Alcohol use disorder, also known as alcoholism, is a problematic pattern of alcohol use leading to significant impairment or distress, as demonstrated by at least two of the following factors, occurring within a 12-month period:
Alcohol use disorder is rated as mild with the presence of 2-3 symptoms, moderate with 4-5 symptoms, and severe with 6 or more symptoms.
A diagnosis of “alcohol intoxication” is based on a person’s recent ingestion of alcohol with:
The signs or symptoms are not attributable to another medical condition or mental disorder, including intoxication with another substance.
A diagnosis of “alcohol withdrawal” is based on a person stopping or reducing heavy or prolonged alcohol with two or more of the following symptoms:
The symptoms cause significant distress or impairment in social, occupation, or other important areas of functioning. In addition, they are not attributable to another medical condition or mental disorder, including intoxication or withdrawal from another substance.
Other alcohol-induced disorders include:
The diagnosis of “unspecific alcohol-related disorder” is used for alcohol-related disorders that do not meet the diagnostic criteria for any of the other alcohol-related disorders.
Three general steps are involved in treating the alcoholic person: intervention, detoxification, and rehabilitation.
Intervention
The goal in the intervention step is to break through feelings of denial and help the person realize the adverse consequences likely to occur if the disorder is not treated. This step often involves convincing patients that they are responsible for their own actions while reminding them of how alcohol has created significant life impairments.
Detoxification
Most persons with alcohol dependence have relatively mild symptoms when they stop drinking. If the patient is in relatively good health, is adequately nourished, and has a good social support system, the depressant withdrawal syndrome usually resembles a mild case of the flu. To aid in the patient’s alcohol withdrawal, a brain depressant such as chlordiazepoxide or lorazepam may be given for 4-5 days. For patients with severe withdrawal symptoms, either benzodiazepines or antipsychotic agents, such as haloperidol, may be given.
Symptoms of anxiety, insomnia, and mild autonomic overactivity are likely to continue for 2 to 6 months after the acute withdrawal period has passed. In some cases, medications such as acamprosate (Campral) may help diminish some of the symptoms.
Rehabilitation
The treatment process used in both inpatient and outpatient settings involves intervention, optimizing physical and psychological functioning, enhancing motivation, reaching out to family, and using the first 2 to 4 weeks of care as an intensive period of help. These efforts are followed by at least 3 to 6 months of less frequent outpatient care.
Counseling
Whether in an inpatient or outpatient setting, individual or group counseling is usually offered a minimum of three times a week for the first 2 to 4 weeks, followed by less intense efforts, such as once a week, for the subsequent 3 to 6 months.
Much time in counseling focuses on how to build a lifestyle free of alcohol. Discussions cover the need for a sober peer group, a plan for social and recreational events without drinking, and approaches for reestablishing communication with family members and friends.
An important aspect of recovery involves helping family members and close friends understand alcoholism and realize that rehabilitation is an ongoing process that lasts for 6 to 12 or more months.
Participation in self-help groups such as Alcoholics Anonymous is associated with improved outcomes for recovery from alcoholism.
During the initial alcohol detoxification period, either benzodiazepines such as chlordiazepoxide, or antipsychotic agents, such as haloperidol, may be given for 4-5 days to help patients through severe alcohol withdrawal.
Most clinical trials indicate no benefit in prescribing antidepressants or lithium to treat the average alcoholic person who has no independent or long-lasting psychiatric disorder.
Newer drugs that may be used to help prevent alcohol cravings and relapsed include naltrexone hydrochloride (Revia and Vivitrol) and acamprosate (Campral).
Yes. Studies show that close relatives of individuals with an alcohol disorder are at three to four times greater risk for severe alcohol problems. The rate of alcohol problems increases with the number of alcoholic relatives, the severity of their illness, and the closeness of their genetic relationship to an individual.
Fetal alcohol syndrome is the leading cause of intellectual disability in the United States. It occurs when a pregnant woman drinks alcohol, exposing the fetus to alcohol in utero. The alcohol inhibits intrauterine growth and postnatal development. Microcephaly, craniofacial malformations, and limb and heart defects are common in affected infants. Short adult stature and development of a range of adult maladaptive behaviors have also been associated with fetal alcohol syndrome. Women with alcohol-related disorders have a 35 percent risk of having a child with defects.
A diagnosis of “caffeine intoxication” applies when a person has consumed a high dose of caffeine (typically in excess of 250 mg) with five or more of the following symptoms:
The symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms are not attributable to another medical condition or mental disorder, including intoxication with another substance.
A diagnosis of “caffeine withdrawal” is based on abrupt cessation or reduction in caffeine use, after prolonged daily use, followed within 24 hours by three or more of the following symptoms:
The symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms are not associated with the physiological effects of another medical condition (e.g., migraine, viral illness) and are not better explained by another mental disorder, including intoxication or withdrawal from another substance.
Yes, other caffeine-induced disorders include caffeine-induced anxiety disorder and caffeine-induced sleep disorder. These disorders are diagnoses instead of caffeine intoxication or caffeine withdrawal only when the symptoms are sufficiently severe to warrant independent clinical attention.
Since caffeine-related disorder is not recognized as a diagnosable condition, there is no standardized treatment. It is on the list of substance-related disorders that require more investigation because progressive caffeine overuse that results in a dependency could lead to negative physical, psychological, and social consequences.
The recommended treatment for caffeine addiction is to gradually reduce consumption of caffeine over time. Stopping all caffeine use abruptly is more likely to produce withdrawal symptoms. Analgesics, such as aspirin, almost always can control the headaches and muscle aches that may accompany withdrawal.
Cannabis use disorder, also known as marijuana addiction, is a problematic pattern of cannabis use leading to significant impairment or distress, as demonstrated by at least two of the following signs or symptoms occurring within a 12-month period:
Cannabis use disorder is rated as mild with the presence of 2-3 symptoms, moderate with 4-5 symptoms, and severe with 6 or more symptoms.
The risk of developing cannabis dependence is around 1 in 10 for anyone who uses cannabis. The earlier the age of first use, the more often cannabis has been used, and the longer it has been used, the higher the risk of dependence.
A diagnosis of cannabis or marijuana intoxication is based on a person’s recent use of cannabis (marijuana) while showing:
The signs and symptoms are not attributable to another medical condition or mental disorder, including intoxication with another substance.
Cannabis intoxication commonly heightens the user’s sensitivities to external stimuli, reveals new details, makes colors seem brighter and richer, and subjectively slows the appreciation of time. In high doses, users may experience depersonalization and derealization. Cannabis use impairs motor skills for 8 to 12 hours and can interfere with the operation of motor vehicles and other heavy machinery. The delirium associated with cannabis intoxication is characterized by marked impairment on cognition and performance tasks. Even modest doses of cannabis impair memory, reaction time, perception, motor coordination, and attention.
A diagnosis for cannabis withdrawal is based on cessation of marijuana use that has been heavy or prolonged, usually daily or almost daily use, over a period of at least a few months, with three or more of the following symptoms:
The symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning. In addition, they are not attributable to another medical condition or mental disorder, including intoxication or withdrawal from another substance.
Other cannabis-induced disorders include:
The diagnosis of “unspecified cannabis-related disorder” applies when a person has symptoms characteristic of a cannabis-related disorder that cause significant distress or impairment in social, occupational, or other important areas of functioning. However, the symptoms do not meet the full criteria for any specific cannabis-related disorder or any of the disorders in the substance-related and addictive disorders diagnostic class.
Treatment of cannabis use involves the same process and approaches as the treatment of any substance abuse disorder. Steps include intervention, abstinence and support achieved through the use of individual, family and group psychotherapies. For some patients, an antianxiety medication may be useful for short-term relief of withdrawal symptoms. For other patients, cannabis use may be related to an underlying depressive disorder that may respond to specific antidepressant treatment.
A diagnosis of “gambling disorder” is based on persistent and recurrent problematic gambling behavior leading to significant impairment or distress, as indicated by four or more the following symptoms in a 12-month period:
The gambling behavior is not better explained by a manic episode.
A gambling disorder is rated as mild with 4-5 symptoms, moderate with 6-7 symptoms, and severe with 8-9 symptoms.
Gambling problems are prevalent in an estimated 3 to 5 percent of the general population, and approximately 1 percent of individuals meet the criteria for a gambling disorder. Gambling addiction is more common in men and young adults than in women and older adults. Approximately two-thirds of pathological gamblers are men. Individuals with a substance abuse disorder have a greater tendency to have a gambling problem.
Yes, there is a strong connection between pathological gambling and mood disorders (especially major depression and bipolarity) and other substance use and addictive disorders, notably alcohol and stimulant abuse, as well as caffeine and tobacco dependence.
Yes, several factors may predispose individuals to develop gambling disorder, including loss of a parent by death, separation, divorce, or desertion before a child is 15 years of age. Other contributing factors may include inappropriate parental discipline (absence, inconsistency or harshness of discipline), exposure to and availability of gambling activities for adolescents, a family emphasis on material and financial status, and a lack of family emphasis on saving, planning and budgeting.
Several studies have suggested that gamblers’ risk-taking behavior may have an underlying neurobiological cause related to an individual’s brain chemistry.
Gamblers seldom come forward voluntarily to be treated for gambling addiction. In some cases, hospitalization may help by removing an individual from his or her gambling environment. Gamblers Anonymous, modeled on Alcoholics Anonymous, is an effective treatment for some individuals.
Insight-oriented psychotherapy can also be effective after an individual has stopped gambling for 3 months.
Pharmacological treatment is also effective in helping to manage gambling disorder. Effective medications include antidepressants, notably selective serotonin reuptake inhibitors (SSRIs) and bupropion (Wellbutrin, Zyban); mood stabilizers, including sustained-release lithium (Eskalith) and antiepileptics such as topiramate (Topamax); atypical antipsychotics; and opioid agents such as naltrexone (ReVia).
A diagnosis of phencyclidine (PCP) intoxication is based on the recent use of phencyclidine (or a pharmacologically similar substance) that causes:
The symptoms are not attributable to another medical condition or mental disorder, including intoxication with another substance.
Phencyclidine use disorder is a pattern of phencyclidine (PCP) use (or a pharmacologically similar substance) that causes significant impairment or distress, as demonstrated by at least two of the following factors occurring within a 12-month period:
Phencyclidine use disorder is rated as mild with the presence of 2-3 symptoms, moderate with 4-5 symptoms, and severe with 6 or more symptoms.
Yes, other phencyclidine-induced disorders include phencyclidine-induced psychotic disorder, phencyclidine-induced bipolar disorder, phencyclidine-induced depressive disorder, phencyclidine-induced anxiety disorder, and phencyclidine-induced intoxication delirium. These phencyclidine-induced disorders are diagnosed instead of phencyclidine intoxication or phencyclidine withdrawal only when the symptoms are sufficiently severe to warrant independent clinical attention.
A diagnosis of “unspecific phencyclidine-related disorder” is given when symptoms of a phencyclidine (PCP) disorder are present that cause significant distress or impairment in social, occupational, or other important areas of functioning. However, the symptoms to not meet the full criteria for any specific phencyclidine-related disorder or any of the disorders in the substance-related and addictive disorders diagnostic class.
A diagnosis “other hallucinogen intoxication” is based on the recent use of a hallucinogen (other than phencyclidine) that causes:
A diagnosis of “hallucinogen persisting perception disorder” may be given when:
Three comorbid conditions are associated with hallucinogen persisting disorder: panic disorder, major depression, and alcohol dependence.
Yes. A diagnosis of “other hallucinogen use disorder” is made when there is a problematic pattern of hallucinogen use (other than phencyclidine) that causes significant impairment or distress, as demonstrated by at least two of the following factors occurring within a 12-month period:
Patients experiencing intense and unpleasant hallucinogen intoxication can be helped by a quiet environment, verbal reassurance, and the passage of time. More rapid relief of intense anxiety is likely after oral administration of 20 mg of diazepam (Valium) or an equivalent dose of a benzodiazepine.
Hallucinogen Persistent Perception Disorder
Treatment for hallucinogen persistent perception disorder is palliative in nature. Pharmacological approaches include long-lasting benzodiazepines, such as clonazepam (Klonopin), anticonvulsants including valproic acid (Depakene) and carbamazepine (Tegretol). Currently, no drug is completely effective in treating symptoms. Behavioral treatment is also necessary. The patient must be instructed to avoid use of over-the-counter drugs, caffeine, and alcohol, as well as physician and emotional stressors. Marijuana smoke is a particularly strong intensifier of the disorder, even when passively inhaled.
Hallucinogen-Induced Psychosis
Hallucinogen-induced psychosis benefits from the same treatments as other forms of psychoses. In addition to antipsychotic medications, other effective treatments may include lithium carbonate, carbamazepine, and electroconvulsive therapy. Medical therapies are best applied in a context of supportive, educational, and family therapies.
Phencyclidine (PCP) Use Disorder
Treatment of PCP intoxication aims to address significant medical, behavioral, and psychiatric issues. No drug is known to function as a direct PCP antagonist. Treatment must therefore be supportive and directed at specific symptoms and signs of toxicity. Patients should be treated in an environment that is as quiteand isolated as possible. Because PCP disrupts sensory input, environmental stimuli can cause unpredictable, exaggerated, distorted, or violent reactions. Pharmacological sedation can be accomplished with oral or IM antipsychotics or benzodiazepines.
A diagnosis of “inhalant intoxication” is based on:
The symptoms are not attributable to another medication condition or mental disorder, including intoxication with another substance.
A diagnosis of “inhalant use disorder” is based on a problematic pattern of using a hydrocarbon-based inhalant substance leading to significant impairment or distress. Inhalant substances include solvents for glues and adhesives; propellants (e.g., for aerosol paint sprays, hair sprays); paint thinners; and fuels (e.g., gasoline and propane). Inhalants are associated with a number of problems including conduct disorder, mood disorders, suicidality, and physical and sexual abuse or neglect.
A diagnosis for inhalant use disorder requires at least two of the following factors, occurring within a 12-month period:
Inhalant use disorder is rated as mild with the presence of 2-3 symptoms, moderate with 4-5 symptoms, and severe with 6 or more symptoms.
A diagnosis of “unspecific inhalant disorder” is given when symptoms of an inhalant-related disorder are present that cause significant distress or impairment in social, occupational, or other important areas of functioning. However, the symptoms to not meet the full criteria for any specific inhalant-related disorder or any of the disorders in the substance-related and addictive disorders diagnostic class.
Inhalant intoxication usually requires no medical attention and resolves spontaneously. Care primarily involves reassurance and quiet support. Sedative drugs, including benzodiazepines, should not be used because they worsen inhalant intoxication. No established treatment exists for cognitive and memory problems of inhalant-induced persisting dementia. The treatment of inhalant-induced psychotic disorder is brief, lasting a few hours to a few weeks beyond the intoxication. Sedative drugs should be avoided because they may aggravate the psychosis. Antianxiety medications and antidepressants are not useful in the acute phase of the disorder; however, they may be of use in cases of a coexisting anxiety or depressive illness.
For treating the inhalant-related disorders, day treatment and residential programs have been used successfully, especially for adolescent abusers with combined substance dependence and other psychiatric disorders. Treatment addresses the comorbid state which, in most cases, is conduct disorder, or maybe ADHD, major depressive disorder, dysthymic disorder, or PTSD. Both group and individual therapies are used that are behaviorally oriented. Treatment usually lasts 3 to 12 months. Participation in a 12-step program is required, and patients’ families are often involved in family therapy.
A diagnosis of “opioid intoxication” is based on recent use of an opioid with symptoms listed below. Opioids include heroine, fentanyl, and prescription pain relievers such as oxycodone (OxyContin), hydrocodone (Vicodin), codeine, morphine, and others.
Symptoms of opioid intoxication include:
The symptoms are not attributable to another medication condition or mental disorder, including intoxication with another substance.
Opioids include heroine, fentanyl, and prescription pain relievers such as oxycodone (OxyContin), hydrocodone (Vicodin), codeine, morphine, and others.
A diagnosis of “opioid-related disorder” is based on a problematic pattern of opioid use leading to significant impairment or distress, as demonstrated by at least two of the following factors, occurring within a 12-month period:
Opioid use disorder is rated as mild with the presence of 2-3 symptoms, moderate with 4-5 symptoms, and severe with 6 or more symptoms.
A diagnosis of “unspecified opioid-related disorder” may apply in situations in which a person shows symptoms characteristic of an opioid-related disorder, but the symptoms do not meet the full criteria for any specific opioid-related disorder or any of the disorders in the substance-related and addictive disorders diagnostic class.
A diagnosis of “opioid Intoxication” is based on the recent use of an opioid with the following symptoms:
The symptoms are not attributable to another medical condition or mental disorder, including intoxication with another substance.
The diagnosis of “opioid withdrawal” may apply after a person stops/reduces opioid use that has been heavy and prolonged (i.e., several weeks or longer), or after the person has been given an opioid antagonist. Three or more of the following symptoms must be present within minutes to several days after stopping/reducing opioid use, or after receiving an opioid antagonist:
The symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms are not attributable to another medical condition or mental disorder, including intoxication or withdrawal from another substance.
Yes, other “opioid-induced disorders” include opioid-induced depressive disorder, opioid-induced anxiety disorder, opioid-induced sleep disorder, and opioid-induced sexual dysfunction. These opioid-induced disorders are diagnosed instead of opioid intoxication or opioid withdrawal only when the symptoms are sufficiently severe to warrant independent clinical attention.
Medications, including buprenorphine (Suboxone, Subutex), methadone, and extended-release naltrexone (Vivitrol), are effective for the treatment of opioid use disorders.
Buprenorphine and methadone are “essential medicines” according to the World Health Organization.
A NIDA study shows that once treatment is initiated, a buprenorphine/naloxone combination and an extended-release naltrexone formulation are similarly effective in treating opioid use disorder.
Medications should be combined with psychotherapy for effective treatment of opioid-related disorders. Individual psychotherapy, behavioral therapy, cognitive-behavioral therapy, family therapy, support groups (e.g., Narcotics Anonymous) and social skills training may all prove effective for specific patients. Family therapy is usually indicated when the patient lives with family members.
A diagnosis for sedative, hypnotic or anxiolytic use disorder is based on a problematic pattern of drug use leading to significant impairment or distress, as demonstrated by at least two of the following, occurring within a 12-month period:
Sedative, hypnotic or anxiolytic use disorder is rated as mild with the presence of 2-3 symptoms, moderate with 4-5 symptoms, and severe with 6 or more symptoms. A diagnosis of unspecified sedative, hypnotic, or anxiolytic-related disorder may apply when there are symptoms characteristic of sedative, hypnotic, or anxiolytic-related disorder but the symptoms do not meet the full criteria for one of these specific disorders, nor any of the disorders in the substance-related and addictive disorders diagnostic class.
A diagnosis of sedative, hypnotic or anxiolytic intoxication is based on recent use of one of these drugs while demonstrating:
The symptoms are not attributable to another medical condition or mental disorder, including intoxication with another substance.
A diagnosis of sedative, hypnotic or anxiolytic withdrawal is based on a person stopping/reducing prolonged use of one of these drugs with two or more of the following symptoms appearing within several hours to a few days:
Yes, other sedative, hypnotic, or anxiolytic-induced disorders include sedative, hypnotic, or anxiolytic-induced psychotic disorder; sedative, hypnotic, or anxiolytic-induced bipolar disorder; sedative, hypnotic, or anxiolytic-induced depressive disorder; sedative, hypnotic, or anxiolytic-induced anxiety disorder; sedative, hypnotic, or anxiolytic-induced sleep disorder; and sedative, hypnotic, or anxiolytic-induced sexual dysfunction. These disorders are diagnosed instead of sedative, hypnotic, or anxiolytic intoxication or withdrawal only when the symptoms are sufficiently severe to warrant independent clinical attention.
Recovery from a sedative, hypnotic, or anxiolytic-induced disorder typically involves a one-month period of abstinence, along with behavioral counseling that includes instruction on stress management, relaxation, and coping techniques. Medication may be used to reduce withdrawal symptoms and help maintain abstinence. Self-help groups such as 12-step programs and other types of recovery programs can provide long-term support and help prevent relapse.
A diagnosis of “stimulant use disorder” is based on a pattern of amphetamine-type substance, cocaine, or other simulant use leading to significant impairment or distress, as demonstrated by at least two of the following symptoms occurring with a 12-month period:
Stimulant use disorder is rated as mild with the presence of 2-3 symptoms, moderate with 4-5 symptoms, and severe with 6 or more symptoms.
A diagnosis of “unspecified stimulant disorder” may apply in situations in which a person shows symptoms characteristic of an opioid-related disorder, but the symptoms do not meet the full criteria for any specific opioid-related disorder or any of the disorders in the substance-related and addictive disorders diagnostic class.
A diagnosis of “stimulant intoxication” is based on recent use of an amphetamine-type substance, cocaine, or other simulant while demonstrating the following:
The symptoms are not attributable to another medical condition or mental disorder, including intoxication with another substance.
A diagnosis of “stimulant withdrawal” is based on a person stopping/reducing prolonged amphetamine-type substance, cocaine, or other stimulant use while demonstrating two or more of the following symptoms within a few hours to several days:
The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms are not attributable to another medical condition or mental disorder, including intoxication or withdrawal with another substance.
Yes, other stimulant-related disorders include stimulant-induced psychotic disorder, simulant-induced bipolar disorder, stimulant-induced depressive disorder, stimulant-induced anxiety disorder, stimulant-induced obsessive-compulsive disorder, stimulant-induced sleep disorder, and stimulant-induced sexual dysfunction. These stimulant-induced disorders are diagnosed instead of stimulant intoxication or stimulant withdrawal only when the symptoms are sufficiently severe to warrant independent clinical attention.
Treatment of stimulant-related disorders first requires patients to remain abstinent from the drug. Treatment of specific amphetamine-induced disorders (e.g., psychotic disorder, anxiety disorder) with antipsychotic drugs and anxiolytics may be necessary on a short-term basis. Antipsychotics may be prescribed for the first few days. If there are no symptoms of psychosis, diazepam (Valium) is useful to treat patients’ agitation and hyperactivity. Coexisting conditions, such as depression, may respond to antidepressant medication. Bupropion (Wellbutrin) may be of use after patients have withdrawn from amphetamine use.
Patients withdrawing from cocaine typically experience fatigue, dysphoria, disturbed sleep, and some craving; many experience depression. No pharmacological agents reliably reduce the intensity of withdrawal, but recovery over a week or two is generally uneventful. Because of the cocaine user’s intense craving for the drug, attaining abstinence can be difficult. It may require complete or partial hospitalization to remove a patient from the usual settings in which they had obtained or used cocaine.
Stimulant addiction treatment involves non-confrontational behavioral counseling that provides general information about the addiction process and specifics about the individual treatment plan. Counseling may be offered to family and significant others. In addition to initial individual counseling, a treatment plan for a stimulant-related disorder usually includes setting up abstinence goals, attending group therapy, encouraging family support, and establishing long-term support and follow-up.
A diagnosis of “tobacco use disorder” is based on a problematic pattern of tobacco use (smoking cigarettes or pipes, or chewing tobacco), leading to significant impairment or distress as demonstrated by at least two of the following symptoms, occurring within a 12-month period:
Stimulant use disorder is rated as mild with the presence of 2-3 symptoms, moderate with 4-5 symptoms, and severe with 6 or more symptoms.
A diagnosis of “unspecified stimulant disorder” may apply in situations in which a person shows symptoms characteristic of an opioid-related disorder, but the symptoms do not meet the full criteria for any specific opioid-related disorder or any of the disorders in the substance-related and addictive disorders diagnostic class.
Stimulant use disorder is rated as mild with the presence of 2-3 symptoms, moderate with 4-5 symptoms, and severe with 6 or more symptoms.
A diagnosis of “unspecified tobacco-related disorder” may apply in situations in which a person shows symptoms characteristic of a tobacco-related disorder, but the symptoms do not meet the full criteria for any specific tobacco-related disorder or any of the disorders in the substance-related and addictive disorders diagnostic class.
Yes, “tobacco-induced sleep disorder” is a diagnosis based on severe disturbance in sleep caused by tobacco use. Types of tobacco-induced sleep disorders include:
A diagnosis of “tobacco withdrawal” is based on stopping or reducing daily tobacco use (smoking or chewing tobacco) after at least several weeks. Four or more of the following symptoms are required for the diagnosis:
The symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms are not attributable to another medical condition or mental disorder, including intoxication or withdrawal from another substance.
Tobacco use disorder is considered highly treatable when the appropriate pharmacological, behavioral, and psychosocial interventions are used. Treatment may include behavioral therapy, education about the nature and health consequences of tobacco addiction, individual and group addiction support programs, relapse prevention counseling, hypnosis, and tailored treatments for those with lower or higher motivation to quit. Nicotine replacement medications may be used to treat nicotine dependence. Non-nicotine medications may help patients who fail replacement therapy. Bupropion (Zyban) is an antidepressant medication that has both dopaminergic and adrenergic action. In one study, combined bupropion and nicotine patch had higher quite rates than either alone. Other medications that may be helpful include nortriptyline (Pamelor) and clonidine (Catapres).
