Nicotine Dependence
Zeel Ladhani, Anaisha Rachel Paul, Angeline Sneha Nagabathula,
Shimmer
AMH Section 03
What is Nicotine
Dependence?
• Nicotine, which is found in tobacco plants, is now
recognized as a highly addictive type of substance
addiction.
• The addiction is physical, mental and behavioral
(Gabbey, 2018).
Angeline Sneha Nagabathula
Nicotine Dependence’s Mechanism
• Nicotine is typically consumed by inhaling tobacco
cigarette smoke, pipes and cigars.
• Inhaled smoke delivers nicotine to the brain in less
than 20 seconds (Gabbey, 2018).
• Enters the brain –> stimulates the release of
neurotransmitters (example: dopamine) –> elevates
mood and induces emotions of pleasure.
• Also, boosts beta-endorphin levels –> decreases
anxiety.
• In both cases, smoking produces "a buzz of
pleasure and energy" as well as mood-altering
effects that produce a momentary feeling of
contentment and bliss (Barhate, 2023).
Angeline Sneha Nagabathula
Angeline Sneha Nagabathula
Diagnosis
CAGE Questionnaire
• Have you ever felt a need to Cut down or control your
smoking, but had difficulty doing so?
• Do you ever get Annoyed or angry with people who criticize
your smoking or tell you that you ought to quit smoking?
• Have you ever felt Guilty about your smoking or about
something you did while smoking?
• Do you ever smoke within half an hour of waking up (Eyeopener)?
* —Two “yes” responses constitute a positive screening test.
Angeline Sneha Nagabathula
“Four Cs” Test
• Compulsion—the intensity with which the desire to use a
chemical overwhelms the patient's thoughts, feelings and
judgment.
• Control—the degree to which patients can (or cannot) control
their chemical use once they have started using.
• Cutting down—the effects of reducing chemical intake;
withdrawal symptoms.
• Consequences—denial or acceptance of the damage caused
by the chemical.
Angeline Sneha Nagabathula
Fagerstrom test
• Patients who quit smoking and relapse within two
or three weeks usually do so to relieve withdrawal
symptoms secondary to their physical dependence
on nicotine.
• Standard instrument for assessing the intensity of
this physical addiction.
Angeline Sneha Nagabathula
Risks of Nicotine Dependence
Cardiovascular diseases
• Stimulates the release of adrenaline and noradrenaline –> increase in
heart rate and blood pressure.
• constriction of blood vessels –> places additional stress on the heart.
• triggers the release of inflammatory substances and promotes the
formation of blood clots –> development and progression of
atherosclerosis.
Diabetes
• Triggers the release of stress hormones such as cortisol and
catecholamines –> leads to an increase in heart rate, blood pressure, and
blood glucose levels.
• Prolonged exposure –> leads to insulin resistance –> glucose remains in
the bloodstream at higher levels, increasing the risk of developing type 2
diabetes.
Angeline Sneha Nagabathula
Cataract
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Studies highlight an association between smoking, nicotine exposure, and an increased risk
of cataract development.
Chronic smokers have been found to be more susceptible to cataracts compared to nonsmokers.
Blood vessels that supply nutrients and oxygen to the eye's lens get narrowed –> impede
the normal metabolic functions of the lens cells –> accumulation of oxidative stress and
damage –> formation of cataracts
Lung and Mouth Cancer
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While using tobacco products, smokers inhale harmful substances, including carcinogens
that damage the cells lining the respiratory tract and oral cavity.
Repetitive exposure to carcinogens causes genetic mutations in lung cells.
Smokeless tobacco, such as chewing tobacco or snuff, also poses a significant risk for oral
cancer due to the direct exposure of the mouth tissues to carcinogenic substances.
Lung Diseases: Emphysema
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Smoking tobacco smoke also exposes the lungs to a range of toxic chemicals, including tar
and carbon monoxide.
In Emphysema, the alveoli get damaged and lose their elasticity –> destruction of lung
tissue –> reduced airflow and impaired respiratory function –> making breathing difficult.
Angeline Sneha Nagabathula
Effective Treatment
There are effective treatments that support tobacco
cessation, including both behavioral therapies and FDAapproved medications (NIDA, 2021).
Behavioral Treatments
Cognitive Behavioral Therapy (CBT)
• Identifying triggers—the people, places, and things
that spur behavior.
• Teaches individual relapse-prevention skills (e.g.,
relaxation techniques) and effective coping strategies
to avoid smoking in the face of stressful situations and
triggers.
Motivational Interviewing (MI)
• Patient-focused and nonconfrontational.
• Explores discrepancies between patients’ goals or values
and their current behaviors.
Zeel Ladhani
Mindfulness
• Includes mindfulness-based Smoking Cessation Treatments.
• Aims to increase individual’s awareness of and detachment
from sensations, thoughts, and cravings that may lead to
relapse.
Medications
Bupropion
• Bupropion (immediate-release and extended-release) inhibits
the reuptake of norepinephrine and dopamine and stimulates
their release.
Varenicline
• Varenicline increases likelihood of quitting compared to
placebo.
• Some studies find that it is more effective than single forms of
NRT and bupropion.
Zeel Ladhani
Nicotine Replacement Therapy (NRT)
• NRTs stimulate the brain receptors targeted by nicotine, helping
relieve nicotine withdrawal symptoms and cravings that lead to
relapse.
• NRT is popularly used in the early stages of cessation, and those
with more severe nicotine addiction can benefit from longer-term
treatment.
• Use of NRT improves smoking cessation outcomes, and adding
behavioral therapies further increases quit rates.
• Researchers estimate that NRT increases quit rates by 50%-70%.
• Using the patch for up to 24 weeks has been shown to be safe.
Zeel Ladhani
Transcranial Magnetic Stimulation (TMS)
• It is a physiological intervention
that noninvasively stimulates
neural activity in targeted areas
of the brain using magnetic
fields.
• Multiple TMS pulses given
consecutively are referred to as
repetitive TMS (rTMS).
• Future randomized controlled
clinical trials with large numbers
of patients will be needed to
establish its efficacy for smoking
cessation.
Zeel Ladhani
• Research indicates that smokers who receive a
combination of behavioral treatment and cessation
medications quit at higher rates than those who
receive minimal intervention.
• Interventions such as brief advice from a health care
worker, telephone helplines, automated text
messaging, and printed self-help materials can also
facilitate smoking cessation.
• Cessation interventions utilizing mobile devices and
social media also show promise in boosting tobacco
cessation
Zeel Ladhani
Treatment Facilities in GTA
CAMH (Centre for Addiction and
Mental Health)
Services: CAMH in Toronto offers addiction
services, including support for nicotine
addiction. They provide counselling, support
groups and outpatient programs.
Cost: Publicly funded services have minimal or
no cost.
Local Public Health Units
Services: Public health units often offer
smoking cessation programs, counselling, and
resources to help individuals quit smoking.
Cost: Some services are free and some are
offered at a low cost.
Shimmer
Nicotine Anonymous (NA)
Services: Nicotine Anonymous follows a 12step program similar to Alcoholics Anonymous
(AA). Meetings provide a supportive
environment for individuals wanting to quit
nicotine.
Cost: NA meetings are typically free, relying
on voluntary contributions.
Private Addiction Treatment
Centers
Services: Private addiction treatment
centres offer inpatient or outpatient
programs for nicotine addiction. These
programs include counselling, therapy, and
support groups.
Cost: Costs can vary widely and are not be
covered by public health insurance. Private
insurance or self-payment is required.
Shimmer
Local Hospitals with Addiction Programs
Services: Some hospitals in the GTA have addiction programs that include
services for nicotine addiction. This involves counselling, group therapy, and
medical support.
Cost: Costs can vary, and public hospitals offer subsidized or publicly funded
programs. Private hospitals have different payment structures.
Shimmer
Resources for Families in
Toronto
• Families of individuals with nicotine dependence may face an equal
health threat.
• Studies have found addictive behavior to be heritable (Pérez-Rubio
et al., 2016; Gorwood et al., 2017).
• Family members of smokers are frequently exposed to second hand
smoke, which puts them at a significant risk of developing illnesses
(Tsai et al., 2018).
• Non smoker family members such as children, are likely to develop
nicotine consuming habits.
• Resources for families of smokers helps mitigate these risks and
also contribute to quitting journey of smokers.
Moms Stop The Harm
• A network of Canadian families
impacted by substance-userelated harms and deaths.
• Encourage the revision of
ineffective drug laws, offer
grieving families peer support,
and help those who have
smoker loved ones.
• Conduct research programs,
Provincial Resources, and Anti
Stigma Resources.
Anaisha Rachel Paul
Families for Addiction Recovery
• A national charity aiming for long
term recovery for those with
addiction and their families.
• Founded by parents of children
who have struggled with
addiction.
• Provide parent-to-parent
assistance to families.
• Provide addiction, health law, and
drug policy education to law
enforcement, community groups,
and medical professionals.
Anaisha Rachel Paul
Community Addictions Peer Support
Association (CAPSA)
• Free peer-facilitated
group meetings.
• Provides a stigma-free
and accepting
environment for smokers
wishing to quit.
• CAPSA is not limited to
smokers but also includes
and involves their family
members.
• WOW (Working on
Wellness) Festival.
Anaisha Rachel Paul
References
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Barhate, M. (2023). Nicotine Addiction Treatment: Addiction Signs, Causes, And Withdrawal
Symptoms. Lybrate. https://www.lybrate.com/topic/nicotine-addiction
Gabbey, A. E. (2018, May 17). Nicotine addiction: what you need to know. Healthline.
https://www.healthline.com/health/nicotine-and-related-disorders
Gorwood, P., Le Strat, Y., & Ramoz, N. (2017). Genetics of addictive behavior: the example of
nicotine dependence. Dialogues in clinical neuroscience, 19(3), 237-245.
National Institute on Drug Abuse. (2021, April 12). What are treatments for tobacco
dependence? | National Institute on Drug Abuse. https://nida.nih.gov/publications/researchreports/tobacco-nicotine-e-cigarettes/what-are-treatments-tobacco-dependence
Pérez-Rubio, G., Sansores, R., Ramírez-Venegas, A., Camarena, Á., Pérez-Rodríguez, M. E., &
Falfán-Valencia, R. (2016). Nicotine addiction development: from epidemiology to genetic
factors. Revista de Investigación Clínica, 67(6), 333-343.
Rustin, T. A. (2000, August 1). Assessing nicotine dependence. AAFP.
https://www.aafp.org/pubs/afp/issues/2000/0801/p579.html
Tsai, J., Homa, D. M., Gentzke, A. S., Mahoney, M., Sharapova, S. R., Sosnoff, C. S., ... & Trivers,
K. F. (2018). Exposure to secondhand smoke among nonsmokers—United States, 1988–
2014. Morbidity and Mortality Weekly Report, 67(48), 1342.
Anaisha Rachel Paul