Harm reduction innicotine addiction
Helping people whocan't quit
A report by the Tobacco Advisory Group of the Royal Collegeof Physicians, October 2007
Citation of this report
: Royal College of Physicians.
Harm reduction in nicotineaddiction: helping people who can’t quit
. A report by the Tobacco Advisory Group of theRoyal College of Physicians. London: RCP, 2007.
Royal College of Physicians of London11 St Andrew’s Place, London NW1 4LE
Registered Charity No 210508
Copyright
All rights reserved. No part of this publication may be reproduced in any form(including photocopying or storing it in any medium by electronic means and whetheror not transiently or incidentally to some other use of this publication) without thewritten permission of the copyright owner. Applications for the copyright owner’swritten permission to reproduce any part of this publication should be addressed tothe publisher.Copyright © 2007 Royal College of PhysiciansISBN 978-1-86016-319-7
Coverphotograph:
Brenda Ann Kenneally
Design:
Suzanne FuzzeyTypeset by Dan-Set Graphics, Telford, ShropshirePrinted in Great Britain by The Lavenham Press Ltd, Suffolk
Acknowledgements
The members of the Tobacco Advisory Group acknowledge with thanks DianaBeaven, Hannah Thompson and Joanna Reid of the RCP Publications Departmentfor the editing and production of the book.
Contents
ContributorsviiMembers of the Tobacco Advisory Group of the Royal College of PhysiciansviiiForewordixPrefacexi
1Use of tobacco in society
11.1Introduction11.2The history of tobacco use11.3The smoking epidemic61.4The health impacts of tobacco smoking 121.5Conclusions 18
2Nicotine and nicotinic receptors, and their role in smoking
232.1Chemical and pharmacokinetic aspects of nicotine232.2The physiological functions of nicotinic receptors252.3Brain nicotinic receptors and cigarette smoking272.4Insights into nAChR activation, desensitisation andresensitisation from
in vivo
studies312.5Regulation of nicotinic receptor expression and function bychronic nicotine exposure312.6Acute actions of nicotine maintained in habitual cigarette smokers342.7Effects of nicotine on release of brain dopamine in smokers352.8Contribution of nicotinic receptor subtypes to the reinforcingeffects of nicotine in animal models372.9Conclusions38
3The neurobiological mechanisms underlying nicotine dependence
453.1Introduction453.2Nicotine self-administration in experimental animals463.3Neurobiology underlying the reinforcing properties of nicotine473.4The role of the accumbal shell483.5The role of the accumbal core 503.6The role of conditioned stimuli in nicotine reinforcement513.7Desensitisation and the neurobiology of addiction523.8The effects of nicotine withdrawal533.9The putative role of paracrine dopamine54
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A report by the Tobacco Advisory Group of the Royal College of Physicians, October 2007
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