Nicotine Dependence: Diagnosis, Chemistry, and Pharmacologic Treatments

Abstract

Columbus brought tobacco to the Old World, and in the following centuries, tobacco smoking spread throughout the world, despite vigorous opposition. The tobacco plant was named Nicotiana tabacum after Jean Nicot, who promoted his belief that the plant had medicinal value. Nicotine, the basic addicting drug contained in cigarettes, may be the deadliest drug known to humans in terms of overall morbidity and mortality. The morbidity and mortality from nicotine addiction is greater than that from World Wars I and II, the Vietnam War, AIDS (Acquired Immune Deficiency Syndrome), and heroin and cocaine addiction combined. Tobacco use is linked to more than 390 000 deaths per year in the United States alone. The powerful lobbying forces of the tobacco industry have managed to keep supplies of nicotine available to the public despite efforts from medical and legal bodies to reduce advertising and educate the public about the adverse consequences of nicotine use. The addictive potential of cigarettes and the extent to which nicotine is the active ingredient in generating and sustaining addiction has been debated. The reasons for the resistance to considering whether nicotine is addictive have origins in attitudes toward addiction. Free will and personal choice have prevailed as explanations for why a 20-cigarette per day smoker will receive more then 70 000 boluses of nicotine per year despite the high rate of morbidity and mortality associated with this drug.