Treatment of Nicotine Dependence: An Update
Nicotine is the most common substance of abuse in India, and the most neglected substance of abuse. Nicotine dependence is a significant public health problem. Effective assessment tools for those with the condition include Fagerstrom’s test for nicotine dependence and carbon monoxide concentration of expired air. Nicotine Replacement Therapy (NRT) or bupropion doubles the quit rates, and varenicline triples them. There is no difference in efficacy between the five forms of NRT currently available. NRT in combination with varenicline or bupropion would be of a greater benefit than NRT alone. Data on e-cigarettes are inconclusive as of now. Psychosocial interventions with proven efficacy include setting of a quit date, brief advice, motivational interviewing, and group behavioral programs. A combination of pharmacological and behavioral strategies is most likely to produce the best results. Treatments under development include those based on the principles of pharmacogenetics, agents targeting the cognitive dysfunction that accompanies nicotine withdrawal, and nicotine vaccine.
Lal R, editor. Substance Use Disorder: Manual for physicians [Monograph on the internet]. National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi 2005. Available from: http://www.aiims.edu/aiims/departments/spcenter/nddtc/Substance%20Use%20Disorder%20-%20Manual%20for%20Physicians.pdf
Lal R, Ambedkar A, editors. Substance Use Disorder: Manual for paramedical staff [Monograph on the internet]. National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi 2009. Available from: http://www.aiims.edu/aiims/departments/spcenter/nddtc/Downloadable%20documents/Manual%20Paramedical%20-NDDTC.pdf
Who.int/gho/en [homepage on the internet]. Global health observatory data repository 2014. Available from: http://apps.who.int/gho/data/view.main.1805
Thankappan KR, Thresia CU. Tobacco use and social status in Kerala. Indian J Med Res 2007; 126:300-8.
Sellman D. Clinical neglect of nicotine dependence. Aust N Z J Psychiatry 2005; 39(10):847-8.
Ross GL. Smoke out doctors who neglect their smoking patients. MedGenMed 2006; 8:43.
Agency for Healthcare Research and Quality. Statistical Brief #101. Variations in smoking by selected demographic, socioeconomic, insurance, and health characteristics, United States, 2003. Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey. October 2005. Available from: http://www.meps.ahrq.gov/papers/st101/stat101.pdf.
Grant BF, Hasin DS, Chou SP, Stinson FS, Dawson DA. Nicotine dependence and psychiatric disorders in the United States results from the national epidemiologic survey on alcohol and related conditions. Arch Gen Psychiatry 2004; 61(11):1107-15.
Salín-Pascual RJ, Alcocer-Castillejos NV, Alejo-Galarza G. Nicotine dependence and psychiatric disorders. Rev Invest Clin 2003; 55(6):677-93.
Heatherton TF, Kozlowski LT, Frecker RC, Fagerstrom KO. The Fagerstrom Test For Nicotine Dependence: a revision of the Fagerstrom Tolerance Questionnaire. Br J Addict 1991; 86(9):1119-27.
The Agency for Health Care Policy and Research Smoking Cessation Clinical Practice Guideline. JAMA 1996; 275(16):1270-80.
Cahill K, Stevens S, Perera R, Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database Syst Rev 2013; 5:CD009329
Hughes JR, Stead LF, Hartmann-Boyce J, Cahill K, Lancaster T. Antidepressants for smoking cessation. Cochrane Database Syst Rev 2014; 1:CD000031
Le Foll B, Forget B, Aubin HJ, Goldberg SR. Blocking cannabinoid CB1 receptors for the treatment of nicotine dependence: insights from pre-clinical and clinical studies. Addict Biol 2008; 13(2):239-52.
Schnoll RA, Patterson F, Wileyto EP, Heitjan DF, Shields AE, Asch DA, et al. Effectiveness of extended-duration transdermal nicotine therapy: a randomized trial. Ann Intern Med 2010; 152(3):144-51.
Hurt RD. New medications for nicotine dependence treatment. Nicotine Tob Res 1999; 1 Suppl 2:S175-9; discussion S207-10
Jiloha RC. Pharmacotherapy of smoking cessation. Indian J Psychiatry 2014; 56(1):87-95.
CADTH. Nicotine replacement therapy for smoking cessation or reduction: a review of the clinical evidence. Ottawa: Canadian Agency for Drugs and Technologies in Health (CADTH). Rapid Response - Summary with Critical Appraisal; 2014.
Stapleton JA. Breaking away from a narrow prescribing protocol for medicinal nicotine. Addiction 2008; 103(4):564-5.
Fucito LM, Bars MP, Forray A, Rojewski AM, Shiffman S, Selby P, et al. Addressing the evidence for FDA nicotine replacement therapy label changes: a policy statement of the Association for the Treatment of Tobacco use and Dependence and the Society for Research on Nicotine and Tobacco. Nicotine Tob Res 2014; 16(7):909-14.
Piper ME, Smith SS, Schlam TR, Fiore MC, Jorenby DE, Fraser D, et al. A randomized placebo-controlled clinical trial of 5 smoking cessation pharmacotherapies. Arch Gen Psychiatry 2009; 66(11):1253-62.
Stead LF, Perera R, Bullen C, Mant D, Hartmann-Boyce J, Cahill K, et al. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev 2012; 11:CD000146
Rose JE, Herskovic JE, Behm FM, Westman EC. Precessation treatment with nicotine patch significantly increases abstinence rates relative to conventional treatment. Nicotine Tob Res 2009; 11(9):1067-75.
Joseph AM, Fu SS, Lindgren B, Rothman AJ, Kodl M, Lando H, et al. Chronic disease management for tobacco dependence: a randomized, controlled trial. Arch Intern Med 2011; 171(21):1894-900.
Menossi HS, Goudriaan AE, de Azevedo-Marques Perico C, Nicastri S, de Andrade AG, D'Elia G, et al. Neural bases of pharmacological treatment of nicotine dependence - insights from functional brain imaging: a systematic review. CNS Drugs 2013; 27(11):921-41.
McRobbie H, Bullen C, Hartmann Boyce J, Hajek P. Electronic cigarettes for smoking cessation and reduction. Cochrane Database Syst Rev. 2014. 12:CD010216.
DeBattista C, Schatzberg AF. Bupropion. In Sadock BI, Sadock VA, Ruiz P, Kaplan HI, editors. Kaplan and Sadock's Comprehensive Textbook of Psychiatry. 9th edition. Philadelphia, PA: Wolters Kluwer Health / Lippincott Williams & Wilkins; 2009. pp 3056-9.
Hughes JR. Nicotine related disorders. In Sadock BI, Sadock VA, Ruiz P, Kaplan HI, editors. Kaplan and Sadock's Comprehensive Textbook of Psychiatry. 9th edition. Philadelphia, PA: Wolters Kluwer Health / Lippincott Williams & Wilkins; 2009. pp 1353-9.
Koegelenberg CF, Noor F, Bateman ED, van Zyl-Smit RN, Bruning A, O'Brien JA, et al. Efficacy of varenicline combined with nicotine replacement therapy vs varenicline alone for smoking cessation: a randomized clinical trial. JAMA 2014; 312(2):155-61.
FDA: FDA Drug Safety Communication: Safety review update of Chantix (varenicline) and risk of neuropsychiatric adverse events, 2009 [Internet] Silver Spring: U.S. Food and Drug Administration; [Updated 2011 October 24; cited 2015 April 10] Available from: http://www.fda.gov/Drugs/DrugSafety/ucm276737.htm
Lee JH, Jones PG, Bybee K, O’Keefe JH. A longer course of varenicline therapy improves smoking cessation rates. PrevCardiol 2008; 11(4):210-4.
Crain D, Bhat A. Current treatment options in smoking cessation. Hosp Pract (1995) 2010; 38(1):53-61.
Fiore MC, Jaen CR, Baker TB, Bailey WC, Benowitz NL, Curry SJ, et al. Treating tobacco use and dependence: clinical practice guideline. Rockville MD: U.S. Department of Health and Human Services, Public Health Service, Agency for Healthcare Research and Quality; 2000.
Roberts NJ, Kerr SM, Smith SM. Behavioral interventions associated with smoking cessation in the treatment of tobacco use. Health Serv Insights 2013; 6:79-85.
Lai DT, Cahill K, Qin Y, Tang JL. Motivational interviewing for smoking cessation. Cochrane Database Syst Rev 2010;(1) CD006936
Michie S, Abraham C, Eccles MP, Francis JJ, Hardeman W, Johnston M. Strengthening evaluation and implementation by specifying components of behaviour change interventions: a study protocol. Implement Sci 2011; 6:10.
Stead LF, Lancaster T. Group behavior therapy programs for smoking cessation. Cochrane Database Syst Rev 2005(2):CD001007
Stead LF, Hartmann-Boyce J, Perera R, Lancaster T. Telephone counselling for smoking cessation. Cochrane Database Syst Rev 2013; 8:CD002850
Free C, Knight R, Robertson S, Whittaker R, Edwards P, Zhou W, et al. Smoking cessation support delivered via mobile phone text messaging (txt2stop): a single-blind, randomized trial. Lancet 2011; 378(9785):49-55.
UbhiHK, Michie S, Kotz D, Wong WC, West R. A mobile app to aid smoking cessation: preliminary evaluation of SmokeFree28. J Med Internet Res 2015;17(1):e17
Ussher MH, Taylor AH, Faulkner GE. Exercise interventions for smoking cessation. Cochrane Database Syst Rev 2014; 8:CD002295
Jaehne A, Loessl B, Frick K, Berner M, Hulse G, Balmford J. The efficacy of stepped care models involving psychosocial treatment of alcohol use disorders and nicotine dependence: a systematic review of the literature. Curr Drug Abuse Rev 2012; 5(1):41-51.
Schnoll RA, Leone FT. Biomarkers to optimize the treatment of nicotine dependence. Biomark Med 2011; 5(6):745-61.
Ashare RL, Falcone M, Lerman C. Cognitive function during nicotine withdrawal: Implications for nicotine dependence treatment. Neuropharmacology 2014; 76 Pt B:581-91.
Hartmann-Boyce J, Cahill K, Hatsukami D, Cornuz J. Nicotine vaccines for smoking cessation. Cochrane Database Syst Rev 2012; 8:CD00
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