From the Guidelines
The DSM-5-TR criteria for nicotine abuse, dependence, or misuse are combined into a single disorder called Tobacco Use Disorder, which is characterized by a pattern of tobacco use that leads to significant impairment or distress. The diagnostic criteria for Tobacco Use Disorder include using tobacco in larger amounts or over longer periods than intended, persistent desire or unsuccessful efforts to cut down or control use, spending significant time obtaining or using tobacco, experiencing cravings, failing to fulfill major role obligations due to tobacco use, continued use despite social or interpersonal problems, giving up important activities because of tobacco use, using in physically hazardous situations, continued use despite physical or psychological problems caused by tobacco, tolerance (needing increased amounts or diminished effect), and withdrawal symptoms 1.
Key Points
- The severity of Tobacco Use Disorder is classified as mild (2-3 symptoms), moderate (4-5 symptoms), or severe (6+ symptoms) 1.
- These criteria reflect the addictive nature of nicotine, which causes neurochemical changes in the brain's reward pathways, particularly involving dopamine, and physical dependence develops through neuroadaptation, leading to withdrawal symptoms when nicotine levels decrease 1.
- Understanding these criteria helps clinicians accurately diagnose and develop appropriate treatment plans for individuals struggling with tobacco use, including the use of behavioral skills and pharmacologic therapies to support smoking cessation 1.
Treatment Considerations
- The use of behavioral skills, such as interpersonal communication skills, behavioral change techniques, stress management counseling, patient contracting and goal setting, self-efficacy, motivational interviewing, and relapse prevention, can facilitate smoking cessation 1.
- Pharmacologic therapies, such as nicotine replacement therapy or prescription medications, can also support smoking cessation and should be used based on age, pregnancy status, medical history, and comorbidities of the patient 1.
From the Research
DSM-5-TR Criteria for Nicotine Abuse, Dependence, or Misuse
The DSM-5-TR criteria for nicotine abuse, dependence, or misuse are not directly addressed in the provided studies, which focus on the effectiveness of behavioral and cognitive therapies for smoking cessation and the validity of proposed DSM-5 diagnostic criteria for nicotine use disorder.
- The studies 2, 3 discuss the use of behavioral and cognitive therapies for smoking cessation, highlighting their effectiveness when combined with pharmacological treatments.
- Other studies 4, 5, 6 examine the proposed DSM-5 nicotine use disorder criteria, comparing them to DSM-IV nicotine dependence criteria and assessing their validity and prevalence.
- The proposed DSM-5 criteria include 11 criteria, such as craving, neglect of roles, hazardous use, and interpersonal problems, and would lower the threshold for diagnosis from three to two symptoms 5, 6.
- The studies suggest that the proposed DSM-5 criteria have substantial limitations when applied to adolescents and young adults 5, but may provide improved diagnosis of nicotine disorders in other populations 6.
Key Findings
- The proposed DSM-5 nicotine use disorder criteria have been evaluated in several studies, with mixed results regarding their validity and prevalence 5, 6.
- Behavioral and cognitive therapies are effective for smoking cessation, particularly when combined with pharmacological treatments 2, 3, 4.
- The DSM-5-TR criteria for nicotine abuse, dependence, or misuse are not explicitly addressed in the provided studies, but the proposed DSM-5 nicotine use disorder criteria may be relevant to understanding nicotine-related disorders.