Dr. Tesita Sherry presented on nicotine dependence and addiction. Some key points:
- Nicotine addiction develops from repeated nicotine exposure that changes the brain's reward system and causes withdrawal symptoms. This makes quitting difficult.
- Symptoms of nicotine withdrawal include craving, irritability, anxiety, and difficulty concentrating.
- Treatments include both pharmacological options like nicotine replacement therapy, bupropion, and varenicline, as well as behavioral counseling to address the habit of smoking.
- The goal of treatment is to reduce cravings and withdrawal symptoms to make quitting easier while also providing support to break the behavioral component of tobacco use. Monitoring progress is important
Dr. Tesita Sherry presented on nicotine dependence and addiction. Some key points:
- Nicotine addiction develops from repeated nicotine exposure that changes the brain's reward system and causes withdrawal symptoms. This makes quitting difficult.
- Symptoms of nicotine withdrawal include craving, irritability, anxiety, and difficulty concentrating.
- Treatments include both pharmacological options like nicotine replacement therapy, bupropion, and varenicline, as well as behavioral counseling to address the habit of smoking.
- The goal of treatment is to reduce cravings and withdrawal symptoms to make quitting easier while also providing support to break the behavioral component of tobacco use. Monitoring progress is important
Dr. Tesita Sherry presented on nicotine dependence and addiction. Some key points:
- Nicotine addiction develops from repeated nicotine exposure that changes the brain's reward system and causes withdrawal symptoms. This makes quitting difficult.
- Symptoms of nicotine withdrawal include craving, irritability, anxiety, and difficulty concentrating.
- Treatments include both pharmacological options like nicotine replacement therapy, bupropion, and varenicline, as well as behavioral counseling to address the habit of smoking.
- The goal of treatment is to reduce cravings and withdrawal symptoms to make quitting easier while also providing support to break the behavioral component of tobacco use. Monitoring progress is important
Dr. Tesita Sherry presented on nicotine dependence and addiction. Some key points:
- Nicotine addiction develops from repeated nicotine exposure that changes the brain's reward system and causes withdrawal symptoms. This makes quitting difficult.
- Symptoms of nicotine withdrawal include craving, irritability, anxiety, and difficulty concentrating.
- Treatments include both pharmacological options like nicotine replacement therapy, bupropion, and varenicline, as well as behavioral counseling to address the habit of smoking.
- The goal of treatment is to reduce cravings and withdrawal symptoms to make quitting easier while also providing support to break the behavioral component of tobacco use. Monitoring progress is important
DEPENDENCE SYNDROME Understanding And Addressing Nicotine Addiction
Presenter : Dr. Tesita Sherry
Overview Introduction
Indian smoking products
How do people become addicted to nicotine?
Symptoms and withdrawal symptoms of
nicotine addiction.
Treatment of nicotine dependence.
Introduction Tobacco use is the world's leading cause of death, accounting for 4 million deaths per year.
On the basis of current use patterns by the
year 2030, it may kill more than 10 million people annually.
Tobacco was introduced in India by the
Portuguese 400 years ago. Since then tobacco consumption continued to rise in India. Nicotine is Not Harmless Increase in blood pressure, respiration, and heart rate
Adversely affects nervous, cardiovascular,
respiratory, and reproductive systems
May contribute to cancerous tumor
development
Can be lethal if orally ingested
Associated with poor reproductive health
outcomes Nicotine is Not Harmless Early exposure can produce lasting effects on brain and lung development
Early exposure is associated with cognitive,
emotional, and behavioral deficits
Increases the risk of nicotine addiction and
alcohol and other drug use and addiction INDIAN SMOKING PRODUCTS Tobacco is used for smoking as well as in smokeless forms in India.
Bidi and cigarette smoking: Bidi smoking stick is specific
to India although it is being exported and raising alarm bells in other countries as well. It is about 6 times more common than cigarette smoking . Although bidi contains about 1/4th the amount of tobacco compared to a cigarette. It delivers a comparable amount of tar and nicotine.
Smokeless Tobacco: In India, tobacco is used in smokeless
manners in a wide variety of ways with multitude products such as betel quid, mixture of tobacco, lime areca nut, tobacco with lime, mishri, gutkha and many others.
Cigars: Cigars smoking is limited to certain social groups.
Nicotine Addiction Linked to Other Substance Use Disorders How Do People Become Addicted to Nicotine? Brain cells (neurons) stimulated by nicotine release chemicals, such as dopamine, that produce feelings of pleasure and that maintain or perpetuate those feelings
After continued use, the body adjusts to the presence of
nicotine and increasing amounts are needed to produce the same rewarding effects (i.e., tolerance) and to stave off the negative effects of its absence (i.e., withdrawal)
Withdrawal symptoms--such as anxiety, depression, and
cognitive deficits--can occur within minutes of the last dose of nicotine, increasing the risk of repeated use to avoid discomfort
As tolerance develops, nicotine ingestion must occur more
frequently and at shorter intervals to alleviate withdrawal symptoms High nicotine levels achieved in 11 seconds from inhalation.
The half life of nicotine
is only 2hrs. This along with its rapid clearance from the CNS results in withdrawal symptoms occurring quickly. Symptoms of Nicotine Addiction Fagerstrom test for Nicotine Dependence Pharmacological nicotine dependence Craving (nicotine hunger) Nicotine withdrawal symptoms Tobacco dependence has Two Parts Tobacco dependence is a 2-part problem
Physical Behavior The habit of using The addiction to nicotine tobacco Treatment Treatment
Medications for cessation
Behavior change program
Treatment should address both the addiction
and the habit Treatment of nicotine dependence A. Identification and assessment of tobacco use.
B. Interventions
C. Monitoring the progress
Identification and assessment of tobacco use. 5A’s for brief smoking cessation counseling
Ask about tobacco use
Advise to stop smoking Assess willingness to quit Assist with quit plan Arrange follow up Interventions Pharmacotherapy
Psychosocial therapy Interventions: Pharmacotherapy First line therapies: Three general classes of FDA-approved drugs for smoking cessation: Nicotine replacement therapy(NRT): -Nicotine gum, patch, lozenge, nasal spray, inhaler Psychotropics -Sustained release bupropion Partial nicotine receptor agonist -Varenicline Second line therapies: - Clonidine - Nortriptyline Nicotine replacement therapy(NRT): NRT relives craving and withdrawal symptoms. Many studies have shown using NRT can nearly double the chances of quitting with success. Nicotine gum Sugar free chewing gum base.
Contains buffering agents to enhance buccal
absorption of nicotine.
Available: 2mg, 4mg; Mint, Cinnamon, Paan
etc Chewing technique: Dosing
OR Side effects: Nicotine in NRT vs Smoking Absorbed more slowly (less acute effect).
No carbon monoxide; No oxidants
Nicotine is not a significant risk factor for
cardiovascular events, even in people with cardiovascular disease.
NRT and bupropion taken over long periods
are safer than cigarette smoking. Nicotine patch (Transdermal) Nicotine is well absorbed across the skin.
Delivery to systemic circulation avoids
hepatic first pass metabolism.
Plasma nicotine levels are lower and
fluctuate less than with smoking Direction for use: Dosing:
Heavy Smoker Light Smoker
> 10 cigarettes/day < 10 cigarettes/day
Step 1 (21mg x 6 weeks) Step 2 (14mg x 2 weeks)
Step 2 (14mg x 2 weeks) Step 3 (7mg x 2 weeks) Step 3 (7mg x 2 weeks) Side effects Nicotine lozenge Use: allow to dissolve (Don’t chew but suck like a hard candy)
Pros: Flexible dosing, Keeps the mouth bust,
OTC
Cons: Need to use it
correctly. May cause insomnia, nausea, hiccups, heartburn, coughing. Dosing Based on time to first cigarette (TTFC) 4mg if < 30mins to TTFC 2mg if > 30mins to TTFC
Length of treatment: 12weeks
Frequency= 1lozenge every 1-2 hrs for 6
weeks, with gradual reduction in the number used per day over the second 6 weeks
Max dose: 5 lozenges every 6hrs or 20/day
Nicotine inhaler The nicotine inhaler consists of a mouthpiece and a plastic nicotine containing cartridge.
When the smoker inhales through
the device, nicotine vapor (not smoke) is released and deposited in the Oropharynx and absorbed through the oral mucosa.
Frequency: 6 to 12 cartridges per
day for the first 6 to 12 weeks, followed by gradual reduction of dose over the next 6 to 12 weeks. Nasal Spray Produces a more rapid rise in plasma nicotine concentration than orally absorbed products. Peak of nicotine occurs 10 minutes after use
Frequency 1 to 2 sprays per hr are
recommended for about 3 months.
The max dose is 10 sprays/ hr or 80 total
sprays/day Changes to NRT indications More than one form of NRT can be used concurrently.
NRT can be used by pregnant and lactating
smokers.
All forms of NRT can be used by patients
with cardiovascular disease.
All forms of NRT can be used by smokers
aged 12 to 17 years. Non- Nicotine Pharmacotherapy First line non nicotine medications -bupropion -Varenicline
Others (nortriptyline, clonidine)
Bupropion
craving symptoms of withdrawal Dosing Patients should begin therapy 1 to 2 weeks prior to their quit date to ensure that therapeutic plasma levels of drug are achieved.
Initial treatment: 150md po OD x 3 day
Then 150mg po BD Duration 7 to 12 weeks Contraindications Seizures, heavy alcohol use, serious head injury, bipolar, anorexia or bulimia (eating disorders).
Neuropsychiatric effect - Suicidal/self-
injurious behavior and/or depression. Varenicline Side effect The most frequently reported adverse events with varenicline were nausea, headache, insomnia and abnormal dreams.
Serious neuropsychiatric symptoms have occurred in
patients being treated with varenicline.
All patients being treated with varenicline should be
observed for neuropsychiatric symptoms.
Recommended that it should be avoided in smokers
with current unstable psychiatric status or a history of recent suicidal ideation. Second line treatment Nortryptylline:
Clonidine: -Antihypertensive agent, centrally acting alpha- agonist. E-cigarette The e-cigarette delivers vaporized nicotine through the heating of a nicotine-containing solution, producing a visible ‘vapor’ that can be inhaled and exhaled.
However, FDA has not finalized
its regulatory process.
Difference between nicotine
inhaler and e-cigarette is that in nicotine inhaler you don’t inhale nicotine into your lungs. It stays mostly in your throat and mouth. There's’ no heating element or liquid nicotine. Herbal drug for smoking cessation Lobeline: -Derived from the leaves of Indian tobacco plant. -Partial nicotine agonist. -No scientifically rigorous trials with long-term follow up. -No evidence to support use for smoking cessation. PSYCHOSOCIAL TREATMENTS Behavior therapy -Skill training and relapse prevention -Stimulus control -Aversive therapy -Social support: -Contingency management -Cue exposure -Relaxation
Self help material
Educational, supportive groups, religious and spiritual
influences.
Hypnosis :The usual goal of hypnotherapy for smoking cessation is
to implant non-conscious suggestion that will deter smoking. Thank you
Ayahuasca Handbook: A Beginner's Guide to Spiritual Awakening, Inner Wisdom and Personal Transformation. Includes Step-by-Step Preparation For Your Ceremony, Finding Your Shaman, Integration & Aftercare
Ayahuasca Handbook: A Beginner's Guide to Spiritual Awakening, Inner Wisdom and Personal Transformation. Includes Step-by-Step Preparation For Your Ceremony, Finding Your Shaman, Integration & Aftercare
