Nicotine Abuse - Causes, Effects, and Treatment Options

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What do the terms "nicotine abuse" and "tobacco abuse" mean? How can such misuse develop, and what factors contribute to it? And is there a difference between (harmful) misuse and addiction? Additionally, what treatment options are available for tobacco abuse, and what role does the so-called "biopsychosocial model" play in this? This article answers these and other questions.

Meaning of Nicotine Abuse

"Abuse" is the Latin term for misuse or improper use. In the medical context, it primarily refers to the abusive and harmful use of both illegal and legal drugs or recreational substances.

In the case of legal psychoactive substances, harmful use can therefore be contrasted purely conceptually - and thus at least theoretically - with considered, moderate, less or non-harmful use. However, even smaller quantities of even such legal substances often harbour a certain potential for dependency, so the line between ‘moderate enjoyment’ and ‘harmful abuse’ can quickly become blurred for this reason alone. One reason why some experts take offence at the term ‘abuse’ for substances with an addictive potential is therefore that less or non-harmful consumption is implied conceptually - but when there is an increased potential for addiction, in practice abuse is potentially valid and obvious for this reason alone. Incidentally, this implies that dependence entails abuse - but does not necessarily mean that, conversely, abuse already signifies de facto substance dependence.

The term nicotine abuse is specifically used for the abusive use of nicotine, usually in the excessive consumption of tobacco products, especially cigarettes. Often, the term "tobacco abuse" is used interchangeably, referring to a form of harmful consumption that frequently serves to satisfy an existing tobacco dependency.

Causes of Nicotine Abuse

Tobacco consumption has a high addiction potential, increasing the risk of abuse. The nicotine within tobacco creates a progressively stronger craving depending on the amount and duration of use. Due to a tolerance effect, the stimulus-response interval can shorten, necessitating higher amounts to achieve the same effects.

However, multiple factors typically interact to influence the transition from mere enjoyment to misuse. The "biopsychosocial model," a medical paradigm often used to explain the development and persistence of illnesses, provides an explanation for how nicotine abuse and other addictions arise.

Just as the bio-psycho-social model provides a multidimensional view of the maintenance of health, it can also explain the development and maintenance of certain (addictive) diseases - © Image: AdobeStock/Богдан Скрипник

Without going into detail, superficially speaking, there are three levels that create reciprocal relationships here. Biological, psychological and social factors interact with each other and can significantly increase the risk of nicotine abuse.

Although in each case the key lies in the tobacco consumption itself, you will therefore have a significantly higher risk of developing tobacco abuse if you, for example:

• have an unfavourable genetic predisposition to addiction (hereditary increased susceptibility = biological factors),
  
• also have dysfunctional/maladaptive cognitive schemata and a lack of coping strategies (e.g. the assessment of and handling of stressful situations is correspondingly inadequate = psychological factors)
• and have heavy smokers within your family or social circles who normalize smoking (= social factors).

The development of nicotine abuse should therefore not only be understood as multifactorial, but also multidimensional in the sense of bio-psycho-social aspects. If then - perhaps explained by individually different reasons - excessive use has finally led to actual tobacco addiction, the nicotine abuse of all those affected seems to have in common that they counteract the withdrawal symptoms that occur during nicotine abstinence by maintaining abusive consumption.

Seen in this light, the two terms ‘abuse’ and ‘addiction’ appear to be closely intertwined and this is also probably the reason, why they are often used interchangeably.

Symptoms of Nicotine Abuse

Misuse and dependency are closely intertwined phenomena, making it difficult to draw a clear line between the two.

Strictly speaking, however, one could state:

• Nicotine abuse involves consumption behaviour that deviates from the norm, goes far beyond enjoyment and is harmful to health. However, even if such abusive use quickly leads to dependence in the case of tobacco, ‘abusive’ consumption could still be the case, at least for the aforementioned individual, primarily psycho-social factors, without there having to be a de facto dependence on tobacco with nicotine-specific withdrawal symptoms in the case of abstinence.
• In this case, dysfunctional cognitive schemata could simply lead to a strong craving for tobacco consumption - because, for example, emotional needs are ‘wrongly’ assessed in such a way that they could be overcome through consumption. And so this craving could also be compensated/satisfied with another substitute satisfaction in addition to tobacco consumption, without having to experience nicotine-specific withdrawal symptoms.
• Conversely, a de facto substance dependence is linked to substance-specific withdrawal symptoms and can thus cause/fuel abusive use.

Nicotine abuse ICD 10

The International Statistical Classification of Diseases and Related Health Problems (ICD 10) also recognises a similar distinction with two separate diagnosis codes with regard to a possible version of tobacco abuse - namely between ‘harmful use’ (F17.1) and a so-called ‘dependence syndrome’ (F17.2), whereby F17.1 can primarily apply to nicotine abuse. In addition, the F17 category (mental and behavioural disorders caused by tobacco) includes ‘acute intoxication’ with the further diagnosis code F17.0. This may be mentioned because excessive, harmful consumption that deviates from the norm in the sense of tobacco abuse can lead to intoxication.

>> Read more about the symptoms of nicotine poisoning here

For the harmful use of tobacco, it can now be stated that consumption leads to damage to health, which can manifest itself both physically and psychologically, whereby a repetitive pattern of consumption is usually recognisable, which is continued despite the knowledge of the negative consequences and (thus) a reduced control over consumption can also be determined. Anyone who delves deeper into the F17.2 diagnosis will eventually realise that similar elements are considered a subset of the diagnosis, or that abuse appears to be a core element.

>> Here you can find the symptomatic criteria for tobacco dependence

Chronic nicotine abuse and the effects of tobacco abuse

Above all, smoking in the sense of chronic tobacco abuse can have serious health consequences. The longer the tobacco abuse persists, the more likely these will eventually become.

© Image: AdobeStock/CHOI POO

Typical diseases include lung cancer, chronic obstructive pulmonary disease (COPD) and cardiovascular diseases. The risk of stroke, diabetes and depressive and other psychiatric illnesses also increases. It can also lead to social and financial problems.

Nicotine abuse therapy and treatment options

There are various treatment options for nicotine abuse. If you think of the aforementioned bio-psycho-social model, their respective methods also address the correspondingly different levels. And as you might guess, the success of therapy will increase through a combination of several such methods - when ‘biological’, ‘psychological’ and ‘social’ factors interact with each other.

Nicotine replacement therapy and psychiatric drugs

Nicotine replacement therapy (NRT for short) is a common way of counteracting the withdrawal symptoms associated with abstinence from tobacco and getting a grip on the mainly neurophysiological factors that result from a de facto substance dependency and increase the pressure of addiction and therefore abuse. The nicotine that has become necessary for the body as a result of tobacco abuse is substituted in the form of common nicotine replacement products such as nicotine patches/chewing gum and gradually phased out in a controlled manner.

An innovative white snus variant with Nicotine Polacrilex, a pharmaceutical formulation of nicotine bound to a so-called ion exchange resin, which enables a controlled and even nicotine intake, could certainly offer an interesting opportunity in the future and provide a successful alternative to nicotine chewing gum.

>> Read here how a doctor and expert in smoking cessation programmes advocates nicotine pouches as cigarette alternatives when quitting smoking in his practical work.

Treatment with psychiatric drugs is also common - particularly those from the antidepressant group, especially bupropion and nortriptyline. However, the drug varenicline, a so-called nicotine receptor agonist developed specifically for tobacco cessation, is also commonly used.

In any case, such treatment approaches aim to alleviate the withdrawal symptoms and the desire to smoke in tobacco cessation, which - one could say - starts at the neuro-‘biological’ level.

Psychotherapy

There are usually numerous psychological factors and triggers that favour tobacco abuse. For example, a dysfunctional way of dealing with stressful situations or the often unconscious fulfilment of other (emotional) needs through consumption. Psychotherapy can provide relief, solutions and, in the long term, coping strategies - which, in the best case, can prevent a relapse. For this reason alone, it is extremely useful as a complementary measure to the aforementioned approach.

Cognitive and behavioural therapy (CBT) offers a promising approach here - which above all allows the maladaptive schemata already mentioned, i.e. unfavourable behavioural patterns with psychologically relevant dynamics, to be cleared and modified. In most cases, therapy successes can be achieved quickly and psychological distress can be reduced.

Other psychotherapeutic approaches such as psychodrama (PD) or systemic family therapy (SF) can also address psychosocially unfavourable dynamics in the case of nicotine abuse and help to understand the aforementioned social circumstances that promote addiction and their effects on abusive consumption behaviour.

Life and social counselling in smoking counselling

Difficult social circumstances often favour tobacco abuse. For example, precarious living conditions or simply the complexity of everyday life can be overwhelming. Various facilities and centres for smoking counselling can provide targeted help to break out of such socially overwhelming circumstances and find sustainable solutions. Anyone who wants to get their nicotine addiction under control can also take advantage of the help on offer here, which is usually free of charge.

There are therefore various treatment approaches that - understood in terms of the bio-psycho-social model - can counteract tobacco abuse in a variety of ways. In practice, they usually interact with each other - in the form of interdisciplinary connexion - and can then also promise the greatest success.

How can tobacco abuse be avoided?

If you don't start in the first place, you don't run the risk of becoming addicted to tobacco. And for those who would still like to enjoy it, we would like to remind you of the aforementioned multidimensional health/disease model. When reflecting on your own needs and behaviour, it can be very helpful to consider the three levels of biological, psychological and social equally. Possible neuralgic aspects often become clearer in this way when it comes to one's own consumer behaviour - which can of course extend beyond nicotine/tobacco consumption.

Anyone who can recognise in the light of this that psycho-social factors in particular influence their own behaviour in such a way that relatively excessive consumption and abuse could be obvious - regardless of the tobacco addiction potential - should take particular care when using tobacco products. In this case, it can help to make use of preventive psychotherapy or social counselling services - also simply to promote personal development.
Knowing your own self is reassuring and gives you the opportunity to develop yourself to the full.

It can often also be helpful to monitor your own consumption targets - perhaps in dialogue with your friends and family. And if you don't manage to stick to a set amount of consumption, even if your own coping strategies should actually help, you should rely all the more on external support.

In any case, the following applies: keep your consumption as reflective as possible and enjoy it instead of ‘needing’ it.

>> Read also: Tobacco Directive in the new EU Commission: The future for snus and nicotine pouches