With free smokes available around every corner, nicotine-related mental disorders have become more prevalent since the 1980’s. Today, one in ten adults in the world smokes regularly, and five in ten adults or 50% of the adult population in the US smokes. Nearly 500,000 adults die due to smoking-related disorders every year in the US alone 45% of smokers die due to nicotine-related disorders. Thus, addressing this massive health and social phenomenon from its core is crucial. The Diagnostic Statistical Manual of Mental Disorders (DSM) defines two basic types of nicotine-related substance addictions – dependence and withdrawal.

Both of the above disorders are interlinked in most cases. Nicotine dependence is primarily characterized by the strong desire to consume the substance and if withdrawn, the individual is likely to suffer from severe withdrawal symptoms which will lead them to use the substance once more. Most addicts who suffer from dependence are likely to seek ways to stop smoking but most often, especially if unaided, fails. Thus, nicotine addiction is cyclic and carefully planned interventions must be initiated to break it.

Nicotine is an alkaline substance found in nightstand plants that interferes with the human mesolimbic pathway or reward system. In simple, nicotine makes you feel good; so, the more you take it, the better you feel. This substance which has many pharmacological uses is known to be more addictive than cocaine and heroin. The causes of nicotine-related disorders vary from social pressure to physical needs.

Cigarettes, chewing tobacco, pipes, cigars and snuffs or any other nicotine-containing substance can be addictive because it increases the brain’s neurotransmitter activity once consumed. The pleasure hormone, dopamine is also released which gives the person a heightened feeling of joy. Like most other drugs, the exhilaration is what makes nicotine addictive and difficult to stop using. Social pressure, depression, anxiety, low self-esteem, frustration, etc. are listed as the key causes that lead individuals to smoke.

Symptoms and Types

The obvious indication that one is suffering from a nicotine-related disorder is the fact that they are addicted. In other words, they cannot go without nicotine. If they do try to stop, they suffer from withdrawal symptoms as listed below. In addition, the nicotine consumption habits of the individual interfere with his or her regular functioning and may ultimately lead to severe mental and physical problems.

Addicts also tend to keep smoking even when they suffer from severe consequences. For example, a sufferer of bronchitis will not stop smoking even if he knows that it will worsen his condition. Denial is also a commonly seen characteristic among substance abusers.

Diagnosis and Tests

Diagnostic criteria for nicotine dependence are as follows;

1. maladaptive patterns of nicotine use that cause marked impairments or distress with three or more of the following symptoms for a period of one year or more
2. need for a larger quantity of substance to achieve the desired level of intoxication or display markedly diminished levels of intoxication when the same amount is used (tolerance level increases)
3. if nicotine is avoided, withdrawal symptoms are displayed (refer to the following section on nicotine withdrawal)
4. persistent desire and unsuccessful efforts to avoid the substance
5. going to great extents to acquire nicotine-containing substances (stealing money, skipping work, risking relationships, etc)
6. impairments in social, occupational, academic, recreational and cognitive activities solely due to the substance and related symptoms
7. continuous use of nicotine leads to other severe problems such as depression, self-harm and physiological disorders

Diagnostic criteria for nicotine withdrawal are as follows

1. daily use of nicotine-containing substances for several weeks
2. four or more of the below symptoms, within 24 hours if the use of nicotine is ceased or reduced
   i. anxiety
   ii. decreased heart rate
   iii. increased appetite and weight gain
   iv. depressed mood
   v. insomnia or altered sleep patterns
   vi. restlessness
   vii. irritability, anger and/ or frustration
   viii. difficulties in concentrating

   There are no methodical diagnostic tests to detect the degree to which you are a nicotine addict, but doctors may conduct interviews to find out. The number of cigarettes you take per day, the number of hours you go without nicotine after you wake up each day, and the types of withdrawal or addiction symptoms you display are some of the indicators of the degree of the problem.

Treatment and Care

Nicotine addiction can lead to many psychological and physiological problems such as depression, social withdrawal, anxiety, cancer, bronchitis, etc. It is also known to be a contributor to skin diseases, Alzheimer’s diseases, pneumonia, coronary heart disease, cataracts and pulmonary diseases. Thus, realising the risk of nicotine dependence and treating it is crucial.

According to medical health statistics, only 5% of those who attempt to quit smoking succeed. The reason is that withdrawal symptoms give many smokers no option, but to smoke again. Therefore, properly aided treatments in optimal environments must be conducted. Treatments to reduce withdrawal symptoms such as the drug bupropion or nicotine patch are most successful. These types of nicotine-substitution therapies also include nicotine gum, nasal spray lozenges and inhalers. Varenicline (Chantix), Clonidine (Catapres) and Nortriptyline (Pamelor) are other commonly used drugs.

Various behavioural modification techniques also help smokers be free of addiction for longer periods. Since modelling and social reinforcement are known to be two key reasons to start smoking in the first place, reversing those behavioural incentives helps smokers. In addition to educating them about the consequences of smoking, pairing negative experiences with the smoking habit will help smokers quit. Counselling, and group and family therapy, where smokers can openly discuss their addictions in a corporate environment are additional treatment options. However, pairing medication with psychotherapy is known to be more promising than using one method only.