Nicotine is only one of 4,000+ compounds released from burning tobacco but is the major addictive substance from tobacco use (see Section 6.2 for the pharmacokinetics). 1 The most widely used criteria for assessing nicotine as a drug of addiction are the criteria for tobacco use disorder or dependence. These are reported in the International Classification of Diseases (ICD) of the World Health Organization, and the Diagnostic and Statistical Manual of Mental Disorders (DSM), compiled by the American Psychiatric Association. Both of these classification schemes undergo major periodic revision, the most recent versions are the ICD-10 (1990), 2 and DSM-5 (2013) 3 . The ICD-11 (Nicotine Dependence, Compulsive Tobacco Use Syndrome, Tobacco Dependency Syndrome, Nicotine Addiction, and Tobacco Addiction) is currently under development. The main features from the DSM-5 and ICD-10 are summarised in Table 6.1.1, and include:
- a strong desire to use tobacco
- taking tobacco in larger amounts or for longer than intended
- difficulty in controlling tobacco use
- spending a great deal of time in obtaining, using or recovering from the effects of tobacco use
- giving a higher priority to tobacco use than to other activities and obligations
- continued tobacco use despite harmful consequences
- tolerance (i.e., increasing tobacco use to achieve the desired effect or diminished effects from the same amount of tobacco use).
- withdrawal symptoms (e.g., after sustained daily tobacco use, abrupt cessation or reduction results in: irritability, anxiety, difficulty concentrating, increased appetite, restlessness, depressed mood, insomnia causing clinically significant distress or impairment).
The DSM-5 specifies tobacco use disorder in early or sustained remission, in maintenance therapy, or in a controlled environment. Further, it specifies severity rating based on endorsement of 2–3 criteria (mild), 4–5 criteria (moderate), and 6 or more (severe).
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References
1. Advocat C, Comaty J, and Julien R, Julien’s primer of drug action. 13th ed New York: Worth Publishers; 2014. Available from: http://www.ncbi.nlm.nih.gov/nlmcatalog/101666863
2. World Health Organization. Nomenclature and classification of drug-and alcohol-related problems: A who memorandum. Bulletin of the World Health Organization, 1964; 59(2):225–42. Available from: http://www.ncbi.nlm.nih.gov/pubmed/6972816
3. American Psychiatric Association, Diagnostic and statistical manual of mental disorders. 5th ed Arlington, VA: American Psychiatry Association; 2013.