Alcohol and Tobacco Dependence

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Alcohol and Tobacco Dependence

Nature of the Problem, Assessment Procedures and Non-psychological Treatments


What is dependence?

Both tobacco dependency and alcohol dependency are classified as a subtype under substance-related disorders in the DMS-IV-TR. There has been disagreement on how to define dependence or addiction, with different models focusing on either physiological or psychological dependence.

Physiological dependency:

§ Tolerance: require greater amounts of substance to experience the same effect.

§ Withdrawal: negative physical response resulting from cessation

Chronic alcoholics can have severe withdrawal symptoms, including hand tremors, nausea and vomiting, anxiety and in extreme cases experience delirium tremens, which can produce hallucinations and body tremors (Barlow & Durand, 2002).

Psychological dependency:

§ Craving: Need to ingest more of a substance

§ Repeated use of a substance

§ Likelihood use will resume after a period of abstinence

The DMS-IV-TR combines these two aspects of dependence when defining alcohol and tobacco dependency.

The relationship between nicotine and tobacco dependency

The Surgeon General's report (1988) on Smoking and Health stated that nicotine was the drug responsible for tobacco dependence (cited in Atrens, 2001). This statement has been supported and accepted as the core element that makes quitting difficult (Shadel, Shiffman, Niaura, Nichter, & Abrams, 2000). Nicotine is a mild CNS stimulant. Growing evidence suggests that rewarding effects of nicotine interfere with the balance of neurotransmitters such as dopamine, endorphins, epinephrine, and cholinergic (Killen, Fortmann, Schatzberg, Hayward, Sussman, Rothman, Strausberg & Varady, 2000). Atrens (2001) disputes this statement, believing the notion that nicotine is addictive lacks empirical support. The effects of nicotine on the brain are similar to harmless substance and events such as salt, sugar, exercise (Atrens, 2001). Also, the pleasure factor must be taken into account, which may explain why some smokers can stop and others cannot, or...