Disorders Due to Substance Use: Nicotine

Abstract

Tobacco use disorders (TUD) or nicotine dependence (ND) are the most common substance use disorders in the United States and across the globe, and there are many new nicotine and tobacco use products, as well as vaping and other e-cigarette electronic devices. TUDs increase morbidity and mortality for the user as well as the family members and others exposed to environmental tobacco smoke. TUD is a gateway to other substance use. Both public health and clinical treatment strategies have reduced tobacco use and therefore nicotine use; however, more efforts are needed to further reduce tobacco use and address concerns about e-cigarette and vaping technologies. E-cigarettes are formally a type of electronic nicotine delivery systems (ENDS) and there are also electronic non-nicotine delivery systems (ENNDS). Both types of products create an aerosol by heating a liquid such as nicotine and/or some other substance and usually include propylene glycol, flavoring agents, and other known or unknown substances. In recent years, new TUD treatment approaches have been developed and further evaluated, including mobile phone apps, transcranial magnetic stimulation, harm reduction strategies, and evidence-based medications and behavioral interventions. Rural and underserved communities may not have adequate access to addiction treatment specialists nor all the evidence-based treatment options. There may be a need in these settings to rely on generic medications, over-the-counter medications, behavioral interventions, practical advice, community health workers support, public health phone quit lines, harm reduction recommendations, and self-help groups such as nicotine anonymous.