Nicotine and nicotine withdrawal 6 quick facts for clinicians and administrators Mary.f.brunette@dartmouth.edu Geisel School of Medicine at Dartmouth 2015

WHAT is Nicotine? Nicotine is a chemical made by the tobacco plant Nicotine is the main addictive component of tobacco Nicotine is otherwise safe in cigarette amounts Nicotine in huge doses can be poisonous, but it is not possible to get that amount from smoking or from nicotine replacement therapy

Other components of tobacco can be very harmful Many other tobacco components Plant components 599 approved additives Many are harmful toxins Tobacco smoke has over 4000 components Many chemicals in smoke are harmful

IT’S THE Toxins in smoke THAT cause CVD, cancer, lung disease, diabetes

Neurobiology of Nicotine Nicotine from tobacco is a chemical that is similar to naturally made chemicals in the body Nicotine effects are mediated by receptors in many parts of the body, including the gastro-intestinal system and the neurons in the brain Nicotine slightly improves Memory and attention Relaxation, ability to enjoy things (reward) People who use tobacco regularly become dependent on nicotine, as with caffeine, causing withdrawal if one stops abruptly

What is Nicotine withdrawal? Withdrawal symptoms Peak in 1-4 days, lasts weeks to months Can be very uncomfortable and they include: Urges & craving for tobacco Dysphoric or depressed mood Irritability, frustration, anger Anxiety Insomnia Difficulty concentrating Restlessness Decreased heart rate Increased appetite/weight gain Reduced concentration and increased impulsivity Nicotine Replacement Therapy reduces withdrawal symptoms

Nicotine Replacement Therapy reduces nicotine withdrawal Using nicotine replacement therapy makes cutting down and quitting more tolerable for people May improve ability to remember and use coping skills when urges occur Nicotine replacement therapy does not suppress cue-induced craving People need help learning skills to avoid smoking when they have an urge even when using nicotine replacement therapy

Summary: 6 facts about nicotine Nicotine is the addictive component in tobacco Nicotine in cigarette doses is not toxic; smoke is toxic People who use nicotine regularly become addicted Reducing or stopping nicotine leads to withdrawal symptoms Nicotine replacement therapy reduces but does not completely get rid of withdrawal symptoms Learning skills to cope during withdrawal increases people’s ability to quit tobacco