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hooked. Smoking is an extremely effective way of delivering nicotine to the brain. It is rapidly absorbed through the lungs into Why is it so hard to quit
the bloodstream, where it is carrieddirectly to the heart and reaches the brainin about 6–10 seconds (akin to an smoking?
intravenous injection: Rose et al., 2000).
Because of this direct route, nicotine does Lynne Dawkins explores the role of nicotine and non-nicotine contributions to not get a chance to dissipate, so the high smoking and considers a promising new device for kicking the habit concentration of nicotine in the lungsfrom a puff on a cigarette remains in theblood as this ‘hit’ (often referred to as a Smoking is the single most
‘bolus’) until it reaches the brain. Whilst preventable major cause of illness
addictive, nicotine is relatively safe; it’s and early death, with nearly one in
five deaths (in those aged 35 or
people a day – or nine people an hour – above) caused by smoking.
Smoking has a multitude of effects
on health, that most smokers are
carcinogens) that carry the health risks aware of. So why do more than one
deaths and 14 per cent of all circulatory in five adults continue to smoke?
And why is it so hard to give up?
smoking. This figure rises to 87 per cent acetylcholine’ receptors. Many of these are located on the cell bodies in the ventral Information Centre: tinyurl.com/cym3apk). dopamine ‘reward’ pathway that projects regular smoker loses an average of 10 years of their life (Doll et al., 2004). That is, activities (such as eating, drinking, sexual live beyond 70 years compared to only half activity, and so on), but addictive drugs of long-term smokers (Kenny, 2012). If it can ‘hijack’ this system resulting in faster other ways of making your life a misery: (NIDA, 2010). When nicotine activates the nicotinic receptors in the VTA, it results in How important is the nicotine delivery in addictive drugs are positively reinforcing – smokers are aware of these harmful effects, why do 21 per cent of the adult population are more than 95–97 per cent of unaided quit attempts unsuccessful (Hughes et al., awareness, setting up a strong motivational drive to smoke, which may conflict withconscious thoughts, beliefs and plans.
West, R. (2006). Theory of addiction. The problem with nicotine
Barrett, S.P. & Darredeau, C. (2012). The delivery. Tobacco Control, 19, 98–103. Etter, J.F. & Bullen, C. (2011). Electronic Psychopharmacology, 190, 457–467. Corrigall, W.A., Coen, K.M. & Adamson, Dawkins, L., Turner, J., Hasna, S. & Soar, satisfaction and perceived efficacy.
Addiction, 106(11), 2017–2028.
male and female smokers. Behavioral Etter, J.F. & Stapleton, J.A. (2006).
Pharmacology, 23(3), 221–227.
area. Brain Research, 653, 278–284.
Addictive Behaviors, 37(8), 970–973.
Bullen, C., McRobbie, H., Thornley, S. et Dawkins, L., Powell, J.H., West, R. et al.
Doll, R., Peto, R., Boreham J. et al.
meta-analysis. Tobacco Control, 15, Hughes, J.R., Keely, J. & Naud, S. (2004).
male British doctors. British Medical inhibition and executive functioning.
vol 26 no 5
as well as elicit positive subjective effects individual, that is, they whet the addict’s (e.g. irritability, depression, restlessness, contains nicotine (Barrett & Darredeau, inducing craving and motivation to use.
During a quit attempt, encountering a cue (the sight or smell of a cigarette) can be light or a tone; Sorge et al., 2009). So, likely that craving and a lapse to smoking nicotine in combination with other salient Is the smoking habit just about
sensorimotor cues might be a particularly nicotine ingestion?
Although the nicotine content is clearly a critical component of tobacco addiction, (Robinson & Berridge, 1993) suggests context of a particular set of cues (e.g. with a cup of coffee or tea; the sight and smell ordinarily mediates how ‘noticeable’ and ‘attention grabbling’ things are in the drugs such as heroin, cocaine and alcohol cigarette in the hand) these cues can then, via classical conditioning, act as ‘secondary easily activated) because of the repeated reinforcers’ – they become moderately a cigarette in one’s hand, are unlikely to be describe such things as pleasurable. It is harder to inhibit over-learned tendencies (Dawkins et al., 2007), makes it extremely hard for the smoker to resist the urge to reinforcing (it triggers dopamine release nicotine is punished (it is associated with During a quit attempt,
encountering a cue can be
cigarette, the ‘catch’ of smoke in the particularly troublesome
learning therefore results in a highly over- primary reinforcer – nicotine – can come smoking can alleviate nicotine withdrawal Robinson, T.E. & Berridge, K.C. (1993).
smokers. Addiction, 99(1), 29–38.
dose selection for in vivo research.
Hughes, J.R., Rennard, S.I., Fingar, J.R.
Psychopharmacology, 190(3), 269–319.
et al. (2011). Efficacy of varenicline to NIDA (2010). Drugs, brains, and behavior: addiction. Brain Research Reviews, planning to quit. Nicotine Tobacco Perkins, KA., Gerlach, D., Vender, J. et al.
Research, 13(10), 955–964. Parrot, A.C. & Craig, D. (1995).
Kenny, T. (2012). Smoking: The facts. British Medical Journal 328(7438), Rose, J.E., Behm, F. M., Westman, E.C. & Matta, S.G., Balfour, D.J., Benowitz, N.L.
Perkins, K.A., Donny, E. & Caggiula, A.R.
read discuss contribute at www.thepsychologist.org.uk
according to the presence of external cuesas well as his or her internal state.
Sensitisation of the dopamine rewardpathway with chronic nicotine useestablishes a heightened desire or cravingfor nicotine, especially in the presence ofsmoking-related stimuli. Thus nicotineaddiction can be thought of as a deeplyentrenched pattern of behaviour underpowerful stimulus control because ofrepeated reward and punishment effects. Efficacy of currently available
‘quit smoking’ aids
With the considerable evidence that
smoking behaviour is driven by nicotine
addiction and that nicotine itself is
relatively safe, came the introduction of
nicotine replacement therapy (NRT) –
Although the existing literature does not merit a conclusion that e-cigarettes are safe in
absolute terms, they are clearly much safer than tobacco cigarettes
lozenge, inhalator and nasal spray. Therationale is to partially replace the the drug company suggests that it is three times better than placebo (Wu et al., 2006) with a 14 per cent success rate (Hughes et smoke. Over 100 placebo-controlled trials cigarette smoking, but also the ‘activity’ of associated with a number of side-effects, smoking. If we could manufacture a device smoker’s chances of quitting successfully to 6–12 months (see Silagy et al., 2005, without the CO and tar and that mimicked for a meta-analysis). However, given that suicidal thoughts and an increased risk of the success rate for unaided quit attempts is so low, this means that, even with NRT, the absence of side-effects, is still far from end in failure (Etter & Stapleton, 2006).
addiction (by replacing it, mimicking it The electronic cigarette
increasing the availability of noradrenaline or preventing it from having its rewarding and dopamine thus mimicking the effect of nicotine and helping to reduce craving and deliver nicotine via inhaled vapour. Since (Roddy, 2004). Champix partially activates Dragonite) in China, electronic cigarettes and nicotine withdrawal. It also prevents nicotine from activating these receptors denicotinised cigarette (which provides the sensory and behaviour aspects of smoking, propylene glycol, flavouring, and varying Seigel, M. & Cahn, Z. (2010). Evidence of cigarette smoking. Pharmacology, suggests e-cigs safer than cigarettes: stimulus. Psychopharmacology, 207, Biochemistry and Behavior, 67, 71–81.
administration. Nicotine and Tobacco Rose, J.E., Salley, A., Behm, F.M. et al.
Vansickel, A.R., Cobb, C.O., Weaver, M.F., Silagy, C., Lancaster, T. & Stead, L. et al.
& Eissenberg, T.E. (2010). A clinical West, R. (2006). Theory of addiction.
Psychopharmacology, 210, 1–12.
‘cigarettes’. Cancer Epidemiology, Wu., P., Wilson, K., Dimoulas, P. & Mills, Siegel, M. (2011). The rest of the story: Sorge, R.E., Pierre, V.J. & Clarke, P.B.S.
Vansickel, A.R. & Eissenberg, T. (2012).
vol 26 no 5
times this level (Siegel & Cahn, 2010). Let’s face it, inhaling any chemical into differences are consistent with an emerging ‘drawing’ on the device or pressing a the lungs is likely to be associated with button. ‘Smoking’ an electronic cigarette (often referred to as ‘vaping’) therefore reinforced more by nicotine intake, and in mimics the act of smoking: the user holds the device and draws on it like a cigarette; responses to smoke stimuli (Perkins et al., in working memory with nicotine (relative to placebo) in the whole sample, suggesting flavouring resembles the taste of inhaled the literature, Professor Siegel from Boston that nicotine delivery is at least sufficient tobacco smoke. In short, it addresses the absolute terms, they are clearly much safer than tobacco cigarettes. In fact, ‘the truth Rose et al., 2010). Furthermore, since no demonstrated significantly elevated blood cigarettes’ (Siegel & Cahn, 2010). achieved via cigarette smoking. This latter study clearly suggests that e-cigarettes are Can the e-cigarette help
smokers to quit?
Although a product that delivers nicotine the nature of vaping and product choice. To conclude
smoking cessation address only the former.
The e-cigarette delivers nicotine without to provide pleasure as well as save lives.
clinical trials have yet to be completed, a recent large online survey reported over cigarettes are a highly effective nicotine cartridges, the properties of the vapour, 90 per cent of users stated that e-cigarette replacement, such respondents are likely reduce their cigarette consumption (Etter & Bullen, 2010). Two published reports of e-cigarette use in naive users, however, concern. On balance, however, e-cigarettes are probably doing people very little harm raised blood nicotine levels is consistent and, in all likelihood, doing people a lot of good if they are using these as a complete or partial alternative to tobacco smoking.
content analysis of 19 e-cigarette cartridges with smoking contribute to its reinforcing What is very apparent is that the potential University of East London (Dawkins et al., causing agents) in some of the cartridges, as well as inaccurate reporting of nicotine (placebo) e-cigarette reported comparable Lynne Dawkins
replacement therapies. TSNA levels present read discuss contribute at www.thepsychologist.org.uk

Source: http://www.thepsychologist.org.uk/archive/archive_home.cfm/volumeID_26-editionID_225-ArticleID_2265-getfile_getPDF/thepsychologist%5C0513dawk.pdf

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CURRICULO VITAE Lair Geraldo Theodoro Ribeiro, M. D., F.A.C.C. EDUCATION Educational Foundation Machado Sobrinho, Medical School of the Federal University INTERNSHIP AND POSTGRADUATE TRAINING Residency in Cardiology, Pontificia Universidade Catolica of Rio de Janeiro (RJ), Brazil Research Fellow in Medicine, Peter Bent Brigham Hospital and Harvard Medical School, Boston (MA


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