Tobacco Addiction Treatment Scottsdale | Phoenix

Dr. Jack Shier, Psychiatrist in Scottsdale, AZ specializes in the treatment of tobacco use disorder/nicotine dependence. Our private outpatient clinic offers a comprehensive psychiatric/medical assessment and treatment plan. Treatment may include medications, behavioral therapies or a combination of treatments.

What is Tobacco?

Tobacco is a product that is cured from the leaves of the Nicotiana plant. Tobacco contains alkaloid nicotine, which provides the substance with most of its stimulative and addictive properties, as well as other chemicals depending on its form. Tobacco is found in cigarettes, cigars, chewing tobacco and pipe tobacco among others.

What is Tobacco used for?

Tobacco is most often used recreationally and socially. In some cultures it has a history of ceremonial uses.

What are the Effects of Tobacco?

The immediate effects of tobacco may include, but are not limited to increased alertness and concentration, feelings of relaxation, increased blood pressure and heart rate, feelings of euphoria, decreased body temperature, decreased appetite, headache, nausea and/or dizziness.

What are the Long-Term Effects of Tobacco Use?

Long-term tobacco users are likely to develop a tolerance for nicotine’s effects, meaning they must use more tobacco to achieve the same effects as when they initially used. Similarly, there is potential for physical or psychological dependence to occur. Physical dependence occurs when the body adapts to functioning when nicotine is present, whereas psychological dependence occurs when individuals find that they feel an urge or craving to use tobacco, especially in social settings.

The list of long-term health effects linked to tobacco use is extensive. These effects may include, but are not limited to, increased risk of brain damage and/or stroke, loss of sense of smell or taste, tooth decay or staining, possible hearing loss, shortness of breath, coughing, chronic bronchitis, emphysema, heart disease, stomach ulcers, hypertension, lower fertility, early menopause, impotence, and an increased susceptibility to infection. Tobacco use has also been associated with cancers of the nose, lip, tongue, mouth, larynx, lung, stomach and bladder. External effects may include yellowing of the teeth, grey appearance and early wrinkles.

What Causes Tobacco Use Disorder?

Genetic and environmental factors both play a role in the development of a tobacco use disorder. Nicotine is absorbed into the bloodstream where it stimulates the adrenal glands to release epinephrine (adrenaline). This hormone stimulates the central nervous system, increasing blood pressure and heart rate. Nicotine increases the release of dopamine, which affects the reward centers of the brain, located in the nucleus accumbens and orbitofrontal cortex. Individuals whose brains naturally release higher levels of endorphins like dopamine in response to tobacco use will receive more pleasure from its effects and may be more susceptible to developing a tobacco use disorder. Tobacco addiction may also be more prevalent in individuals with alcohol and other drug use disorders.

Tobacco use disorder is one of the leading substance use disorders in the United States affecting approximately 13% of adults 18 years and older.

What is a Tobacco Use Disorder?

According to the DSM-5, the diagnostic criteria of tobacco use disorder include:

A problematic pattern of tobacco use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12 month period:

  1. Tobacco is often taken in larger amounts of over a longer period than was intended
  2. There is a persistent desire or unsuccessful efforts to cut down or control tobacco use.
  3. A great deal of time is spent in activities necessary to obtain or use tobacco.
  4. Craving, or a strong desire or urge to use tobacco.
  5. Recurrent tobacco use resulting in a failure to fulfill major role obligations at work, school, or home.
  6. Continued tobacco use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of tobacco.
  7. Important social, occupational, or recreational activities are given up or reduced because of tobacco use.
  8. Recurrent tobacco use in situations in which it is physically hazardous.
  9. Tobacco use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by tobacco.
  10. Tolerance, as defined by either a need for markedly increased amounts of tobacco to achieve the desired effect or a markedly diminished effect with continued use of the same amount of tobacco.
  11. Withdrawal, as defined by either the characteristic withdrawal syndrome for tobacco or tobacco (or a closely related substance such as nicotine) is taken to relieve or avoid withdrawal symptoms.

What Are the symptoms of Tobacco Withdrawal?

According to the DSM-5, tobacco/nicotine withdrawal is most likely to occur within 24 hours of the abrupt cessation of tobacco use or reduction in tobacco use. The symptoms of tobacco withdrawal may include, but are not limited to, irritability, frustration or anger, anxiety, difficulty concentrating, increased appetite, restlessness, depressed mood, and/or insomnia. The symptoms of tobacco withdrawal may cause significant distress in social, occupational or recreational functioning.

What is the Treatment for Tobacco Addiction/Use Disorder?

Treatment for tobacco use disorder/addiction may include psychotherapy, medication, and 12-step programs, but research has shown that a combination of these three strategies may be most effective.

Nicotine replacement therapies (NRTs) were the first type of medications FDA-approved for tobacco use disorder. The current NRT products available include the transdermal patch, chewing gum, inhalers, nasal spray and lozenges. These medications work by delivering small doses of nicotine into the system to avoid/relieve withdrawal symptoms after the cessation of tobacco use. Two other FDA-approved medications, Bupropion (Zyban) and Varenicline (Chantix) work by targeting the brain’s nicotine receptors, minimizing withdrawal symptoms and blocking the effects of nicotine to lessen the appeal of tobacco use if the individual starts using again.

Cognitive-behavioral therapy (CBT), contingency management, and motivational enhancement therapy are common methods used in the treatment of tobacco use disorder through psychotherapy. CBT focuses on identifying feelings, modifying distorted thoughts, and finding alternatives to maladaptive behaviors, i.e. tobacco use. Contingency management is a type of therapy that is designed to reinforce positive behaviors, i.e avoiding tobacco use, through incentives. Motivational enhancement therapy focuses on building motivation and committing to specific treatment plans to work towards recovery. This type of therapy is most commonly used in the early stages of treatment to increase engagement.

How to Cope?

  1. Maintaining a balanced lifestyle can help an individual manage nicotine addiction.
  2. Relaxation techniques – Participating in mindfulness meditation or deep breathing exercises can reduce an individual’s overall stress level and may help curb maladaptive urges to use tobacco or nicotine.
  3. Exercise routine – 30 minutes of daily aerobic exercise may help manage nicotine addiction by reducing anxiety and diverting an individual’s attention away from tobacco use
  4. Good sleep hygiene – Healthy sleep patterns promote a stronger ability to maintain emotional equilibrium, making it easier to maintain stress and avoid the use of nicotine.
  5. Avoid activities surrounding tobacco use – Engage in activities that are not associated with tobacco use in order to prevent urges.
  6. Increase number of social contacts that are not associated with tobacco or nicotine use/that do not promote the use of tobacco.
  7. Join 12-step/support group – Support groups will help you meet others with similar experiences, share coping strategies, and gain a sense empowerment and connection.

Last update: July 18, 2017

The content on this website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.