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Nicotine dependence

Nicotine dependence
Other namestobacco dependence; tobacco use disorder, cigarette dependence
Video of medical explanation of nicotine dependence and its health effects
ComplicationsHealth effects of tobacco
Prognosis10-year shorter lifespan[notes 1]
Prevalence1.2 billion tobacco users globally (2022)[2]
Deaths8 million per year (2023)[3]

Nicotine dependence[notes 2] is a state of substance dependence on nicotine.[4] It is a chronic, relapsing disease characterized by a compulsive craving to use the drug despite social consequences, loss of control over drug intake, and the emergence of withdrawal symptoms.[8] Tolerance is another component of drug dependence.[9] Nicotine dependence develops over time as an individual continues to use nicotine.[9] While cigarettes are the most commonly used tobacco product, all forms of tobacco use—including smokeless tobacco and e-cigarette use—can cause dependence.[3][10] Nicotine dependence is a serious public health problem because it leads to continued tobacco use and the associated negative health effects. Tobacco use is one of the leading preventable causes of death worldwide, causing more than 8 million deaths per year and killing half of its users who do not quit.[3][11] Current smokers are estimated to die an average of 10 years earlier than non-smokers.[1]

According to the World Health Organization, "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."[12] The WHO estimates that there were 1.24 billion tobacco users globally in 2022, with the number projected to decline to 1.20 billion in 2025.[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.[13] There is an increased incidence of nicotine dependence in individuals with psychiatric disorders, such as anxiety disorders and substance use disorders.[14][15]

Various methods exist for measuring nicotine dependence.[6] Common assessment scales for cigarette smokers include the Fagerström Test for Nicotine Dependence, the Diagnostic and Statistical Manual of Mental Disorders criteria, the Cigarette Dependence Scale, the Nicotine Dependence Syndrome Scale, and the Wisconsin Inventory of Smoking Dependence Motives.[6]

Nicotine is a parasympathomimetic stimulant[16] that binds to nicotinic acetylcholine receptors in the brain.[17] Neuroplasticity within the brain's reward system, including an increase in the number of nicotine receptors, occurs as a result of long-term nicotine use and leads to nicotine dependence.[4] In contrast, the effect of nicotine on human brain structure (e.g., gray matter and white matter) is less clear.[18] Genetic risk factors contribute to the development of dependence.[19] For instance, genetic markers for specific types of nicotinic receptors (the α5–α3–β4 nicotinic receptors) have been linked to an increased risk of 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]

  1. ^ a b Banks, Emily; Joshy, Grace; Weber, Marianne F; Liu, Bette; Grenfell, Robert; Egger, Sam; Paige, Ellie; Lopez, Alan D; Sitas, Freddy; Beral, Valerie (2015-02-24). "Tobacco smoking and all-cause mortality in a large Australian cohort study: findings from a mature epidemic with current low smoking prevalence". BMC Medicine. 13 (1). doi:10.1186/s12916-015-0281-z. ISSN 1741-7015. PMID 25857449.
  2. ^ a b World Health Organization (2024-01-16). WHO global report on trends in prevalence of tobacco use 2000–2030 (PDF). World Health Organization. p. 19. ISBN 978-92-4-008828-3. Retrieved 2024-10-04.
  3. ^ a b c "Tobacco". www.who.int. 2024-07-31. Retrieved 2024-10-04.
  4. ^ a b c Cite error: The named reference D'Souza2011 was invoked but never defined (see the help page).
  5. ^ Stratton 2018, p. Dependence and Abuse Liability, 256.
  6. ^ a b c Cite error: The named reference PiperMcCarthy2006 was invoked but never defined (see the help page).
  7. ^ Cite error: The named reference AkermanBrunette2015 was invoked but never defined (see the help page).
  8. ^ 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.
  9. ^ a b Cite error: The named reference SG1988 was invoked but never defined (see the help page).
  10. ^ Jankowski, Mateusz; Krzystanek, Marek; Zejda, Jan Eugeniusz; Majek, Paulina; Lubanski, Jakub; Lawson, Joshua Allan; Brozek, Grzegorz (2019-06-27). "E-Cigarettes are More Addictive than Traditional Cigarettes-A Study in Highly Educated Young People". International Journal of Environmental Research and Public Health. 16 (13): 2279. doi:10.3390/ijerph16132279. ISSN 1660-4601. PMC 6651627. PMID 31252671.
  11. ^ Doll, Richard; Peto, Richard; Boreham, Jillian; Sutherland, Isabelle (2004-06-22). "Mortality in relation to smoking: 50 years' observations on male British doctors". BMJ. 328 (7455): 1519. doi:10.1136/bmj.38142.554479.ae. ISSN 0959-8138. PMID 15213107.
  12. ^ "WHO | Gender, women, and the tobacco epidemic". WHO. Archived from the original on June 4, 2014. Retrieved 2021-04-17.
  13. ^ Creamer, MeLisa R. (2019). "Tobacco Product Use and Cessation Indicators Among Adults — United States, 2018". MMWR. Morbidity and Mortality Weekly Report. 68 (45): 1013–1019. doi:10.15585/mmwr.mm6845a2. ISSN 0149-2195. PMC 6855510. PMID 31725711.
  14. ^ Cite error: The named reference MoylanJacka2012 was invoked but never defined (see the help page).
  15. ^ Airagnes, Guillaume; Sánchez-Rico, Marina; Deguilhem, Amélia; Blanco, Carlos; Olfson, Mark; Ouazana Vedrines, Charles; Lemogne, Cédric; Limosin, Frédéric; Hoertel, Nicolas (2024-09-11). "Nicotine dependence and incident psychiatric disorders: prospective evidence from US national study". Molecular Psychiatry: 1–9. doi:10.1038/s41380-024-02748-6. ISSN 1476-5578. PMID 39261672.
  16. ^ Cite error: The named reference BeebeMyers2012 was invoked but never defined (see the help page).
  17. ^ Cite error: The named reference Bullen2014 was invoked but never defined (see the help page).
  18. ^ Hampton WH, Hanik I, Olson IR (2019). "[Substance Abuse and White Matter: Findings, Limitations, and Future of Diffusion Tensor Imaging Research]". Drug and Alcohol Dependence. 197 (4): 288–298. doi:10.1016/j.drugalcdep.2019.02.005. PMC 6440853. PMID 30875650. Heavy nicotine use in the form of smoking tobacco has been linked to neuropathy (Brody, 2006), often manifesting as prefrontal gray matter atrophy (Gallinat et al., 2006; Zhang et al., 2011). Conversely, consumption of nicotine via smoking has been associated with higher white matter volume (Gazdzinski et al., 2005; Yu et al., 2011). Studies examining nicotine use via DTI have found similarly conflicting results. In chronic nicotine users, heavy consumption has been associated with lower FA (Lin et al., 2013) and higher FA (Paul et al., 2008), as well has both lower RD (Wang et al., 2017) and higher RD (Lin et al., 2013). The results of studies examining non-chronic, regular nicotine use are similarly split. Regular nicotine use has been associated with lower FA (Huang et al., 2013; Liao et al., 2011; Zhang et al., 2011) and higher FA (Hudkins et al., 2012; Wang et al., 2017). These seemingly conflicting nicotine results may be partly accounted for by the developmental stage in which it is consumed, with higher FA more commonly observed in younger nicotine users (Hudkins et al., 2012; Jacobsen et al., 2007). Alternatively, it maybe that the association between nicotine use and higher FA in adolescents is temporary, eventually leading to microstructural declines with chronic use. Future longitudinal studies could formally address this theory.
  19. ^ a b Cite error: The named reference Saccone2010 was invoked but never defined (see the help page).
  20. ^ Cite error: The named reference Fiore2008 was invoked but never defined (see the help page).


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