Nicotine dependence
305.1 Nicotine Dependence
Refer, in addition, to the text and criteria for Substance Dependence (see p. 192). Some of the generic Dependence criteria do not appear to apply to nicotine, whereas others require further explanation. Tolerance to nicotine is manifested by a more intense effect of nicotine the first time it is used during the day and the absence of nausea and dizziness with repeated intake, despite regular use of substantial amounts of nicotine. Cessation of nicotine use produces a well-defined withdrawal syndrome that is described below. Many individuals who use nicotine take nicotine to relieve or to avoid withdrawal symptoms when they wake up in the morning or after being in a situation where use is restricted (e.g., at work or on an airplane). Individuals who smoke and other individuals who use nicotine are likely to find that they use up their supply of cigarettes or other nicotine-containing products faster than originally intended. Although more than 80% of individuals who smoke express a desire to stop smoking and 35% try to stop each year, less than 5% are successful in unaided attempts to quit. Spending a great deal of time in using the substance is best exemplified by chain-smoking. Because nicotine sources are readily and legally available, spending a great deal of time attempting to procure nicotine would be rare. Giving up important social, occupational, or recreational activities can occur when an individual forgoes an activity because it occurs in smoking-restricted areas. Continued use despite knowledge of medical problems related to smoking is a particularly important health problem (e.g., an individual who continues to smoke despite having a tobacco-induced general medical condition such as bronchitis or chronic obstructive lung disease).
Specifiers
The following specifiers may be applied to a diagnosis of Nicotine Dependence (see p. 195 for more details):
- With Physiological Dependence
- Without Physiological Dependence
- Early Full Remission
- Early Partial Remission
- Sustained Full Remission
- Sustained Partial Remission