National Drug Strategy
National Drug Strategy

Comorbidity of mental disorders and substance use: a brief guide for the primary care clinician

3.7 Tobacco

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Tobacco comes from the dried leaves of the tobacco plant with the majority of tobacco consumption in Australia being via cigarettes. After drying, the tobacco leaves are treated with a vast array of chemicals before being made into cigarettes. Many of the chemicals used to treat the tobacco leaves are carcinogenic.

Tobacco smoking is the leading preventable cause of premature death in Australia and causes more sickness and disease than any other drug, contributing to the death of over 15,000 Australians each year.

Nicotine is the pharmacologically active ingredient in tobacco. It is responsible for the addictiveness of cigarettes and other tobacco products and is highly toxic. Smoking tobacco delivers nicotine rapidly to the brain, contributing to its addictiveness. Its absorption causes nervous system stimulation, increased heart rate, raised blood pressure and constriction of small blood vessels.

Effects sought by user: Reduction of anxiety and tension and increased alertness.

Associated harms: Nausea, increased heart rate and blood pressure, cancer (especially lung, mouth and throat cancer), hypertension, ischaemic heart disease, chronic bronchitis, stroke and blindness.

Smoking harms nearly every organ in the body causing a wide range of diseases, many of which can result in the premature death of the smoker.

Overdose: Unlikely.

Withdrawal: Nicotine is highly addictive and produces a withdrawal syndrome characterised by craving, irritability, restlessness and anxiety, impaired performance of psychomotor tasks as well as difficulty concentrating, aggressiveness, frustration, sleep disturbances, depressed mood, decreased heart rate, increased appetite or weight gain.

Smokers claim they smoke to relax, reduce stress, increase alertness and concentration, regulate mood and control/lower body weight. However, it is difficult to separate these reported positive effects from the relief of nicotine withdrawal symptoms.

Withdrawal symptoms can last for two to three weeks; however, cravings may persist for months but at reduced frequency and intensity.

Psychological presentations commonly associated with use (likely to resolve on cessation of substance use): Not currently described.

For further information please consult:

Smoking cessation guidelines for Australian general practice(66).

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