Tobacco use disorder: Summary

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Tobacco use disorder: Summary

Definition

Tobacco use disorder describes dependence on or addiction to tobacco products caused by the drug nicotine. People who have the disorder find it difficult to stop using tobacco even though it is causing harm.

Prevalence

17% of Canadians smoke and 14% smoke daily.
More males smoke (20%) than females (15%).
Young adults have the highest prevalence of smoking: 22% for ages 20–24 and 24% for ages 25–34.
The decline in smoking prevalence seen over the past decade has slowed.
Almost half of smokers have tried to quit in the last year, and one third have tried to quit more than once.

Causes

Genetic factors play a role in whether a person will become addicted to nicotine.
The mood-altering effects of nicotine (pleasure, alertness, relaxation) are powerful. Once a person begins to smoke, especially at a young age, the risk of becoming addicted is high.
Smoking raises levels of dopamine, a brain chemical that increases feelings of pleasure and reinforces the desire to continue smoking.
People with mental disorders have much higher rates of smoking (40–90%) compared to the general population (17%). This includes bipolar disorder (51–70%), major depressive disorder (40–60%), anxiety disorders (8–66%) and schizophrenia (45–88%).
People with other substance use disorders are more likely to smoke, and nearly 50% have nicotine dependence. Rates range from 11–48% for those who have problems with alcohol, cannabis, cocaine, amphetamines and opioids.
Smokers develop habits or triggers for smoking (e.g., after a meal, when feeling anxious, when working in a certain place). These triggers are difficult to change.

Prognosis

Quitting smoking can take several attempts. Almost half of smokers have tried to quit, and one third have tried to quit more than once.
People who quit smoking can generally achieve the same health levels as non-smokers, especially if they quit while they are young.
Stop-smoking aids that contain nicotine (the patch, gum, inhalers, lozenges or nasal spray) can help to ease symptoms of withdrawal.
People are more likely to succeed in stopping tobacco use if they are very motivated and have family, social and other supports.

Treatment

When making treatment decisions, consider:

comorbidity with other substance use or mental health disorders
client preferences and motivation
routine screening in primary care settings. Tobacco use disorder is a chronic, relapsing condition, and brief interventions can trigger attempts to quit. Brief interventions generally involve one to four counselling sessions that last 5–15 minutes. The clinician provides feedback and advice and helps the client to set goals.

Treatment options include: