IB Psychology HLTopic 1 — Prevention and TreatmentPaper 1 & 2Biological approach~9 min read
Drug Treatments for Nicotine Addiction
The logic here is different from antidepressants. Nobody is trying to correct a shortage. The aim is to give the brain the substance it is craving in a safer, slower, controlled form — and then take it away gradually enough that the person barely notices.
📘 What you need to know
Nicotine addiction is often treated with agonist substitution therapy, delivered as Nicotine Replacement Therapy (NRT).
An agonist acts on the same receptors as the original drug. NRT acts on nicotinic receptors in the brain.
It stimulates dopamine release, mimicking nicotine’s effects but in a safer, controlled dose.
NRT comes as gum, skin patches, sprays or pouches, and is released into the bloodstream more slowly than from a cigarette.
It also lacks the harmful chemicals in tobacco smoke, and is reduced gradually over about two to three months.
Naltrexone works the opposite way: it blocks the rewarding effects of nicotine, reducing the desire to smoke by removing the pleasure.
Stead et al. (2012) reviewed 150 trials with over 50,000 participants and found NRT raised quit rates by 50–70% compared with placebo.
Why the speed matters
The reason cigarettes are so addictive is not only the nicotine but how fast it arrives. A sharp spike of nicotine within seconds produces a strong reward signal, and the brain learns to want that spike again. NRT delivers the same chemical without the spike.
This also explains why combination therapy works better: a patch holds the baseline steady, while gum handles the sudden cravings that a patch alone cannot reach.
Two opposite drug strategies sit on this page. NRT gives the brain a safer version of what it wants; naltrexone blocks the reward so wanting it stops paying off. Naming both, and explaining that they work in opposite directions, is an easy way to look well prepared.
Research support: Stead et al. (2012)
Aim: to compare the effectiveness of NRT against a placebo and other biological treatments for quitting smoking.
Method: a literature review of 150 drug trials involving over 50,000 participants, focused on randomised trials and dose comparisons.
Results: NRT in the form of gum, patches and sprays increased quit rates by 50–70% compared with placebo. Heavily addicted smokers responded best to higher doses of NRT gum, but higher doses of patches did not significantly benefit them. Combination therapy — a patch plus a rapid delivery form such as gum — was more effective than a single form of NRT.
Conclusion: NRT is an effective and viable treatment for quitting smoking.
The dose finding is the interesting one. More gum helped heavy smokers; more patch did not. That fits the delivery-speed idea exactly — gum can answer a craving in the moment, while a patch only raises the baseline. Using this detail shows you have understood the mechanism rather than memorised a conclusion.
Evaluation
Strengths
Accessible and cheap. Drug treatment needs a prescription and medical supervision, but not a trained therapist, weekly appointments or a waiting list. That makes it easier to engage with than CBT.
It reduces stigma. Treating addiction as a medical condition rather than a moral weakness encourages more people to seek help.
Very strong evidence base. 150 trials and 50,000+ participants is about as much data as psychology ever gets, and the focus on randomised trials raises the quality further.
Gradual reduction manages withdrawal rather than forcing an abrupt stop, which improves the chances of getting through the difficult early weeks.
Limitations
Side effects. Sleep disturbance, digestive problems and headaches can lead to non-compliance and relapse.
Effectiveness is not universal. Small genetic variations between people affect outcomes — naltrexone’s effectiveness, for example, depends on variations in the mu-opioid receptor gene.
It cannot work in isolation. The smoker has to want to quit before NRT is even started. Motivation and self-efficacy are doing a lot of the work.
Short-term evidence. Reviews rarely follow people for years, so we know less about whether the effect lasts.
Confirmation bias is a risk in any literature review, depending on which trials get included.
EXAM QUESTION
Evaluate one biological treatment of one health problem. [22]
Step 1: name the strategy and define the key termAgonist substitution therapy; an agonist acts on the same receptors as the original drug.Step 2: give the mechanism, including the speed pointNicotinic receptors, dopamine release, slower delivery, no tobacco smoke chemicals, gradual reduction over 2-3 months.Step 3: add naltrexone as the contrasting approachBlocks the rewarding effects instead of replacing them.Step 4: use Stead and evaluate150 trials, 50,000+ participants, 50-70% improvement, combination therapy best. Then side effects, genetic variation, and the motivation requirement.Best closing point: the drug manages the body, but the decision to quit is not biological
Link to concepts
Perspective
NRT clearly plays a role in reducing nicotine addiction, but it cannot work on its own. The smoker has to want to quit before they start, so motivation and self-efficacy are key factors in any decision to improve one’s health. A purely biological account of the treatment leaves those out.
Change
Research on NRT needs follow-up studies that measure the longevity of the effect. If NRT only works in the short term, that matters enormously for public health, because a quit rate measured at six weeks and a quit rate measured at five years are very different things.
💡 Exam tip
Define agonist explicitly. It is the term that makes the whole mechanism make sense.
Use the gum-versus-patch dose finding. It is specific, it is memorable, and it shows understanding.
Include naltrexone even briefly. Two mechanisms beat one.
The motivation point is your best evaluation move, because it exposes the limit of a purely biological treatment.
Name the method as a literature review and say what that means for the evidence.
This page pairs directly with the CBT for nicotine page. Combination treatment is the answer both of them point towards.
⚠ Common mix-up
Saying NRT has no nicotine. It has nicotine. What it lacks is the smoke and the sharp spike.
Confusing agonist with antagonist. NRT is an agonist; naltrexone blocks.
Reading “50 to 70%” as a quit rate. It is an increase in quit rates relative to placebo.
Calling Stead an experiment. It is a review of 150 existing trials.
Forgetting the gradual reduction. Tapering over two to three months is part of the treatment, not an afterthought.
Treating higher dose as always better. It helped for gum, not for patches.
Up next: Is Drug Treatment Too Reductionist? — both treatment pages assume a chemical fix for a human problem. Time to put that assumption on trial.
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