Clinicians, social scientists, researchers, and policy makers appreciate the need to understand the neurobiology of nicotine addiction and how this information can lead to new treatments and provide support for public policy debates on parity and preventing adolescent tobacco use. In a “bench-to-bedside” manner, this review covers both clinical and basic science perspectives. Both the reward and sensitization-homeostasis theories of nicotine addiction are supported by new understanding of clinical issues of rapid tolerance, withdrawal, sensitization, and craving when examined by functional brain imaging, genetics, and basic science studies of nicotinic acetylcholine receptors. This review provides information to help shape public policy, fight stigma, and improve clinical treatment and research. The fight for parity in health care requires education about the neurobiological basis of addiction versus the stigmatized bad habit or simple socialization. Parity must support reimbursement for nicotine replacement medications or other FDA approved medications and psychosocial treatments.
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