Nicotine addiction

Schizophrenia and the motivation for smoking

PROBLEM

People with mental illness are twice as likely to smoke than people without a mental illness.

METHODS

Data were collected through interviews with individuals who smoke and have been diagnosed with schizophrenia (N = 100). The research design included a descriptive, correlational design that described and examined the relationships among psychiatric symptoms, medication side effects, and reasons for smoking; and a qualitative analysis of the subjective experience of smoking.

FINDINGS

A positive relationship was found between the age of onset of smoking and the onset of schizophrenia. Subjects reported they smoked primarily for sedative effects and control of negative symptoms of schizophrenia. Subjects also reported smoking related to addiction. Most indicated they would like to quit smoking or at least cut down on the number of cigarettes.

CONCLUSIONS

Among people with schizophrenia, the motivation to smoke is related to their schizophrenia.

Absence of alpha7-containing neuronal nicotinic acetylcholine receptors does not prevent nicotine-induced seizures

Nicotine is the primary addictive component in tobacco, and at relatively low doses it affects cardiovascular responses, locomotor activity, thermoregulation, learning, memory, and attention. At higher doses nicotine produces seizures. The mechanisms underlying the convulsive effects of nicotine are not known, but studies conducted on a number of inbred strains of mice have indicated a positive correlation between the number of alpha-bungarotoxin (alpha-BTX) binding sites in the hippocampus and the sensitivity to nicotine-induced seizures. Because alpha7-containing neuronal nicotinic acetylcholine receptors (nAChRs) represent the major binding site for alpha-BTX, mice lacking the alpha7 nAChR subunit were predicted to be less sensitive to the convulsive effects of nicotine. To test this hypothesis, we injected nicotine intraperitoneally in alpha7 mutant mice and found that the dose-response curve for nicotine-induced seizures was similar in the alpha7 +/+, alpha7 +/- and alpha7 -/- mice. The retained sensitivity to the convulsant effects of nicotine could not be explained by the presence of cholinergic compensatory mechanisms such as increases in mRNA levels for other nAChR subunits, or changes in binding levels or affinity for nicotinic ligands such as epibatidine and nicotine. These findings indicate that alpha7 may not be necessary for the mechanisms underlying nicotine-induced seizures.

Theoretical applications of smoking cessation interventions to individuals with medical conditions: women's initiative for nonsmoking (WINS)-part III

This paper reviews the Theory of Self-Efficacy, Transtheoretical Model of Readiness for Change, and Theory of Addictions to provide a basis for smoking cessation, and explores how these theories have been used to guide clinical research and clinical interventions. Selected randomized controlled trials of the past ten years are reviewed for demonstrated efficacy, integration of theory into the design of the interventions, and how theories guide analysis. Results show that surprisingly little effort has been put forth to examine and develop these theories within the context of clinical interventions, despite the claims of importance. For example, the relationship between stages of readiness of change and smoking cessation outcome has not been examined. Despite the complexity of smoking behaviors (quitting, relapsing, maintaining, occasional smoking and so on), the concept of self-efficacy was mostly measured on single occasions over the course of most studies reviewed; multiple measurements of concepts were not utilized in the randomized controlled trials. Taking into account the gaps between theory and application, theory driven nursing strategies are offered.

Consenso sobre o tratamento da dependência de nicotina

Têm sido atribuídas à dependência de nicotina 20% das mortes nos EUA. Estudos têm mostrado que 30% a 50% das pessoas que começam a fumar escalam para um uso problemático. Nos últimos 20 anos, a educação e a persuasão não foram suficientes para promover uma mudança política, cultural e social relacionada ao comportamento de fumar. As intervenções para interromper o uso de tabaco ainda não estão integradas às rotinas dos serviços de saúde no mundo. A falta de estratégias de integração, de tempo disponível para acoplar ações assistenciais mais específicas e mesmo a percepção dos profissionais de saúde de que os tratamentos para a dependência de nicotina são pouco efetivos são algumas das barreiras apontadas. Assim, elaborar um consenso sobre a dependência de nicotina teve como objetivos: • levantar dados epidemiológicos relevantes relacionados ao uso do tabaco no mundo e no Brasil; • revisar as ações gerais e centrais da nicotina; • elaborar um protocolo de triagem mínimo para serviços de atenção primária à saúde; • recomendar diretrizes básicas de avaliação, diagnóstico e tratamento para todos os níveis de atenção à saúde em relação à dependência de nicotina; • fornecer sugestões para a abordagem de grupos especiais de pacientes: adolescentes, gestantes, idosos, pacientes em regime de internação, obesos e pacientes com comorbidades psiquiátricas, cardiovasculares e respiratórias.

Cellular mechanisms of nicotine addiction

In developed countries, tobacco use is estimated to be the largest single cause of premature death [Lancet 339 (1992) 1268]. Nicotine is the main addictive component of tobacco that motivates continued use despite the harmful effects. Nicotinic acetylcholine receptors (nAChRs) are widely distributed throughout the mammalian central nervous system (CNS), where they normally respond to acetylcholine (ACh) and modulate neuronal excitability and synaptic communication. Nicotinic receptors are structurally diverse and have varied roles. Presynaptic and preterminal nAChRs enhance neurotransmitter release. Postsynaptic and somal nAChRs mediate a small proportion of fast excitatory transmission and modulate cytoplasmic second messenger systems. Although the impact of nicotine obtained from tobacco is not completely understood, a portion of nicotine's addictive power is attributable to actions upon the dopaminergic systems, which normally help to reinforce rewarding behaviors. As obtained from tobacco, nicotine activates and desensitizes nAChRs, and both processes contribute to the cellular events that underlie nicotine addiction.

Mecamylamine effects on haloperidol-induced catalepsy and defecation

Recent clinical experience with Tourette syndrome (TS) patients suggests that the nicotinic receptor antagonist, mecamylamine (Inversine), may be a useful adjunct to neuroleptic therapy for controlling tic symptom. This is consistent with previous preclinical findings demonstrating that mecamylamine can potentiate the cataleptic effects of neuroleptics in rats. However, these earlier preclinical studies employed high doses (1-2.5 mg/kg) of mecamylamine that may not be clinically relevant since human doses of mecamylamine used to treat TS have been much lower (0.03-0.1 mg/kg). In order to test the potential therapeutic properties of mecamylamine preclinically, we conducted catalepsy experiments in rats employing both a low and high dose of mecamylamine in combination with haloperidol. Sixty-four male Sprague Dawley rats were randomized into four treatment groups (n = 16/group). Each rat received an injection of either saline or mecamylamine (0.1 or 3.0 mg/kg s.c.) followed one hour later with a second injection of either saline or haloperidol (0.4 mg/kg s.c.). The bar test was used to measure duration of catalepsy at 3 hrs following the second injection. The results demonstrated that only the mecamylamine treated rats showed statistically significant haloperidol-induced catalepsy when measured at 3 hrs. In addition, haloperidol-induced defecation was not affected by the 0.1 mg/kg mecamylamine dose, but completely abolished by the 3.0 mg/kg dose. These findings suggest that a clinically relevant dose of mecamylamine (0.1 mg/kg) can affect the duration of haloperidol-induced catalepsy without having significant effects on gastrointestinal function.

New directions in the genetic mechanisms underlying nicotine addiction

Major advances have been made in understanding nicotine addiction and smoking behaviour in recent years. In particular, evidence for the relative importance of genetic and environmental effects on smoking initiation and persistence has emerged from behaviour genetic studies. These data have supported evidence from molecular genetic studies for the role of particular candidate genes in tobacco dependence. Studies of the personality correlates of smoking behaviour suggest that these factors mediate the association between genetics and smoking initiation, while learning models of nicotine addiction suggest a role for dopaminergic genes in facilitating neuroadaptations associated with smoking persistence and development of nicotine dependence. Integrating these different avenues of research represents one of the most interesting and potentially fruitful ventures in the treatment of tobacco dependence.

Legislation, policy, and tobacco use among youth: implications for health care providers

This paper addresses implications of recent tobacco legislation, policy, and tobacco use among youth in the context of health care policy and services. Tobacco use prevalence and definitions and diagnoses of nicotine addiction and dependence are described. Assessment of smoking prevalence in Texas provides a case study of the problem and potential solutions for tobacco use among youth. The case study highlights specific implications to be considered when providing health care focused on prevention and risk reduction for youth. The paper concludes with implications and critical Internet resources for health care providers engaging in youth tobacco control.

Adolescent nicotine exposure produces immediate and long-term changes in CNS noradrenergic and dopaminergic function

Animal studies have only recently begun to address whether nicotine evokes unique or persistent effects on brain structure or function during adolescence, the period in which smokers typically begin their habit. In the current study, we examined the impact of adolescent nicotine treatment on catecholaminergic synaptic function in rats infused with nicotine on postnatal days 30-47.5, using a paradigm that reproduces the plasma levels of nicotine found in smokers. We assessed norepinephrine and dopamine content, turnover (an index of neural activity), and the response to an acute challenge dose of nicotine. In the midbrain, the region most closely associated with addiction, both norepinephrine and dopamine turnover were activated during the infusion period, an effect not seen in any other region for norepinephrine, and only in the striatum for dopamine. In the immediate post-infusion period (PN50-60), there was a decrement in midbrain catecholamine turnover restricted to males, whereas there was a later-emerging (PN80) activation of these pathways. Again, this pattern was not observed in any other region: the cerebral cortex showed post-treatment increases in turnover without gender selectivity, the striatum showed late-emerging deficits in dopamine turnover and the hippocampus displayed a profound deficit in noradrenergic activity that was limited to females. We also assessed the catecholaminergic response to an acute challenge with nicotine (0.3 mg/kg s.c.). The midbrain once more displayed unique properties; there was initial suppression of responses followed by post-treatment rebound elevations that were more prominent in males and eventual deficits that, in the case of dopamine, were selective for males. With the exception of the cerebellum, other regions showed the initial loss of response during the infusion period but no persistent changes in responsiveness. The current results indicate that adolescent nicotine produces immediate and long-term changes in CNS catecholaminergic systems, with regional targeting and gender selectivity corresponding to the changes seen previously in nicotinic receptor upregulation or indices of cell damage. These effects may underlie long-term behavioral changes associated with adolescent nicotine exposure.

Opioid antagonists for smoking cessation

BACKGROUND

The reinforcing properties of nicotine may be mediated through release of various neurotransmitters both centrally and systemically. Smokers report positive effects such as pleasure, arousal, and relaxation as well as relief of negative affect, tension, and anxiety. Opioid (narcotic) antagonists are of particular interest to investigators as potential agents to attenuate the rewarding effects of cigarette smoking.

OBJECTIVES

To evaluate the efficacy of opioid antagonists in promoting long-term smoking cessation. The drugs include naloxone and the longer-acting opioid antagonist naltrexone.

SEARCH STRATEGY

We searched the Cochrane Tobacco Addiction Group trials register for trials of naloxone, naltrexone and other opioid antagonists and conducted an additional search of Medline using '"Narcotic antagonists" and smoking terms in March 2001. We also contacted, when possible, investigators for information on unpublished studies.

SELECTION CRITERIA

We considered randomized controlled trials comparing opioid antagonists to placebo or an alternative therapeutic control for smoking cessation. We included only trials reporting data on abstinence of a minimum of 6 months in the meta-analyses. We also reviewed, for descriptive purposes, results from short-term laboratory-based studies of opioid antagonists designed to evaluate psychobiological mediating variables associated with nicotine dependence.

DATA COLLECTION AND ANALYSIS

We extracted data in duplicate on the type of study population, the nature of the drug therapy, the outcome measures, method of randomisation, and completeness of follow-up. The main outcome measure was cotinine or carbon monoxide verified abstinence from smoking after at least six months follow-up in patients smoking at baseline. Where appropriate, we performed meta-analysis using a fixed effects model (Peto method).

MAIN RESULTS

Two trials of naltrexone met inclusion criteria for meta-analyses for long term cessation. Both trials failed to detect a significant difference in quit rates between naltrexone and placebo. In a pooled analysis there was no significant effect of naltrexone on long-term abstinence, and confidence intervals were wide (OR 1.34, 95% CI 0.49,3.63). No trials of naloxone or buprenorphine reported long term follow-up

REVIEWER'S CONCLUSIONS

Based on limited data from two trials it is not possible to confirm or refute whether naltrexone helps smokers quit. The confidence intervals are compatible with both clinically significant benefit and possible negative effects of naltrexone in promoting abstinence. Data from larger trials of naltrexone are needed to settle the question of efficacy for smoking cessation.

Zyban: an effective treatment for nicotine addiction

Recent research has identified nicotine as a powerfully addictive substance. This article outlines how the new non-nicotine smoking cessation drug, Zyban, can help people to break the cycle of addiction and stop smoking.

Prenatal nicotine exposure is associated with an increase in [125I]epibatidine binding in discrete cortical regions in rats

Previously, it was reported that hyperactive male offspring of dams exposed to nicotine (6 mg/kg/day) during gestation had an increase in cortical alpha4-beta2 nicotinic receptor subtype density as determined by [3H]cytisine binding in tissue homogenate [Tizabi Y, Popke EJ, Rahman MA, Nespor SM, Grunberg NE. Hyperactivity induced by prenatal nicotine exposure is associated with an increase in cortical nicotinic receptors. Pharmacol, Biochem Behav 1997;58:141-6]. [125I]Epibatidine labels alpha4beta2 nicotinic receptors with higher affinity than [3H]cytisine. In the present study, using quantitative autoradiography, we evaluated the effects of in-utero exposure to nicotine (9 mg/kg/day) on [125I]epibatidine binding in 46 discrete brain regions of 36-day-old male offspring of Sprague-Dawley rats. This dosage of nicotine administered during pregnancy to same rats was shown to result in increased vertical activity in the male offspring [Tizabi Y, Russell LT, Nespor SM, Perry DC, Grunberg NE. Prenatal nicotine exposure: effects on locomotor activity and central [125I]alpha-BT binding in rats. Pharmacol, Biochem Behav (in press).]. Prenatal nicotine exposure resulted in increases in receptor densities of the somatosensory cortex (90%) and the visual cortex (107%) only. Moreover, these increases were restricted to cortical layer 1. Collectively, these results indicate that prenatal nicotine exposure affects specific nicotinic receptors in selective cortical regions of male offspring. These neurochemical effects may be responsible for some of the behavioral abnormalities seen in such offspring.

Regulation of feeding-associated peptides and receptors by nicotine

Although numerous epidemiological studies have provided convincing evidence for the inverse association between tobacco smoking and body weight, the molecular mechanisms underlying this relationship are not well-understood. Nicotine, as a potent secretagogue, could be expected to influence the levels and expression of many classes of neurotransmitters, as well as of cell-membrane constituents linked to neurotransmission, including signal transducers and related effectors. A potentially major group of candidate molecules that could be involved in feeding-related actions of nicotine are the numerous neuropeptides and peptide hormones shown in the past two decades to regulate food intake and energy expenditure. These could include neuropeptide Y (NPY), orexins, leptins, and uncoupling proteins (UCPs). Some of these peptides were already shown to respond to nicotine treatment in terms of regulation of levels and of activity at the level of cell-membrane receptors. The primary objective of this review is to summarize our current understanding of the regulatory effects of nicotine on the food intake and energy expenditure as related to the expression levels of leptin, NPY, orexin, uncoupling proteins, and of NPY and orexin receptors.