F17 — Mental and behavioural disorders due to use of tobacco

What is this category?

F17's most distinctive teaching point is defined by absence: tobacco is the clearest illustration in this block that dependence syndrome and withdrawal do not require intoxication or psychotic phenomena at all. Nicotine does not produce a clinically significant intoxication state or psychotic disorder in the way most other substances here do, yet dependence syndrome and a well-characterised withdrawal state are both extremely common.

Core diagnostic concept

Because tobacco lacks an intoxication or psychotic-disorder presentation, F17's classification question is almost always simply: does the six-criteria dependence-syndrome cluster apply? Given how common regular tobacco use is, this category is a strong test of whether a learner checks for the fuller cluster — particularly control difficulty and continued use despite known harm — rather than assuming regular daily smoking is automatically dependence by definition, or conversely dismissing it as "just a habit" once the criteria are clearly met.

Key diagnostic features

No clinically significant intoxication state

Unlike most other categories in this block, tobacco/nicotine use does not produce a disorder-level acute intoxication presentation.

Dependence syndrome

The same six-criteria cluster — desire/compulsion, control difficulty, tolerance, withdrawal, neglect of alternatives, continued use despite harm — very commonly fully met with sustained regular tobacco use.

Withdrawal state

Irritability, anxiety, difficulty concentrating, increased appetite and craving on stopping or reducing sustained use — highly characteristic, though not medically dangerous in the way alcohol or sedative withdrawal can be.

No characteristic psychotic disorder

Tobacco use is not associated with a substance-induced psychotic disorder in the way stimulants, cannabinoids or hallucinogens are.

Continued use despite harm

Often the most clearly demonstrable criterion for tobacco, given well-established long-term health risks that most users are aware of yet continue to use despite.

How to weigh evidence

These learning labels are teaching aids, not official ICD-10 terminology (see Sources and Method).

• supports Smoking within minutes of waking, difficulty going more than an hour without a cigarette, multiple unsuccessful quit attempts, and continued smoking despite a recent respiratory diagnosis.
• consistent not decisive The person smokes several cigarettes a day. Frequency alone does not establish dependence without the broader criteria cluster.
• raises alternative Occasional social smoking only at gatherings, with no difficulty going without it between occasions and no withdrawal symptoms reported.
• contradicts or weakens Stopped smoking for several months with only mild, brief irritability and no reported difficulty maintaining abstinence.
• missing and necessary to ask Whether the person has ever tried to quit and, if so, what happened, and how soon after waking they typically smoke their first cigarette.

Duration and course

Minimum duration: Dependence syndrome, as elsewhere in this block, is typically established by three or more criteria present together within the past year.

Course: Nicotine withdrawal typically begins within hours of the last cigarette, peaks within the first few days, and gradually settles over two to four weeks, though craving can persist longer.

Included presentations

• A pattern meeting three or more dependence-syndrome criteria for tobacco use within the past year.
• A withdrawal state with the characteristic symptom pattern, temporally linked to reducing or stopping sustained use.
• Harmful use causing demonstrable harm without the fuller dependence cluster.

Exclusions and distinguishing presentations

Four-character subtypes (orientation)

A learner should not search for intoxication or psychotic-disorder phenomena with tobacco — their clinical absence is itself the teaching point for this category. Subtypes beyond F17.2 and F17.3 are taught here for orientation only and are not separately assessed in this pilot.

F17.0 — Acute intoxication

Not a clinically significant presentation for tobacco/nicotine. (taught for orientation only, not separately assessed in this pilot)

F17.1 — Harmful use

A pattern causing demonstrable harm without the fuller dependence cluster. (taught for orientation only, not separately assessed in this pilot)

F17.2 — Dependence syndrome

Three or more of the six dependence criteria present together within the past year — the practical focus of this category. (in_depth)

F17.3 — Withdrawal state

Irritability, anxiety, difficulty concentrating and craving on stopping or reducing sustained use. (in_depth)

F17.4 — Withdrawal state with delirium

Not a characteristic presentation for tobacco/nicotine. (taught for orientation only, not separately assessed in this pilot)

F17.5 — Psychotic disorder

Not a characteristic presentation for tobacco/nicotine. (taught for orientation only, not separately assessed in this pilot)

F17.6 — Amnesic syndrome

Not a characteristic presentation for tobacco/nicotine. (taught for orientation only, not separately assessed in this pilot)

F17.7 — Residual and late-onset psychotic disorder

Not a characteristic presentation for tobacco/nicotine. (taught for orientation only, not separately assessed in this pilot)

F17.8 — Other mental and behavioural disorders

A tobacco-related presentation not fitting the other listed states. (taught for orientation only, not separately assessed in this pilot)

F17.9 — Unspecified mental and behavioural disorder

A tobacco-related disturbance identified but without enough information to classify further. (taught for orientation only, not separately assessed in this pilot)

Common learner errors

• Common mistake: Treating any regular use of a psychoactive substance as automatic dependence

Worked example — confirming dependence syndrome despite tobacco's social normalisation

A 45-year-old has smoked roughly a pack a day for over 20 years. She lights her first cigarette within five minutes of waking and finds it very difficult to go more than an hour without one during the day. She was diagnosed with early chronic bronchitis a year ago and has tried to quit three times since, each time returning to her previous level of smoking within a week or two, despite genuinely wanting to stop for her health.

1. Step 1 — Check tolerance and pattern: two decades of sustained heavy use establishes a long, stable pattern of use.
2. Step 2 — Check for a withdrawal-linked feature: smoking within minutes of waking is a well-recognised marker of significant nicotine dependence.
3. Step 3 — Check for control difficulty: three failed quit attempts despite genuine intention to stop demonstrates clear difficulty controlling use.
4. Step 4 — Check for continued use despite harm: continuing to smoke after a chronic bronchitis diagnosis, despite wanting to quit, clearly meets this criterion.
5. Conclusion — With multiple criteria clearly present together, this is confidently classified as dependence syndrome (F17.2) — not merely a strong habit — precisely because the full criteria cluster, not social normalisation of smoking, is what determines the classification.

Interactive practice

• Type A Just a habit, or dependence syndrome? Recognition / application · Foundation
• Type B Only at parties, but he knows it's bad for him Boundary / differential · Boundary

Retrieval prompts

Try answering each of these from memory before revealing where to check. Nothing you think or type here is sent or saved anywhere.

1. Without looking back at the page, state the two states that are the practical focus of this category and why.

   Reveal answer location

   Check Duration and course, Diagnostic boundary, or the rapid revision card below — the cue you need is one of those, in this category's own already-authored wording.

   I recalled this I need to review this

2. Name one marker of nicotine dependence severity mentioned on this page.

   Reveal answer location

   Check Duration and course, Diagnostic boundary, or the rapid revision card below — the cue you need is one of those, in this category's own already-authored wording.

   I recalled this I need to review this

3. Explain in one sentence why tobacco's legal and social status has no bearing on its classification.

   Reveal answer location

   Check Duration and course, Diagnostic boundary, or the rapid revision card below — the cue you need is one of those, in this category's own already-authored wording.

   I recalled this I need to review this

These self-checks are a personal study aid only, visible to you on this page for this visit — they are not stored and do not affect your mastery dimensions.

Related glossary terms

• Dependence syndrome

  A cluster of behavioural, cognitive, and physiological phenomena that develop after repeated substance use, in which use of that substance takes on a much higher priority than other behaviours that once had greater value. Classically established when three or more of six criteria (strong desire/compulsion, difficulty controlling use, tolerance, a physiological withdrawal state, progressive neglect of alternative interests, and continued use despite clear harm) have been present together within the past year.

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• Withdrawal state

  A group of symptoms, of variable severity and clustering, occurring on absolute or relative withdrawal of a substance after repeated, and usually prolonged and/or high-dose, use of that substance. Onset, timing, and medical danger vary considerably by substance.

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