尼古丁替代疗法 (NRT) 戒烟

烟草使用：像治疗疾病一样治疗尼古丁成瘾

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?

尼古丁与成瘾：一种习得的模式

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.

将尼古丁依赖视为慢性病

与吸烟相关的疾病是美国可预防死亡的主要原因。持续接触尼古丁会导致大脑内发生可测量的变化，特别是中脑边缘“奖励”中心。这些生物学变化表明存在慢性疾病。停止尼古丁的稳定消费会导致大脑内的生理变化，使用者会经历“戒断综合症”。不幸的是，许多保险公司要么不承保戒烟治疗，要么限制承保治疗的持续时间。对于海洛因等严重成瘾者，通常会长期承保已被证明可以防止复发的药物（美沙酮）。

长期戒烟药物的好处

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.

与吸烟相关的疾病和死亡率高于任何其他慢性疾病。烟草使用者的健康不仅可以通过具有成本效益的戒烟治疗得到改善，而且有助于避免将来对烟草相关疾病进行更昂贵的治疗。提高这些治疗方法的可用性不仅可以提高当前吸烟者尝试戒烟的成功率，还可以为寻求烟草独立之路的吸烟者提供选择。