Definition and Diagnosis
Nicotine use disorder (tobacco use disorder) refers to problematic, compulsive use of nicotine-containing products, accompanied by tolerance and a withdrawal syndrome on cessation, despite awareness of the harmful health effects of continued use.
Epidemiology
Tobacco use remains one of the most prevalent substance use patterns globally, with dependence developing in a substantial proportion of regular smokers. Rates have declined in many high-income countries but remain high in others, and vaping/e-cigarette use has introduced newer patterns of nicotine dependence, particularly among younger people.
Risk Factors
Risk factors include early age of smoking initiation, family or peer smoking, genetic factors affecting nicotine metabolism, co-occurring mental illness or other substance use, and lower socioeconomic status.
Symptoms and Subtypes
Features include strong urges to smoke or use nicotine, difficulty cutting down, tolerance, and withdrawal symptoms such as irritability, anxiety, difficulty concentrating, increased appetite, and dysphoric mood when use is reduced or stopped.
Diagnosis
Diagnosis follows DSM-5-TR criteria for a substance use disorder applied to tobacco, assessing impaired control, social impairment, risky use, and pharmacological criteria (tolerance and withdrawal), with severity based on symptom count.
Treatment
First-line treatment combines behavioral counseling with pharmacotherapy, including nicotine replacement therapy, varenicline, or bupropion. Brief physician advice and structured quit programs meaningfully improve cessation rates.
Prognosis
Relapse is common, and most people make multiple quit attempts before achieving sustained abstinence. Combined behavioral and pharmacological treatment substantially improves long-term quit rates compared with unaided attempts.
Reference
Sadock, B. J., Sadock, V. A., & Ruiz, P. Kaplan & Sadock's Synopsis of Psychiatry (11th ed.).