According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)*, Tobacco Use Disorder is diagnosed when an individual is dependent upon nicotine, which is found in tobacco. A psychoactive drug (affects the mind), nicotine is a highly addictive, central nervous system stimulant. The addictive nature of nicotine includes drug-reinforced behavior, obsessive use and reoccurring use after abstaining from it, as well as physical dependence and tolerance.

Nicotine is found in cigarettes, pipes, cigars, chewing tobacco and snuff. Besides causing dependency, nicotine has many negative physical effects and a variety of withdrawal symptoms.

*The DSM-5 is published by the American Psychiatric Association.

Signs of Tobacco Use Disorder DSM-5 305.1 F17.200

There are three criteria, 15 sub-features and four specifiers the DSM-5 uses to diagnose Tobacco Use Disorder. When an individual uses tobacco for more than a year and a minimum of two of the following sub-features appear, the disorder is diagnosed.

More amounts of tobacco over a longer timeframe than planned are used.

  • Inability to quit or lessen the amount of tobacco use in spite of efforts to do so.
  • Excessive amount of time spent on attaining or using tobacco.
  • Desire (cravings) for tobacco.
  • Relinquish responsibilities because of the tobacco use.
  • Use of tobacco persists in spite of its negative impacts both socially and in relationships.
  • Abandon career, social and other activities to use tobacco.
  • Use tobacco in harmful situations/settings.
  • Use is persistent even in the face of physical or emotional difficulties that are related to the use of tobacco.

The tolerance built up for nicotine is shown by the following.

  • Necessity to increase the amounts of nicotine to get the effect wanted.
  • Nicotine, when using the same amounts, clearly has less of an effect.

Tobacco Withdrawal DSM-5 292.0 F17.203

When an individual makes an effort to stop the use of nicotine, the following withdrawal symptoms may occur.

  • Problems concentrating/focusing, anxiousness, headaches, gain in weight because of greater appetite, slower heart rate, difficulties sleeping, agitation and depression. The symptoms spike in the first several days and gradually fade within 30 days.
  • Another drug (or more nicotine) is used to lessen the symptoms from withdrawal.

The health professional may add the following to the diagnosis.

  • The individual has not used tobacco for three to 13 months (early remission).
  • The person has not used tobacco for more than one year (sustained remission).
  • The individual is undergoing therapy to stop smoking, such as using a nicotine transdermal patch that can be part of a complete program which includes counseling, support groups and behavioral changes.

It should also be noted if the individual is in an environment where smoking is not allowed, such as a hospital.

Mild Tobacco Use Disorder DSM-5 305.1 Z72.0

According to the American Psychiatric Association, the disorder is separated into three categories—mild, moderate and severe. If between two and three symptoms from the criteria exist, the Tobacco Use Disorder is considered mild.

Moderate Tobacco Use Disorder DSM-5 305.1 F17.200

When four to five of the symptoms from the criteria are met, the Tobacco Use Disorder is recognized as moderate.

Severe Tobacco Use Disorder DSM-5 305.1 F17.200

With the presence of six or more of the criteria, the Tobacco Use Disorder is given the diagnosis of severe.

Tobacco Use Disorder DSM-5 305.1 F17.200 Risk Factors

According to the DSM-5, some of the factors for the disorder include:

  • Lower income bracket.
  • Lower education level.
  • Genetics.
  • A number of mental disorders are risks for Tobacco Use Disorder, including:
    • Substance Use Disorders
    • Attention Deficit Hyperactivity Disorder
    • Anxiety Disorders
    • Psychotic Disorders
    • Depressive Disorder
    • Personality Disorders

Health Risks of Tobacco Use

Tobacco causes many risks to a person’s health, including:

  • Cancer, including mouth, esophagus, lungs and throat.
  • Emphysema.
  • Heart Disease.
  • Chronic bronchitis.
  • Stroke.
  • Upper respiratory infections.
  • Roughness to the voice.
  • Gum disease.
  • Tooth decay.
  • Chronic Obstructive Pulmonary Disease.

There are also numerous other risks related to tobacco, including:

  • Facial wrinkles (prematurely)
  • Breath odor.
  • Decreased sense of smell and taste.
  • Staining on teeth and fingers.
  • Odor is left on the skin, clothes and hair.
  • Tobacco use is a costly habit.
  • Residue from chewing tobacco gets stuck between the teeth.
  • Tobacco smoke threatens the health of others, because smoke from cigarettes is composed of toxic chemicals, such as nicotine, arsenic, cyanide, tar and nicotine.

Facts About Tobacco and Tobacco Use

According to the DSM-5:

  • Cigarettes are the most typically used of all tobacco products. They account for 90 percent of all tobacco use in the country.
  • Many individuals in the country first try cigarettes when they are teenagers.
  • By the time they are 18 years old, approximately 20 percent of young adults in the U.S. will use cigarettes every month, and many of them will become smokers on a daily basis.
  • About 22 percent of adults in the country used to smoke.
  • About 21 percent of people in the U.S. are smokers currently.
  • One-fifth of smokers in the country are considered casual or sporadic smokers.
  • People who use chewing tobacco and snuff account for less than five percent of tobacco users in the U.S.
  • Less than one percent of people in the country use tobacco in cigars and pipes.

Other facts include:

  • Nicotine is named for a French ambassador from the 16th century.
  • Interestingly, chewing or snuffing tobacco releases more nicotine in the body than smoking does.
  • The first synthesized nicotine was in 1904.
  • It is as difficult to stop using nicotine as it is to quit using heroin.
  • Nicotine’s side effects can wreak havoc on the heart, gastrointestinal system and hormones.
  • More than a billion people in the world are tobacco smokers.
  • Nicotine is a stimulant and sedative.

What is the Treatment for Tobacco Use Disorder DSM-5 305.1 F17.200?

While the DSM-5 lists no specific treatment for the disorder, there are an assortment of ways that people have used to stop using tobacco. Cognitive Behavioral Therapy can help the individual stay committed to cessation. The therapist can work with the person to find other, positive and healthy habits instead of smoking; how to deal with the cravings for nicotine; and identify what the triggers are that cause the individual to want to use tobacco.

Support groups for smoking cessation, which involves a group of individuals with the same goal of quitting nicotine use, can help to provide support and share ideas for healthy alternatives in lieu of the tobacco use.