Tobacco Dependence Syndrome In the

World Health Organization ICD-10 Classification of Mental and Behavioural Disorders: F17.2 Tobacco Dependence Syndrome A cluster of physiological, behavioural, and cognitive phenomena in which the use of tobacco takes on a much higher priority for a given individual than other behaviours that once had greater value. A central descriptive characteristic of the dependence syndrome is the desire (often strong, sometimes overpowering) to take tobacco There may be evidence that return to substance use after a period of abstinence leads to a more rapid reappearance of other features of the syndrome than occurs with nondependent individuals. Diagnostic Guidelines

A definite diagnosis of dependence should usually be made only if three or more of the following have been experienced or exhibited at some time during the previous year:

(a) a strong desire or sense of compulsion to take tobacco,

(b) difficulties in controlling tobacco-taking behaviour in terms of its onset, termination, or levels of use;

(c) a physiological withdrawal state when tobacco use has ceased or been reduced, as evidenced by: the characteristic withdrawal syndrome for tobacco, or use of the same (or a closely related) substance with the intention of relieving or avoiding withdrawal symptoms;

(d) evidence of tolerance, such that increased doses of tobacco are required in order to achieve effects originally produced by lower doses;

(e) progressive neglect of alternative pleasures or interests because of tobacco use, increased amount of time necessary to obtain or take the substance or to recover from its effects; (f) persisting with tobacco use despite clear evidence of overtly harmful consequences, such as depressive mood states consequent to periods of heavy substance use, or drug-related impairment of cognitive functioning; efforts should be made to determine that the user was actually, or could be expected to be, aware of the nature and extent of the harm. Narrowing of the personal repertoire of patterns of tobacco use has also been described as a characteristic feature.

It is an essential characteristic of the dependence syndrome that either tobacco taking or a desire to take tobacco should be present; the subjective awareness of compulsion to use drugs is most commonly seen during attempts to stop or control substance use. In the USA a slightly different diagnosis tradition exists mainly organised after DSMIV

A.Nicotine abuse: A destructive pattern of nicotine use, leading to significant social, occupational, or medical impairment.

B.Must have three (or more) of the following, occurring when the nicotine use was at its worst:

1. Nicotine tolerance:

Either need for markedly increased amounts of nicotine to achieve intoxication, or markedly diminished effect with continued use of the same amount of nicotine. 2. Nicotine withdrawal symptoms: Either (a) or (b).

(a) Two (or more) of the following, developing within several hours to a few days of reduction in heavy or prolonged nicotine use: sweating or rapid pulse increased hand tremor insomnia nausea or vomiting physical agitation anxiety transient visual, tactile, or auditory hallucinations or illusions grand mal seizures

(b) Nicotine is taken to relieve or avoid withdrawal symptoms. 3. Greater use of nicotine than intended:

Nicotine was often taken in larger amounts or over a longer period than was intended 4.Unsuccessful efforts to cut down or control nicotine use:

Persistent desire or unsuccessful efforts to cut down or control nicotine use 5.Great deal of time spent in using nicotine 6.Nicotine caused reduction in social, occupational or recreational activities:

Important social, occupational, or recreational activities given up or reduced because of nicotine use. 7.Continued using nicotine despite knowing it caused significant problems: Continued nicotine use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been worsened by nicotine Associated Features Somatic/Sexual Dysfunction Addiction

Differential Diagnosis

Nonpathologic nicotine use for recreational purposes.

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