M.  Is Patient Nicotine Dependent?

OBJECTIVE

Identify patients with nicotine dependence for which cessation treatment may be effective.

ANNOTATION

1.        Nearly all daily nicotine users are nicotine dependent (See Module A, Annotation E, for the DSM-IV dependence criteria [305.1]).

2.        Offer and recommend smoking cessation treatment to every patient who is dependent on nicotine. Use the VHA/DoD Clinical Practice Guideline To Promote Tobacco Use Cessation in the Primary Care Setting.

3.        Identification and treatment of co-morbid nicotine dependence may improve recovery rates of other SUDs.

DISCUSSION

Nicotine and alcohol interact in the brain, each drug possibly affecting vulnerability to dependence on the other (Schiffman & Balabanis, 1995).  Initial studies suggest that recovery rates from non-nicotine SUDs are significantly improved in patients who reduce their nicotine usage prior to discharge from structure rehabilitation settings, versus those nicotine addicts who do not effect any reductions in their nicotine use (Frosch, et al., 2000).  Consequently, some researchers postulate that treating both addictions simultaneously might be an effective, even essential, way to help reduce dependence on both (NIAAA, 2000).