Overview of Tobacco Use and Tobacco Use Disorders

Agenda

  • Housekeeping: Paper due next week

  • Overview of tobacco use and disorders:

    • Scope of tobacco use problem

    • Pharmacology and subjective effects

    • Long-term complications

    • Tobacco-related disparities

    • Benefits of smoking cessation

    • DSM criteria for disorders

Scope of Tobacco Use

  • Tobacco cultivated in South America 8,000 years ago.

  • Demand for tobacco fueled European colonies.

  • Tobacco used as currency; increased cigarette supply led to price drop.

Substance Use Statistics (2022)

  • Current users of various substances are not mutually exclusive.

  • Reports on tobacco product use among ages 12 and older by race/ethnicity indicate disparities.

Pharmacology of Tobacco

  • Tobacco composition variables:

    • Packing density, column length, filter characteristics, smoking temperature.

  • "Light" cigarettes equally addictive and risky as regular brands.

Nicotine Details

  • Isolated in 1828; reaches the brain within seconds of inhalation.

  • Daily smoking habit results in 85,000 puffs/year.

  • Minimum of 66% of smokers are addicted; tolerance and withdrawal symptoms occur.

Withdrawal Symptoms

  • Begin in 2 hours, peak in 1 day, and last up to 6 months.

  • Symptoms: irritability, concentration issues, cravings, sleep problems.

Secondhand Smoke

  • Contributes to 1% of global deaths; exposes non-smokers to toxic substances.

Complications of Long-term Tobacco Use

  • Average losses: 13.2 years (male), 14.5 years (female) smokers.

  • Significant health issues: cardiovascular disease, cancers, respiratory illnesses.

Types of Smokeless Tobacco

  • Includes moist snuff, dry snuff, chewing tobacco, snus, and dissolvables.

  • Associated with higher risks for oral cancer and myocardial infarctions.

Tobacco-Related Disparities

  • Social determinants (e.g., discrimination, poverty) affect tobacco use and cessation.

  • Targeted marketing increases tobacco use among specific populations.

Smoking Cessation

  • Only 4-7% can quit without help; relapse rates high.

  • Weight gain common during quitting process; some gain is preferable to smoking.

Medications for Cessation

  • Nicotine Replacement Therapies (NRTs) are effective.

  • Bupropion and Varenicline (Chantix) aid in reducing cravings and supporting abstinence.

Behavioral Approaches

  • Complement medications by teaching stress management, coping strategies, and avoiding relapse triggers.

Interrelationship of Smoking and Alcohol

  • Tobacco enhances effects of alcohol; creates a cycle of cravings for both substances.