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ConditionsNIC

Tobacco Use Disorder

Cigarettes, vapes, pouches, dip — anything that delivers nicotine.

What to know. Most common substance use disorder. Highly treatable with medication.

First-line care
Varenicline or combination NRT

What major medical bodies recommend first when this condition is the focus of care.

Off-label medications can be used in addition to behavioral therapy.


Symptoms

How clinicians think about it.

The DSM-5 lists eleven signs grouped into four areas. The number that fit in the past year suggests a severity — not a verdict.

LOSS OF CONTROL · 4
  • ·Using more than meant to
  • ·Wanting to cut down
  • ·Time spent using
  • ·Cravings
SOCIAL IMPACT · 3
  • ·Trouble at work / school
  • ·Relationship strain
  • ·Giving up activities
RISKY USE · 2
  • ·Risky situations
  • ·Using despite harm
PHYSICAL · 2
  • ·Tolerance
  • ·Withdrawal

Risks worth knowing

Plainly: what makes this condition dangerous.

High concern

Cardiovascular and lung disease

High concern

Multiple cancers

Moderate concern

Vaping — emerging long-term unknowns


Treatment options

What's offered, and what we usually start with.

FIRST-LINE — RECOMMENDED FIRST
01
Varenicline (Chantix)First-line

Most effective single medication. Twelve-week course.

02
Combination nicotine replacementFirst-line

Patch plus gum or lozenge. As effective as varenicline for many.

03
Bupropion

Useful especially when depression is also present.

04
Behavioral support

Quitlines, apps, brief counseling — doubles success rate.


Common questions

Asked often, answered briefly.

Most people who eventually quit make several attempts. Each attempt teaches you something. The medications are better than they used to be.

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This is not a diagnosis. These tools are for reflection and conversation. A clinician's evaluation is the only way to confirm a substance use disorder. If you are in crisis, call or text 988.
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Opioid Use Disorder