Tobacco-Related Disorders

Tobacco-related disorders, particularly tobacco use disorder and tobacco withdrawal, present with various symptoms. Understanding these symptoms may aid in the early identification and subsequent treatment of these disorders.

Signs of tobacco use disorders

Below are a few signs someone is living with tobacco use disorders: 

• Compulsive behavior 
• Difficulty quitting despite repeated attempts
• Overwhelming cravings for tobacco
• Consumption of larger amounts over time or over a more extended period than intended
• Struggling to fulfill obligations at work, school, or home due to tobacco use
• Reduction or abandonment of important social, occupational, or recreational activities in favor of tobacco use
• Spending significant time obtaining, using, or recovering from tobacco
• Consistently using tobacco in situations where it’s hazardous, like while driving
• Continued tobacco use even when knowing it causes or exacerbates physical or psychological problems
• Tolerance,¹ where there is a need for increased amounts of tobacco to achieve the desired effect or experiencing a diminished effect when using the usual amount
• Respiratory issues or persistent coughing
• Yellowing of the teeth or fingers

The use of tobacco products and cigarette smoking also increases the risk of life-threatening medical conditions like lung cancer and heart disease. Tobacco control programs often focus on addressing and raising awareness of these concerns.

Symptoms of tobacco withdrawal

When stopping tobacco use suddenly or over time, people may experience withdrawal symptoms, such as the following: 

• Irritability, frustration, or anger due to heightened sensitivity to stressors, leading to quick or intense reactions to minor annoyances
• A depressed mood or a pervasive feeling of sadness or hopelessness
• Restlessness or a constant sense of unease making relaxation more challenging
• Anxiety can manifest as worry or racing thoughts, causing a sense of being constantly on edge or apprehensive about the future
• Difficulty concentrating, a sense of being “scatterbrained,” or being easily distracted
• Mental fatigue or finding minor mental tasks draining or exhausting
• Insomnia or altered sleep patterns
• Slower heart rate due to the absence of nicotine, a stimulant
• Increased appetite, which may lead to weight gain

In both traditional smoking and vaping, specific symptoms can emerge, driven primarily by the body’s reaction to the absence or presence of nicotine. Recognizing these signs and symptoms can be vital not only for those using tobacco products but also for family, friends, and healthcare providers. Early identification can pave the way for intervention, support, and treatment, supporting individuals in their journey to a tobacco-free life.

Tobacco-related disorders, including tobacco use disorder and tobacco withdrawal, can be influenced by various causes and risk factors. Recognizing these factors may help individuals understand vulnerabilities and address the root causes of the disorder.

Common causes of tobacco use

Common causes of tobacco use may include: 

• Nicotine’s addictive nature: At the core of tobacco use is the addictive substance nicotine. It stimulates the release of dopamine, a neurotransmitter associated with pleasure and reward, making the user want to repeat the experience. 
• Social and peer pressure: Being in an environment where friends or family smoke or vape can significantly influence an individual to pick up the habit, especially during the teenage years.
• Stress relief: Some individuals use tobacco to cope with stress, anxiety, or other emotional challenges because they believe it provides a calming effect.

Risk factors for developing tobacco-related disorders

Risk factors for tobacco-related disorders include the following: 

• Early initiation: Starting tobacco use at a young age increases the risk of developing an addiction in adulthood. 
• Mental health disorders: Individuals with mental illness concerns and diagnoses might be more susceptible to using tobacco as a self-medication method, increasing their risk of addiction.
• Family history: A family history of tobacco use or addiction can increase one’s risk, potentially due to genetic and environmental factors.
• Chronic² pain or illness: Some people with chronic conditions might use tobacco as a means to cope or distract from their symptoms. 

Understanding these causes and risk factors can be crucial in developing effective prevention and intervention strategies. By addressing these root causes, efforts can be directed at reducing the prevalence of tobacco-related disorders.

Treatments for tobacco-related disorders aim to help individuals reduce or quit their tobacco use and manage withdrawal symptoms. Often, the goal is to promote long-term abstinence and reduce the health risks associated with tobacco use. Different approaches, ranging from therapy to self-care techniques, are available to support individuals on their journey to quit.

Medication

In some cases, doctors may prescribe medication to support people living with tobacco-related disorders, such as the following: 

• Antidepressants: Originally developed to treat depression, these medications have been found to aid in reducing tobacco withdrawal symptoms and cravings.
• Partial nicotine agonists: These medications are specifically designed for smoking cessation and reduce withdrawal symptoms while decreasing the pleasure derived from smoking.
• Tricyclic antidepressants: Tricyclic antidepressants are an older class of medications that can aid smoking cessation, especially when coexisting mood disorders like depression are present.

Other treatment options

Other treatment options for tobacco-related disorders may include the following: 

• Quitline hotlines: Telephone-based support services can provide counseling and information for those looking to quit smoking. Usually available 24/7, they may be a helpful resource during intense cravings.
• Mobile apps: Digital tools designed to support smoking cessation may be helpful. Features may include tracking progress, providing motivational messages, and connecting users to resources.
• Acupuncture: Some individuals find relief from cravings through acupuncture. More research is needed, but anecdotal evidence suggests it can be a supportive adjunct treatment, especially when combined with other treatment options.
• Hypnosis or hypnotherapy:⁴ This therapy utilizes hypnosis to instill negative associations with smoking and bolster the desire to quit. Effectiveness varies among individuals, but some find it beneficial. 

Self-care 

Self-care techniques can be a way to cope with challenging symptoms at home and throughout daily life. These techniques may include the following: 

• Avoiding risk factors: It can be beneficial to identify and avoid situations, places, or people that prompt the urge to smoke or use tobacco.
• Staying active: Physical activity may reduce the intensity of cravings and improve mood. Walking, jogging, or short bursts of exercise might be effective.
• Manage stress: Adopt relaxation techniques such as meditation, deep breathing, exercises, or yoga. Reducing stress can lower the reliance on tobacco as a coping mechanism.⁵
• Eat well and stay hydrated: Drinking water may help with the hand-to-mouth smoking habit. A balanced diet supports overall health and mood, aiding the quitting process.
• Seek support: Share your goals to quit with friends and family. You might also consider joining a support group or online forum for additional encouragement and advice. 

While quitting tobacco can be challenging due to its addictive nature, many strategies are available to support individuals in their journey toward a tobacco-free life. Finding the best combination of treatments for each individual can be helpful, as individualization in treatment can significantly increase the chances of long-term success.

Resources can play a pivotal role in aiding individuals on their journey to work through tobacco-related disorders. Therapy, especially with mental health professionals familiar with addiction, may provide tailored guidance. Online platforms like BetterHelp have made therapy more convenient, allowing individuals to connect with therapists from the comfort of their homes. Below are additional resources that may be helpful for those with tobacco-related disorders:

• Smokefree.gov: This website is a comprehensive resource provided by the US government, offering tools, tips, and support to help individuals quit smoking.
• Truth Initiative: Truth Initiative provides factual information to youth about tobacco and nicotine, including the program "This is Quitting," which has supported over 600,000 young individuals in their efforts to stop vaping.
• Nicotine Anonymous: Nicotine Anonymous is a 12-step fellowship program designed for those wanting to quit nicotine. The group provides a community where individuals can share experiences and improve their chances of successfully quitting tobacco, offering informational and emotional support. Use their website to find an online or in-person group. 

For those struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

The fight against nicotine addiction has led researchers to pioneer groundbreaking techniques targeting the brain and molecular interactions. The studies below have shown encouraging progress in aiding individuals to overcome their smoking habits.

Individuals may revert to smoking after attempting to quit through traditional methods. Recent research explores a new technique using EEG-based neurofeedback to target brain patterns linked to smoking urges. In a controlled study, participants trained to diminish these specific brain patterns and saw a significant reduction in cigarette cravings. As a result, they smoked 27.4% fewer cigarettes four months post-training compared to a control group. This innovative neurofeedback method offers a potential brain-centered solution for lasting smoking cessation.

Additionally, researchers have explored a new treatment approach using an enzyme, NicA2, to break down nicotine, reducing its addictive impact. Studies have shown promising results with enhanced versions of this enzyme effectively lowering nicotine levels in the blood and brain. Additionally, modifications to the enzyme extend its presence in the bloodstream while minimizing potential immune reactions, demonstrating that the refined NicA2 enzyme shows potential as a promising therapeutic solution for tackling nicotine addiction in humans.

Below are several statistics on tobacco-related disorders:

• According to the Center for Advancement of Health, in 2020, 3.7% of Americans, equating to 9.1 million people, used e-cigarettes, with teens accounting for 7.6% of this demographic.
• The World Health Organization (WHO) notes tobacco is responsible for the deaths of 50% of its users, leading to over eight million fatalities annually. This number includes 1.3 million non-smokers affected by second-hand smoke, highlighting the broader impact of tobacco-related disorders.
• The Centers for Disease Control and Prevention (CDC) quote that in 2018, roughly 55% of adults with tobacco-related disorders attempted to quit smoking within the year. 8% of these individuals remained abstinent for six to 12 months. 
• The Tobacco Induced Diseases journal cites that individuals who had behavioral support for at least six months increased their likelihood of quitting smoking by 40% to 80%.
• Tobacco use disorder is the most common substance use disorder in the United States.