Tobacco use disorder: Overview​

Key points

• Tobacco use disorder is one of several substance use disorders.
• Tobacco use disorder is common among people who use cigarettes and smokeless tobacco (chewing tobacco) every day.
• Almost half of smokers try to quit and one third have tried to quit more than once.
• People with mental disorders have much higher rates of smoking (40–90%) compared to the general population.
• People with other substance use disorders are more likely to smoke, and nearly 50% have nicotine dependence.

Prevalence

• 17% of Canadians smoke and 14% smoke daily.
• Smoking is more common among males (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

• Genetic factors contribute to the onset of tobacco use, continued tobacco use and the development of tobacco use disorder. The degree of heritability is equivalent to that observed with other substance use disorders (about 50%).
• Several regions across the genome have been implicated in tobacco use disorder, as well as with smoking cessation and treatment. do you mean success with quitting?

Chemical and biological factors

• Smoking raises levels of dopamine, a brain chemical that increases feelings of pleasure and reinforces the desire to continue smoking.
• 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.

Environmental factors

• 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.

Medical factors

• 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. Smoking rates range from 11<–48% for people who have problems with alcohol, cannabis, cocaine, amphetamines and opioids.
• In adolescents, depression predicts smoking and smoking predicts depression.

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 withdrawal symptoms.
• Prognosis for quitting smoking is best when the person is very motivated and has family, social and other supports.

Smoking cessation

Smoking cessation and addiction treatment

Educator Mike DeVillaer has created this presentation on the integration of smoking cessation into addiction treatment in Ontario, where he explains why Ontario's addiction treatment system should care about tobacco.

The misconceptions of smoking cessation - Dr. Andrew Pipe

 

In this series of short videos, Dr. Andrew Pipe, Chief of the Division of Prevention and Rehabilitation at the University of Ottawa Heart Institute, explains the science behind nicotine addiction. He also speaks about tobacco use by psychiatric patients and describes the successful Ottawa model of smoking cessation.

 

Evidence summary

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: Author.

Canadian Action Network for the Advancement, Dissemination and Adoption of Practice-Informed Tobacco Treatment (CAN-ADAPTT). (2011). Canadian Smoking Cessation Clinical Practice Guideline. Toronto, ON: Centre for Addiction and Mental Health.

Centre for Addiction and Mental Health. (2010). Tobacco. Toronto, ON: Author.

Herie, M., Dragonetti, R. & Selby, P. (2012). Alcohol and tobacco use problems. In A. Khenti, J. Sapag, S. Mohamound & A. Ravindran (Eds.), Collaborative Mental Health: An Advanced Manual for Primary Care Professionals (pp. 195–214). Toronto, ON: Centre for Addiction and Mental Health.

Lessov-Schlaggar, C.N., Pergadia, M.L., Khroyan, T.V. & Swan, G.E. (2008). Genetics of nicotine dependence and pharmacotherapy. Biochemical Pharmacology, 75(1), 178–195.

Reid, J.L., Hammond, D., Burkhalter, R., Rynard, V.L. & Ahmed, R. (Eds.). (2013). Tobacco Use in Canada: Patterns and Trends. Waterloo, ON: Propel Centre for Population Health Impact, University of Waterloo.