Tobacco and Public Health - TCSC Indonesia

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PHARMACOLOGY OF NICOTINE ADDICTION
clinical approaches to treating individuals which are determined by the particular drug
under consideration (Goldstein 1994).
Incidence, prevalence, and risk of progression. Following initial use, development of
dependence to nicotine is far more common than that to cocaine, heroin, or alcohol,
and the rate of graduation from occasional use to addictive levels of intake is highest
for nicotine (Anthony et al. 1994; Giovino et al. 1995). Depending upon the definition
used for occasional use, between 33% and 50% escalate to become daily smokers in the
US (US DHHS 1994). In contrast, even when highly addictive dosage forms of cocaine
(i.e. smokable ‘crack’ cocaine) are readily available in the US, the risk of progression
from any use to regular use is the exception and not the rule.
Remission and relapse. An evaluation of several data sets indicates that rates and
patterns of relapse are similar for nicotine, heroin, and alcohol (e.g. Hunt and
Matarazzo 1973; Maddux and Desmond 1986), and probably for cocaine (e.g. Wallace
1989). A closer analysis of relapse to cigarette smoking showed that in the context of a
minimal treatment intervention approach, approximately 25% of persons relapsed
within 2 days of their last cigarette and approximately 50% within 1 week (Kotke et al.
1989), and that among people quitting on their own, two-thirds were smoking within
3 days of their scheduled quit date (Hughes et al. 1992).
Reports of addictiveness by drug abusers. Two studies evaluated ratings across addictions
by polydrug abusers. The first study found that when rating the degree of ‘liking’,
tobacco, cocaine, and heroin were rated similarly and all were rated more highly
than alcohol, and that tobacco was among the most highly rated drugs on a ‘need’
scale (Blumberg et al. 1974). Another study found that compared to other substances,
tobacco was associated with equal or greater levels of difficulty in quitting and urge to
use, but its use was not as pleasurable (Kozlowski et al. 1989).
Psychoactivity and euphoria. One correlate of addiction liability is that a drug
produces pleasurable or euphoriant effects in standard tests of drug liking and
morphine-benzedrine group scale (MBG) scores of the Addiction Research Center
Inventory (Jasinski 1979; Fischman and Mello 1989). Intravenous nicotine mimics
mood-altering effects of tobacco and, when rapidly administered by intravenous
injections in a similar manner as cocaine is often abused, nicotine produces qualitatively
similar effects as cocaine in poly drug abusers (Henningfield et al. 1995a; Jones
et al. 1999).
Reinforcing effects. As discussed earlier, nicotine serves as a reinforcer for a variety of
species. Its reinforcing effects are related to the dose and are increased when sensory
stimuli are associated with injections and by food deprivation (US DHHS 1988;
Corrigall 1999).
Physical dependence. Among addictive drugs, the most severe withdrawal syndromes
are those that occur following acute deprivation of extended administration of alcohol