|
|
 |
Tobacco Use Disorder
DefinitionTobacco use disorder occurs when the use of tobacco harms a person’s health or social functioning, or when a person becomes dependent on tobacco. Tobacco may be consumed in the form of cigarettes, smokeless tobacco products (eg, snuff, chewing tobacco), cigars, or pipes. This condition can be treated. Talk to your doctor if you think you have tobacco use disorder.
CausesTobacco products contain nicotine, which is transported to the brain and causes pleasurable sensations. The effects of nicotine dissipate within a few minutes, however. This cause tobacco users to continue using tobacco to maintain the pleasurable effects and prevent withdrawal. Other chemicals in tobacco products may also contribute to tobacco use disorder.
Risk Factors
The following factors increase your chance of developing tobacco use disorder. If you have any of these risk factors, tell your doctor:
Symptoms
If you experience any of these symptoms, do not assume it is due to tobacco use disorder. These symptoms may be caused by other health conditions. If you experience any one of them, see your physician.
-
Nicotine “highs”
- Increase in blood pressure, respiration, and heart rate
- Hyperglycemia (abnormally high blood sugar level)
-
Nicotine withdrawal
- Irritability
- Craving
- Thinking and attention problems
- Sleep disturbances
- Increased appetite
- Nervousness
- Headache
-
Tobacco-related health problems:
- Smoker’s cough
-
Hot flashes in women
-
Cancer, including cancers of the
larynx (voice box), oral cavity,
throat,
esophagus,
lung, and
colon.
- Chronic bronchitis
- Emphysema
- Chronic obstructive pulmonary disease
- Heart disease
- Stroke
- Miscarriage,
premature delivery, stillbirth, infant death, low birth weight, or
sudden infant death syndrome (SIDS)
- Tobacco-related social problems
A study involving over 100,000 women found that smoking is associated with a shorter life span. After five years of quitting smoking, though, women had a reduced chance of dying compared to those who continued smoking.
DiagnosisYour doctor will ask about your symptoms and medical history, and perform a physical exam. He or she will ask you specific questions about your tobacco use, such as how long you have been using tobacco and how often you use it.
Your doctor can test your lung function and compare the results to those of a non-smoking person. The results can be given to you as your “lung age.” Knowing your “lung age” right after having the test done may help you to stop smoking.
TreatmentTalk with your doctor about the best treatment plan for you. Treatment options include the following: Nicotine Replacement Therapy
Nicotine replacement therapy
(NRT) are used to relieve nicotine withdrawal symptoms. Examples of NRT products include: nicotine gum, lozenges, nasal sprays, patches, and inhalers. Sometimes, these products are used in combination, which may help some people stay smoke-free. Since NRT does not produce the pleasurable effects of tobacco, there is little chance that these products will be abused.
According to studies, NRT may help you to:
-
Reduce the amount of tobacco you usually consume and quit altogether even if you are unable or unwilling to stop smoking
-
Quit and stay smoke-free if you use the product before your actual "quit day"
-
Abstain from smoking
Talk to you doctor about how to best use this therapy. Combining behavioral therapy with NRT may be even more helpful.
Behavioral Therapy
Behavioral therapies to help people quit using tobacco include:
- Step-by-step manuals—Self-help materials can aid some to quit smoking, but behavioral counseling may work better.
- Telephone quit lines
- Internet and computer-based programs—You can find many smoking cessation programs online, such as the American Lung Association's Freedom from Smoking.
- Self-help classes
-
Group behavior therapy—This may be more helpful than self-help programs.
- Counseling
- Cognitive behavioral therapy
—This teaches people to recognize high-risk tobacco use situations, develop alternate coping strategies, manage stress, improve problem-solving skills, and increase social support.
Other Medications
Research has shown that certain medications, including the antidepressants
bupropion
(Zyban)
and
varenicline tartrate
(Chantix) may help people quit smoking. Varenicline tartrate helps ease symptoms of nicotine withdrawal and may block the effects of nicotine if people resume smoking.
|
FDA Public Health Advisory for Smoking Cessation Drugs
|
|
Two smoking cessation drugs—varenicline (Chantix) and bupropion (Wellbutrin, Zyban)—may increase the risk of serious mood and behavior changes. Stop taking the medication right away and call your doctor if you feel hostile, agitated, or depressed; have suicidal thoughts or attempt suicide; or experience worsening of depressive symptoms.
For more information, please visit: http://www.fda.gov/Drugs/DrugSafety/PublicHealthAdvis...es/ucm169988.htm
|
Secondhand Smoke ExposureEven if you’re not a smoker, exposure to smoke from tobacco products on a regular basis is dangerous, sometimes even life-threatening.
Here are the US Surgeon General’s conclusions about effects from inhaling secondhand smoke:
- Secondhand smoke exposure causes disease and premature death in children and adults who do not smoke.
-
Children exposed to secondhand smoke are at an increased risk for sudden infant death syndrome (SIDS), acute respiratory infections, ear problems, and more severe
asthma. Smoking by parents causes respiratory symptoms and slows lung growth in their children.
- Exposure of adults to secondhand smoke has immediate adverse effects on the cardiovascular system and causes coronary heart disease and lung cancer.
- The scientific evidence indicates that there is no risk-free level of exposure to secondhand smoke.
- Separating smokers from nonsmokers, cleaning the air, and ventilating buildings cannot eliminate exposure of nonsmokers to secondhand smoke. But eliminating smoking in indoor spaces fully protects nonsmokers from exposure to secondhand smoke.
PreventionThe best way to prevent tobacco use disorder is to never use tobacco products. Tobacco products are highly addictive. Also, avoid regular exposure to secondhand smoke.
Diagnostic codes (ICD9-CM). Surgeon General website. Available at:
http://www.surgeongeneral.gov/tobacco/codes.htm. Accessed September 25, 2006.
Kenfield SA, Stampfer MJ, Rosner BA, Colditz GA. Smoking and smoking cessation in relation to mortality in women.
JAMA.
2008;299:2037-2047. In: Tobacco use disorder. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed/what.php. Accessed May 22, 2008.
Public health advisory: FDA requires new boxed warnings for the smoking cessation drugs Chantix and Zyban. US Food and Drug Administration website. Available at:
http://www.fda.gov/Drugs/DrugSafety/PublicHealthAdvisories/ucm169988.htm. Published July 1, 2009. Accessed July 8, 2009.
Questions about smoking, tobacco, and health. American Cancer Society website. Available at:
http://www.cancer.org/. Accessed September 25, 2006.
Research report series: tobacco addiction. National Institute on Drug Abuse website. Available at:
http://www.nida.nih.gov/ResearchReports/Nicotine/Nicotine.html. Accessed September 25, 2006.
2/27/2007 DynaMed's Systematic Literature Surveillance
http://www.ebscohost.com/dynamed/what.php: Etter JF, Stapleton JA. Nicotine replacement therapy for long-term smoking cessation: a meta-analysis.
Tob Control.
2006;280-285.
9/24/2007 DynaMed's Systematic Literature Surveillance
http://www.ebscohost.com/dynamed/what.php: LF Stead, T Lancaster. Interventions to reduce harm from continued tobacco use [review].
Cochrane Database of Systematic Reviews.
2007;3.
3/25/2008 DynaMed's Systematic Literature Surveillance
http://www.ebscohost.com/dynamed/what.php: Parkes G, Greenhalgh T, Griffin M, Dent R. Effect on smoking quit rate of telling patients their lung age: the Step2quit randomised controlled trial.
BMJ.
2008;336:598-600.
10/14/2008 DynaMed's Systematic Literature Surveillance
http://www.ebscohost.com/dynamed/what.php: Shiffman S, Ferguson SG. Nicotine patch therapy prior to quitting smoking: a meta-analysis.
Addiction.
2008;103:557-563.
12/16/2008 DynaMed's Systematic Literature Surveillance
http://www.ebscohost.com/dynamed/what.php: Eisenberg MJ, Filion KB, Yavin D, et al. Pharmacotherapies for smoking cessation: a meta-analysis of randomized controlled trials. CMAJ.
2008;179:135-144.
2/5/2009 DynaMed's Systematic Literature Surveillance
http://www.ebscohost.com/dynamed/what.php: Cochran CJ, Gallicchio L, Miller SR, Zacur H, Flaws JA. Cigarette smoking, androgen levels, and hot flushes in midlife women.
Obstet Gynecol.
2008;112:1037-1044.
2/17/2009 DynaMed's Systematic Literature Surveillance
http://www.ebscohost.com/dynamed/what.php: Stead LF, Lancaster T. Group behaviour therapy programmes for smoking cessation.
Cochrane Database Syst Rev.
2009;(1):CD001007.
7/6/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Myung SK, McDonnell DD, Kazinets G, Seo HG, Moskowitz JM. Effects of Web- and computer-based smoking cessation programs: meta-analysis of randomized controlled trials. Arch Intern Med. 2009;169:929-937.
7/21/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Lancaster T, Stead L. Self-help interventions for smoking cessation. C ochrane Database Syst Rev. 2009;(2):CD001118.
11/13/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Piper ME, Smith SS, Schlam TR, et al. A randomized placebo-controlled clinical trial of 5 smoking cessation pharmacotherapies. Arch Gen Psychiatry. 2009;66(11):1253-1262.
Last reviewed January 2009 by
Theodor B. Rais, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © EBSCO Publishing. All rights reserved.
|