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The neurobiology of tobacco dependence: A preclinical perspective on the role of the dopamine projections to the nucleus
Abstract
It is now widely accepted that nicotine is the primary addictive component of tobacco smoke and that a majority of habitual smokers find it difficult to quit smoking because of their dependence upon this component of the smoke. However, although nicotine replacement therapy elicits a clinically valuable and significant improvement in the number of quit attempts that are ultimately successful, its efficacy remains disappointingly low. This review considers some of the reasons for this problem. It focuses on the hypothesis that stimulation of the dopamine (DA) projections to the medial shell and the core of the nucleus accumbens play complementary roles in the development of nicotine dependence. The hypothesis proposes that increased extra-synaptic DA in the medial shell of the accumbens confers hedonic properties on behaviors, such as smoking, which deliver nicotine, and thereby increase the probability that the response is learned. It also summarizes the evidence that the primary role of the increased DA overflow, observed in the accumbal core of nicotine-pretreated individuals, challenged with nicotine, is the attribution of incentive salience to cues associated with delivery of the drug and the transition to Pavlovian responding to these conditioned stimuli. The review argues that sensitization of the DA projections to the accumbal core, and the behaviors that depend upon this process, play a pivotal role in the maintenance of the tobacco smoking habit and that it is this component of the dependence that is inadequately addressed by nicotine replacement therapy.
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“Dopamine release in the core appears to act to generate stimulus-impulse associations (10,11).”
From The Multiple Facets of Cigarette Addiction and What They Mean for Encouraging and Helping Smokers to Stop (2009) · cites this paper as [11]
In the citing paper
“The binding of nicotine to receptors in the ventral tegmental area (VTA), aside from generating the impulse to smoke by virtue of dopamine release in the core of the nucleus accumbens, results in pleasant sensations because of dopamine release in the nucleus accumbens shell (11).”
From The Multiple Facets of Cigarette Addiction and What They Mean for Encouraging and Helping Smokers to Stop (2009) · cites this paper as [11]
Citations
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“Environmental stimuli associated with nicotine become powerful conditioned reinforcers and play a major role in the maintenance of nicotine self-administration and in relapse (Balfour, 2004).”
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“The therapeutic action of NRT is considered to operate via a reduction in the acute nicotine withdrawal syndrome (13).”
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“It is thought that during these months, the strength of the associative learning between smoking and reward diminishes and most symptoms of withdrawal remit.(7) After these few months, most smokers should have overcome their addiction and should be able to remain off cigarettes.”
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“The cognitive-affective consequences of smoking, such as pleasure, better concentration, and better tolerance of acute stress, are thought to be rewarding and in this way reinforce the smoking habit (Balfour, 2004;Walton et al., 2001).”
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“The free, nondesensitized receptors may be responsible for cravings and continued smoking acts on these receptors to provide positive reinforcement and sustained dopamine release to prevent withdrawal symptoms (Balfour 2004; Brody et al. 2006).”
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Tailoring Nicotine Replacement Therapy
McClure, J. B., & Swan, G. E. (2006) · CNS Drugs · doi:10.2165/00023210-200620040-00002 · Cited by 38
Ghrelin amplifies the nicotine-induced dopamine release in the rat striatum
Palotai, M., Bagosi, Z., Jászberényi, M., Csabafi, K., Dochnal, R., Manczinger, M., Telegdy, G., & Szabó, G. (2013) · Neurochemistry International · doi:10.1016/j.neuint.2013.06.014 · Cited by 37
“These upon being activated by nicotine, promote a sustained increase in dopamine release in the target areas that is considered essential to the development of nicotine addiction (Balfour, 2004; Pidoplichko et al., 2004).”
Varenicline: New treatment with efficacy in smoking cessation
Reus, V. I., Obach, R. S., Coe, J. W., Faessel, H. M., Rollema, H., Watsky, E. J., & Reeves, K. R. (2007) · Drugs of today · doi:10.1358/dot.2007.43.2.1069956 · Cited by 36
“underlying drug-seeking and other addictive behaviors, thus potentially contributing to nicotinic addiction (23, 25, 26).”
BackgroundPaterson, N. E. (2008) · European Journal of Pharmacology · doi:10.1016/j.ejphar.2008.12.009 · Cited by 37
Sidhpura, N., Redfern, P. H., Rowley, H. L., Heal, D. J., & Wonnacott, S. (2007) · Biochemical Pharmacology · doi:10.1016/j.bcp.2007.06.025 · Cited by 37
Nicotine Replacement Therapy : An Overview
Wadgave, U., & L., N. (2016) · International Journal of Health Sciences · doi:10.12816/0048737 · Cited by 141
“Nicotine is the main active ingredient in tobacco products that reinforces individual to tobacco addiction behavior, (1, 2, 3) it is tobacco’s other components which cause widespread mortality and morbidity.(4, 5, 6, 7) Although almost all of the toxicity of smoking is attributed to other components in cigarettes, it…”
BackgroundRecomendaciones para el tratamiento farmacológico del tabaquismo. Propuestas de financiación
Jimenez-Ruiz, C. A., Miranda, J. A. R., Pinedo, Á. R., Ferrero, M. B., Reina, S. S., Orive, J. I. D. G., Guzmán, J. G., Casado, L. R., Trullén, A. P., & Fagerström, K. O. (2008) · Archivos de Bronconeumología · doi:10.1157/13119541 · Cited by 36
Dingle, G. A., & Carter, N. A. (2017) · Musicae Scientiae · doi:10.1177/1029864916682822 · Cited by 34
“Nicotinic release of dopamine into the Nucleus Accumbens amplifies associative learning between smoking and accompanying stimuli, making these representations increasingly prominent and well-learned (Balfour, 2004).”
BackgroundTronci, V., Vronskaya, S., Montgomery, N., Mura, D., & Balfour, D. J. K. (2010) · Psychopharmacology · doi:10.1007/s00213-010-1868-x · Cited by 35
“…it has been proposed that the powerful reinforcing properties of tobacco smoke may depend, in part, on the ability of nicotine to enhance the reinforcing properties of other weak reinforcers present in the smoke (Rose et al. 2000, 2006; Donny et al. 2003; Palmatier et al. 2006; Balfour 2004, 2006).”
BackgroundSelf-citationEffects of acute nicotine administration on ratings of attractiveness of facial cues
Attwood, A. S., Penton‐Voak, I. S., & Munafo, M. R. (2009) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntn006 · Cited by 35
Shao, X. M., Xu, B., Liang, J., Xie, X., Zhu, Y., & Feldman, J. L. (2012) · Nicotine & Tobacco Research · doi:10.1093/ntr/nts261 · Cited by 34
“Balfour, D. J. (2004). The neurobiology of tobacco dependence: A preclinical perspective on the role of the dopamine projections to the nucleus accumbens [corrected]. Nicotine and Tobacco Research, 6, 899–912. doi:10.1080/14622200 412331324965 Benowitz, N. L., Porchet, H., Sheiner, L., & Jacob, P., 3rd. (1988). Nicoti…”
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Self-citationZhang, T. A., Tang, J., Pidoplichko, V. I., & Dani, J. A. (2010) · The Journal of Neuroscience · doi:10.1523/jneurosci.0458-10.2010 · Cited by 33
“…areas of the brain participate, dopamine signaling within the mesocorticolimbic system serves a vital role in the acquisition of behaviors that progress to addiction (Dani and Heinemann, 1996; Corrigall, 1999; Di Chiara, 2000; Mansvelder and McGehee, 2002; Balfour, 2004; Dani and Harris, 2005).”
BackgroundTargeting nicotine addiction: the possibility of a therapeutic vaccine
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Pharmacological Tobacco Cessation Treatments: Proposals for Financing
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Electronic cigarettes for smoking cessation
Lindson, N., Livingstone‐Banks, J., Butler, A. R., McRobbie, H. J., Bullen, C., Hájek, P., Wu, A. D., Begh, R. A., Theodoulou, A., Notley, C. J., et al. (2025) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010216.pub10 · Cited by 44
Peckham, E. J., Man, M., Mitchell, N., Li, J., Becque, T., Knowles, S. E., Bradshaw, T., Planner, C., Parrott, S., Michie, S., et al. (2015) · Health Technology Assessment · doi:10.3310/hta19250 · Cited by 33
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Metadata
- Authors
- Balfour, D.
- Affiliations
- University of Dundee (GB)
- Corresponding author
- Balfour, David
- ORCID
- Balfour, David
- Venue
- Nicotine & Tobacco Research
- Publisher
- Oxford University Press (OUP)
- Published
- 2004-12-01
- Volume
- 6
- Issue
- 6
- Pages
- 899-912
- ISSN
- 1462-2203 (ISSN-L)
- 1469-994X
- OpenAlex
- W2322700613
- Cited by
- 251
- References
- 2
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 6 · 2023: 5 · 2022: 3 · 2021: 7 · 2020: 4 · 2019: 5 · 2018: 5 · 2017: 12 · 2016: 12 · 2015: 9 · 2014: 14 · 2013: 17 · 2012: 15
- FWCI
- 11.26
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Nicotine & Tobacco Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Wellcome Trust
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Nicotinic Acetylcholine Receptors Study
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
- Keywords
- nicotine dependence, smoking, nucleus accumbens, incentive salience, classical conditioning, nicotine replacement therapy, smoking cessation, hedonic behavior, dopamine sensitization
- MeSH terms
- Conditioning, Classical, Dopamine, Drug Administration Routes, Humans, Neurons, Nicotine, Nucleus Accumbens, Psychological Theory, Synapses, Tobacco Use Disorder, Smoking Cessation
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