From the Guidelines
The DSM-5-TR (2022) classifies nicotine-related conditions under "Tobacco Use Disorder," which is diagnosed when a person exhibits a problematic pattern of tobacco use leading to clinically significant impairment or distress, with at least two of the specified criteria occurring within a 12-month period. This disorder is characterized by symptoms such as using tobacco in larger amounts or longer than intended, persistent desire or unsuccessful efforts to cut down, spending considerable time obtaining, using, or recovering from tobacco, craving tobacco, and other indicators of impaired control and use despite negative consequences 1. The severity of Tobacco Use Disorder is classified as mild (2-3 symptoms), moderate (4-5 symptoms), or severe (6+ symptoms) 1.
Key Criteria for Diagnosis
- Using tobacco in larger amounts or longer than intended
- Persistent desire or unsuccessful efforts to cut down
- Spending considerable time obtaining, using, or recovering from tobacco
- Craving tobacco
- 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)
- Withdrawal symptoms when stopping use
Importance of Accurate Diagnosis
Understanding these criteria is essential for healthcare providers to accurately diagnose and develop appropriate treatment plans for patients struggling with tobacco use, as it directly impacts morbidity, mortality, and quality of life 1. The DSM-5-TR also includes "Tobacco Withdrawal" as a separate diagnosis, characterized by symptoms like irritability, anxiety, difficulty concentrating, increased appetite, restlessness, depressed mood, and insomnia that develop within 24 hours of cessation.
Clinical Implications
Healthcare providers should be aware of these criteria to provide timely and effective interventions, improving patient outcomes and reducing the burden of tobacco use on public health. The alignment of criteria for tobacco use disorder with those for other substance use disorders, as recommended by studies 1, enhances the validity and applicability of these criteria in clinical practice.
From the Research
DSM-5-TR Criteria for Nicotine Abuse, Dependence, or Misuse
The DSM-5-TR criteria for nicotine use disorder include a combination of criteria from the DSM-IV nicotine dependence and abuse criteria, as well as craving 2. The criteria are designed to align with those for other substance use disorders.
Validity of Proposed DSM-5 Diagnostic Criteria
Studies have shown that the proposed DSM-5 criteria for nicotine use disorder are valid and effective in diagnosing nicotine disorders 2. Each criterion is significantly associated with external validators, and the set of criteria as a whole is more discriminating than the DSM-IV nicotine dependence criteria.
Key Criteria
Some key criteria for nicotine use disorder include:
- Neglect of roles or responsibilities due to nicotine use
- Hazardous use of nicotine
- Interpersonal problems due to nicotine use
- Craving or a strong desire to use nicotine
- Continued use of nicotine despite physical or psychological problems
Comparison to Other Substance Use Disorders
The DSM-5-TR criteria for nicotine use disorder are designed to be consistent with those for other substance use disorders, such as alcohol or opioid use disorder 2. This allows for a more comprehensive and consistent approach to diagnosing and treating substance use disorders.
Prevalence of Nicotine Use Disorder
The prevalence of nicotine use disorder is expected to increase with the use of the DSM-5-TR criteria, as the criteria are designed to be more sensitive and inclusive than the DSM-IV criteria 2. This may lead to more individuals being diagnosed and treated for nicotine use disorder.
Treatment Options
Treatment options for nicotine use disorder include medications such as varenicline, bupropion, and nicotine replacement therapy, as well as behavioral therapies such as counseling and support groups 3, 4, 5, 6. The most effective treatment approach may involve a combination of these options.