This review gives an account of the cigarette as a highly efficient nicotine delivery system. It explains how nicotine induces pleasure, reduces stress and anxiety, and causes addiction to tobacco smoking. The basis of nicotine addiction rests on its effects on the brain, but addiction is also influenced by learned or conditioned factors, genetics, and social and environmental conditions.
Funding and Disclosures
Supported by grants from the Flight Attendants Medical Research Institute and the National Institute on Drug Abuse (U.S. Public Health Service grants DA02277 and DA20830).
Disclosure forms provided by the author are available with the full text of this article at NEJM.org.
I thank Marc Olmsted for editorial assistance on an earlier version of the manuscript.
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