Tobacco Use Disorder in Children and Adolescents

ICD-10 code: F17.200

Tobacco use disorder is grouped within the cluster of diagnoses called the substance-related and addictive disorders.  Substance-related addictive disorders are characterized by a maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the use of substances. These problems are persistent and occur repeatedly within the same 12-month period.

The term substance can refer to a drug, a medication, or a toxin. In addition to alcohol, types of substances to which individuals may become addicted include:

  • Tobacco
  • Caffeine
  • Cannabis
  • Hallucinogens
  • Inhalants
  • Opioids
  • Sedatives
  • Stimulants

Substance-related disorders are divided into two groups:

  • Substance use disorders (SUD)
  • Substance-induced disorders—intoxication, withdrawal, and other substance/medication-induced metal disorders (psychotic disorders, bipolar and related disorders, depressive disorders, anxiety disorders, obsessive-compulsive and related disorders, sleep disorders, sexual dysfunction, delirium, and neurocognitive disorders).

The essential feature of a substance use disorder is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems. An important characteristic of this disorder is an underlying change in brain circuits that may persist beyond detoxification, particularly in individuals with severe disorders. The behavioral effects of these brain changes may be exhibited in the repeated relapses and intense drug craving when the individuals are exposed to drug-related stimuli.  

What is Tobacco?

Tobacco contains the psychoactive drug nicotine, which is a CNS (Central Nervous System) stimulant. The immediate effects of nicotine administration are tachycardia, hypertension, increased respiration, hyperglycemia, enhanced memory storage, improved concentration, and appetite suppression.

Nicotine can be administered through several routes, including Inhalation (e.g. smoking cigarettes), buccal (e.g. chewing tobacco), and insulfation (e.g. snuff). Nicotine has a half- life of about two hours, with withdrawal symptoms felt as soon as one hour after the last dose. Withdrawal symptoms may include Irritability, anxiety, and cravings for nicotine.

What is tobacco use disorder?

The diagnosis of tobacco use disorder is assigned to children and adolescents who are dependent on the drug nicotine, due to use of tobacco products. 

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Understanding Tobacco Use Disorder

According to the National Survey on Drug Use and Health, more than 80 percent of smokers begin smoking before age 18, and more than 90 percent do so before leaving their teens. The DSM-5 notes that many people in the United States experiment with cigarettes in their teens, and the American Psychiatric Association estimates that about 20 percent of individuals will use tobacco at least monthly by age 18.


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Health Consequences of Tobacco Use Disorder

Early exposure and addiction to tobacco can negatively impact brain development and overall physical health in children and adolescents. Some of the many health consequences to tobacco use include:

  1. Oral problems such as periodontal disease and tooth loss
  2. Increased risk of respiratory infections, such as bronchitis and emphysema
  3. Mild airway obstruction and reduced lung growth and function
  4. Shortness of breath and increased heart rate
  5. Increased risk of cardiovascular disease
  6. Increased vulnerability to stress, irritability, and tension

How is tobacco use disorder treated?

At this time, there is no published consensus about the best ways to treat Tobacco Use Disorder in children and adolescents.  However, clinical research suggests that the following treatments are effective:


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