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How to Assess the Role of Transcranial Magnetic Stimulation in Nicotine Addiction

  • Farid Talih
    Affiliations
    Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
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  • Ziad Nahas
    Correspondence
    Address correspondence to Ziad Nahas, M.D., M.S.C.R., Department of Psychiatry, American University of Beirut Medical Center, PO Box 11–0236, Riad El-Solh 1107 2020, Beirut, Lebanon
    Affiliations
    Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
    Search for articles by this author
      Substance use disorders (SUD) in general and nicotine dependence in particular account for significant mortality, morbidity, and socioeconomic burdens. This is a global issue that affects various societies as established by numerous health organizations including the World Health Organization, the Centers for Disease Control, and the National Institute on Drug Abuse. Researchers now believe that whereas positive reward from nicotine initiates smoking, it is mainly the relief from withdrawal symptoms and negative affect associated with it that contribute to the persistence of smoking and relapse (
      • Perkins K.A.
      • Gerlach D.
      • Broge M.
      • Fonte C.
      • Wilson A.
      Reinforcing effects of nicotine as a function of smoking status.
      ). Nicotine directly stimulates N-acetylcholine receptors (nAChRs) in the ventral tegmental area and increases dopamine (DA) levels in mesolimbic brain structures that initiate and perpetuate addictive behaviors. Activation of nAChRs on glutaminergic and gamma-aminobutyric acid (GABA)ergic terminals also modulate DA release in the nucleus accumbens and frontal cortex. Nicotine also increases release of norepinephrine in the amygdala and hippocampus, regions known as “incubators of craving phenomenon” that are activated on exposure to substance-related cues. Conversely, withdrawal from nicotine and cravings are associated with lower DA levels. Less than 5% of smokers who stop smoking on their own achieve 6- to 12-month abstinence (
      • Koob G.F.
      Neurobiology of addiction.
      ).
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