Tobacco addiction

from Wikipedia, the free encyclopedia
Classification according to ICD-10
F17 Mental and behavioral disorders due to tobacco
F17.2 Addiction syndrome
ICD-10 online (WHO version 2019)

Tobacco dependence refers to the dependence on nicotine , an alkaloid of the tobacco plant , in interaction with various other ingredients of tobacco or tobacco smoke. Tobacco addiction arises mostly and in a particularly pronounced way through smoking tobacco containing nicotine. However, nicotine can be addictive in any form of administration , although there are considerable differences in whether it is smoked, chewed or snorted .

Effects of tobacco smoke

Tobacco smoke, together with nicotine and other substances, is a rapidly addicting substance. It not only has psychostimulatory effects like cocaine or amphetamine , but also triggers the entire range of neuromodulators in the brain .

In connection with other substances, nicotine attacks two different compartments , the presynaptic and postsynaptic acetylcholine receptors (“nicotine receptors”). When it binds to the receptors, various neurotransmitters (chemical substances that serve to exchange information between the individual nerve cells) such as dopamine , serotonin , noradrenaline and endorphins are released . These influence different functional structures of the brain, with individual variations. The nicotinic acetylcholine receptors are very closely related to the prefrontal cortex . This may temporarily improve brain functions such as attention, memory and learning through nicotine. However, if nicotine is considered in connection with tobacco smoke, studies come to the conclusion that memory performance deteriorates due to tobacco abuse.

Dependency potential

Comparisons of animal studies and studies on human drug use show that pure nicotine is only slightly addictive, while tobacco cigarette smoke is very addictive. Nicotine is jointly responsible for the dependence on tobacco products and, in connection with other substances in tobacco smoke, has a high potential for dependency and can very quickly lead to dependent behavior. According to an article by D. Nutt et al. Published in 2007. the addiction potential of tobacco smoke lies somewhere between alcohol and cocaine. More precisely, the potential for physical dependence is that of alcohol or barbiturates and the potential for psychological dependence is that of cocaine. A few cigarettes or a few days with small cigarette consumption are enough to become physically dependent. The potential for dependence on orally ingested nicotine is significantly lower, and patches have almost no potential for dependence.

Studies on the question of whether the consumption of a single cigarette is enough to cause typical symptoms of dependency such as inner restlessness, irritability and difficulty concentrating and to cause a loss of personal self-determination (autonomy) have so far not led to reliable results because they are sometimes untenable or headstrong Addiction definitions and superficial criteria were used for the diagnosis of “nicotine dependence”, and the data were interpreted biased.

Above all, it is important that nicotine, in conjunction with other substances in tobacco smoke, subliminally creates the desire for a tobacco product and that the increasingly shorter habit-related stimulus-response interval creates an increasingly pronounced dependency in the form of increased tobacco consumption. Possible withdrawal symptoms can include irritability, restlessness, circulatory problems, headaches and sweating. However, the symptoms go away in 5-30 days.

Today we know that after three weeks of abstinence there is no longer any measurable change in the acetylcholine receptors - that is, they have returned to normal. During this time there can be restlessness and irritability up to aggressiveness and depression. At this point in time, the nicotine itself is no longer detectable in the brain (up to a maximum of three days after the end of nicotine consumption).

As a result, it can be stated that during withdrawal the dependence on the effects produced by the tobacco smoke is less important, as shown by many failed therapies with nicotine substitutes, but rather the learning process induced by the nicotinergic stimulation of the nucleus accumbens . Appropriately, this learning process can only be influenced or reversed by strong self-motivation or professional behavioral therapies. Nicotine substitutes and other medications can help with withdrawal.

The psychological dependency due to imprinted behavior patterns that develop in the course of a “smoking career” can still be present years after physical withdrawal.

The likelihood of relapse among smokers who quit tobacco without aids is 97% within six months of quitting. Up until 2012, it was assumed that nicotine replacement preparations with the correct dosage and further professional guidance could increase the chances of success by three percent. Recent studies after 2013 indicate that the relapse rate among those who used nicotine replacement supplements to quit was just as high as those who quit without aids.

Additives as addiction enhancers

Numerous substances that increase the addiction potential of tobacco smoke can be added to tobacco.

A scientific study by the Dutch RIVM ( Rijksinstituut voor Volksgezondheid en Milieu - National Institute for Public Health and the Environment) examined two brands of cigarettes with significantly different ammonium levels in tobacco (brand 1 contained 0.89 mg ammonium / g tobacco; brand 2 contained 3.43 mg ammonium / g tobacco), but the same nicotine content in the smoke. 51 study participants each smoked one of the cigarettes (mark 1 in the morning and mark 2 in the afternoon). Both brands had to be smoked according to an identical puff protocol. The individual train volumes were determined for each participant. After smoking, nicotine uptake and nicotine excretion in the blood were measured. No differences in nicotine intake were found between the two brands of cigarettes. The ammonium content in tobacco therefore has no influence on nicotine intake.

Economic aspects of tobacco smoking

Depending on the inclusion and consideration of the tobacco tax and the consequences for the health and social system (lost work, treatment costs , earlier death, lower pension payments, falling tobacco tax revenues ...) the calculations of the costs caused by tobacco consumption fluctuate considerably.

Therapy options

Ways to quit smoking include:

The scientific study on the effectiveness of hypnotherapy is considered inconsistent. The effectiveness of acupuncture does not go beyond the placebo effect.

There are currently three active ingredients available for drug therapy (nicotine preparations, bupropion , varenicline ), which can help with weaning. Cases of adverse effects on the cardiovascular system were documented in all of them. With varenicline, cases of depression , thoughts of suicide and committed suicide , aggressiveness and abnormal behavior have been documented. In the USA, this led to the drug having to be given warning labels. A review from 2013, which included 63 individual studies, found no increase in serious cardiovascular risks.

If the habit is stronger than the pure nicotine addiction (the secondary effects of smoking also apply to substitutes):

See also

literature

Web links

Individual evidence

  1. ^ Lutz Schmidt at the 2nd Nicotine Conference of the German Society for Nicotine Research in Erfurt.
  2. ↑ Tom Heffernan and others: Self-rated everyday and prospective memory abilities of cigarette smokers and non-smokers: a web-based study . In: Drug and Alcohol Dependence . 3. Edition. tape 78 , June 1, 2005, p. 235 ff . (English, sciencedirect.com - access with costs).
  3. ↑ James D. Belluzzi et al .: Acetaldehyde Enhances Acquisition of Nicotine Self-Administration in Adolescent Rats . October 20, 2004; Retrieved August 1, 2013.
  4. ^ JE Rose, WA Corrigall: Nicotine self-administration in animals and humans: similarities and differences. In: Psychopharmacology , Volume 130, Number 1, March 1997, pp. 28-40, ISSN  0033-3158 . PMID 9089846 . (Review).
  5. ↑ SCENIHR : Questions about tobacco additives - Is the development of nicotine addiction dose-dependent? (2010), accessed July 29, 2013.
  6. ^ Determinants of Tobacco Use and Renaming the FTND to the Fagerström Test for Cigarette Dependence , accessed July 28, 2013.
  7. ↑ James D. Belluzzi et al .: Monoamine Oxidase Inhibitors Allow Locomotor and Rewarding Responses to Nicotine . (December 14, 2005); Retrieved August 1, 2013.
  8. ↑ How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General, Nicotine Addiction: Past and Present . (2010); Retrieved July 29, 2013.
  9. ↑ Development of a rational scale to assess the harm of drugs of potential misuse. (PDF; 127 kB) 2007, accessed on March 9, 2013 .
  10. ↑ Harm reduction on nicotine addiction . (PDF) pp. 98/99
  11. ↑ Reuven Dar, Hanan Frenk: Can one puff really make an adolescent addicted to nicotine? A critical review of the literature . In: Harm Reduction Journal . 7, No. 28, 2010. PMID 21067587 .
  12. ^ Lindsay F. Stead, Rafael Perera, Chris Bullen, David Mant, Tim Lancaster: Nicotine replacement therapy for smoking cessation. Cochrane Tobacco Addiction Group, 2008, doi: 10.1002 / 14651858.CD000146.pub3
  13. ↑ HR Alpert et al .: A prospective cohort study challenging the effectiveness of population-based medical intervention for smoking cessation. Center for Global Tobacco Control, January 2013, doi: 10.1136 / tobaccocontrol-2011-050129 , PMID 22234781 .
  14. ↑ D. Kotz, J. Brown, R. West: 'Real-world' effectiveness of smoking cessation treatments: a population study Addiction, Vol. 109, No. 3, pp. 491–499, March 2014, doi: 10.1111 / add.12429 .
  15. ↑ Chemical changes in cigarettes. Potential for dependence on cigarettes (DKFZ). (No longer available online.) Non-Smoking Kids - online, archived from the original on January 19, 2013 ; Retrieved on September 29, 2011 (Excerpts from the red series of the DKFZ Heidelberg, tobacco prevention and tobacco control. The DKFZ website, however, is wrong with regard to ammonium compounds; they must not be added to smoking tobacco in Germany (see Tobacco Ordinance ). Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this note. ) @1@ 2Template: Webachiv / IABot / www.nichtübers-kids.de
  16. ↑ Article in the journal Food Chemical Toxicology , accessed November 29, 2011.
  17. ^ Statistics on tax revenue from the Federal Statistical Office. Retrieved February 23, 2013 .
  18. ↑ Hanno Charisius : Those who die earlier are cheaper longer , sueddeutsche.de, September 1, 2015, accessed on December 6, 2015.
  19. ↑ Combined strategy modules for smoking cessation ( memento of the original from October 29, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF; 131 kB). @1@ 2Template: Webachiv / IABot / www.api.or.at
  20. ↑ hypnosis. In: rauchfrei-info.de. www.rauchfrei-info.de, accessed on February 22, 2020 .
  21. ↑ acupuncture. In: rauchfrei-info.de. www.rauchfrei-info.de, accessed on February 22, 2020 .
  22. ^ FDA: Safety review update of Chantix (varenicline) and risk of cardiovascular adverse events
  23. ↑ AM Joseph, SM Norman, LH Ferry, AV Prochazka, EC Westman, BG Steele, SE Sherman, M. Cleveland, DO Antonuccio, DO Antonnucio, N. Hartman, PG McGovern: The safety of transdermal nicotine as an aid to smoking cessation in patients with cardiac disease. In: The New England Journal of Medicine . Volume 335, Number 24, December 1996, pp. 1792-1798, ISSN  0028-4793 . doi: 10.1056 / NEJM199612123352402 . PMID 8943160 .
  24. ↑ EJ Mills, K. Thorlund, S. Eapen, P. Wu, JJ Prochaska: Cardiovascular Events Associated with Smoking Cessation Pharmacotherapies: A Network Meta-Analysis. In: Circulation. , S., doi: 10.1161 / CIRCULATIONAHA.113.003961 .