), producing pleasure, stimulation, and
mood modulation. Neuroadaptation develops with repeated exposure to nicotine, resulting
in tolerance to many of the effects of nicotine. When a smoker stops smoking, a nicotine
withdrawal syndrome ensues, characterized by irritability, anxiety, increased eating,
dysphoria, and hedonic dysregulation, among other symptoms. Smoking is also reinforced
by conditioning, such that specific stimuli that are psychologically associated with
smoking become cues for an urge to smoke. These include the taste and smell of tobacco,
as well as particular moods, situations, and environmental cues. Pharmacotherapies
to aid smoking cessation should ideally reduce nicotine withdrawal symptoms and block
the reinforcing effects of nicotine obtained from smoking without causing excessive
adverse effects. Further, given the important role of sensory effects of smoking and
psychoactive effects of nicotine, counseling and behavioral therapies are important
adjuncts to and substantially augment the benefits of pharmacotherapy.
Keywords
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Article Info
Footnotes
Statement of conflict of interest: Please see Author Disclosures section at the end of this article.
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