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Tobacco-Related Disorders

A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D.

In the United States, 57% of the population has never smoked. Of the remaining 43%, about 22% are former smokers, and 21% are current smokers. Cigarettes are by far the most commonly used tobacco product. Less than 5% use smokeless tobacco (chew), and less than 1% use pipes or cigars. Tobacco use disorder is the only substance-related disorder than does not include a category for intoxication.

Tobacco Use Disorder

man smokingThe diagnostic criteria for a substance use disorders were previously reviewed. These criteria apply to tobacco use disorders.

Not all habitual smokers qualify for a diagnosis of tobacco use disorder. Just as there are "social drinkers," there are "social smokers." However, because the nicotine in tobacco is so highly addictive, true social smokers are rather rare. Nicotine is the addictive chemical contained in tobacco products. There is evidence that genetics play a role in tobacco use.

Tolerance and withdrawal symptoms are indicated by the absence of nausea and dizziness. These symptoms would ordinarily occur when a non-addicted person smokes.

Cigarettes include many other harmful chemicals besides nicotine. These other chemicals make tobacco use so harmful. These other chemicals cause serious, long-term health problems. These include bronchitis, emphysema, and many types of cancers. Nicotine can cause serious problems to a developing fetus.

Although the dangers of tobacco use are widely known, only a small percentage of people attempt to quit each year. Of those who try to quit, an even smaller percentage succeed. The intense cravings associated with regular nicotine use make quitting very challenging. Successful quitters are usually people who have not developed tolerance. This means they don't smoke when they first wake up, or when they are sick. They smoke fewer cigarettes per day and for fewer years. They typically use tobacco products with a lower nicotine content. However, highly motivated people, regardless of their level of nicotine dependence, are able to stop even if they need to try several times.

Tobacco withdrawal

Tobacco withdrawal may occur after someone discontinues or significantly reduces tobacco use following a period of daily use for at least several weeks. Nearly half of all tobacco users will experience tobacco withdrawal after 2 days of non-use. The withdrawal symptoms usually last 2-3 weeks. Withdrawal symptoms include depression; difficulty sleeping; irritability, frustration, and anger; anxiety; problems concentrating; restlessness; slowed heart rate; dry cough; and increased appetite/weight gain. People often report strong cravings lasting several days to several weeks.

Withdrawal symptoms generally cause people so much discomfort that they try to avoid them. People avoid these symptoms by using nicotine as soon as they wake up. Then, they continue to use at regular intervals throughout the day. One measure of nicotine tolerance is how soon the first cigarette of the day is smoked. Smoking within minutes of awakening suggests that tolerance has developed.

 

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