Nicotine dependence
[2] Of the 34 million smokers in the United States in 2018, 74.6% smoked every day, indicating the potential for some level of nicotine dependence.
[19] Evidence-based treatments—including medications such as nicotine replacement therapy, bupropion, varenicline, or cytisine, and behavioral counseling—can double or triple a smoker’s chances of successfully quitting.
[20] 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] The long use of Fagerström Test for Nicotine Dependence is supported by the existence of significant preexisting research, and its conciseness.
[6] 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..."[6] 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.
[29] Nicotine is a parasympathomimetic stimulant[16] that binds to and activates nicotinic acetylcholine receptors in the brain,[17] which subsequently causes the release of dopamine and other neurotransmitters, such as norepinephrine, acetylcholine, serotonin, gamma-aminobutyric acid, glutamate, endorphins,[30] and several neuropeptides.
[30] This upregulation or increase in the number of nicotinic receptors significantly alters the functioning of the brain reward system.
[30] Its physiological effects stem from the stimulation of nicotinic acetylcholine receptors, which are located throughout the central and peripheral nervous systems.
[35] These symptoms can include cravings for nicotine, anger, irritability, anxiety, depression, impatience, trouble sleeping, restlessness, hunger, weight gain, and difficulty concentrating.
[40] Increasing evidence indicates that the genetic variant CHRNA5 predicts the response to smoking cessation medicine.
[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.
[citation needed] Evidence-based medicine can double or triple a smoker's chances of quitting successfully.
[20] Mental health conditions, especially Major depressive disorder, may also impact the success of attempts to quit smoking.
[42] 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.
[citation needed] There is no consensus for remedies for tobacco use disorder among pregnant smokers who also use alcohol and stimulants.
[42] 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.
[20] A non-invasive, brain-based therapy called rTMS (repetitive transcranial magnetic stimulation) gained FDA approval in 2020 for treating nicotine addiction and aiding the quitting process.
[54] 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.
[51] Nicotine dependence is a serious public health concern due to it being one of the leading causes of avoidable deaths worldwide.
[57] 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.
