Cigarette smoking is estimated to lead to 4.9 million premature
deaths per year worldwide. This is predicted to rise to 10 million
by 2020. In western countries it kills half of all smokers who fail
to stop.
The prevailing model for tobacco addiction is that nicotine from
cigarettes rewards smoking and punishes abstinence, tapping into a
motivational system of operant conditioning that requires no
conscious awareness. However, there are also accounts which involve
cognitive biases and the effect of nicotine on impulse control. The
brain pathways involved have been studied extensively, but the role
of different nicotine receptor subtypes and other neurotransmitter
systems is still subject to debate.
In western countries, cigarette smoking as an adult has a
heritability of 30-50% and candidate genes have been identified
that may contribute in part to addiction susceptibility. Many
socio-cultural correlates of cigarette smoking have been
established, but a comprehensive model that accounts for these and
links them with the psychobiological aspects of nicotine addiction
has not been forthcoming. Structured behavioural support programmes
aid cessation attempts, as do a number of pharmacotherapies, most
notably nicotine replacement treatments and bupropion, but the
underlying mechanisms are unclear.
This book deals with the problems involved in understanding and
treating nicotine and tobacco addiction. Topics covered include the
nature of the worldwide health problem posed by cigarette smoking,
the psychodynamics of cigarette addiction, and the basic
pharmacology and biochemistry of nicotine and its effect on the
brain. Further chapters analyse the genetic basis of
susceptibilityto nicotine addiction. Finally, the contributors
address approaches to therapy. A continuing theme in the
discussions throughout the book is how best to treat nicotine
addiction, given that many smokers would like to stop smoking but
are unable to do so because of their addiction.
This book will be of great value to all psychologists and
psychiatrists working on addiction, specifically to nicotine but
also to other compounds and behaviours. It will also be of interest
to neuroscientists and pharmacologists working on nicotine
receptors and the brain pathways involved in dependence, as well as
to biochemists, molecular biologist and to public health
officials.
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