Tobacco Use Disorder and Co-Occurring Mental Health Conditions: Considerations for Future DSM.
There is a significantly higher prevalence of tobacco use disorder (TUD) among individuals with mental health conditions, and they account for nearly 40% of cigarettes smoked in the United States. Although the DSM-5 notes the high prevalence of co-occurring mental health conditions with TUD and that nicotine withdrawal symptoms mimic the symptoms of other mental health conditions such as anxiety, depressive, and bipolar disorders, the discussion of co-occurring mental health conditions in relation to TUD is limited. DSM-6 presents an important opportunity to expand diagnostic guidance, recognize shared and bidirectional etiological mechanisms, and recommend systematic screening and intervention approaches for TUD in the context of mental health treatment. Expanded guidance for differential diagnosis and treatment in DSM-6 could promote tobacco cessation as an essential component of mental health care, thereby improving clinical outcomes for people with TUD and co-occurring mental health conditions.