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Drug Abuse and Addiction in Medical Illness pp 137–150Cite as

Nicotine

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Abstract

Tobacco use is the leading cause of preventable mortality worldwide, and nicotine (a small tertiary amine consisting of a pyridine and pyrrolidine ring) is the primary psychoactive constituent in tobacco. When inhaled, nicotine reaches the brain within 7–10 s, with peak blood levels occurring within a few minutes. In the USA, the prevalence of smoking among adults is just under 20%, although over half of all ever-smokers have now quit. Nicotine dependence is characterized by tolerance, withdrawal symptoms (e.g., irritability, depression, restlessness, insomnia, anxiety, hunger and poor concentration, as well as craving), and compulsive use. Tobacco use and dependence are more prevalent among psychiatric patients and persons with certain medical conditions, including HIV and chronic pain. Smokers often report that cigarettes enhance both their mood state and their cognitive functioning (e.g., attention); however, it is difficult to determine if these are actual nicotine onset effects, relief of nicotine withdrawal effects, or psychological expectancy (i.e., placebo) effects. Treatments for tobacco use include seven FDA-approved pharmacotherapies (nicotine gum, patch, nasal spray, inhaler, and lozenge, plus bupropion, and varenicline) with roughly similar efficacies. In addition, behavioral counseling enhances efficacy rates. Even minimal counseling, such as brief physician advice, significantly increases the odds of cessation, but more intensive counseling produces greater effects. Other options include self-help and telephone quitlines.

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Authors and Affiliations

  1. Tobacco Research & Intervention Program, H. Lee Moffitt Cancer Center, University of South Florida, 4115 E. Fowler Avenue, Tampa, FL, 33617, USA

    Erika B. Litvin, Bryan W. Heckman & Thomas H. Brandon

  2. Department of Psychology, Texas A&M University, College Station, TX, 77843, USA

    Joseph W. Ditre

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  1. Erika B. Litvin
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  2. Joseph W. Ditre
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  3. Bryan W. Heckman
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  4. Thomas H. Brandon
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Correspondence to Thomas H. Brandon .

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Editors and Affiliations

  1. Inst. Pharmaceutical Sciences, Department of Psychopharmacology, Utrecht University, Universiteitsweg 99, Utrecht, 3584CG, Netherlands

    Joris C. Verster

  2. Dept. Psychiatry, Medical University of South Carolina, President St. 67, Charleston, 29425, South Carolina, USA

    Kathleen Brady

  3. School of Medicine, Div. Alcoholism & Drug Abuse, New York University, First Ave. 550, New York, 10016, New York, USA

    Marc Galanter

  4. Institute of Psychiatry, King's College London, National Addiction Centre, Windsor Walk 4, London, SE5 8AF, United Kingdom

    Patricia Conrod

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Litvin, E.B., Ditre, J.W., Heckman, B.W., Brandon, T.H. (2012). Nicotine. In: Verster, J., Brady, K., Galanter, M., Conrod, P. (eds) Drug Abuse and Addiction in Medical Illness. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-3375-0_10

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