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Tobacco Use Disorder

Definition

An individual who is addicted to nicotine through the use of tobacco products may have Tobacco Use Disorder (TUD).  Nicotine, which stimulates the central nervous system, can be inhaled by smoking cigarettes, cigars, or pipes; can be placed directly in the cheek with chewing tobacco; or can be sniffed through the nose by using snuff.   Nicotine causes dependence and withdrawal symptoms when the product is no longer being used.  Tobacco use and smoking does damage to almost every organ in the body which can lead to lung cancer, respiratory diseases, heart disease, stroke, and other illnesses. Tobacco use is the leading cause of death in the developed world.   

Symptoms

To be diagnosed with Tobacco Use Disorder, an individual will have used tobacco products for at least one year and have two of the following symptoms.  The severity of TUD is described as:

Mild = 2 or 3 symptoms

Moderate = 4 or 5 symptoms

Severe = 6 or more symptoms

Symptoms

1.     Larger quantities of tobacco over a longer period then intended are consumed.

2.     Unsuccessful efforts to quit or reduce intake of tobacco

3.     Inordinate amount of time acquiring or using tobacco products

4.     Cravings for tobacco

5.     Failure to attend to responsibilities and obligations due to tobacco use

6.     Continued use despite adverse social or interpersonal consequences

7.     Forfeiture of social, occupational or recreational activities in favor of tobacco use

8.     Tobacco use in hazardous situations

9.     Continued use despite awareness of physical or psychological problems directly   attributed to tobacco use

10.  Need for increasingly larger doses of nicotine in order to obtain the desired effect

11.  A noticeably diminished effect from using the same amounts of nicotine

12.  The onset of typical nicotine-associated withdrawal symptoms is present

13.  More nicotine or a substituted drug is taken to alleviate withdrawal symptoms

Causes

Risk factors for Tobacco Use Disorder include low-income levels, low level of education, and diagnosis of the following disorders: ADD/ADHD, Conduct disorder, Depressive Disorder, anxiety disorders, personality disorders, psychotic disorders, and other substance use disorders. There is also a genetic component to Tobacco Use Disorder.

Treatment

There are a number of methods to attempt smoking cessation. Nicotine replacement therapy increases the chances of stopping smoking by 50 to 70%. Adding behavioral counseling support to nicotine replacement therapy increases the chances of stopping smoking by a further 10 to 25%. There are medications available that contain nicotine and others that do not. Other methods that have been attempted include hypnosis, social support through smoking cessation self-help groups, and exercise as a way to relieve nicotine cravings.