Thompson G H, Hunter D A
Darnall Army Community Hospital, Pharmacy Department, Fort Hood, TX 76544, USA.
Ann Pharmacother. 1998 Oct;32(10):1067-75. doi: 10.1345/aph.17382.
To review the literature on nicotine dependence, nicotine pharmacology, health consequences associated with the use of nicotine, and nicotine replacement therapies used to aid smokers who are nicotine dependent.
A review of articles, book bibliographies, and published studies identified by a search of the MEDLINE database from 1982 to 1996 on nicotine dependence, nicotine addiction, nicotine withdrawal, smoking, smoking cessation, smoking intervention, nicotine pharmacology, nicotine pharmacokinetics, nicotine pharmacodynamics, and nicotine replacement therapies.
Inclusion criteria were published randomized, double-blind trials of at least 12 weeks' duration, meta-analyses, and panel consensus guidelines.
Cigarette smoking and tobacco use have met the surgeon general's primary criteria as well as additional criteria for drug dependence. Drug dependence requires that the drug produce psychoactive effects. Nicotine has been identified as the cause of tobacco dependence. First, nicotine provides positive reinforcement by stimulating nicotinic receptors to promote high self-administration rates. Second, nicotine causes a negative reinforcement in the form of withdrawal symptoms when nicotine is withheld after chronic use. Nicotine replacement therapy reduces the severity of withdrawal symptoms in smokers abstaining from tobacco. Nicotine replacement therapy allows the smoker to focus on psychosocial aspects of tobacco abstinence while receiving relief from withdrawal symptoms. The long-term effectiveness and health benefits of nicotine replacement therapy coupled with nonpharmacologic approaches have been clearly established. Smoking cessation has received wide attention from the public and medical communities; it is complex and has several interwoven factors to be considered. The psychological, behavioral, and physical components have to be understood before designing a treatment plan. The most successful approaches to smoking cessation involve multicomponent, multisession behavioral treatment programs as a foundation coupled with pharmacologic intervention. Pharmacists can play a key role in initiating behavior change and ensuring the safe and proper use of nicotine replacement in order to produce the desired outcome.
The optimum choice in nicotine replacement depends on the individual's needs and coping abilities. Individualized nicotine replacement coupled with nonpharmacologic interventions produces the highest rate of success for abstinence from nicotine.
回顾关于尼古丁依赖、尼古丁药理学、与使用尼古丁相关的健康后果以及用于帮助尼古丁依赖吸烟者的尼古丁替代疗法的文献。
对1982年至1996年通过检索MEDLINE数据库确定的文章、书籍参考文献及已发表研究进行回顾，内容涉及尼古丁依赖、尼古丁成瘾、尼古丁戒断、吸烟、戒烟、吸烟干预、尼古丁药理学、尼古丁药代动力学、尼古丁药效学以及尼古丁替代疗法。
纳入标准为已发表的至少持续12周的随机、双盲试验、荟萃分析以及专家共识指南。
吸烟和使用烟草已符合美国卫生局局长关于药物依赖的主要标准以及其他标准。药物依赖要求药物产生精神活性作用。尼古丁已被确定为烟草依赖的原因。首先，尼古丁通过刺激烟碱受体提供正性强化作用，以促进高自我给药率。其次，长期使用尼古丁后停止使用时，尼古丁会以戒断症状的形式导致负性强化作用。尼古丁替代疗法可减轻戒烟者戒断症状的严重程度。尼古丁替代疗法使吸烟者在缓解戒断症状的同时，能够专注于戒烟的心理社会方面。尼古丁替代疗法与非药物方法相结合的长期有效性和健康益处已得到明确证实。戒烟已受到公众和医学界的广泛关注；它很复杂，有几个相互交织的因素需要考虑。在设计治疗方案之前，必须了解心理、行为和身体方面的因素。最成功的戒烟方法是以多成分、多疗程行为治疗方案为基础，再结合药物干预。药剂师在启动行为改变以及确保安全、正确使用尼古丁替代疗法以产生预期效果方面可发挥关键作用。
尼古丁替代疗法的最佳选择取决于个人需求和应对能力。个性化的尼古丁替代疗法与非药物干预相结合，戒烟成功率最高。
