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Alcohol and Tobacco Dependence Nature of the Problem Assessment Procedures and Non-psychological Treatments 1 NATURE OF THE PROBLEM What is dependence Both tobacco dependency and alcohol dependency are classified as a subtype under substance-related disorders in the DMS-IV-TR There has been disagreement on how to define dependence or addiction with different models focusing on either physiological or psychological dependence Physiological dependency Tolerance require greater amounts of substance to experience the same effect Withdrawal negative physical response resulting from cessation Chronic alcoholics can have severe withdrawal symptoms including hand tremors nausea and vomiting anxiety and in extreme cases experience delirium tremens which can produce hallucinations and body tremors Barlow Durand 2002 Psychological dependency Craving Need to ingest more of a substance Repeated use of a substance Likelihood use will resume after a period of abstinence The DMS-IV-TR combines these two aspects of dependence when defining alcohol and tobacco dependency The relationship between nicotine and tobacco dependency The Surgeon Generals report 1988 on Smoking and Health stated that nicotine was the drug responsible for tobacco dependence cited in Atrens 2001 This statement has been supported and accepted as the core element that makes quitting difficult Shadel Shiffman Niaura Nichter Abrams 2000 Nicotine is a mild CNS stimulant Growing evidence suggests that rewarding effects of nicotine interfere with the balance of neurotransmitters such as dopamine endorphins epinephrine and cholinergic Killen Fortmann Schatzberg Hayward Sussman Rothman Strausberg Varady 2000 Atrens 2001 disputes this statement believing the notion that nicotine is addictive lacks empirical support The effects of nicotine on the brain are similar to harmless substance and events such as salt sugar exercise Atrens 2001 Also the pleasure factor must be taken into account which may explain why some smokers can stop and others cannot or in actual fact will not quit Self-administration of nicotine in animal studies has not been demonstrated as it is with other addictive substance
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