Nicotine

Nicotine

Nicotine is a highly addictive substance and as the psychoactive substance responsible for the most number of deaths in the United States (400,000 per year; probably responsible or implicated in 20% of deaths in the United States each year). When smoked, it reaches the brain in approximately 7 seconds, creating an immediate effect.

There has been a 41% decrease in nicotine use in the United States since 1965.

35% of college graduates used in 1965, versus 14% in the most recent surveys
high school graduate nicotine use has been constant, however, at about 36%
quit rate increased from 30% to 50%

Withdrawal:
Characterized by craving, irritability, anxiety, and increased appetite. It can be severe, but, unlike with alcohol or benzodiazepine withdrawal, nicotine doesn't cause seizures.

Treatment:

Wellbutrin has been FDA approved for treatment of nicotine craving.

40% abstinence at 3 months, 22% at 12 months.
Level of psychosocial treatment (support groups, psychotherapy) affects outcome.

Nicotine patch doubles quit rate v. placebo.

Nicotine gum increases the abstinence rate at 6 months (1.6: 1).

high dose better than low dose
highest quit rate when patients receive adjunctive behavioral therapy

Comorbidity:

85-100% of those with alcohol dependence also smoke cigarettes. Alcoholics smoke more heavily than nonalcoholics. Note that despite AA folklore to the contrary, alcoholics who address their nicotine dependence simultaneously with their alcohol dependence have lower relapse rates (on alcohol).

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