Tobacco Use Disorder in Adults


ICD-10 code: F17.200

Tobacco Use Disorder is part of a cluster of often co-occurring diagnoses called the substance-related and addictive disorders.  Substance use disorders are a group of psychiatric conditions that include:

  • Tobacco use disorder
  • Cannabis use disorder (i.e., marijuana)
  • Stimulant use disorder (e.g., cocaine, crack, methamphetamine, amphetamines)
  • Opioid use disorder (e.g., heroin, prescription painkillers)
  • Hallucinogen use disorder (e.g., LSD, PCP, ecstasy/MDMA, psilocybin)

These disorders are characterized by recurrent use of substances that causes significant impairment, such as health problems, disability, and failure to meet responsibilities at work, school, or home. Individuals with substance use disorders have difficulty controlling their drug use, trouble with social functioning, risky use, and pharmacological changes such as increased tolerance to substances and symptoms of withdrawal when they do not use substances. In addition, individuals with substance use disorders find it is very difficult to change their substance use despite negative consequences of their use and the desire to make changes. The severity of a substance use disorder – mild, moderate, or severe – is based on the number of criteria met.

What is Tobacco?

Tobacco is a product prepared from the leaves of the tobacco plant by curing them. Tobacco contains the alkaloid nicotine, which is classified as a stimulant. Nicotine’s mood-altering effects include both stimulating and relaxing properties. It also reduces appetite and increases metabolism, and has been observed to have positive effects on fine motor abilities, attention, and memory. These effects contribute to nicotine’s addictive effects. In and of itself, nicotine delivered as a drug in regulated nicotine replacement therapy, poses minimal health risks except in certain vulnerable groups. However, the route of administration in which nicotine is most commonly consumed (e.g., smoking or chewing tobacco) has substantial deleterious health effects.  In addition, large amounts of nicotine can lead to overdose, though this is unlikely to occur from smoking alone. The use of electronic cigarettes, which may be filled with e-liquid containing variable levels of nicotine, has renewed concerns about nicotine overdoses, however.

What is tobacco use disorder?

Tobacco use disorder is a chronic disorder that often requires repeated interventions and multiple attempts to quit.

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Understanding Tobacco Use Disorder

In 2014, 16.8% of U.S. adults aged 18 or older currently smoked cigarettes. Smoking is the leading cause of preventable death in the U.S., causing over 480,000 deaths per year, or 1 out of every 5 deaths. Secondhand smoke is a serious health hazard for people of all ages, causing more than 41,000 deaths each year. 

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Health Consequences of Tobacco Use Disorder

Tobacco use is the leading cause of death in the developed world, due to cancers, cardiovascular diseases, chronic obstructive pulmonary disease (COPD). In addition, "second hand smoke" causes cancer for those nearby (family, coworkers). Smoking kills one in every two smokers; smokers die, on average, 10 years younger than non-smokers.

All patients with COPD, regardless of severity, appear to benefit from quitting smoking. Similarly, patients with recent cardiovascular disease events also benefit from quitting smoking. The risk of total mortality and rate of recurrence of lung cancer is substantially lower in smokers who manage to quit smoking following the diagnosis of early stage lung cancer or small cell lung cancer. Together, these data suggest that quitting smoking is effective both as a primary and a secondary intervention in reducing total morbidity and mortality related to COPD, CVD, and lung cancer.

How is tobacco use disorder treated?

The United States Department of Health and Human Services suggests tobacco use disorder is a chronic disorder that often requires repeated interventions and multiple attempts to quit, but that effective treatments exist that can significantly increase rates of long-term abstinence.


 

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