Neurocognitive Insights in Nicotine Addiction

In the Netherlands, 27% of the population is currently smoking. Nicotine is among the most addictive substances of abuse. Thirty-two percent of the people who tried smoking develop nicotine dependence within ten year. This percentage is higher for nicotine than for other substances of abuse (e.g., 23 for heroin: Anthony, et al. 1994). Eighty percent of the smokers intend to quit smoking in the future while only 25% actually attempt to quit every year. Most of these quit attempts fail as 88-95% of the quitters smoke again in the year following the quit attempt (International Tobacco Control Policy Evaluation Project 2011). Although smoking rates are decreasing since 1970, the decline in smoking rates is less distinct in populations with a lower social economic status. Youngsters with lower educational levels start smoking more often and it could be that those with lower social economic status have more difficulties giving up smoking. Nicotine dependence is currently included in the Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV-TR) as a ‘substance use disorder’. Examples of diagnostic criteria are tolerance, withdrawal, smoking more than one intended, and the continuation of smoking despite knowledge of adverse consequences. Although nicotine dependence is included in the DSM-IV, nicotine dependence is rarely diagnosed. In addition, many smokers do not meet the diagnostic criteria, although they do experience problems giving up smoking (Schmitz, et al. 2003) and have increased risks for serious health problems. All these characteristics of smoking imply that smoking is a serious and chronic condition that occurs in a substantial part of the population.

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