ABSTRACT
This chapter reviews biological and pharmacological mechanisms that link nicotine dependence comorbidity to psychiatric disorders (PDs) and substance use disorders (SUDs) and medication treatments for nicotine dependence in these disorders. Increasing evidence suggests that the pathophysiology of PD or SUD may predispose these patients to nicotine dependence, and, accordingly, such a biological vulnerability may also guide the development of targeted medication treatments. Empirical studies of currently available treatments in comorbid populations are reviewed, and recommendations for future research for medications development in this area are presented.
Since the Surgeon General’s committee released its landmark report on smoking and health in 1964, the prevalence of cigarette smoking in the U.S. population has decreased from 43.8% to 22.5% as of 2002 [1]. Despite a downward trend overall, the rate of cigarette smoking among persons with psychiatric disorders (PDs) and substance use disorders (SUDs) remains inordinately high, exceeding the general population by two-to fourfold. For example, in a population-based study on smoking prevalence, Lasser and colleagues [2] found that 41% of persons with PDs and up to 67.9% of persons with SUDs smoke cigarettes vs. only 22.5% of the general population. Degenhardt and Hall [3] found similar rates of smoking among clinical and nonclinical populations in Australia. Data collected from smaller communitybased samples have also indicated a greater smoking prevalence in persons with PDs and SUDs [4,5].
