How is Tobacco Addictive?

Scientists have long known that nicotine attaches to the core neurons of the brain�s reward system (where beneficial behaviours such as drinking water when thirsty are rewarded), the ventral tegmental area (VTA). Reward system neurons, dopaminergic neurons, trigger release of dopamine in a nearby region of the brain called the nucleus accumbens (NAc). When nicotine attaches to these neurons, they increase their activity, flooding the NAc with dopamine. This produces pleasure and disposition to repeat the behaviour that lead to it (smoking). This pleasure drives the process of addiction.

Also, two other neurons are involved, glutamate and GABA. Whereas glutamate attaches to other neurons and stimulates them to speed up their activities, GABA has the opposite affects of slowing them down. Nicotine increases the ratio of glutamate to GABA in the VTA. As Dr. McGehee explains, �It would be difficult to design a better drug to promote addiction.� (Mansvelder & McGehee, 2000).

Negative Physical Consequences of Smoking

Cancer of lung(s), mouth, voice box, throat, kidney, bladder, cervix, bowel

Heart attack, circulatory problems, stroke

Lung disease including COPD (asthma, chronic bronchitis, emphysema)

Tooth loss, gum disease

Harm to growing fetus

Negative Psychological Consequences of smoking

Rejection from non-smoking friends and family

Knowing who physically harmful it is and not stopping

Treatment Methods for Tobacco Addiction

Zyban � PO medicine, non-nicotine anti-smoking agent

Patches - transdermal nicotine patches that continuous deliver nicotine

Gum � a piece of gum that the chewer chews slowly to deliver nicotine

Inhalers � much like a salbuterol inhaler, delivers nicotine

Nasal Spray � delivers nicotine mist through nasal cavity

Specific Strategies for Nurses to Help Patients Addicted to Nicotine

COMMUNITY:

• refer to 12-step nicotine program or other support program
• refer to addiction specialist
• be willing to talk with smoker and not judge him/her
• praise efforts to quit/reduce smoking

HOSPITAL:

• refer to in-hospital 12-step program or other support program
• suggest use of patches, gum, inhalers, nasal spray to provide nicotine
• praise efforts to reduce quit/reduce smoking
• help patient to smoking area of hospital if he/she is not ready to quit (patients should be self-governing agents unless deemed incapable of being so)

  Created By: Lisa Powers