Understanding Tobacco Use Disorder
Key Takeaways
- Tobacco use disorder is dependence on nicotine in tobacco products - Jump to Section
- Symptoms include inability to quit and health issues from smoking - Jump to Section
- Disorder severity ranges from mild to severe with varying symptoms - Jump to Section
- Diagnosis involves self-recognition or doctor assessment of nicotine dependence - Jump to Section
- Treatments include medication, therapy, and nicotine replacement tools - Jump to Section
- Causes range from genetics to stress and mental health conditions - Jump to Section
- Risk is higher with mental health issues, early smoking, or familial use - Jump to Section
- DSM-5 criteria require a year of use and several specific behaviors for diagnosis - Jump to Section
What is Tobacco Use Disorder?
Tobacco use disorder is a diagnosis given to people who have developed a dependence on nicotine found in tobacco products. Nicotine is a highly addictive psychoactive drug and central nervous system stimulant. Anyone who smokes is at risk of developing physical dependence.
Nicotine-containing tobacco products trigger the release of endorphins, which activates the reward center of the brain. It triggers feelings of happiness and relaxation.
To get that same feeling, one must continue to use the product, causing a cycle of addiction. For many, the rush and relaxation someone gets from using tobacco and nicotine outweigh the negative physical effects of using these products.
The most commonly used nicotine-containing tobacco product is cigarettes. Cigarettes account for about 90 percent of the tobacco products in the United States. Less than five percent of tobacco users prefer chewing tobacco or snuff and less than one percent smoke tobacco in pipes or smoke cigars.
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Symptoms of Tobacco Use Disorder
The most noticeable symptom of tobacco use disorder is being unable to quit using without success. Additionally, some people feel angry or depressed when they attempt to end their addiction. Other symptoms of tobacco use disorder include:
- Developing health problems related to smoking, including certain cancers, bronchitis, heart problems, vision problems, and poor immune system health
- Neglecting relationships and responsibilities to smoke
- Avoiding people who encourage you to quit smoking
Over time, people with tobacco use disorder develop the many negative physical effects associated with smoking. Their health suffers and their recurrent tobacco use puts them at a higher risk of a wide variety of problems.
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Stages of Tobacco Use Disorder
Tobacco use disorder occurs in three stages. The stages are as follows:
Mild
Two to three symptoms of tobacco use disorder are present.
Moderate
Four to five symptoms of tobacco use disorder are present.
Severe
Six or more symptoms of tobacco use disorder are present.
Health Effects of Tobacco & E-Cigarettes
Tobacco use increases a person’s existing risk of many health issues and creates new health problems directly related to the use of tobacco.
There are both short- and long-term effects, including:
Short-Term
Short-term health effects of the use of tobacco products include:
- Bad breath
- Shortness of breath
- Reduction in productivity
- Social problems
- Increased risk associated with mild, moderate, and severe illnesses (you’ll contract more illnesses and take longer to recover)
Long-Term
Long-term health effects of the use of tobacco product include:
- Cardiovascular problems
- Cancer
- COPD
- Sexual and reproductive problems
- Dental problems including gum disease and yellowing teeth
- Bone health problems
- Increased cataract risk
- Onset or worsening of type 2 diabetes
- Rheumatoid arthritis
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How is Tobacco Use Disorder Diagnosed?
Many people recognize their tobacco use disorder without ever seeking medical attention. Many people try to quit using tobacco without success and/or experience significant withdrawal symptoms when they stop using.
If you suspect you have tobacco use disorder but you aren’t sure, speak to your doctor. They’ll assess your use of tobacco and help you determine how dependent you are on nicotine.
Treatment Options for Tobacco Use Disorder
Several treatment options help with smoking cessation and tobacco use disorders. Many people find a combination of treatments offers the greatest likelihood of successful smoking cessation.
These include:
- Hypnosis
- Self-help groups
- Medication
- Cognitive behavioral therapy (CBT)
- Positive reinforcement
- Prescription and over-the-counter nicotine replacement therapy (NRT), including the nicotine patch, nicotine gum, the nicotine lozenge, nasal spray, and inhalers
- Counseling
Electronic cigarettes are marketed as a smoking cessation tool, but many people in the medical community do not consider these tools effective for helping people stop smoking.
Adolescent smokers introduced to e-cigarettes have just as great of a risk of addiction and health problems as people who smoke cigarettes.
Smokeless tobacco use is also seen by some as a smoking cessation tool. Using smokeless tobacco reduces the risk posed to others in relation to second-hand smoke, but it is still a dangerous practice and does little to nothing to help someone with treating tobacco or nicotine addiction.
What Medications are Approved to Treat Nicotine Dependence?
Medications approved by the FDA to help smokers avoid withdrawal symptoms and treat nicotine dependence include:
- Bupropion (including brand name drugs such as Zyban, Wellbutrin, Aplenzin, Budeprion, Buproban, and Forfivo) are antidepressant medications that reduce cravings for nicotine and help ease withdrawal symptoms.
- Varenicline (including brand name drug Chantix) is a partial agonist that reduces nicotine withdrawal and cravings. It also triggers mild nicotine toxicity symptoms when someone on the drug uses nicotine.
Causes of Tobacco Use Disorder
The causes of tobacco use disorder vary from person to person and include:
Genetics
In addition to exposure within the home to tobacco use, there is also a genetic component. People with family members addicted to nicotine are more drawn to smoking and have a greater likelihood of developing an addiction.
Peer Pressure
People, especially adolescents and pre-teens, are more likely to try smoking if their friends smoke.
Stress
People turn to smoking to ease stress because nicotine triggers endorphin release. Higher and more frequent levels of stress increase a person’s likelihood to seek substances that provide a boost of endorphins.
Response to Tobacco and Nicotine
Not everyone gets pleasure from smoking or using other tobacco products. If you are someone who experiences nausea, headaches, or other negative side effects, your risk of developing an addiction is lower.
Mental Health Conditions
Some people substitute cigarettes and other drugs instead of getting medical treatment for their mental health issues. Tobacco use disorder is higher among people with depression, anxiety, and other mental health issues.
Family Dysfunction
People with unsatisfactory family lives turn to tobacco products more often than those with healthy and functional families.
Who is at Risk of Developing Tobacco Use Disorder?
Anyone who uses tobacco is at risk of developing tobacco use disorder. Some people have a higher risk of addiction than others, so it’s possible to use tobacco without becoming addicted.
A person’s risk of tobacco use disorder is higher if they have:
- Depression
- ADD or ADHD
- Anxiety
- Personality disorders
- Psychotic disorders
- Parents who smoked
- Used other substances, including drugs (specifically opioids) or alcohol
- Started smoking early in life
In addition to growing up in a household where smoking was the norm, there might also be a genetic link with tobacco use disorder.
Additionally, the DSM-5 indicates that other factors, including education and income level affect a person’s likelihood to develop tobacco addiction.
How to Approach Your Loved One
It can be challenging to confront someone you care about who smokes or uses other forms of tobacco. Encouraging a loved one to quit offers benefits for you and your loved one. Second-hand exposure to tobacco smoke, even if you do not use tobacco, is dangerous.
Unfortunately, quitting is a challenge even when you understand the risks of a nicotine addiction.
Tobacco withdrawal is a lengthy process and one that triggers relapse for many people who smoke cigarettes and use other tobacco products.
Nicotine addiction is one of many substance use disorders. And substance abuse treatment is an effective way to deter cigarette smokers from continuing with their unhealthy behavior.
For some smokers, knowing that secondhand smoke exposure puts loved ones at risk is enough to help them stop smoking.
If you’d like to address a loved one’s use of tobacco or you want to support them with smoking cessation, try the following:
- Express your support often and as positively as you can
- Be compassionate and understand they are working to overcome a challenge
- Suggest and share non-smoking activities that keep them active, such as going for walks or playing board games
- Let them know they can turn to you when they feel a craving to use tobacco
- Create a tobacco-free environment
- Avoid drinking alcohol or coffee when together
- Explain why it’s important to you for your loved one to maintain tobacco sobriety
- Don’t be critical if they slip
DSM-5 Diagnostic Criteria for Tobacco Use Disorder (Nicotine Dependence)
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines several criteria that make up a diagnosis of tobacco use disorder.
A person must use tobacco products for at least a year and develop:
- A need for larger quantities of tobacco with unsuccessful attempts to stop or reduce intake of tobacco
- A lot of time spent acquiring and using tobacco
- Cravings for tobacco
- Failure to meet obligations due to tobacco use
- Continued use of tobacco despite social or interpersonal problems
- Avoidance of social, occupational, or recreation activities that do not allow tobacco use
- Use of tobacco in hazardous situations
- Continued use of tobacco despite awareness of the risks and problems associated with the product
- Tolerance indicated by a need for larger doses, noticeably diminished desired effect without increasing dosage, and withdrawal symptoms
- Need for nicotine or a substitute drug to alleviate withdrawal symptoms
Additionally, medical professionals note how long it’s been since someone last used tobacco and divide users into the following categories:
- Early remission (3 to 13 months tobacco-free)
- Sustained remission (more than 12 months tobacco-free)
- On-maintenance therapy (need for transdermal nicotine)
- In a controlled environment (restrained to a location where tobacco is not allowed, such as a hospital or correctional facility)
What's Next?
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- National Institute on Drug Abuse. “What Are Treatments for Tobacco Dependence?” Drugabuse.gov, 2018, www.drugabuse.gov/publications/research-reports/tobacco-nicotine-e-cigarettes/what-are-treatments-tobacco-dependence.
- World Health Organization. “Tobacco.” Who.int, World Health Organization: WHO, 27 May 2020, www.who.int/news-room/fact-sheets/detail/tobacco.
- CDCTobaccoFree. “How to Quit.” Centers for Disease Control and Prevention, 26 Mar. 2019, www.cdc.gov/tobacco/quit_smoking/how_to_quit/index.htm.
- Tobacco Use. 2019, www.cdc.gov/chronicdisease/resources/publications/factsheets/tobacco.htm.
- CDC. “CDC – Fact Sheet – Health Effects of Cigarette Smoking – Smoking & Tobacco Use.” Smoking and Tobacco Use, 2018, www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/index.htm.
- “Medications for Tobacco Use Disorder or Nicotine Dependence.” Office of Addiction Services and Supports, oasas.ny.gov/providers/medications-tobacco-use-disorder-or-nicotine-dependence
