Dependence on Tobacco and Nicotine Products: A Case for Product-Specific Assessment
Dependence on Tobacco and Nicotine Products: A Case for Product-Specific Assessment
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DOI：
10.1093/ntr/nts007
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发表时间：
2012-11-01
影响因子：
4.7
通讯作者：
Eissenberg, Thomas
中科院分区：
文献类型：
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作者：
Fagerstrom, Karl;Eissenberg, Thomas
用于诊断烟草/尼古丁依赖的《国际疾病分类》和《诊断和统计手册》强调了产生依赖的尼古丁药物。这些诊断工具因预测有效性差而受到挑战，并且它们不能区分各种形式的含尼古丁产品。事实上，含尼古丁的产品（例如，烟草香烟、无烟烟草[ST]、水烟、电子香烟[ECIG]和尼古丁替代[NR]产品）在感觉和行为参与以及药代动力学和药效学效应方面具有非常不同的特征。例如，香烟和尼古丁贴片在几乎所有这些维度上都是非常不同的。当停止使用尼古丁/烟草产品的能力被用作依赖性的标准时，不同产品的成功率差异很大：烟草戒烟比ST戒烟更困难，而ST戒烟又比NR产品戒烟更困难。基于这些结果，我们假设存在一个连续的依赖性，就像存在一个连续的伤害一样，烟草卷烟和NR产品位于连续体的两端，而其他产品（水管和ECIG）介于两者之间。为了更精确地捕获尼古丁及其给药形式产生的依赖性，可能需要特定于产品的仪器。这种方法的利弊进行了讨论。
The International Classification of Diseases and the Diagnostic and Statistical Manual for diagnosing tobacco/nicotine dependence emphasize the dependence-producing drug nicotine. These diagnostic tools have been challenged on grounds of poor predictive validity, and they do not differentiate across various forms of nicotine-containing products. In fact, nicotine-containing products (e.g., tobacco cigarettes, smokeless tobacco [ST], waterpipe, electronic cigarettes [ECIGs], and nicotine replacement [NR] products) have very different characteristics both in terms of sensory and behavioral involvement and also in pharmacokinetic and pharmacodynamic effects. For example, a cigarette and a nicotine patch are very different on almost every one of these dimensions. When ability to stop using a nicotine/tobacco product is used as a criterion for dependence, success rates vary considerably across products: Tobacco cigarette cessation is more difficult than ST cessation that in turn is more difficult than NR product cessation. Based on these results, we hypothesize that there is a continuum of dependence as much as there is a continuum of harm, with tobacco cigarettes and NR products on opposite ends of both continua and other products (waterpipe and ECIGs) somewhere in between. In order to capture more precisely the dependence produced by both nicotine and its administration forms, product-specific instruments may be required. The pros and cons of this approach are discussed.