"Please, Consult with a Medical Doctor"
Tobacco Use Disorder (TUD) is a pattern of tobacco use that leads to clinically significant impairment or distress, despite the person experiencing negative consequences or wanting to cut down or quit.
Tobacco Use Disorder (TUD) is a Substance Related and Addictive Disorder. The diagnosis may apply to dependence on nicotine from cigarettes, cigars, smokeless tobacco, or other tobacco products.
Why tobacco is addictive
“Please, Consult with a Medical Doctor”
The primary addictive substance in tobacco is nicotine. Nicotine activates the mind’s reward system, particularly pathways involving dopamine. With repeated use, the mind adapts to nicotine, producing tolerance and dependence.
When nicotine levels fall, a person may experience withdrawal symptoms such as:
“Please, Consult with a Medical Doctor”
Irritability or anger
Anxiety or restlessness
Difficulty concentrating
Depressed or dysphoric mood
Increased appetite
Insomnia or disturbed sleep
Strong cravings for tobacco
Tobacco Use Disorder involves a problematic pattern of tobacco use. Examples of diagnostic features include:
“Please, Consult with a Medical Doctor”
Using tobacco in larger amounts or for longer than intended.
Repeated unsuccessful efforts to cut down or quit.
Spending substantial time obtaining or using tobacco.
Experiencing strong cravings.
Continued use despite physical or psychological problems caused or worsened by tobacco.
Giving up or reducing important activities because of tobacco use.
Developing tolerance.
Experiencing tobacco withdrawal when use is reduced or stopped.
Treatment
“Please, Consult with a Medical Doctor”
Tobacco Use Disorder is treatable, and combining behavioral support with medication generally provides the strongest approach.
Common interventions include:
“Please, Consult with a Medical Doctor”
Motivational interviewing (MI) to explore ambivalence about quitting.
Cognitive behavioral therapy (CBT) to identify triggers and develop coping strategies.
Behavioral strategies for managing cravings and preventing relapse.
Nicotine replacement therapy (NRT) such as patches, gum, or lozenges:”Please, Consult with a Medical Doctor”
Prescription medications such as varenicline or bupropion, when clinically appropriate:”Please, Consult with a Medical Doctor”
Quitlines, support groups, and structured tobacco cessation programs.
An important distinction
“Please, Consult with a Medical Doctor”
Nicotine dependence describes the physiological and behavioral dependence on nicotine, while Tobacco Use Disorder is a framework for determining whether tobacco use has become sufficiently problematic to constitute a mental health/substance use disorder.
A person may be nicotine dependent without necessarily experiencing severe functional impairment, so assessment should consider the entire pattern of use, consequences, withdrawal, attempts to quit, and level of impairment.
Shervan K Shahhian
LIBERTY PSYCHOLOGICAL ASSOCIATION 