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Understanding Nicotine and Tobacco Addiction



Understanding Nicotine and Tobacco Addiction

Gregory R. Bock (Editor), Jamie A. Goode (Editor)

ISBN: 978-0-470-01657-2 May 2006 284 Pages

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Cigarette smoking is estimated to lead to 4.9 million premature deaths per year worldwide. This is predicted to rise to 10 million by 2020. In western countries it kills half of all smokers who fail to stop.

The prevailing model for tobacco addiction is that nicotine from cigarettes rewards smoking and punishes abstinence, tapping into a motivational system of operant conditioning that requires no conscious awareness. However, there are also accounts which involve cognitive biases and the effect of nicotine on impulse control. The brain pathways involved have been studied extensively, but the role of different nicotine receptor subtypes and other neurotransmitter systems is still subject to debate.

In western countries, cigarette smoking as an adult has a heritability of 30-50% and candidate genes have been identified that may contribute in part to addiction susceptibility. Many socio-cultural correlates of cigarette smoking have been established, but a comprehensive model that accounts for these and links them with the psychobiological aspects of nicotine addiction has not been forthcoming. Structured behavioural support programmes aid cessation attempts, as do a number of pharmacotherapies, most notably nicotine replacement treatments and bupropion, but the underlying mechanisms are unclear.

This book deals with the problems involved in understanding and treating nicotine and tobacco addiction. Topics covered include the nature of the worldwide health problem posed by cigarette smoking, the psychodynamics of cigarette addiction, and the basic pharmacology and biochemistry of nicotine and its effect on the brain. Further chapters analyse the genetic basis of susceptibility to nicotine addiction. Finally, the contributors address approaches to therapy. A continuing theme in the discussions throughout the book is how best to treat nicotine addiction, given that many smokers would like to stop smoking but are unable to do so because of their addiction.

This book will be of great value to all psychologists and psychiatrists working on addiction, specifically to nicotine but also to other compounds and behaviours. It will also be of interest to neuroscientists and pharmacologists working on nicotine receptors and the brain pathways involved in dependence, as well as to biochemists, molecular biologist and to public health officials.

Symposium on Understanding nicotine and tobacco addiction, held at the Novartis Foundation, London, 17–19 May 2005

Editors: Gregory Bock (Organizer) and Jamie Goode

This symposium is based on a proposal made by Robert West and Gino van Heeke

William A. Corrigall Chair’s introduction 1

Richard Peto and Richard Doll The hazards of smoking and the benefits of stopping 3

Discussion 15

Ian Stolerman Animal models for nicotine dependence 17

Discussion 28

Robert West Defining and assessing nicotine dependence in humans 36

Discussion 52

General discussion I 59

Uwe Maskos, Sylvie Granon, Philippe Faure and Jean-Pierre Changeux Nicotinic acetylcholine receptor functions in the CNS investigated with a novel method of stereotaxic gene re-expression in knockout mice 64

Discussion 79

Marina R. Picciotto Nicotine-mediated activation of signal transduction pathways 83

Discussion 90

David Balfour Complementary roles for the accumbal shell and core in nicotine dependence 96

Discussion 105

Christian Heidbreder The dopamine D3 system: new opportunities for dopamine-based reward 116

Discussion 123

Athina Markou Pathways and systems involved in nicotine dependence 132

Discussion 145

Arthur L. Brody Localizing tobacco dependence pathways with functional brain imaging 153

Discussion 166

Caryn Lerman Pharmacogenetic approach to nicotine dependence treatment 171

Discussion 178

Robert Walton Pharmacogenomics and smoking cessation 184

Discussion 194

General discussion II Power in studies 197

Receptor desensitization 199

Peter Hajek What limits the efficacy of current nicotine replacement therapies? 204

Discussion 213

Saul Shiffman, Stuart Ferguson and Deborah Scharf Exploring behavioural mechanisms of nicotine replacement therapy for smoking cessation 219

Discussion 231

Rachel F. Tyndale and Edward M. Sellers Modifying the metabolism of nicotine as a therapeutic strategy 235

Discussion 244

William A. Corrigall Challenges in discovery and development of pharmacotherapies for tobacco addiction 249

Discussion 259

Final discussion Nicotine comorbidity 262

Animal models 264

Index of contributors 266

Subject index 268

"…an excellent resource for individuals interested in this area." (Doody's Health Services)

"…thinking of all the clients…who smoke… Do we not owe it to our clients to save them from this Killer?" (Journal of Mental Health and Psychiatric Nursing, September 2007)