Cigarette smoking is estimated to lead to 4.9 million premature
deaths per year worldwide. This is predicted to rise to 10 million
by 2020. In western countries it kills half of all smokers who fail
to stop.
The prevailing model for tobacco addiction is that nicotine from
cigarettes rewards smoking and punishes abstinence, tapping into a
motivational system of operant conditioning that requires no
conscious awareness. However, there are also accounts which involve
cognitive biases and the effect of nicotine on impulse control. The
brain pathways involved have been studied extensively, but the role
of different nicotine receptor subtypes and other neurotransmitter
systems is still subject to debate.
In western countries, cigarette smoking as an adult has a
heritability of 30-50% and candidate genes have been identified
that may contribute in part to addiction susceptibility. Many
socio-cultural correlates of cigarette smoking have been
established, but a comprehensive model that accounts for these and
links them with the psychobiological aspects of nicotine addiction
has not been forthcoming. Structured behavioural support programmes
aid cessation attempts, as do a number of pharmacotherapies, most
notably nicotine replacement treatments and bupropion, but the
underlying mechanisms are unclear.
This book deals with the problems involved in understanding and
treating nicotine and tobacco addiction. Topics covered include the
nature of the worldwide health problem posed by cigarette smoking,
the psychodynamics of cigarette addiction, and the basic
pharmacology and biochemistry of nicotine and its effect on the
brain. Further chapters analyse the genetic basis of susceptibility
to nicotine addiction. Finally, the contributors address approaches
to therapy. A continuing theme in the discussions throughout the
book is how best to treat nicotine addiction, given that many
smokers would like to stop smoking but are unable to do so because
of their addiction.
This book will be of great value to all psychologists and
psychiatrists working on addiction, specifically to nicotine but
also to other compounds and behaviours. It will also be of interest
to neuroscientists and pharmacologists working on nicotine
receptors and the brain pathways involved in dependence, as well as
to biochemists, molecular biologist and to public health officials.
Tabla de materias
Symposium on Understanding nicotine and tobacco addiction, held at the Novartis Foundation, London, 17-19 May 2005
Editors: Gregory Bock (Organizer) and Jamie Goode
This symposium is based on a proposal made by Robert West and Gino van Heeke
William A. Corrigall Chair’s introduction 1
Richard Peto and Richard Doll The hazards of smoking and the benefits of stopping 3
Discussion 15
Ian Stolerman Animal models for nicotine dependence 17
Discussion 28
Robert West Defining and assessing nicotine dependence in humans 36
Discussion 52
General discussion I 59
Uwe Maskos, Sylvie Granon, Philippe Faure and Jean-Pierre Changeux Nicotinic acetylcholine receptor functions in the CNS investigated with a novel method of stereotaxic gene re-expression in knockout mice 64
Discussion 79
Marina R. Picciotto Nicotine-mediated activation of signal transduction pathways 83
Discussion 90
David Balfour Complementary roles for the accumbal shell and core in nicotine dependence 96
Discussion 105
Christian Heidbreder The dopamine D3 system: new opportunities for dopamine-based reward 116
Discussion 123
Athina Markou Pathways and systems involved in nicotine dependence 132
Discussion 145
Arthur L. Brody Localizing tobacco dependence pathways with functional brain imaging 153
Discussion 166
Caryn Lerman Pharmacogenetic approach to nicotine dependence treatment 171
Discussion 178
Robert Walton Pharmacogenomics and smoking cessation 184
Discussion 194
General discussion II Power in studies 197
Receptor desensitization 199
Peter Hajek What limits the efficacy of current nicotine replacement therapies? 204
Discussion 213
Saul Shiffman, Stuart Ferguson and Deborah Scharf Exploring behavioural mechanisms of nicotine replacement therapy for smoking cessation 219
Discussion 231
Rachel F. Tyndale and Edward M. Sellers Modifying the metabolism of nicotine as a therapeutic strategy 235
Discussion 244
William A. Corrigall Challenges in discovery and development of pharmacotherapies for tobacco addiction 249
Discussion 259
Final discussion Nicotine comorbidity 262
Animal models 264
Index of contributors 266
Subject index 268
Sobre el autor
The Novartis Foundation is an international scientific and educational charity which promotes the study and general knowledge of science and in particular encourages international co-operation in scientific research.