Tobacco Use Disorder

Question 1

Symptoms commonly seen during tobacco withdrawal

Answer 1

• Anxiety
• Depressed mood
• Difficulty concentrating
• Increased appetite
• Insomnia
• Irritability, anger
• Restlessness

Question 2

Treatment of tobacco use disorder

Answer 2

• Should combine behavioral and pharmacologic interventions
• Behavioral: Counseling, possible referral to 12 step programs or similar
• Pharmacologic:
  
  • Nicotine replacement therapy (nicotine gum, patch, lozenge, inhaler, spray). There is often benefit to combining the long-acting patch with a short-acting agent, like gum.
  • Buproprion
  • Varenicline (partial agonist at a4b2 subunit of nicotinic receptors)

Question 3

Both buproprion and varenicline have a black box warning for risk of. . .

Answer 3

. . . suicidality

Question 4

Is naltrexone effective in smoking cessation?

Answer 4

No, per Cochrane reviews

It was once thought that it may be helpful and there was mixed RCT evidence, but meta analyses now suggest that it is not effective for this indication.

There remains good evidence for naltrexone’s efficacy in alcohol cessation and opioid cessation.