Why does smoking so often produce dependence? A somewhat different view

Hughes, John R.

doi:10.1136/tc.10.1.62

Cited by 33 publications

(26 citation statements)

References 26 publications

(14 reference statements)

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“…The same author stated that smokers with a high degree of dependence can also present with low motivation due to their lack of confidence in their ability to succeed; they believe they are incapable of quitting and are afraid of suffering from withdrawal syndrome, since their previous attempts have been unsuccessful. (25) We found a significant correlation between the degree of nicotine dependence and probable depression. Among the elderly individuals whose Geriatric Depression Scale scores were indicative together with depression, less social and medical pressure to stop smoking, fewer opportunities, low self-efficacy and lack of productive activity can reinforce the smoking habit.…”

Section: Discussionmentioning

confidence: 58%

Tabagismo em idosos internados em instituições de longa permanência

2010

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Objective: To determine the prevalence of smoking among elderly patients admitted to long-term care facilities (LTCFs) and to determine whether the degree of nicotine dependence is associated with sociodemographic variables, affective ties, motivation for smoking cessation and depression. Methods: Cross-sectional, population-based study involving 573 individuals over the age of 60, admitted to 13 LTCFs in the Federal District of Brasília, Brazil. We analyzed the following variables: type of LTCF, gender, age, level of education, monthly income, marital status, retirement status, affective ties, probable depression, motivation for smoking cessation and degree of nicotine dependence. In order to collect these data, the following instruments were used: a sociodemographic questionnaire; the Flanagan Quality of Life Scale; the Mini-Mental State Examination; the Geriatric Depression Scale; the Richmond test; and the Fagerström Test for Nicotine Dependence. Results: The prevalence of smokers in the study sample (573 individuals) was 23.0%. Of the 132 smokers, there were 90 males (25.8%) and 42 females (18.7%). Of these, 116 smokers were included in the study, 70 of whom (60.3%) presented with probable depression. The degree of nicotine dependence was found to be significantly associated with level of education, monthly income, affective ties, motivation for smoking cessation and probable depression, although not with the type of LTCF, gender, age, retirement status or marital status. Conclusions: Among elderly patients admitted to LTCFs in the Federal District of Brasília, the prevalence of smoking is high and the motivation for smoking cessation is low. Keywords:Smoking; Homes for the aged; Health services for the aged. ResumoObjetivo: Determinar a prevalência de tabagismo entre idosos internados em instituições de longa permanência para idosos (ILPIs) e verificar a associação do grau de dependência nicotínica com variáveis sociodemográficas, vínculo afetivo, motivação para cessação e depressão. Métodos: Estudo transversal de base populacional, incluindo 573 idosos com idade ≥ 60 anos, internados em 13 ILPIs no Distrito Federal. Foram analisadas as seguintes variáveis: tipo de ILPI, gênero, idade, escolaridade, renda mensal, estado civil, condição previdenciária, vínculo afetivo, motivação para a cessação, depressão provável e o grau de dependência nicotínica. Para a obtenção dos dados, foram utilizados os seguintes instrumentos: questionário sociodemográfico, Escala de Qualidade de Vida de Flanagan, Miniexame do Estado Mental, Escala de Depressão Geriátrica, teste de Richmond e Teste de Fagerström para Dependência de Nicotina. Resultados: A prevalência geral de fumantes na amostra (573 indivíduos) foi de 23,0%. Dos 132 fumantes, havia 81 homens (24,9%) e 35 mulheres (20,1%). Foram incluídos no estudo 116 fumantes, dos quais 70 (60,3%) apresentavam depressão provável. Houve significativas associações entre o grau de dependência nicotínica e as seguintes variáveis: escolaridade, renda mensal, vínculo afetivo, m...

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Section: Discussionmentioning

confidence: 58%

Tabagismo em idosos internados em instituições de longa permanência

2010

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“…It has been suggested that smokers who experience chronic, low-grade withdrawal are more likely to relapse than those whose symptoms abate quickly (Hughes, 2001), underscoring the important role that duration plays in predicting relapse. Few studies have examined physiological correlates of intermediate to longterm withdrawal.…”

Section: Discussionmentioning

confidence: 99%

Ventral Striatal Blood Flow is Altered by Acute Nicotine but Not Withdrawal from Nicotine

Tanabe

Crowley

Hutchison³

et al. 2007

Neuropsychopharmacol

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Neural mechanisms underlying the reinforcing effects of nicotine and other drugs have been widely studied and are known to involve the ventral striatum, which is part of the mesocorticolimbic dopamine system. In contrast, mechanisms of nicotine withdrawal have received less attention although subjective withdrawal likely contributes to the difficulty of quitting. The goal of this study was to determine if nicotine withdrawal was associated with alterations of cerebral blood flow (CBF) in ventral striatum. Twelve smokers, moderately dependent on nicotine, underwent MR dynamic susceptibility contrast (DSC) imaging at baseline, after overnight withdrawal from nicotine, and after nicotine replacement. DSC images were used to calculate CBF in three regions of interest: ventral striatum, thalamus, and medial frontal cortex. Subjective withdrawal symptoms were measured at each time point. In spite of significant subjective withdrawal symptoms, there was no main effect of withdrawal on CBF in the three regions. However, there was a significant correlation between the increase in withdrawal symptoms and a reduction in thalamic CBF. In contrast to withdrawal, nicotine replacement significantly increased CBF in ventral striatum. Our findings are consistent with the known role of ventral striatum in drug reward. The lack of a main effect on withdrawal, but correlation of thalamic blood flow with withdrawal symptoms suggests that more complex mechanisms mediate the subjective features of the withdrawal state.

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“…(194) Smokers who consume a large quantity of cigarettes can also present low motivation due to their lack of confidence to succeed. They believe they are incapable and are afraid of suffering from withdrawal syndrome, since they have already tried and failed before.…”

Section: Low Motivationmentioning

confidence: 99%

“…They believe they are incapable and are afraid of suffering from withdrawal syndrome, since they have already tried and failed before. (194) The principal strategies to overcome low motivation are discussed in the "Evaluation of the motivation level" section of these guidelines. the physician to practice the art of care until they achieve total abstinence.…”

Section: Low Motivationmentioning

confidence: 99%

Diretrizes para cessação do tabagismo - 2008

Reichert

Araújo

Gonçalves³

et al. 2008

J. bras. pneumol.

167

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that has been made in this area, even in a short period of time. Tobacco dependence is increasingly acknowledged as a chronic condition that can require multiple interventions. In addition, recent evidence supports the critical role of counseling, in individual and group interventions, as well as in conjunction with pharmacological treatment.The evidence-based selection method was applied in order to identify appropriate references in the specialized litera- IntroductionThis update represents the strong commitment of the Brazilian Thoracic Association to smoking cessation. It provides health professionals with a comprehensive instrument to deal with the principal aspects of tobacco dependence. It includes new and effective clinical treatments and highlights changes in procedures in certain situations.The comparison between this content and that of the previous guidelines shows the significant scientific progress The use of the strength of recommendation associated with the bibliographic citations in the text has as the following principal objectives: to clarify the information source; to stimulate the search for stronger scientific evidence; and to introduce a didactic and simple way to aid in the critical evaluation on the part of the reader, who is the one responsible for making the decisions concerning the patient being treated. Diagnostic approach Clinical evaluationThe smoker should be submitted to clinical evaluation upon admission to the smoking cessation program. The objective is to identify functional alterations in the lungs, the existence of smoking related diseases (SRDs), possible contraindications and drug interactions during the pharmacological treatment of the dependence. The profile of the smoker, the level of nicotine dependence and the motivation to stop smoking are also evaluated at this time.This evaluation (Chart 1) should include accurate clinical history, complete physical examination, and some complementary tests, depending on local diagnostic resources.Chest X-ray is an essential tool during the treatment. A good physician-patient relationship, together with professional sensitivity and observation skills, will indicate the most appropriate time. Some people are afraid of what they might find, avoiding treatment so that they do not have to face the situation. ture. This was followed by critical review by pairs, who ultimately presented their recommendations.The decision to adopt any of these guidelines should be made by the professional, taking into consideration the resources available in the locale and the specific circumstances of the patient. Although this document describes the principal recommendations in each situation, there is limited space for publishing. Therefore, additional references are provided to those interested in broadening their scientific knowledge on this subject.These guidelines are an up-to-date and comprehensive tool to aid health professionals in treating smokers, in public or private health care clinics. This is the role of the government and the public poli...

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Why does smoking so often produce dependence? A somewhat different view

Cited by 33 publications

References 26 publications

Tabagismo em idosos internados em instituições de longa permanência

Tabagismo em idosos internados em instituições de longa permanência

Ventral Striatal Blood Flow is Altered by Acute Nicotine but Not Withdrawal from Nicotine

Diretrizes para cessação do tabagismo - 2008

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