**Understanding Tobacco Use Disorder and the Role of Nicotine Replacement Gum: A Guide for PMHNP Providers**
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### Introduction
Tobacco use disorder is a prevalent and challenging addiction that significantly impacts public health. It is characterized by the compulsive use of tobacco products, primarily cigarettes, despite the awareness of adverse health effects. As PMHNP providers, it is crucial to understand the intricacies of this disorder, the diagnostic criteria, and the effective treatments available. In this blog post, we will delve into the nature of tobacco use disorder, how nicotine replacement gum can be used as a treatment, and provide a comprehensive guide for managing patients with this condition.
### Understanding Tobacco Use Disorder
**Diagnostic Criteria**
Tobacco use disorder is defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as a problematic pattern of tobacco use leading to significant impairment or distress. The diagnostic criteria include:
1. Tobacco is often taken in larger amounts or over a longer period than intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control tobacco use.
3. A great deal of time is spent in activities necessary to obtain or use tobacco.
4. Craving, or a strong desire 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 the effects of tobacco.
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.
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 a need for markedly increased amounts of tobacco to achieve the desired effect or markedly diminished effect with continued use of the same amount of tobacco.
11. Withdrawal, as manifested by characteristic symptoms or tobacco use to relieve or avoid withdrawal symptoms.
**Street Names**
Tobacco is commonly referred to by various street names, including “smokes,” “cigs,” “butts,” and “chew” (for chewing tobacco).
**Modes of Use**
Tobacco can be used in several forms:
– **Smoking:** Cigarettes, cigars, and pipes.
– **Oral:** Chewing tobacco and snuff.
– **Other forms:** E-cigarettes and vaping devices, which deliver nicotine without burning tobacco.
**Symptoms of Use and Withdrawal**
Individuals under the influence of nicotine from tobacco may exhibit:
– Increased heart rate and blood pressure.
– Enhanced alertness and concentration.
– Reduced appetite.
– Sense of relaxation or stress relief.
Symptoms of nicotine withdrawal can include:
– Irritability, frustration, or anger.
– Anxiety.
– Difficulty concentrating.
– Increased appetite.
– Restlessness.
– Depressed mood.
– Insomnia.
### Treatment Recommendations
**First-line Treatment Options**
The primary goal in treating tobacco use disorder is to help patients quit tobacco use entirely. First-line treatment options include behavioral therapies and pharmacologic interventions.
**FDA-Approved Medications**
Nicotine replacement therapy (NRT) is widely used and includes:
– **Nicotine gum**
– **Nicotine patches**
– **Nicotine lozenges**
– **Nicotine nasal spray**
– **Nicotine inhaler**
Other FDA-approved medications include:
– **Bupropion (Zyban)**
– **Varenicline (Chantix)**
### Focus on Nicotine Replacement Gum
**Mechanism of Action**
Nicotine gum works by delivering nicotine to the bloodstream through the oral mucosa. This helps to alleviate withdrawal symptoms and reduce cravings by providing a controlled amount of nicotine without the harmful chemicals found in tobacco smoke.
**Common Side Effects**
Patients using nicotine gum may experience:
– Mouth and throat irritation.
– Hiccups.
– Nausea.
– Jaw discomfort.
– Indigestion.
**Administration Guidelines**
Patients should use nicotine gum according to a fixed schedule initially and then gradually reduce the dosage. The gum should be chewed slowly until a tingling sensation occurs, then parked between the cheek and gum to allow nicotine absorption. The process is repeated for about 30 minutes per piece.
**Baseline and Ongoing Assessments**
Before starting nicotine gum, assess the patient’s tobacco use history, including the amount and duration of use. Monitor for any side effects, and adjust the dosage as necessary. Regular follow-ups are essential to support the patient through the quitting process and to make any necessary adjustments to the treatment plan.
**Non-Pharmacologic Interventions**
Non-pharmacologic interventions are crucial in treating tobacco use disorder. These include:
– **Behavioral Therapy:** Cognitive-behavioral therapy (CBT) helps patients develop coping strategies to deal with cravings and triggers.
– **Support Groups:** Programs such as Nicotine Anonymous provide peer support and encouragement.
– **Motivational Interviewing:** This technique helps patients resolve ambivalence about quitting and strengthens their motivation to stop using tobacco.
– **Education:** Educating patients about the risks of tobacco use and the benefits of quitting can enhance their commitment to treatment.
### Conclusion
Tobacco use disorder remains a significant public health challenge. As PMHNP providers, it is essential to be well-versed in both the diagnostic criteria and the treatment options available for this condition. Nicotine replacement gum is a valuable tool in the arsenal against tobacco addiction, providing a means to alleviate withdrawal symptoms and reduce cravings. Combined with behavioral therapies and support, it can significantly increase the likelihood of successful cessation. By staying informed and proactive, we can play a vital role in helping patients overcome tobacco use disorder and improve their overall health and well-being.
### References
– American Psychiatric Association. (2013). *Diagnostic and Statistical Manual of Mental Disorders* (5th ed.). American Psychiatric Publishing.
– Benowitz, N. L. (2010). Nicotine addiction. *New England Journal of Medicine, 362*(24), 2295-2303.
– Rigotti, N. A. (2012). Strategies to help a smoker who is struggling to quit. *Journal of the American Medical Association, 308*(15), 1573-1580.
Blog discussion
In this Blog, you will have the opportunity to teach your peers about a specific substance use and/or addiction/impulse control disorder. A Blog is a conversational, informal written piece on a topic. Your faculty will assign you a particular illness and the approved treatment for the illness to create a presentation to share with your peers.
The below illness and treatment were assigned to me
Tobacco use disorder: Nicotine replacement gum
Construct a Blog post, not to exceed 1,500–2,000 words, written for a PMHNP provider audience to post in the Discussion area.
Post your Blog response by doing the following:
· Identify the substance or addiction with discussion on pertinent diagnostic criteria for the use disorder.
· Identify the street names of the substance for the use disorder.
· Describe how someone can use or abuse the substance (oral, smoke, IV, etc.).
· Describe the symptoms of someone under the influence of this substance.
· Describe the symptoms of someone under the withdrawal of this substance.
After describing the substance, discuss the treatment recommendations by doing the following:
· Identify the first-line treatment options.
· Identify the FDA-approved medications for the substance.
Note: If there are no FDA-approved medications, describe any evidenced-based, clinically acceptable off-label medications to treat the illness.
· Identify the proposed mechanisms of action for the medication to treat the illness.
· Describe the common side effects of the medication.
· Describe how the patient should take the medication.
· Identify any baseline and/or ongoing tests and assessment(s) needed when taking the medication.
· Describe the non-pharmacologic intervention recommendations.
This Assignment requires a minimum of three (3) peer-reviewed, evidence-based scholarly references outside of course Learning Resources.
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