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Tobacco abuse is one of the leading preventable causes of sickness and death in the US. About 440,000 deaths occur each year because of smoking. It is the most common habit contributing to cancer in the US. It causes deaths from heart disease, stroke, lung cancer, COPD, oesophageal cancer, laryngeal cancer, and bladder cancer, among other things. It costs more than $150 billion per year in healthcare costs.

Nicotine dependence is the tolerance for nicotine and the withdrawal symptoms in relationship to nicotine abuse. Nicotine dependence can occur with any type of tobacco abuse. A total of 55 percent of Americans have tried smoking and about 23 percent of them are current smokers. About 30 percent are ex-smokers. The rates of smokers have dropped dramatically since a high of 42 percent in 1965 to around 25 percent in 1990. About 20 percent of Americans are considered to be nicotine dependent at some point in their lives. There are more people with mood disorders and schizophrenia who are nicotine dependent.

In recent years, 25 percent of men and 21 percent of women have been smokers. Genetics appears to be a factor in who gets nicotine dependent and who does not. Those who have close relatives who are nicotine dependent are three times more likely to be dependent themselves when compared to persons who have no close relatives with the disease. Emotional factors play a role in who gets nicotine dependent.

Nicotine dependence can occur from the first use of tobacco. Nicotine binds to the cholinergic receptors in the CNS and the receptors increase in numbers as a result. The receptors desensitize and increase the addictive power of nicotine. Nicotine activates the dopamine neurons in the brain, especially those parts of the brain associated with reward and reinforcement. As the dose of nicotine increases, you become increasingly tolerant to nicotine and the cholinergic receptors become more desensitized.

Nicotine withdrawal has many symptoms. It occurs after using a nicotine-containing product for at least several weeks. People can have dysphoric or depressed mood, irritability, anger or frustration, insomnia, anxiety, difficulty concentrating, decreased heart rate and restlessness. Blood levels of certain medications can go up if you quit smoking.

Doctors should ask about use of tobacco products at every visit. This increases the chance of being able to help the individual stop smoking. Documenting smoking status at every visit is important in the doctor-patient relationship when it comes to smoking.

These are the Diagnostic and Statistical Manual for Psychiatric Diseases reveals that three of the following conditions must be present before nicotine dependence can be diagnosed: There must be tolerance for nicotine and an increased use over time. There must be withdrawal symptoms when nicotine is withdrawn. The user has a persistent desire to cut down on cigarette smoking but cannot do it. The person must spend a lot of time obtaining or using the substance. There must be unsuccessful attempts at cutting down on tobacco. Social, occupational or recreational activities are dropped because of use of tobacco. Even if there are social or physical consequences of tobacco abuse, the individual continues to use tobacco.

Treatment of nicotine dependence begins with psychosocial intervention such as cognitive behavioural therapy to stop smoking. Education alone can make a difference to the stopping of tobacco abuse. There can be minor interventions on behalf of the primary care provider. The interventions can take as little as three minutes. Doctors need to ask about tobacco use, advice to help them quit, assessing the patient's willingness to quit, helping the patient to quit, and arranging for follow up to see how the patient is doing. Providers can assess whether or not the patient is ready to quit.

Nicotine replacement therapy can be used in patch, gum or lozenge form. This tricks the body into thinking you are smoking and is safe for almost all patients who smoke. Zyban or buproprion is an antidepressant that also reduces the urge to smoke. Varenicline is a partial agonist that binds to nicotine receptors and stops the urge to smoke. It helps 21 to 23 percent of smokers stop for at least a year.

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Medical Negligence Solicitors

Our personal injury solicitors operate a specialist medical negligence compensation service. Our Nicotine Dependence solicitors deal with claims using a no win no fee arrangement which means that if you don�t win then you don�t pay them their professional costs. If you would like legal advice at no cost with no further obligation just complete the contact form or email our lawyers offices or use the helpline and a Nicotine Dependence solicitor will review your medical negligence compensation claim and phone you immediately.

HELPLINE: ☎ 1800 633 634

The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here