Bucklin M. A 5-Factor Framework for Assessing Tobacco Use Disorder.
Tob Use Insights 2021;
14:1179173X21998355. [PMID:
33716514 PMCID:
PMC7922618 DOI:
10.1177/1179173x21998355]
[Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 02/04/2021] [Indexed: 11/30/2022] Open
Abstract
Cigarette use is the leading cause of preventable death in the United
States. Despite the well documented dangers of smoking, nearly 20% of
adults report regular use of tobacco. A majority desire to discontinue
but the long-term cessation success rate remains near 4%. One
challenge to reducing the prevalence of tobacco use is an incomplete
understanding of the individual correlates that reinforce continued
use. Evidence from research on nicotine and tobacco suggests that
Tobacco Use Disorder is a complex, and multifactorial condition.
Personality traits, comorbidities, habits and lifestyle, genetics,
socioeconomic status, and mental and physical health all contribute to
the risk for dependence and to the likelihood of quitting. This
perspective review provides an overview of some common factors that
contribute to liability risk for Tobacco Use Disorder and a framework
for assessing individual tobacco users. The framework includes 5 areas
that research suggests contribute to continued tobacco use: nicotine
addiction, psychological influences, behavioral dependencies,
neurobiological factors, and social reinforcement. Nicotine addiction
includes drug-seeking behavior and the role of withdrawal avoidance.
Psychological and emotional states contribute to a perceived reliance
on tobacco. Behavioral dependence is reinforced by associative and
non-associative learning mechanisms. Neurobiological factors include
genetic variables, variations in neurotransmitters and receptors,
pharmacogenetics, and interaction between psychiatric illnesses and
nicotine use and dependence. Finally, social reinforcement of smoking
behavior is explained by a network phenomenon and consistent visual
cues to smoke. A comprehensive assessment of individual tobacco users
will help better determine appropriate treatment options to achieve
improved efficacy and outcomes.
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