Exploring behavioural mechanisms of nicotine replacement therapy for smoking cessation

摘要

Discussions of the 'mechanisms' by which medications help smokers quit usually focus on neuropharmacological mechanisms, with nicotine replacement therapy (NRT) considered simply as an agonist replacement. However, understanding the behavioural mechanisms by which proven therapies influence cessation can guide both basic research and treatment development. NRT is thought to promote abstinence by reducing craving and withdrawal. However, new analyses show that this does not fully mediate NRT's effects. It is also important to distinguish how treatment affects different milestones of cessation: i.e. promoting initial abstinence, preventing lapses from abstinence, or keeping lapses from progressing to relapse. New analyses show that NRT does all three. Surprisingly, its strongest effect is on preventing progression from lapse to relapse. This effect is apparently not mediated by reduction in hedonic response to the initial lapse. Different forms of nicotine delivery may also involve different behavioural mechanisms. For example, whereas nicotine patch (slow, steady administration) does not prevent the provocation of craving by smoking-related cueing stimuli that can trigger lapses, nicotine gum (acute administration) can rapidly relieve craving associated with these cue exposures, possibly preventing lapses. Behavioural mechanisms of other treatments are relatively unexplored.