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Concept
Nicotine dependence
Summary
Nicotine dependence is a state of dependence upon nicotine. Nicotine dependence is a chronic, relapsing disease defined as a compulsive craving to use the drug, despite social consequences, loss of control over drug intake, and emergence of withdrawal symptoms. Tolerance is another component of drug dependence. Nicotine dependence develops over time as a person continues to use nicotine. The most commonly used tobacco product is cigarettes, but all forms of tobacco use and e-cigarette use can cause dependence. Nicotine dependence is a serious public health problem because it leads to continued tobacco use, which is one of the leading preventable causes of death worldwide, causing more than 8 million deaths per year.
According to the World Health Organization, "Greater nicotine dependence has been shown to be associated with lower motivation to quit, difficulty in trying to quit, and failure to quit, as well as with smoking the first cigarette earlier in the day and smoking more cigarettes per day." The WHO estimates that there are 1.1 billion smokers globally. Of the 34 million smokers in the US in 2018, 74.6% smoked every day, indicating the potential for some level of nicotine dependence. There is an increased frequency of nicotine dependence in people with anxiety disorders.
There are different ways of measuring nicotine dependence. Common dependence assessment scales for cigarette smokers are the Fagerström Test for Nicotine Dependence, the Diagnostic and Statistical Manual of Mental Disorders, the Cigarette Dependence Scale, the Nicotine Dependence Syndrome Scale, and the Wisconsin Inventory of Smoking Dependence Motives (WISDM).
Nicotine is a parasympathomimetic stimulant that attaches to nicotinic acetylcholine receptors in the brain. Neuroplasticity within the brain's reward system, including an increase in the number of nicotine receptors, occurs as a result of long-term nicotine use and leads to nicotine dependence. In contrast, the effect of nicotine on human brain structure (e.g. grey matter and white matter) is less clear.
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