Review: Nicotinic receptors and stages of nicotine dependence

Smoking is one of the leading causes of preventable death, where nicotine has been identified as the primary addictive constituent of tobacco. Consequently, there have been extensive investigations into the neuroadaptations that occur as nicotine dependence develops, where numerous neurological systems have been implicated. The focus of this review was on nicotinic acetylcholine receptor neuroadaptations that occur during the development of nicotine dependence. This focus was selected because (1) the nicotinic receptors are the primary binding sites for both nicotine and the most efficacious pharmacological smoking cessation treatments and (2) the receptors are located throughout the brain with considerable neuromodulatory ability. However, there was difficulty associated in outlining the role of nicotinic receptors in the development of nicotine dependence because it comprises a series of stages involving different neurological systems rather than a single state. To address this issue, the review adopts a novel approach and considers the role of nicotinic receptor subtypes at separate stages of the nicotine dependence cycle. This information was then used to examine the nicotinic receptor-related therapeutic mechanisms of three main pharmacological smoking cessation treatments.