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Tobacco and nicotine use

Nature Reviews Disease Primers volume 8, Article number: 19 (2022) Cite this article

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Abstract

Tobacco smoking is a major determinant of preventable morbidity and mortality worldwide. More than a billion people smoke, and without major increases in cessation, at least half will die prematurely from tobacco-related complications. In addition, people who smoke have a significant reduction in their quality of life. Neurobiological findings have identified the mechanisms by which nicotine in tobacco affects the brain reward system and causes addiction. These brain changes contribute to the maintenance of nicotine or tobacco use despite knowledge of its negative consequences, a hallmark of addiction. Effective approaches to screen, prevent and treat tobacco use can be widely implemented to limit tobacco’s effect on individuals and society. The effectiveness of psychosocial and pharmacological interventions in helping people quit smoking has been demonstrated. As the majority of people who smoke ultimately relapse, it is important to enhance the reach of available interventions and to continue to develop novel interventions. These efforts associated with innovative policy regulations (aimed at reducing nicotine content or eliminating tobacco products) have the potential to reduce the prevalence of tobacco and nicotine use and their enormous adverse impact on population health.

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Fig. 1: Male smokers in the world.
Fig. 2: Female smokers in the world.
Fig. 3: Male and female smokers (combined) in the world.
Fig. 4: Cycle of tobacco/nicotine use.
Fig. 5: Brain regions involved in nicotine addiction.
Fig. 6: PET imaging shows elevation of dopamine in the human brain after smoking.

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Acknowledgements

B.Le F. is supported by a clinician-scientist award from the Department of Family and Community Medicine at the University of Toronto and the Addiction Psychiatry Chair from the University of Toronto. The funding bodies had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication. The authors thank H. Fu (University of Toronto) for assistance with Figs 1–3.

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Authors and Affiliations

  1. Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada

    Bernard Le Foll

  2. Departments of Family and Community Medicine, Psychiatry, Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada

    Bernard Le Foll

  3. Department of Medicine, University of Wisconsin, Madison, WI, USA

    Megan E. Piper

  4. University of Wisconsin Center for Tobacco Research and Intervention, Madison, WI, USA

    Megan E. Piper

  5. Department of Neurobiology and Behaviour, University of California Irvine, Irvine, CA, USA

    Christie D. Fowler

  6. Section for Preventive Cardiology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway

    Serena Tonstad

  7. Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA

    Laura Bierut

  8. Institute of Mental Health, Peking University Sixth Hospital, Peking University, Beijing, China

    Lin Lu

  9. National Institute on Drug Dependence, Peking University Health Science Center, Beijing, China

    Lin Lu

  10. Centre for Global Health Research, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada

    Prabhat Jha

  11. National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Queensland, Australia

    Wayne D. Hall

  12. Queensland Alliance for Environmental Health Sciences, The University of Queensland, Woolloongabba, Queensland, Australia

    Wayne D. Hall

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  1. Bernard Le Foll
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Contributions

Introduction (B.Le F.); Epidemiology (P.J. and W.D.H.); Mechanisms/pathophysiology (C.D.F., L.B., L.L. and B.Le F.); Diagnosis, screening and prevention (P.J., M.E.P., S.T. and B.Le F.); Management (M.E.P., S.T., W.D.H., L.L. and B.Le F.); Quality of life (P.J. and W.D.H.); Outlook (all); Conclusions (all). All authors contributed substantially to the review and editing of the manuscript.

Corresponding author

Correspondence to Bernard Le Foll.

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Competing interests

B.Le F. has obtained funding from Pfizer (GRAND Awards, including salary support) for investigator-initiated projects. B.Le F. has received some in-kind donations of cannabis product from Aurora and medication donation from Pfizer and Bioprojet and was provided a coil for TMS study from Brainsway. B.Le F. has obtained industry funding from Canopy (through research grants handled by CAMH or the University of Toronto), Bioprojet, ACS, Indivior and Alkermes. B.Le F. has received in-kind donations of nabiximols from GW Pharma for past studies funded by CIHR and NIH. B.Le F. has been an advisor to Shinoghi. S.T. has received honoraria from Pfizer the manufacturer of varenicline for lectures and advice. All other authors declare no competing interests.

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Nature Reviews Disease Primers thanks Jamie Brown, Elisardo Iglesias and Ming Li for their contribution to the peer review of this work.

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Le Foll, B., Piper, M.E., Fowler, C.D. et al. Tobacco and nicotine use. Nat Rev Dis Primers 8, 19 (2022). https://doi.org/10.1038/s41572-022-00346-w

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