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Psychology & Neuroscience of Addiction > Nicotine addiction and treatment > Flashcards

Nicotine addiction and treatment Flashcards

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1
Q

What characterises tobacco dependence?

A

It is a chronic, relapsing condition, sustained by nicotine

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2
Q

What are the three types of treatment for tobacco dependence?

A
  1. Medication
  2. Behavioural support
  3. Electronic cigarettes
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3
Q

What is the smoking prevalence?

A

> 1 billion people smoke cigarettes

> Smoking rates have declined in UK, USA, Australia and New Zealand to less than 20%

> Some groups have not benefitted from tobacco control initiatives

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4
Q

What is the smoking prevalence in people with Depression and anxiety?

A

32%

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5
Q

What is the smoking prevalence in people with psychosis?

A

62%

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6
Q

What is the smoking prevalence among substance users?

A

80%

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7
Q

When does tobacco dependence usually start?

A

Usually in childhood

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8
Q

What happens physiologically when you smoke?

A

> Nicotine rapidly absorbed through lungs

> Stimulates nicotine acetylcholine receptors in VTA

> Iincreased firing and release of dopamine in VTA -> increased amount in nucleus accumbens
= Direct Reward pathway
-> “teaching signal” to get more

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9
Q

What are the rewarding properties of nicotine?

A

> Stimulant which improves attention and mood

> BUT tolerance diminishes these cognitive improvements

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10
Q

What is the mechanism of nicotine tolerance?

A

Negatively reinforcing:

- brain adapts and has to be cooped up in order not to experience irritability and loss of concentration

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11
Q

What is the half-life of nicotine and what is its consequence?

A

Nicotine half-life = 2 hours
-> after short periods of not smoking -> experience of withdrawal symptoms

=> brain teaches smoker to smoke in presence of withdrawal symptoms

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12
Q

How are cigarettes engineered to get nicotine to the brain?

A

Ammonia + Cocoa:
- products and chemicals added to tobacco plant as it’s growing or after harvest

  • some chemicals are dangerous and become more toxic once tobacco is burned
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13
Q

What is the action of ammonia in cigarettes?

A

Speeds up transport of nicotine form lungs to brain

best used for cleaning toilets

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14
Q

What is the action of cocoa in cigarettes?

A
  • Enhances taste
    AND
  • It’s a bronchodilator: widens airways
    -> more tobacco smoke in your lungs -> more nicotine to brain (reward pathway…)
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15
Q

What composes tobacco smoke?

A

> Ammonia

> Cocoa

> 500 gases: carbon monoxide, ammonia, formaldehyde, hydrogen cyanide

> 3,500 particulates: nicotine, tobacco nitrosamines, polycyclic hydrocarbons

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16
Q

How does nicotine differ from other ingredients of tobacco smoke?

A

> Nicotine: main cause of addiction and dependence

> Other ingredients (toxins, carcinogens): main cause of high mortality rate

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17
Q

Why does the nicotine delivery system matter?

A

Because nicotine is the main cause of addiction and dependence (not mortality)

-> switching to a less harmful form of nicotine delivery system is a step away from tobacco smoking
AND a step towards better health

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18
Q

What is the average duration of most withdrawal symptoms?

A
  • Top-up needed every 2 hours
  • Peak 24-48 hours after quitting
  • Subside within 2-4 weeks
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19
Q

What does the plasma nicotine concentration graph of Benowitz (2010) tell us?

A

First cigarettes of the day are the most pleasurable and satisfying

  • in neutral zone: no pleasure/arousal and no withdrawal (abstinence) symptoms
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20
Q

What are the physical health damages of smoking?

A

> Harms heart and affects blood circulation

> Harms brain and can cause strokes

> Lung related illnesses
- bronchitis, emphysema, cancer, chronic obstruction pulmonary disease

> Reproductive health damages

> Dental damages

> Bone damages

=> 50% of smokers will die of smoking related disease

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21
Q

What characterises chronic obstruction pulmonary disease?

A

Progressive and debilitating condition

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22
Q

How does smoking contribute to poor mental health?

A

> More severe symptoms of psychosis

> Higher rates of depression, anxiety

-> longer time in hospital

> Higher doses of medication needed

> Can cause poverty

> Exploitation and stigma

> Unhealthy coping skills (reach cigarette at times of stress)

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23
Q

How does smoking lead to a need of higher doses of medication?

A

Tar in tobacco smoke speeds up metabolism of some medication

-> lower levels of drug in the blood

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24
Q

How can smoking lead to poverty in people with mental health conditions?

A

A lot of people with mental health conditions spend approximately 1/3 of their income on cigarettes per week

25
Q

What is the current treatment pathway for tobacco dependence?

A
  1. Health professionals raise issue of smoking
    - at every appropriate moment
  2. Advise smokers to quit
  3. Offer support
  4. If person receptive: referral to trained practitioner
  5. Trained practitioner provides combination of medication and behavioural support
26
Q

What is the available medication for treating tobacco dependence?

A

> Nicotine replacement therapy (NRT) products

> Bupropion

> Varenicline

> Nortriptyline

> Cytisine

27
Q

What is the importance of medication for treating tobacco dependence?

A

At least doubles smoker’s chances of quitting

28
Q

What are the types of behavioural support for treating tobacco dependence?

A
  • One to one
  • Group
  • Telephone
  • Self-help materials

=> improves smoker’s chances of quitting

29
Q

What characterises nicotine replacement therapy (NRT) products?

A

> 8 NRT products on the market

> More effective when 2 types used together

> All products are equally effective -> smoker’s choice

> Use of these products requires explaining and practice

30
Q

What are the currently available nicotine replacement therapy (NRT) products?

A

> Nicotine patches

> Lozenges and chewing gum

> Inhalator

> Nasal and mouth sprays

> Tablets

> Mouth strips

31
Q

What are the properties of nicotine patches?

A
  • Deliver regular dose of nicotine over 16 or 24 hours
  • Long-lasting action
  • > they can be worn around the clock
32
Q

What are the properties of lozenges and chewing gum (NRT)?

A
  • Release nicotine as they are absorbed through cheeks
  • Start with 1/hour
  • Use up to 15 pieces a day
33
Q

What are the properties of inhalators for nicotine replacement therapy (NRT)?

A
  • Can help if you miss physical action of smoking

- You can have up to 6 cartridges per day

34
Q

What are the properties of nasal and mouth sprays?

A
  • Deliver nicotine quicker than other NRT products

- Have up to 64 sprays per day
1-2 sprays/hour

35
Q

What are the properties of tablets for nicotine replacement therapy (NRT)?

A
  • Dissolve under your tongue
  • > more discreet than lozenges
  • Normally start with 1-2 tablets per hour
  • Up to 40 per day
36
Q

What are the properties of mouth sprays for nicotine replacement therapy (NRT)?

A
  • Dissolve on top of the tongue

- Have up to 15 per day

37
Q

How to manage the dosage of smoker’s medications?

A

> Smokers often under dose on medications

  • > they are encouraged to constantly keep up on their levels of nicotine rather than react to a craving
  • > assess level of withdrawal discomfort and adjust dose

> Professional support is vital to successfully quitting

38
Q

What is the average time for oral NRT products to take effect?

A

15-20 minutes

39
Q

What is the average time for mouth and nasal NRT products to take effect?

A

5 minutes

40
Q

What characterises the medication Bupropion (Zyban)?

A
  • Antidepressant
  • Acts on dopamine and noradrenaline pathways
  • Used for at least 8 to 12 weeks
41
Q

What characterises the medication Varenicline (Champix)?

A

> Nicotine acetylcholine partial agonist
- targets α4β2 receptor subtype

> Designed to reduce motivation to smoke

  • makes cigarettes less satisfying
  • reduces cravings, withdrawal symptoms, and reward from smoking

> Used for 12 weeks (with option of further 12 weeks)

42
Q

What are the potential neuropsychiatric side effects of varenicline, bupropion and nicotine patches for smokers with and without psychiatric disorders (Anthenelli et al., 2016)?

A
  • Anxiety
  • Depression
  • Agression
  • Delusions
  • Hallucinations
  • Psychosis
  • Suicidal behaviour
43
Q

What is the efficacy (quit rates) of varenicline, bupropion and nicotine patches in smokers with and without psychiatric disorders (Anthenelli et al., 2016)?

A

Efficacy of medications in terms of odds ratios is similar for smokers with or without psychiatric disorders

44
Q

Do varenicline or bupropion have varying neuropsychiatric adverse events relative to nicotine patches or placebo?

A

No significant increase in rates of neuropsychiatric adverse events in Varenicline or Bupropion relative to nicotine patch or placebo

45
Q

What are the implications of the absence of significant difference in rates of neuropsychiatric adverse events between Varenicline or Bupropion and nicotine patches or placebo?

A
  • Good news for smokers with mental illnesses
  • Hope of change in prescribing behaviours of many doctors who’ve been put off by early case negative reports
    (e. g. varenicline may compromise individual mental health)
46
Q

What are the common side effects of nicotine replacement therapy (NRT) products?

A
  • Skin rash
  • Hiccups
  • Sore throat
  • Sleep disturbance
47
Q

What are the common side effects of Varenicline?

A
  • Sleep disturbance
  • Dry mouth
  • Nausea
  • Dizziness
48
Q

What are the common side effects of Bupropion (Zyban)?

A
  • Sleep disturbance
  • Nausea
  • Change in taste
  • Dry mouth
49
Q

What is the consequence of overlapping side effects between NRT products, Varenicline and Bupropion?

A

It can be difficult to know whether patient’s sleep disturbance is due to withdrawal or because of NRT, Varenicline or Bupropion taken

50
Q

What are the 3 elements that constitute a structured programme of behavioural support?

A
  1. Education on how dependence develops and is sustained
  2. Minimise withdrawal symptoms through medication
  3. Personal coping plans
    - get ahead of potential cravings that might occur
51
Q

What is the structure of the standard treatment programme of behavioural support for smoking, which is available online?

A

> Session 1: Pre-quit Assessment

> Session 2: Quit Date

> Session 3: 1, 2, 3 weeks post Quit Date

> Session 4: 4 weeks post Quit Date
(4-week follow-up appointment)

52
Q

What can people who don’t want to quit smoking do?

A

Switch to cleaner forms of nicotine

  • e-cigarettes: less harmful nicotine delivery system
  • 2.6 million e-cigarette smokers in UK
53
Q

What characterises E-cigarettes?

A

> Not a licensed medication

> E-cig use led by smokers, rather than public health and tobacco communities

> Media debate if they are safe

> Rapidly evolving technology

> Battery, heating element/coil, e-liquid

54
Q

What does an e-liquid typically contain?

A
  • Nicotine
  • Propylene glycol or glycerin
  • Flavours
55
Q

What are the differences between cigarettes and e-cigarettes?

A
  • No tobacco in e-cigarettes
  • Solution is heated not burned
  • E-cigarettes are vaped, not smoked
56
Q

What is the effectiveness of e-cigarettes?

A

Likely comparable to other evidence-based treatments (e.g. NRT, Bupropion, Varenicline) when taking into account other factors such as self-selection

57
Q

What are the common side effects of e-cigarettes?

A
  • Dry throat and cough

- BUT normally disappears

58
Q

Why should smokers switch to vaping completely?

A

Because health benefits come when you switch to vaping completely

  • also, vapers should stop smoking completely

Psychology & Neuroscience of Addiction (14 decks)

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