Tobacco-related mental and behavioral disorders (synonyms: Dependence on nicotine; Withdrawal syndrome after use of tobacco; Nicotine dependence; Nicotine abuse; Nicotine withdrawal syndrome; Smoking cessation; Tobacco dependence; Tobacco dependence syndrome; Tobacco abuse; Tobacco withdrawal syndrome; ICD-10 F17.2: Mental and behavioral disorders due to tobacco: Dependence syndrome; F17.3: Withdrawal syndrome) includes a wide variety of disorders or diseases that can occur due to the use of tobacco. Chief among these are:
- Dependence syndrome (tobacco dependence).
- Withdrawal syndrome
Tobacco is predominantly absorbed through cigarette smoking, but also through chewing tobacco. As nicotine, it is further absorbed through nicotine gum or patch. A “tobacco dependence” exists if 3 of the 6 criteria were true for at least 2 months within the last year:
- Strong desire or urge to use tobacco.
- Limited ability to control initiation, cessation, and amount of use
- Development of tolerance (to achieve the same effect, increasingly higher doses are required).
- Withdrawal symptoms upon reduction or cessation of use (see under “Symptoms – Complaints”).
- Increasing neglect of other activities and interests in favor of tobacco use.
- Continued consumption despite awareness of the harmful consequences (see under “Consequential diseases”).
In 2012, the average age at which girls or boys smoked for the first time was 14.3 years. Children and adolescents are particularly at risk of addiction. 80% of adolescents who smoke up to 5 cigarettes a day already meet one criterion (see above) of the indicators of tobacco dependence. On average, about 15.4 cigarettes are smoked per day in Germany – men smoke 16.4 cigarettes per day and women 40. More than 22 % of men and 12.5 % of women smoke more than 20 cigarettes per day. Sex ratio: men are slightly more affected than women. Frequency peak: The disease usually starts in adolescence, triggered mainly by curiosity and social aspects. On average, males begin smoking at age 18.5 years and females at 19.7 years. The prevalence (disease incidence) is 25% (from the age of 15). Among men, 32.6% smoke (in the 15-40 age group, the figure is 41.8%), among women, 21.1% smoke (in the 15-40 age group, the figure is 31.9%), and among adolescents between 15 and 20 years of age, 24.8% smoke (in Germany). A decrease in the prevalence of smoking is observed in adolescents between 12 and 17 years of age. Progression and prognosis: Although the majority of smokers are aware of the possible health consequences of smoking, they do not give up cigarettes. Regarding the life expectancy of smokers, a study shows that men who smoke more than 10 cigarettes a day reduce their life expectancy by an average of 9.4 years. Women lose an average of 7.3 years. Those who smoke fewer than ten cigarettes a day still lose about 5 years (both sexes).Only one in five smokers in Germany makes at least one quit attempt a year.Many smokers do not quit because they are afraid of the withdrawal symptoms. Yet modern cessation therapies take into account both physical and psychological behavior patterns. Nicotine replacement therapy via e-cigarette is most commonly used to support quit attempts (about 7% of attempts), followed by brief medical counseling.If nicotine withdrawal is medically or psychologically supervised, the success rate is 25%, otherwise 10%. In many cases, only several attempts lead to lasting abstinence. On average, most of those affected need three to four serious attempts to give up smoking. Approximately 110,00 to 140,000 people in Germany die each year as a result of tobacco use. Smoking is one of the most preventable health problems.
