Tobacco use disorder

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at July 23, 2016
StartDiseasesTobacco use disorder

Almost everyone knows that smoking cigarettes is unhealthy for you, but its harmful effects can't be overstated, and many people do not realize just how harmful addiction to these carcinogenic products can be. Not everyone who uses tobacco develops tobacco use disorder, but unfortunately this disorder can make it very hard for people to stop the damaging habit of using tobacco.


Definition & Facts

Tobacco use disorder is defined as a problematic pattern of behaviors. Typically, a person is diagnosed with tobacco use disorder if their actions are harming their own health or damaging their social, professional, or educational goals. Even one cigarette or use of chewing tobacco can slightly harm health, but people with tobacco use disorder become addicted to tobacco and continue using the product even if there are clear and present damages to their health. Sometimes this disorder can be so severe that people continue smoking even after being diagnosed with potentially terminal illnesses such as emphysema or lung cancer.

Symptoms & Complaints

There are both health problems and behavioral issues that are signs of tobacco use disorder. Symptoms include experiencing nicotine highs while using tobacco and craving tobacco products. When individuals do not use any tobacco for an extended period of time, they may experience nicotine withdrawal; they may become irritable and have difficulty sleeping without tobacco.

Over time, tobacco use disorder causes more and more health issues. Almost everyone who uses tobacco regularly develops high blood pressure, hyperglycemia (high blood sugar), headaches, hot flashes, and coughing.

Eventually, tobacco use can lead to severe chronic health problems, including cancer, bronchitis, cardiovascular disease, emphysema, stroke, and chronic obstructive pulmonary disease (COPD). The hold that tobacco has over a person with tobacco use disorder is often so strong that they will ignore health problems and continue using tobacco products.

Since tobacco use is normally frowned upon in many cultures as a risk to both individual and public health (via secondhand smoke), tobacco use disorder can also lead to many social and interpersonal problems. For example, people with this disorder may only choose jobs that allow them smoking breaks, and they may end romantic or social relationships because the other person disapproves of their behavior. Despite the repeated negative consequences of tobacco use, it is hard for the person to overcome the addiction.


The underlying cause behind tobacco use disorder is nicotine dependence. Nicotine is a chemical present in tobacco that alters the brain when tobacco is smoked or otherwise consumed. Nicotine quickly enters the bloodstream and travels to the brain, where it triggers the release of certain neurotransmitters. These neurotransmitters include dopamine and other brain chemicals that create a feeling of pleasure, happiness, and relief, but the nicotine high quickly fades, requiring a person to use more and more tobacco to achieve the same effects (tolerance). Over time, the brain starts having trouble functioning without these constant emotional highs, and a person becomes addicted.

Not everyone who uses tobacco becomes addicted quickly. Tobacco use disorder is far more common among people who grew up with a parent who smoked, because there are certain genetic factors that may make the brain more receptive to nicotine. There is also a social cause to tobacco use disorder, because people are more likely to start regularly using tobacco if their peers make it seem acceptable, fun, or normal. People who have been regularly smoking since their teenage years are far more likely to suffer from tobacco use disorder later in life.

Diagnosis & Tests

It can be difficult for a person to decide whether or not they are addicted to tobacco because its effects can be insidious. Therefore, a medical professional's input is sometimes needed to diagnose tobacco use disorder. Normally, a tobacco use disorder diagnosis will mostly focus on the doctor asking the patient a series of questions to look for signs of addiction. Most people with a tobacco use disorder tend to have a cigarette within the first hour of waking up, and they smoke at least seven cigarettes a day. The doctor may also ask about social habits, because a patient who will smoke even when sick or go outside in cold weather to smoke is most likely addicted.

Another method of diagnosis is to determine what happens when a patient stops smoking tobacco. Nicotine withdrawal symptoms, including irritability, depression, restlessness, and a feeling of malaise, are all signs that a person has tobacco use disorder. A spirometry test or another test to determine lung function can be used to discover whether or not a patient has damaged their health due to tobacco use. 

Treatment & Therapy

Every treatment for tobacco use disorder will rely on finding methods to help a patient cut back on tobacco use and eventually stop using it altogether. Some people are able to just stop using tobacco through willpower, but the success rates of "going cold turkey" are very low. There are many smoking cessation aids (nicotine replacement therapies) that can provide some benefit.

A tapering method that teaches a person with tobacco use disorder to slowly lower their intake of tobacco can help to treat the disorder without causing severe withdrawal symptoms. To avoid the particularly health-damaging effects of smoking, many doctors recommend that patients chew a nicotine gum or use a nicotine patch and gradually lower their amount.

There are also a few medicines, such as bupropion, that have a moderately beneficial effect on nicotine cravings. Bupropion is a receptor antagonist that essentially blocks the pleasurable effects of nicotine on the brain. Varenicline is another drug that is prescribed to aid in smoking cessation. This drug may help reduce cravings.

Prevention & Prophylaxis

The only way to truly prevent tobacco use disorder is to never start using tobacco in the first place. Any tobacco ingestion method, including cigarettes, pipes, chewing tobacco, hookah, or electronic cigarettes can trigger a nicotine addiction. Since starting at a young age increases risks of tobacco use disorder, parents should talk to their children about the importance of avoiding any and all uses of tobacco.

Educational and public service initiatives that inform the public about health risks, laws that ban smoking from public places and restrict cigarette marketing to children, and changing social norms such as the reduced acceptability of smoking in films and television shows all play a role in preventing tobacco use disorder.