Tobacco-Related Disorders


Tobacco products contain many harmful substances, including nicotine, a highly addictive chemical that causes changes in the brain that result in cravings for more nicotine use and leads to tobacco-related disorders. Tobacco-related disorders include tobacco-use disorder and tobacco withdrawal. Those with tobacco-use disorder continue to use tobacco even though they know it is harmful. Tobacco-use disorder is not only the most common substance use disorder in the U.S., it is also the most preventable cause of disability and early death. Exposure to tobacco smoke can also cause early death in nonsmokers.


Those with tobacco-use disorder experience symptoms such as impairment or distress within a 12-month period because of tobacco use, taking tobacco in larger amounts or over a longer period of time than was originally intended, having a strong craving or urge to use tobacco, having a strong desire to cut down on tobacco use, or making unsuccessful efforts to do so. Other symptoms include spending a lot of time trying to obtain or using tobacco products, continuing to use tobacco despite problems it causes in major areas of life, such as work, school, home, or relationships, using tobacco in situations in which it is physically hazardous, such as smoking in bed or near flammable substances, needing an increasing amount of tobacco to reach the desired effect, and experiencing withdrawal symptoms when tobacco use is discontinued.

Symptoms of withdrawal set in within 24 hours and include irritability, anxiety, difficulty concentrating, increased appetite, depressed mood, and insomnia. Symptoms peak at two to three days after abstinence and last two to three weeks.


Tobacco-related disorders result from the addictive nature of the substance itself. A majority of users report experiencing cravings when they do not smoke for several hours. Studies have found that people with alcohol and other substance use disorders are more likely to use tobacco and have a lower rate of quitting tobacco use than those who do not have substance-use disorders. Children of parents who use tobacco are more likely to use it themselves, compared with children of parents who do not use tobacco. Many individuals with tobacco-use disorder continue to use tobacco products to relieve or prevent withdrawal symptoms.


Tobacco use disorder is considered highly treatable when the appropriate pharmacological, behavioral and psychosocial interventions are used. Treatment may include education about the nature and health consequences of tobacco addiction, individual and group addiction support programs, relapse prevention counseling, and separate, tailored treatments for those with lower and higher motivation to quit. Any of a number of FDA-approved medications may also be use to treat nicotine dependence. 


American Academy of Addiction Psychiatry. Nicotine Dependence. Revised May 2015. Accessed July 2017.

Weinberger AH, Funk AP, Goodwin RD. A review of epidemiologic research on smoking behavior among persons with alcohol and illicit substance use disorders. Preventive Medicine. November 2016;92:148-159.

Kandel DB, Griesler PC, Hu Mei-Chen. Intergenerational patterns of smoking and nicotine dependent adolescents. American Journal of Public Health. November 2015.

Last reviewed 09/19/2017