Treatment of tobacco dependence: integrating recent progress into practice

Abstract

Tobacco use is one of the leading preventable causes of death in developed countries. Adoption of approaches that have demonstrated efficacy to improve the treatment of tobacco dependence are critical to reduce the health consequences of tobacco use. We summarize the latest epidemiologic data on tobacco use, the mechanisms that underlie tobacco dependence, and advances in pharmacotherapy and nonpharmacologic interventions available for the treatment of tobacco dependence. Specifically, we discuss the use of nicotine replacement therapy, bupropion and varenicline in primary care settings.

Figure 1: Areas in the brain involved in nicotine addiction. Nicotine stimulates nicotinic acetylcholine receptors located in the ventral tegmental area, which leads to the release of dopamine in the nucleus accumbens, an important step in the process of nicotine addiction. Neurons projecting from the prefrontal cortex and amygdala modulate the release of dopamine in the nucleus accumbens, which allows for control of these addictive behaviours. These regulatory pathways are comprised of glutamate and gamma-aminobutyric acid (GABA) neurons. Image by: Lianne Friesen and Nicholas Woolridge

Figure 2: Algorithm for integrating a patient's smoking status and his or her readiness to quit. A comprehensive approach integrating assessment, behavioural interventions and pharmacologic treatment of tobacco dependence.