Tobacco use disorder

Tobacco use disorder is the diagnostic term for problematic, dependent use of tobacco products such as cigarettes, cigars and smokeless tobacco.

Nicotine in tobacco drives dependence, but the disorder is defined by the pattern of use: cravings, tolerance, withdrawal symptoms on stopping, unsuccessful attempts to quit and continued use despite health problems. Tobacco smoke also delivers thousands of other chemicals, which is why the disorder is tied to cancer, heart disease, stroke and lung disease. It remains a leading cause of preventable death and often begins in adolescence.

Clinicians assess it with a history of use, the Fagerström test for nicotine dependence and screening at routine visits. Counseling, nicotine replacement and prescription medications such as varenicline and bupropion are the established approaches, and quitlines offer free support. Cannabidiol has been examined in small early studies related to cigarette craving, and there is no approved cannabinoid use for tobacco dependence.