Tobacco Addiction and Psychological Co-morbidities

Nicotine dependence is a psychiatric disorder characterized by a recurrent, periodic compulsion to use tobacco due to neurophysiological, psychological, and social factors. This disorder has behavioral and physiological characteristics that are similar to those of other addictions, but also unique aspects that require special attention because of its ubiquity on a global scale, its staggering effects on rates of morbidity and mortality, and its high prevalence of psychological comorbidities, including psychiatric disorders. Our chapter focuses on the epidemiology of comorbid nicotine dependence and psychiatric disorders, the underlying biobehavioral mechanisms of comorbidity, cultural factors, psychiatric disorders most often associated with nicotine dependence, and treatment approaches. While there is a need for ongoing studies to more clearly delineate the best treatment interventions for persons with comorbid psychiatric disorders and nicotine dependence, the evidence to date suggests use of all of the medication, behavioral, and peer-support approaches available. Culture changes are needed in mental health and addiction treatment settings to continue to improve access to effective interventions for persons with nicotine dependence and psychological comorbidities.