Nicotine dependence It’s in ICD 10! MRCPsych addiction psychiatry seminars March 2010

Tobacco addiction Cigarettes are addictive Nicotine is the drug causing addiction Pharmacology and behavioural processes are similar to other drug addictions

Pharmacological interventions Nicotine replacement therapy (NRT) –Chewing gum –Lozenges –Transdermal patches –Inhalers and nasal sprays

Pharmacological interventions Bupropion Varenicline Clonidine, nortriptyline

Beneficial Advice from a doctor Bupropion Nicotine replacement therapy (NRT) Antismoking interventions in pregnant women Antismoking interventions in people at high risk of disease

Likely to be beneficial Advice from a nurse to quit Self help material Telephone advice to quit

Likely to be ineffective Acupuncture for smoking cessation Anxiolytics

Unknown effectiveness Physical exercise Training health professionals to give advice

NICE TAG 39 Recommends both NRT and bupropion Part of an abstinent-contingent treatment with a specific quit date Time limited –2/52 after target date for NRT –4/52 after target date for bupropion

NRT (BAP guidelines) All NRT products are effective (~doubles abstinence rate) Combinations can be used High dose for heavy smokers (4mg gum) Added behavioural support improves outcome NRT can be used in cardiac disease Can be used in pregnant and young people

NRT (BAP guidelines) Bupropion is effective Not licensed for adolescents or pregnant women Insufficient evidence to use NRT/bupropion in combination Contraindicated in those with a history of seizures or eating disorder