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should provide brief counselling intervention to all patients who brain via the lungs in as little as seven seconds. Nicotine binds
use tobacco (Figure 1.1). to specific acetylcholine receptors (mainly alpha4beta2 nicotinic
Once tobacco use and dependence are correctly perceived as a acetylcholine receptor) in the nucleus accumbens area of the
disease, it follows suit that tobacco-dependent smokers require forebrain which stimulate the release of neurotransmitters,
medical assistance offered by a health professional in order to such as dopamine and noradrenaline which is perceived as
7, 8
quit, which is provided through tobacco dependence treatment. pleasure by the tobacco user. The pleasure that the tobacco
As is the case for other chronic diseases, medical aid consists user perceive is in fact the relief of early withdrawal symptoms
of diagnosing chronic tobacco use and tobacco dependence, as nicotine levels rise and nicotine receptor stimulation occurs.
followed by regular treatment for remission of tobacco Nicotine dependence main feature is the desire to experience
consumption and treatment of chronic tobacco dependence. nicotine’s pharmacological effects and avoid the possible
By way of conclusion, by smoking tobacco, individuals not only withdrawal phenomena and conditioned associations, either
introduce nicotine into their own bodies and maintain or increase positive (nicotine produces psychoactive stimulation) or negative
tobacco dependence, but also expose themselves to numerous (absence of nicotine results in discomfort). 7
severe illnesses, many of which are fatal, caused by the toxins Each cigarette immediately decreases the craving but
contained in tobacco. The earlier tobacco dependence is treated, desensitizes nicotine receptors and increases their number,
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the earlier the patient quits smoking or using oral tobacco and thus increasing the urge for the next cigarette. This stimulation
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tobacco smoke and the higher the health benefit for the patient. 3 caused by tobacco use triggers chronic consumption. During
the phase of tobacco dependence initiation, the smoker will have
to raise the amount of nicotine administered in order to recreate
1.2 Definitions, classifications, terms the same intense sensations. After the initial adaptation period,
and specific explanations the smoker needs his/her individual dose of nicotine in order to
feel a neutral state and to prevent withdrawal symptoms. This
1.2.1 Tobacco dependence: an acquired industrial disease morphologic adaptation occurring in the central nervous system
Tobacco dependence is an addiction to tobacco caused by the drug corresponds to the development of a physical dependence. 7, 9
nicotine. The smoker suffering from tobacco dependence cannot
stop using the substance despite the fact that it causes him/ 1.2.3 Nicotine is not the only driver of tobacco dependence
her harm. Inhaled nicotine is known as a drug able to induce an Nicotine dependence has two components: physical dependence
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addiction at least as strong as that of heroin or cocaine. Tobacco and psychological dependence.
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users who took up smoking as teenagers are usually more In addition to the physical dependence, the repeated use of
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addicted than those who took up tobacco use as adults. Nicotine, tobacco products can become a habit. The social contacts and the
a substance with psycho-active properties, creates the cravings situations associated with a certain daily routine can reinforce
for cigarettes, cigars, pipes, making smokers unable to quit tobacco use. Over time, this behaviour becomes anchored in
easily and causes smokers to have physical and psychological daily life. As such, it is recommended that tobacco use treatment
symptoms when abstaining from smoking. While the nicotine be supported both by pharmacological treatment to alleviate
contained in tobacco causes the nicotine dependence, the toxic the physical symptoms and by behavioural therapy aimed at
effects are mainly due to other substances contained in the addressing routines and triggers associated with an individuals
tobacco smoke. tobacco use.

1.2.2 Mechanism of induction of tobacco dependence 1.2.4 Nicotine dependence according to WHO
Inhaled nicotine reaches the arterial blood circulation of the A person is considered as nicotine-dependent when he/she has a

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