http://emedicine.medscape.com/article/287555-clinical
Nicotine addiction is now referred to as tobacco use disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). [2]
There are 11 possible criteria, of which at least 2 must be present in the last 12 months:
1. Tobacco taken in larger amounts or over longer periods of time
2. Persistent desire or unsuccessful efforts to cut down or control use
3. A great deal of time is spent on activities necessary to obtain or use tobacco
4. Craving or a strong desire or urge to use tobacco
5. Recurrent tobacco use resulting in a failure to fulfill major role obligations at work, school, or home
6. Continued tobacco use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by effects of tobacco (eg, arguments with others about tobacco use)
7. Important social, occupational, or recreational activities are given up or reduced because of tobacco use
8. Recurrent tobacco use in situations in which it is physically hazardous (eg, smoking in bed)
9. Tobacco use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by tobacco
10. Tolerance, as defined by either the need for markedly increased amounts of tobacco to achieve the desired effect or a markedly diminished effect with continued use of the same amount of tobacco.
11. Withdrawal, as manifested by either the characteristic withdrawal syndrome or the use of tobacco to relieve or avoid withdrawal symptoms.
Symptoms of withdrawal include difficulty concentrating, nervousness, headaches, weight gain due to increased appetite, decreased heart rate, insomnia, irritability, and depression. These symptoms peak in the first few days but eventually disappear within a month.
Symptoms of nicotine toxicity, otherwise known as acute nicotine poisoning, include nausea, vomiting, salivation, pallor, abdominal pain, diarrhea, and cold sweat.
A previous history of depression, use of antidepressants in the past, and onset of depression during previous attempts to quit smoking should be obtained.
The time to first cigarette and total cigarettes per day are the 2 strongest predictors of nicotine addiction. The nicotine dependence and nicotine withdrawal could be treated by means of the following [4, 29] :
• Other forms of nicotine delivery
• Drugs that selectively target one or more of the underlying mechanisms
• Behavioral treatments, acupuncture, and other therapies