Tobacco-related disorders include Tobacco Use Disorder and tobacco withdrawal. Tobacco and tobacco-based products contain many harmful substances, including nicotine, a highly addictive chemical that causes changes in the brain that result in cravings for more nicotine. Those with tobacco-use disorder continue to use tobacco even though they know it is harmful. Tobacco Use Disorder is the most common substance use disorder in the U.S., as well as a major cause of disability and early death. Exposure to tobacco smoke can also cause early death in nonsmokers.
Tobacco Use Disorder is defined by the DSM-5 as a problematic pattern of tobacco use leading to clinically significant impairment or distress, involving at least two of the following within a 12-month period:
- Tobacco is taken in larger dosages and/or for a longer period of time than intended
- There is a persistent desire and/or failed attempts to reduce tobacco use
- A large amount of time goes into the procuring or using tobacco
- An overwhelming desire or urge to use tobacco
- The inability, due to tobacco use, to maintain obligations for one's job, school, or home life
- Continued tobacco use in the face of social/interpersonal problems that result from, or are made worse by, the use of the stimulant
- Tobacco use becomes prioritized to such an extent that social, occupational, and recreational activities are either given up on completely or are reduced drastically
- Tobacco use occurs even in situations where it becomes physically hazardous
- Use of tobacco continues even though one knows the physical and psychological risks and problems associated with it
- A considerable increase in the amount of tobacco is needed to achieve the desired effect, or the same amount of tobacco no longer produces the desired effect
- Withdrawal symptoms characteristic of tobacco use are present, or tobacco is taken to relieve or avoid withdrawal symptoms
Symptoms of tobacco withdrawal set in within 24 hours, and may include:
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-related 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 such 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 or higher motivation to quit. Any of a number of FDA-approved medications may also be used 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.
- Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
Last reviewed 03/25/2019