Understanding Tobacco Use Disorder: Symptoms, Types, and Treatment

Tobacco Use Disorder is characterised by problematic pattern of tobacco use leading to clinically significant impairment or distress. This guide summarises diagnostic features, common product types (cigarettes, bidis, smokeless, e-cigarettes), assessment tools and evidence-based treatments including pharmacotherapy and psychosocial interventions.

WhatsApp +91-7010702114 Email emocare@emocare.co.in

Diagnostic features (DSM-5 style)

Patterns of tobacco use meeting criteria for a substance use disorder include: craving, unsuccessful attempts to cut down, continued use despite harm, tolerance, withdrawal, neglect of roles and time spent obtaining/using tobacco. Severity is graded mild/moderate/severe based on number of criteria met.

Types & product considerations

Smoked tobacco: manufactured cigarettes, bidis, cigars — deliver rapid nicotine and many combustion-related toxins.
Smokeless tobacco: chewing tobacco, gutka, khaini — associated with oral cancers and local mucosal disease.
E‑cigarettes / vaping: variable nicotine delivery; evolving evidence on harms and utility for cessation.
Dual-use: use of more than one product complicates dependence severity and cessation planning.

Clinical presentation — signs & symptoms

Tolerance and needing more tobacco or stronger products to achieve the same effect.
Withdrawal symptoms on cessation (cravings, irritability, anxiety, difficulty concentrating, increased appetite).
Health consequences: cough, dyspnoea, oral lesions, cardiovascular symptoms.
Behavioural impacts: social, occupational harm, financial burden.

Screening & assessment tools

Ask all patients: “Do you use tobacco or nicotine products?” Document product, frequency, last use.
Heaviness of Smoking Index (HSI) / Fagerström Test for Nicotine Dependence for dependence severity.
AUDIT, ASSIST if polysubstance use suspected; PHQ-9 / GAD-7 for comorbid mood/anxiety disorders.

Treatment approaches

Effective treatment combines pharmacotherapy with behavioural support tailored to product type, dependence severity and patient preference.

Pharmacotherapy

Nicotinic replacement therapy (patch, gum, lozenge, inhalator, nasal spray) — consider combination therapy for heavy dependence.
Varenicline — highest efficacy; consider pre-quit initiation and 12-week course with possible extension for relapse prevention.
Bupropion SR — alternative or adjunct, particularly when comorbid depression exists.
Consider special dosing/monitoring for smokeless tobacco and vaping users; tailor NRT route to patient’s product of choice where possible.

Behavioural interventions

Brief advice and motivational interviewing.
Cognitive-behavioural therapy for relapse prevention and coping skills.
Group programs, telephone counselling, digital interventions and peer-support options.

Management of special situations

Pregnancy: advise cessation; behavioural interventions first-line, NRT under specialist supervision if needed.
Adolescents: focus on prevention and behavioural approaches; pharmacotherapy considered cautiously by specialists.
Mental health: integrate cessation with psychiatric care; monitor medication levels where smoking affects metabolism (e.g., clozapine).

Relapse prevention & long-term support

Arrange regular follow-up early (1–2 weeks) and provide booster sessions; combine pharmacotherapy with ongoing counselling.
Address social triggers, workplace exposure and provide resources for stress management and weight control.
Consider stepped care: intensify pharmacotherapy or refer to specialist cessation clinics for repeated failures.

Safety considerations & medication interactions

Smoking induces CYP1A2 — may reduce plasma levels of drugs metabolised by this enzyme (clozapine, olanzapine, theophylline); monitor and adjust doses when smoking changes.
Screen for cardiovascular instability before starting varenicline in high-risk patients and monitor mood symptoms with varenicline or bupropion.

Case vignette

Patient: L., 40, smokes 25 cigarettes/day, multiple failed quit attempts. HSI indicates high dependence. Management: started on varenicline with behavioural counselling, arranged weekly follow-up and provided quitline contact. At 3 months L. reports abstinence and improved exercise tolerance; plan to continue support to 6 months and then step down.

தமிழில் — சுருக்கம்

Tobacco Use Disorder என்பது நிகோடின் பழக்கத்தின் காரணமாக வாழ்க்கையை பாதிக்கும் நிலை. சிறிய ஆலோசனை, மருந்து உதவி மற்றும் இருமுறை ஆதரவு சேர்த்து நிறுத்தம் சாத்தியமாகும்.

Key takeaways

Identify tobacco use in every patient encounter; assess dependence and readiness to quit.
Use evidence-based pharmacotherapies (NRT, varenicline, bupropion) combined with behavioural interventions for best outcomes.
Tailor interventions to product type and special populations, monitor for drug interactions and provide ongoing relapse-prevention support.