Tobacco cessation fall 2011 Instructor (1)_ For use in lecture (3)

Most symptoms manifest within the first 12 days peak

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Most symptoms manifest  within the first 1–2 days,  peak within the first  week, and subside within  2–4 weeks. HANDOUT
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NICOTINE ADDICTION Tobacco users maintain a minimum serum  nicotine concentration in order to Prevent withdrawal symptoms Maintain pleasure/arousal Modulate mood Users self-titrate nicotine intake by Smoking/dipping more frequently Smoking more intensely Obstructing vents on low-nicotine brand cigarettes Benowitz. (2008). Clin Pharmacol Ther 83:531–541.
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ASSESSING NICOTINE DEPENDENCE Fagerstr ö m Test for Nicotine Dependence (FTND) Developed in 1978 (8 items); revised in 1991 (6 items) Most common research measure of nicotine dependence;  sometimes used in clinical practice Responses coded such that higher scores indicate higher  levels of dependence  Scores range from 0 to 10; score of greater than 5  indicates substantial dependence Heatherton et al. (1991). British Journal of Addiction 86:1119–1127. HANDOUT
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FACTORS CONTRIBUTING to TOBACCO USE Physiology Genetic predisposition Coexisting medical  conditions Environment Tobacco advertising Conditioned stimuli Social interactions Pharmacology Alleviation of withdrawal  symptoms Weight control Pleasure Tobacco Use
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TOBACCO DEPENDENCE: A 2-PART PROBLEM Tobacco Dependence Tobacco Dependence Treatment should address the physiological  and  the behavioral aspects of dependence. Physiological Physiological Behavioral Behavioral Treatment Treatment The addiction to nicotine Medications for cessation The habit of using tobacco Behavior change program
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NICOTINE PHARMACOLOGY  and ADDICTION: SUMMARY Tobacco products are  effective delivery systems  for  the drug nicotine. Nicotine is a  highly addictive drug  that induces a  constellation of pharmacologic effects. Nicotine activates the  dopamine reward pathway  in  the brain, which reinforces continued tobacco use. Tobacco users who are dependent on nicotine  self- regulate tobacco  intake to maintain pleasurable  effects and prevent withdrawal.
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NICOTINE PHARMACOLOGY  and ADDICTION: SUMMARY  (cont’d) Nicotine dependence is a  chronic disorder. Tobacco use is  complex,  involving the interplay of  the following: Pharmacology of nicotine (pharmacokinetics  and pharmacodynamics) Environmental factors Physiologic factors Treatment of tobacco use and dependence  requires a  multifaceted treatment approach.
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FORMS of TOBACCO
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FORMS of TOBACCO  Cigarettes Smokeless tobacco (chewing tobacco, oral snuff) Pipes Cigars Clove cigarettes Bidis Hookah (waterpipe smoking) Image courtesy of the Centers for Disease Control and Prevention / Rick Ward
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AMERICAN CIGARETTES Sold in packs (20 cigarettes/pack)
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