Lecture 21: Treating tobacco addiction

Question 1

What factors effect the prevalence of cigarette smoking?

Answer 1

-socioeconomic factors (x2 less smokers in affluent areas)

Question 2

Why is there a socio-economic gradient with tobacco use?

Answer 2

• people can’t access healthcare as easily
• more normalised if the whole family smokes
• access to illicit tobacco which is cheaper and they can maintain their addiction

Question 3

Why is tobacco related disease important?

Answer 3

It is the single biggest cause of preventable morbidity and mortality in the NHS

• many neurological/mental disorders are made worse with smoking
• increases risk of lung cancer
• increase risk of cardiovascular disease

Question 4

What are the markers of addiction?

Answer 4

• use despite knowledge of harmful consequences
• cravings during abstinence
• failure of attempts to stop
• withdrawal symptoms during abstinence

Question 5

What causes the addiction in smoking?

Answer 5

Nicotine (this isn’t the harmful part, just the addictive part)
-harmfrom tobacco doesn’t cause the addiction

Question 6

How does nicotine cause addiction?

Answer 6

-it acts on nicotinic acetylcholine receptors stimulating dopamine release
-this results in the satisfaction associated with smoking
-following chronic nicotine exposure, ACh enter upregualted state: increases affinity and functional sensitivity
-a drop in nicotine levels leads to craving and withdrawal
(it takes ACh receptors 6-12 weeks to desensitise after the last cigarette)

Question 7

What impacts people into stopping smoking?

Answer 7

1. health professionals
2. family/friends
3. adverts/posters
4. restrictions
5. related health problems

Question 8

How do you help someone to stop smoking?

Answer 8

3 A’s

• ask and record smoking status
• advise patient of healht benefits of stopping
• act on patients response

Question 9

What are some pharmacological treatments to help with smoking cessation?

Answer 9

• nicotine replacement therapy (patches-long term, sprays, gum-short term)
• varenicline (partial agonist for the ACh receptor)
• E-cigarettes

Question 10

What are the controversies surrounding the use of E-cigarettes?

Answer 10

Against
-continued nicotine use
-long term effects unknown 
-promotes nicotine use in youths
-do they renormalise smoking?
-gateway to tobacco?
-products unsafe 
For
-nicotine is a minor healht risk
-quit rates continue to decrease
-normalises E-cigs, not tobacco
-experimenters (who would have used cigarettes) are in the same group
-tightly regulated