Nicotine dependence
| Nicotine dependence | |
|---|---|
| Classification and external resources | |
| ICD-10 | F17.2 |
| ICD-9-CM | 305.1 |
| OMIM | 188890 |
Nicotine dependence is a state of dependence upon nicotine. There are different ways of measuring nicotine dependence. Some nicotine dependence assessments focus on key physical dependence outcomes like the development of tolerance which allows people to smoke heavily. Other assessments ask about psychosocial outcomes or underlying mechanisms of dependence. These different assessments either characterize dependence as a continuous construct or use cut-offs to diagnose whether or not a person is dependent.
Nicotine dependence is especially a concern among some populations such as those with co-occurring mental illness. There are evidence-based nicotine dependence treatments that include both medication and psychosocial interventions that can significantly increase a smoker’s chances of quitting successfully.
Nicotine dependence develops over time as a person continues to smoke. The risk for the development of dependence and how long it takes to become dependent differs from person to person; there is not a clear consensus on how long it takes for dependence to develop.
Nicotine dependence results in daily, heavy usage of cigarettes and produces withdrawal symptoms such as urges to smoke, negative moods, and difficulty concentrating, when the person stops smoking. These withdrawal symptoms are so unpleasant that smokers very frequently return to smoking. However, while it is known what nicotine dependence does--permits heavy smoking and causes severe withdrawal symptoms and relapse back to smoking--it is hard to measure nicotine dependence apart from these consequences.
From a clinical perspective, nicotine dependence has been classified as a chronic, relapsing disease. In other words, it is a long-term disorder that may have periods of relapse and remission that require repeated intervention, similar to other chronic conditions such as diabetes or hypertension. This perspective reinforces the idea that nicotine dependence is not a bad habit but an actual disease that requires ongoing treatment.
Nicotine dependence is a complex construct and therefore it is challenging to measure. When it comes to assessing nicotine dependence, how one chooses to define it and/or the purpose of the assessment will guide which assessment to use. Some people distinguish between nicotine dependence and addiction, but, for the most part, nicotine dependence instruments ask about ideas that are thought of to be dependence and addiction. Thus the two terms are now often used interchangeably. For instance, someone could use a narrow definition of nicotine dependence that focused on physical dependence characterized as neuroadaptations—changes in the brain—produced by repeated smoking. This would lead them to use one type of assessment. On the other hand, someone could want to include other components such as the influence of cues in the environment that are now linked to smoking and lead to urges to smoke (e.g., finishing a meal, seeing someone smoke) or the degree to which smokers feel they have lost control over their smoking. These constructs are typically thought to be related to addiction but they are included in some dependency assessments. Below are three of the major types of nicotine dependence assessments: physical dependence assessments, clinical assessments, and multidimensional assessments. Each type varies in how nicotine dependence is defined and assessed.
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