TOBACCO USE DISORDERS/VAPING
● Tobacco use continues despite having persistent, recurrent social and interpersonal problems caused by tobacco. ● Important social, occupational, or recreational activities are given up or reduced because of tobacco use. ● Recurrent tobacco use occurs in situations that are physically hazardous. ● Continued tobacco use occurs despite knowledge of persis- tent or recurrent psychological or physical problems. ● Tolerance means a need for a markedly increased amount to achieve intoxication and markedly diminished effect with con- tinued use of the same number of tobacco. ● Withdrawal occurs. (APA, 2013) Tobacco withdrawal Withdrawal symptoms are often a barrier to stopping tobacco use, often due to nicotine deprivation (APA, 2013). Withdrawal symptoms begin within 24 hours of abruptly quitting tobacco and include: ● Irritability, frustration, or anger. ● Anxiety. ● Difficulty concentrating.
Tobacco use is widespread in the United States, and its deleteri- ous effects are well documented (NIDA, 2021; CDC, 2022). Smok- ing cigarettes leads to disease and disability in almost every organ in the body (CDC, 2022) including cancer, heart disease, stroke, lung disease, diabetes, and chronic obstructive pulmonary dis- ease. Additionally, there is an increased risk for tuberculosis, eye diseases, and immune diseases (CDC,2022). Secondhand smoke also harms nonsmoking adults and children including stroke, lung cancer, sudden infant death syndrome, middle ear disease, worsening asthma, acute respiratory infections, and slowed lung growth (CDC, 2022). The strongest predictors of nicotine addic- tion are the time to first cigarette and total cigarettes per day (Lande, 2018). Cigarettes are a highly efficient drug delivery system. On average, the individual takes in 1-2 milligrams of nicotine per lit cigarette and takes 10 puffs over a 5-minute period. This equates to 200 hits of nicotine to the brain daily (CDC, 2022). The adrenaline rush increases blood pressure, respiration, and heart rate while stimu- lating reward pathways in the brain. While nicotine is addictive, multiple dosing is needed to prevent withdrawal symptoms. To- bacco use disorders are documented in the DSM-5 : ● An individual takes tobacco in larger amounts over a longer period than intended. ● The individual experiences a persistent desire or unsuccessful efforts to cut down on tobacco use. ● A great deal of time is spent in activities necessary to obtain tobacco. ● An individual has a craving or strong desire or urge to use tobacco. ● Recurrent tobacco use involves failing to fulfill major work ob - ligations.
● Increased appetite. ● Depressed mood. ● Insomnia. (APA, 2013)
Symptom intensity is higher in individuals who smoke cigarettes or use smokeless tobacco but peaks 2-3 days after abstinence and lasts approximate 2-3 weeks (APA, 2013). However, nicotine replacement therapies (NRTs) and other medications are available to augment quitting (CDC, 2022) The following represents NRTs but is not meant to be an inclusive list or offer individual medical advice.
NRT
Advantages
Disadvantages
Side Effects
Precautions
Nicotine Patches Can be used with other modalities; steady dosing; OTC.
Unable to change doses; may need augmented therapy.
Headache; sleep disturbances; skin sensitivity.
Myocardial infarction (MI) within 2 weeks of starting; arrhythmia; angina; pregnant or breastfeeding; age < 18 years. MI within 2 weeks of starting; arrhythmia, angina; pregnant or breastfeeding; age < 18 years.
Nicotine Lozenges
Can be used regularly with withdrawal symptoms or urges; can control amount of nicotine delivered; may help substitute for a cigarette in the mouth; over the counter (OTC). Can be used regularly with withdrawal symptoms or urges; can control amount of nicotine delivered; may help substitute for a cigarette in the mouth; OTC. Can be used regularly with withdrawal symptoms or urges with patches; can control amount of nicotine delivered; may help substitute for a cigarette in the mouth.
Use it regularly; do not eat/drink for 15 minutes before using or when the mouth; can cause dyspepsia.
Nausea; hiccups; insomnia; headache; cough.
Nicotine Gum
Use it regularly; do not eat/drink for 15 minutes before using or when the mouth; can cause dyspepsia; may be hard to use with dentures/ dental work. Use it regularly; do not eat/drink for 15 minutes before using or when the mouth.
Mouth/jaw soreness; stomach; hiccups; nausea/ vomiting.
MI within 2 weeks of starting; arrhythmia, angina; pregnant or breastfeeding; age < 18 years; temporomandibular joint (TMJ) disease.
Nicotine Oral Inhaler
Mouth and throat irritation; runny nose; cough, headache, hiccups.
MI within 2 weeks of starting; asthma and chronic lung
disease; arrhythmia, angina; pregnant or breastfeeding; age < 18 years; TMJ disease.
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