Nicotine and addiction
Nicotine is the fundamental reason people get addicted to tobacco products. The pharmacologic and behavioural processes underlying nicotine addiction are similar to those for heroin and cocaine.44 Nicotine increases the release of neurotransmitters in the brain, which help regulate mood and behaviour, particularly dopamine [see illustration below].45 In addition, combustible tobacco includes components other than nicotine that are believed to reinforce addiction by altering the levels of neurotransmitters.46
The level of addiction depends on the amount of nicotine delivered and the way in which it is delivered: the faster the delivery, rate of absorption and attainment of high concentrations, the greater the potential for addiction.44
Nicotinic acetylcholine (nACh) receptors
Nicotine binds predominantly to nicotinic acetylcholine (nACh) receptors in the central nervous system (CNS)
Vental tegmental area
Stimulation of nicotinic receptor in the Ventral Tegmental Area (VTA) results in release of dopamine in the Nucleus Accumbens. This is linked to pleasure and is the so-called reward system
Overview of NRT
NRT works by replacing some of the nicotine normally provided from smoking cigarettes, which binds to nicotinic receptors in the brain linked to pleasure and reward. By doing so, NICORETTE® and NICODERM® reduce craving and withdrawal symptoms, leaving the smoker free to concentrate on breaking the ritual of smoking.
Studies suggest widespread misconceptions about NRT: dispelling these myths may help your patients stick to treatment25
NRT isn’t effective.
Long-term NRT use isn’t safe.
- U.S. Clinical Practice Guidelines state that long-term use of NRT (up to 6 months) “does not present a known health risk, and developing dependence… is uncommon.”7
- NRT safety profiles have been established in over 30 years of worldwide clinical use.27
- NRT went over-the-counter in 1993, making it available to consumers without a prescription for almost 25 years. Explore products
- Almost 50% of patients without safety concerns were shown to continue NICORETTE® Gum (for >4 weeks) vs. only 29% of those with safety concerns.49 Dispelling this myth can be key to improving patient adherence to NRT.
Nicotine causes cancer and other smoking-related diseases.
- Nicotine is not proven to cause cancer. There are more than
4,000 other chemicals in cigarette smoke, of which over 60 are known or suspected to be carcinogenic. Using NRT instead of cigarettes reduces the exposure to these carcinogenic substances.26
- It is the myriad of toxins in cigarette smoke, rather than nicotine, which are the cause of chronic lung disease, heart disease and other disorders.26
It’s not possible to control weight gain when giving up smoking.
- When smokers stop smoking, individual responses actually range from weight loss to weight gain. Possible reasons for gain include:45
- Increase in food intake, particularly the consumption of sweet foods and carbohydrates, in the initial period of smoking cessation
- Metabolism changes
- If a patient is worried about gaining weight, advice can be given on healthy eating and staying active with exercise.
NRT replaces one addiction with another.
Nicotine causes yellow stains on the fingers and teeth.
- The tar in cigarettes is what causes the unsightly yellow-brown stains on fingers and teeth, not the nicotine.52
Nicotine is a man-made substance.
- Nicotine is a naturally-occurring substance derived from the tobacco (Nicotiana) plant.
Not all smoking cessation treatments work for everyone.
Some patients may not successfully quit, while others may require additional strategies to help. Customizing a quit plan and medications for each patient can, therefore, be very beneficial.
Misperceptions of NRT are very common.
In one U.S. survey of consumers (n=900):25*
- Only 1 in 4 knew that nicotine gum/lozenges were not as addictive as cigarettes
- 69% did not know that NRT was not as dangerous as cigarettes
- 1 in 4 patients thought NRT only helped smokers quit in the short-term
- 37% thought smokers using NRT are as likely to fail as people who quit 'cold turkey'
*900 daily smokers >18 years of age were recruited from a market research database and completed an online survey about their views on NRT. Multiple responses were allowed. Results were weighted by age, ethnicity and education, using estimates of the US smoking population from the 2006 National Health Interview Survey.
Only 50% or less
of NRT users adhere to the recommended length of treatment21-23
To help ensure your patients are using NRT properly, direct them to these How-to Videos