My presentation is on Nicotine Use Disorder. It falls under substance related disorders in the DSM IV and is defined as, “The disorders related to the taking of a drug of abuse (Including Alcohol), to the side effects of a medication and to toxin exposure”. Let me first start with a brief introduction of smoking (the number one nicotine related killer) and some statistical data retrieved from the US Centers For Disease Control.
Tobacco smoking is the number one cause of reversible mortalities in the United States. Tobacco use is related to 400,000 deaths annually in the United States. A person who smokes one pack a day has an average life expectancy 5 years less than a nonsmoker, and for a two pack a day smoker, 7 years less. Smoking is responsible for 30 percent of all cancers in the general population and 90 percent of all lung cancers in men and 79 percent in women. It also triplicates the risk of death from cardiovascular disease. There is also an increased risk of emphysema and bronchitis.
However, nicotine dependence applies to all forms of tobacco to include cigarettes, chewing tobacco, snuff, pipes and cigars. It can also include prescription medications such as the nicotine gum and patch. The relative ability to produce dependence depends on the method of administration (smoked, oral or transdermal) and is also dependent on the nicotine content of the product. Contrary to some of the other substance related disorders, not all substance related dependence criteria apply to nicotine. Tolerance is usually observed as having a more intense effect the first time it is used during the day (The “Morning Smoke”) and the lack of dizziness and nausea after repeated administration. Another sign with individuals who use nicotine is the likeliness to find they use up their supply of nicotine producing drugs faster than they originally intended. I’m sure you have all heard the phrase, “Can I bum a smoke?”.
Nicotine dependence is more common among individuals with other mental disorders such as schizophrenia. Depending on the geographical segment of society studied, anywhere from 55 percent to 90 percent of individuals with other mental disorders smoke compared to 30 percent in the general population. Mood, Anxiety, and other related disorders are more prominent in those who are ex-smokers as well. This is a good basis for the theory that withdrawal effects can last well beyond the usual month of physical craving.
With all the dangers associated with nicotine abuse, the question that begs to be asked is, “Why do people continue to use nicotine?”. In an independent study, 80 percent of individuals who use nicotine express a desire to quit and 35 percent make an attempt each year. Of that 35 percent though, only a meager 5 percent are successful in quitting “Cold Turkey”. One suggestion is that the individual feels he or she would have to give up important social, occupational, or recreational activities and is not willing to do so. Perhaps it masks another possible social disorder? Continued use despite obvious knowledge of medical problems is an important health problem plaguing society today.
When an individual with nicotine use disorder attempts to quit, they go through a withdrawal phase that meets the following diagnostic criteria per the DSM IV:
A.) Daily use of nicotine for at least several weeks
B.) Abrupt cessation of nicotine use, or reduction in the amount of nicotine used, followed within 24 hours by four or more of the following signs:
1.) Dysphoric or depressed mood
3.) Irritability, frustration, or anger
8.) Increased appetite or weight gain
C.) The symptoms in Criteria B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The symptoms mentioned above are due in a large part due to nicotine deprivation and are typically more intense in people who smoke cigarettes than people who use other products containing nicotine. In most people who quit smoking their heart rates dropped 5 to 10 Beats per Minute in the first few days of quitting smoking and their weight increased 5 lbs on average. The biggest factor in nicotine withdrawal tends to be the craving. This tends to be the most difficult aspect to overcome. However most symptoms