Peterson / Jaén / Vander Weg Nicotine and Tobacco Dependence

1. Auflage 2011
ISBN: 978-1-61334-324-1
Verlag: Hogrefe Publishing
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 104 Seiten

Reihe: Advances in Psychotherapy - Evidence-Based Practice

How to stop patients and clients smoking - guidance on treatments that work, from leading US authorities.

This volume in the series Advances in Psychotherapy – Evidence-Based Practice provides health care providers with practical and evidence-based guidance on the diagnosis and treatment of nicotine and tobacco dependence.

Tobacco use is the leading preventable cause of death in the world, and it is the only legally available consumer product that kills people when used entirely as intended. Research over the past several decades has led to the development of a number of evidence-based treatments for nicotine and tobacco dependence that can be delivered by health care professionals in a variety of primary and specialty care settings. This book aims to increase medical, mental health, and dental practitioners’ access to empirically supported interventions for nicotine and tobacco dependence, with the hope that these methods will be incorporated into routine clinical practice.

The book is both a compact “how-to” reference for clinicians and an ideal educational resource for students and for practice-oriented continuing education. The volume includes tables, boxed clinical pearls, and clinical vignettes, and the appendix includes clinical tools, patient handouts, and links to the top recommended websites for the download of additional patient materials.

Earn 5 CE credits for reading volumes of the Advances in Psychotherapy book series. Click here to find out more!

Autoren/Hrsg.

Peterson, Alan L.

Jaén, Carlos R.

Vander Weg, Mark W.

Fachgebiete

• Sozialwissenschaften Psychologie Psychotherapie / Klinische Psychologie Suchttherapie
• Sozialwissenschaften Psychologie Psychologie / Allgemeines & Theorie Psychologie: Sachbuch, Ratgeber
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete Psychiatrie, Sozialpsychiatrie, Suchttherapie

Leseproben

1
Description of Nicotine and Tobacco Dependence
1.1   Terminology Although the primary emphasis of this book is on cigarette smoking cessation, it is also meant to apply to all forms of tobacco. Therefore, we often use the term tobacco use throughout the book to refer to all forms of tobacco, including cigarettes, chewing tobacco, cigars, bidis, snus, pipe tobacco, and clove cigarettes. As a starting point, it will be useful to clarify some of the terminology we will be using throughout this book. Although there are many different terms used to describe substance use disorders and the experience of dependence, we will use those developed by the American Psychiatric Association (APA) and the World Health Organization (WHO), as well as those commonly utilized in the field of tobacco control. 1.1.1 DSM-IV-TR The American Psychiatric Association (APA) Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR; APA, 2000), is the generally accepted taxonomy of psychiatric and psychological disorders used by medical and mental health professionals in the United States. Based on the assumption that dependence on various substances shares several common characteristics, the basic diagnostic criteria for substance dependence are consistent across several different classes of licit and illicit drugs. According to the DSM-IV-TR (see Appendix 1), substance dependence (including nicotine dependence) is characterized by a maladaptive pattern of substance use involving cognitive, behavioral, and physiological symptoms and resulting in continued use of the substance despite significant substance-related problems (APA, 2000). 1.1.2 ICD-10 The other most commonly adopted criteria for diagnosing substance dependence come from the World Health Organization (WHO) International Classification of Diseases, 10th Revision (ICD-10; WHO, 1992). Outside of the United States, ICD-10 is the most commonly used classification system for psychiatric conditions, including substance use disorders. In an effort to promote consistency and make it easier to facilitate knowledge transfer and comparisons across different countries, the ICD-10 and DSM-IV-TR criteria were designed to be highly similar, with a few exceptions. 1.2   Definitions 1.2.1 Dependence, Addiction, and Abuse Nicotine dependence includes tolerance, withdrawal, and the inability to control use. There is no safe level of tobacco use. The term nicotine dependence refers to problematic tobacco use characterized by tolerance, withdrawal, and the inability to control use. When we say that someone is nicotine dependent, we place the focus on the substance (nicotine) primarily responsible for the physiological and behavioral dependence associated with tobacco use, and we emphasize the fact that nicotine dependence represents much more than a habit or insufficient willpower. Although other behavioral, psychological, and sensory cues associated with cigarette smoking influence the dependence that accompanies regular tobacco use (Rose, 2006), nicotine is the chemical most strongly implicated in this process. In addition, although the terms dependence and addiction are frequently used interchangeably, the lack of a standard definition for the latter contributes to some confusion regarding its meaning. Therefore, we will use the term nicotine dependence throughout the book. Finally, it is important to distinguish substance dependence from substance use and abuse. Substance use refers to any ingestion of a substance, in this case tobacco, regardless of the amount or the effects, whereas substance abuse refers to a maladaptive pattern of substance use that causes clinically significant impairment or distress, such as failure to fulfill role obligations, use in hazardous situations, or recurrent social or legal problems related to use. How these terms relate specifically to nicotine and tobacco is described throughout the chapter. However, it should be noted that tobacco use differs from many other commonly used substances, such as alcohol and caffeine, in that there is no known safe level of tobacco use. 1.2.2 Tolerance, Withdrawal, and Compulsive Use The defining features of substance dependence include increasing tolerance to the substance, withdrawal, and compulsive use. In general, tolerance to a substance refers to the need to use increasing amounts of the substance over time to achieve the same or desired effect. For example, when people first start smoking, it is common for them to smoke occasionally, typically in context-specific situations, such as when they are socializing with peers. Then over time, they begin to smoke daily, and then to smoke throughout the day. At this point, they generally settle into an established smoking pattern, and over the long term, their daily consumption rate remains fairly consistent – a pattern unlike that seen with many other substances of abuse. The ultimate frequency of tobacco use can vary considerably from person to person, with some people meeting criteria for nicotine dependence who smoke just a few cigarettes per day, whereas others may smoke as many as four or more packs (more than 80 cigarettes) per day (Lawrence, Fagan, Backinger, Gibson, & Hartman, 2007). Withdrawal refers to a reversible, substance-specific syndrome involving aversive behavioral, cognitive, and physiological changes brought about by the cessation or reduction of substance use that has been heavy or prolonged (APA, 2000). Finally, compulsive use refers to difficulty controlling the consumption of a substance. For example, individuals who are dependent on a substance might use it in greater amounts or for a longer period of time than they intended; they may experience a persistent desire for the substance; or they may be unable to reduce or discontinue its use. 1.3   Epidemiology The US Centers for Disease Control and Prevention (CDC) conducts regular surveys of the health status and behaviors of US adults (CDC, 2008). A 2007 survey showed that about one in five people in the United States (19.8%; 43.4 million) aged 18 or older currently smokes cigarettes. This rate is substantially reduced from the mid-1960s, when more than 40% of all US adults smoked. Most current cigarette smokers (78%) are daily smokers. In addition, more men (22%) than women (17%) smoke cigarettes. Rates of cigarette smoking are highest among American Indians and Alaska Natives (36%), followed by non-Hispanic Whites (21%) and non-Hispanic Blacks (20%). Rates of smoking are lowest among Asian (10%) and Hispanic (13%) adults. There is a strong inverse association between both education and income level and smoking rates. Adults with less than a high school education or a General Educational Development (GED) diploma are much more likely to smoke (44%) than those with a college degree (11%). Similarly, those who are living below the federal poverty level are much more likely to smoke cigarettes (29%) than those above the poverty level (20%). Young and middle-aged adults are the most likely to smoke cigarettes (22–23%) compared with adults 65 and older (8%). These age differences likely reflect several factors (e.g., increased opportunities to quit with age; smokers are more likely to die at an earlier age than nonsmokers). 1.4   Course and Prognosis Most tobacco use starts in childhood or adolescence. The vast majority of tobacco use has its origins in childhood or adolescence, and the average age at which people first start smoking has been relatively stable since the mid-1990s (National Cancer Institute, 2007). The younger people are when they start smoking, the greater their lifelong risk of developing smoking-related diseases. Most cigarette smokers (63%) start smoking prior to age 18. However, some recent evidence suggests that a larger proportion of tobacco users are now starting to smoke during the 18–25 age range (Klesges et al., 2006; Mayhew, Flay, & Mott, 2000; Tercyak, Rodriguez, & Audrain-McGovern, 2007; Wechsler, Rigotti, Gledhill-Hoyt, & Lee, 1998). It is speculated that this trend is due, at least in part, to policy changes that now prohibit tobacco companies from marketing directly to children, resulting in a shift toward increased efforts to target young adults (Biener & Albers, 2004; Sepe & Glantz, 2002; Sepe, Ling, & Glantz, 2002). Some people can get hooked after smoking just one cigarette. The traditionally held view has been that it takes at least 2 to 3 years of regular smoking for nicotine dependence to develop. It was believed that only after establishing sufficient tolerance to the aversive effects of nicotine and gradually increasing the frequency of use could sufficient nicotine exposure levels occur to produce the physiological changes necessary for dependence. Recent data have challenged this belief. The central feature of nicotine dependence is the loss of autonomy, or the time at which quitting smoking requires effort or becomes uncomfortable (DiFranza, 2008). Several studies have demonstrated that the loss of autonomy among adolescent smokers occurs much more quickly than was previously recognized, and for most well before the onset of daily cigarette use (DiFranza et al., 2007; Scragg, Wellman, Laugesen, & DiFranza, 2008). In fact, Scragg et al. (2008) observed a loss of autonomy among 25–30% of adolescents who had smoked just one cigarette. Nicotine dependence is best viewed as a chronic condition characterized by frequent and repeated episodes of relapse. Once...