금연을 위한 니코틴 대체 요법(NRT)

담배 사용: 니코틴 중독을 질병처럼 치료하기

There are decades of information that concretely establishes tobacco use as hazardous to your health. With the effects of nicotine on the brain and the symptoms of nicotine withdrawal, the challenge for users of tobacco products to end their dependency on tobacco is evident by the various options of Nicotine Replacement Therapy (NRT) available to consumers. Given the relapsing nature of tobacco dependency and the measurable changes within the brain that are a staple of a chronic medical condition, it makes sense to treat nicotine addiction in ways similar to other chronic diseases like asthma, diabetes, and depression.

For smokers, the challenge lies in breaking the dependency cycle of nicotine. Looking deeper into the effects of nicotine on the brain, long–term NRT might be the difference between staying smoke-free or being a lifetime smoker. While long–term pharmacological treatment may not be ideal, it is a significant health improvement over continued tobacco use. Because of the obvious health benefits of not smoking, would it not be wiser to treat tobacco use long–term and reduce the impact of tobacco-related diseases on an already at-risk population?

니코틴 및 중독: 학습된 패턴

Research has shown how nicotine acts within the brain to produce a number of effects. Of primary importance to its addictive nature is the fact that nicotine activates reward pathways in the brain (dopamine receptors). This reaction is similar to that seen with cocaine and thought to be the underlying pleasurable sensation experienced by many smokers. Nicotine’s pharmacokinetic (process by which a drug is absorbed, distributed, metabolized, and eliminated by the body) properties also enhances its abuse potential. Cigarette smoking produces a rapid distribution of nicotine to the brain, with nicotine levels peaking within 10 seconds of inhalation. However, the acute effects of nicotine dissipate in a few minutes, as do the associated feelings of reward, which causes the individual to continue smoking, maintaining the drug’s pleasurable effects and preventing symptoms of withdrawal.

An emerging theoretical explanation of addictive behavior is that addiction is inherently irrational. The addiction behavior pattern uses the same mechanisms as natural rewards, but individuals behave in a non–optimal (addicted) way because of nicotine’s neuropharmacological effects on dopamine. Humans consistently discount the long–term rewards of discontinued substance use more than the short–term penalties for continued substance use. This is a classic example of hyperbolic discounting. However, hyperbolic discounting may not be the fundamental reason for individuals getting trapped in the cycle of addictive behavior. Rather, TDRL (temporal–difference reinforcement learning) theory suggests that the neuropharmacological effect drugs like nicotine and cocaine have on dopamine signals drive the individual into the addicted state.

니코틴 의존성을 만성 질환으로 치료

흡연 관련 질병은 미국에서 예방 가능한 사망의 주요 원인입니다. 니코틴에 지속적으로 노출되면 뇌 내, 특히 중변연계 "보상" 센터 내에서 측정 가능한 변화가 발생합니다. 이러한 생물학적 변화는 만성 질환을 나타냅니다. 니코틴의 꾸준한 섭취를 중단하면 뇌 내의 생리적 변화가 발생하고 사용자는 "금단 증후군"을 경험하게 됩니다. 불행하게도 많은 보험사는 중단 요법을 보장하지 않거나 보장되는 치료 기간을 제한합니다. 헤로인과 같은 심각한 중독의 경우 재발을 예방하는 것으로 입증된 약물(메타돈)이 장기간 보장되는 경우가 많습니다.

장기 중단 약물의 이점

For some users of tobacco products, quitting smoking is the easy part. Their addiction is not to tobacco itself, but to the nicotine that resides within. Through pharmacological treatments like the nicotine patch, inhalers, and gum, smokers can break the physical habits of smoking, but these treatments provide little relief for the chemical dependency on nicotine. Of smokers that successfully quit smoking using NRT and achieve smoking abstinence at 12 months, an estimated 30% relapse and resume smoking.

For some, long–term pharmacotherapy is the difference between staying smoke-free or a life long addiction to tobacco. An extension of NRT treatment periods, additional behavioral counseling, or other medical treatments are all of greater benefit to the patient in comparison to the alternative—a return to smoking and development of tobacco-related diseases. Extended courses of NRT treatment, as required by some patients, is a method currently supported by the U.S. Public Health Service Guidelines. There is a clear overall health benefit for individuals who no longer smoke—quitters using long–term nicotine replacement therapy are exposed to lower levels of nicotine without the 4,000 toxins found in cigarette smoke.

담배 사용과 관련된 질병 및 사망률은 다른 어떤 만성 질환보다 높습니다. 담배 사용자의 건강은 비용 효율적인 금연 치료로 개선될 뿐만 아니라, 향후 담배 관련 질병에 대한 비용이 많이 드는 치료를 피하는 데도 도움이 됩니다. 이러한 치료법의 가용성을 개선하면 현재 흡연자의 금연 시도 성공률이 향상될 뿐만 아니라 담배 독립의 길을 찾는 흡연자에게 선택권도 제공됩니다.