Definition

Tobacco use disorder occurs when the use of tobacco harms a person’s health or social functioning, or when a person becomes dependent on tobacco. Tobacco may be consumed in the form of cigarettes, smokeless tobacco products (eg, snuff, chewing tobacco), cigars, or pipes.

This condition can be treated. Talk to your doctor if you think you have tobacco use disorder.

Causes

Tobacco products contain nicotine, which is transported to the brain and causes pleasurable sensations. The effects of nicotine dissipate within a few minutes, however. This cause tobacco users to continue using tobacco to maintain the pleasurable effects and prevent withdrawal. Other chemicals in tobacco products may also contribute to tobacco use disorder.

Risk Factors

The following factors increase your chances of developing tobacco use disorder. If you have any of these risk factors, tell your doctor:

• Schizophrenia
• Post-traumatic stress disorder
• Bipolar disorder
• Major depression
• Other mental illness

Symptoms

If you experience any of these symptoms, do not assume it is due to tobacco use disorder. These symptoms may be caused by other health conditions. If you experience any one of them, see your physician.

• Nicotine “highs”
  • Increase in blood pressure, respiration, and heart rate
  • Hyperglycemia (abnormally high blood sugar level)
• Nicotine withdrawal
  • Irritability
  • Craving
  • Thinking and attention problems
  • Sleep disturbances
  • Increased appetite
  • Nervousness
  • Headache
• Tobacco-related health problems
  • Cancer, including cancers of the larynx (voice box), oral cavity, throat, esophagus, and lung
  • Chronic bronchitis
  • Emphysema
  • Chronic obstructive pulmonary disease
  • Smoker’s cough
  • Heart disease
  • Stroke
  • Miscarriage, premature delivery, stillbirth, infant death, low birth weight, or sudden infant death syndrome (SIDS)
• Tobacco-related social problems

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam. He or she will ask you specific questions about your tobacco use, such as how long you have been using tobacco and how often you use it.

Treatment

Talk with your doctor about the best treatment plan for you. Treatment options include the following:

Nicotine Replacement Therapy: Nicotine replacement therapy (NRT), including nicotine gum, nasal sprays, patches, and inhalers, are used to relieve nicotine withdrawal symptoms. They do not produce the pleasurable effects of tobacco products, so there is little chance nicotine replacement treatments will be abused.

In a recent review of eight randomized studies involving 4,792 smokers, one trial of nicotine replacement therapy effectively reduced the number of smokers by 10.7% after one year and 7.2% after 4.3 years compared to placebo. Thirty percent of smokers who initially quit at one year starting smoking again later on, suggesting that nicotine replacement often requires more than one trial of treatment if it is to be effective over the long term.*1 Moreover, nicotine replacement treatments work best when used with behavioral therapy.

Other Medications: Research has shown that certain medications, including the antidepressant bupropion (Zyban) and varenicline tartrate (Chantix) may help people quit smoking. Varenicline tartrate helps ease symptoms of nicotine withdrawal and may block the effects of nicotine if people resume smoking.

Behavioral Therapy: Behavioral therapies to help people quit using tobacco include step-by-step manuals, telephone quit lines, self-help classes, counseling, and cognitive-behavioral therapy. Cognitive-behavioral therapy teaches people to recognize high-risk tobacco use situations, develop alternate coping strategies, manage stress, improve problem-solving skills, and increase social support.

The first step in successfully quitting smoking is the decision to quit. Does this mean that smokers who are unable or unwilling to quit cannot be helped? In a recent analysis of eight studies involving 3,273 committed smokers, researchers found that nicotine replacement therapies were, on average, successful at reducing the amount of tobacco consumed compared to those who did not receive NRT. They also found that those smokers exposed to NRT were more likely to quit altogether, at least over the short-term.*2

A Note About the Effects of Secondhand Smoke Exposure

Even if you’re not a smoker, exposure to smoke from tobacco products on a regular basis is dangerous, sometimes even life-threatening.

Here are the US Surgeon General’s conclusions about effects from inhaling secondhand smoke:

• Secondhand smoke exposure causes disease and premature death in children and adults who do not smoke.
• Children exposed to secondhand smoke are at an increased risk for sudden infant death syndrome (SIDS), acute respiratory infections, ear problems, and more severe asthma. Smoking by parents causes respiratory symptoms and slows lung growth in their children.
• Exposure of adults to secondhand smoke has immediate adverse effects on the cardiovascular system and causes coronary heart disease and lung cancer.
• The scientific evidence indicates that there is no risk-free level of exposure to secondhand smoke.
• Separating smokers from nonsmokers, cleaning the air, and ventilating buildings cannot eliminate exposure of nonsmokers to secondhand smoke. But eliminating smoking in indoor spaces fully protects nonsmokers from exposure to secondhand smoke.

Prevention

The best way to prevent tobacco use disorder is to never use tobacco products since tobacco products are highly addictive, and avoid regular exposure to secondhand smoke.

RESOURCES:

American Cancer Society
http://www.cancer.org

National Institute on Drug Abuse
http://www.nida.nih.gov

Smokefree.govTelephone: 1-800-QUITNOW
http://www.smokefree.gov

CANADIAN RESOURCES:

Canadian Cancer Society
http://www.cancer.ca

The Lung Association
http://www.lung.ca

References:

Diagnostic codes (ICD9-CM). Surgeon General website. Available at: http://www.surgeongeneral.gov/tobacco/codes.htm. Accessed September 25, 2006.

Questions about smoking, tobacco, and health. American Cancer Society website. Available at: http://www.cancer.org/. Accessed September 25, 2006.

Research report series: tobacco addiction. National Institute on Drug Abuse website. Available at: http://www.nida.nih.gov/ResearchReports/Nicotine/Nicotine.html. Accessed September 25, 2006.

*1Updated treatment section on 2/27/2007 according to the following study, as cited by DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Etter JF, Stapleton JA. Nicotine replacement therapy for long-term smoking cessation: a meta-analysis. Tob Control. 2006;280-285.

*2Updated treatment section on 9/24/2007 according to the following study, as cited by DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: LF Stead, T Lancaster. Interventions to reduce harm from continued tobacco use [review]. Cochrane Database of Systematic Reviews. 2007;3.

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