Clinicians should assess both daily and nondaily cigarette smoking, as either can include patients with tobacco use disorder (TUD), according to new research published in the Journal of Clinical Psychiatry.
TUD prevalence estimates are lacking, likely because studies generally assess only daily smoking or heaviness of smoking, wrote lead author Dr. Joanna Streck of Harvard and her co-authors, including Dr. Tim Baker and Dr. Megan Piper of UW-CTRI.
In 2021, the prevalence of daily cigarette smoking with TUD was 10 times higher than the prevalence of daily smoking without TUD. In addition, twice as many US adults with nondaily smoking reported TUD than no TUD, illustrating that daily smoking is not necessary for TUD.
Even nondaily smoking can produce or sustain TUD, and clinicians should offer tobacco treatment to any patient who presents with TUD.
“It would also be important to determine how to assess TUD very efficiently amongst smokers (daily and non-daily alike),” Baker said, “and that we identify treatments that are effective and have high reach in the nondaily smoker population, for example, how should we use medications? Another related issue of some clinical importance is to ask nondaily smokers about use of non-cigarette nicotine products since they are more likely to use such products than are daily smokers.”
In the most recent survey year, 2021, 17 percent of the American adult population reported past 30-day cigarette smoking; 11 percent reported daily smoking, and six percent reported nondaily smoking. Of the 11 percent of adults reporting daily cigarette smoking out of the US population, those with TUD outnumbered those without TUD 10 to one.
Factors that can signal TUD can include:
- Consuming tobacco in larger amounts.
- Increased use.
- Failing quit attempts.
- Spending time or concerted efforts to obtain tobacco.
- Craving/desire to use after a few hours.
- Strong and bothersome craving during a quit attempt.
- Failure to fulfill major obligations due to tobacco use.
- Continued use despite problems stemming from the use.
- Giving up or avoiding beneficial activities or situations due to tobacco use.
- Tolerance.
- Withdrawal.
Baker said those who work at rehab centers should consider asking all patients about all frequencies of tobacco use and admitting patients for TUD.
“Indeed, substance use program patients have high rates of smoking,” Baker said. “I think that every patient in such programs should be asked about their smoking in such a way that nondaily smoking is included in the assessment.”
Streck JM, Parker MA, Cruz R, Rosen RL, Baker TB, Piper ME, Weinberger AH. (2024) Prevalence and Trends in Cigarette Smoking with and without Tobacco use Disorder Among Adults in the United States: 2010-2021. Journal of Clinical Psychiatry. 2024;85(3):23m15086. Online June 12, 2024.