Category: F10 F11 F12 F13 F14 F15 F16 F17 F18 F19
F17 — Mental and behavioural disorders due to use of tobacco: facilitator sheet
Teaching objective
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.
Choose material
Worked example · Case: Just a habit, or dependence syndrome? · Case: Only at parties, but he knows it's bad for him
Worked example
Show scenario
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.
Reveal step 1
Step 1 — Check tolerance and pattern: two decades of sustained heavy use establishes a long, stable pattern of use.
Reveal step 2
Step 2 — Check for a withdrawal-linked feature: smoking within minutes of waking is a well-recognised marker of significant nicotine dependence.
Reveal step 3
Step 3 — Check for control difficulty: three failed quit attempts despite genuine intention to stop demonstrates clear difficulty controlling use.
Reveal step 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.
Reveal step 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.
Comparison points
F17 is distinguished from every other category in this block mainly by absence — no clinically significant intoxication state and no characteristic psychotic disorder — making dependence syndrome and withdrawal state the entire practical focus of classification here.
Misconception prompt
Treating any regular use of a psychoactive substance as automatic dependence: "They use it every day, so they must be dependent on it."
Ask the class why this reasoning fails before revealing the explanation below.
Reveal why it fails
Frequency of use, by itself, is only ever consistent-not-decisive evidence. Dependence syndrome requires three or more of six specific criteria together: desire/compulsion, control difficulty, tolerance, withdrawal, neglect of alternatives, and continued use despite harm. Many people use a substance daily for years with no control difficulty, no escalating tolerance, and no harm — this is ordinary, unproblematic use, not a disorder.
Discussion prompts
Prompt 1
Without looking back at the page, state the two states that are the practical focus of this category and why.
Prompt 2
Name one marker of nicotine dependence severity mentioned on this page.
Prompt 3
Explain in one sentence why tobacco's legal and social status has no bearing on its classification.
Summary
Tobacco produces no clinically significant intoxication or psychotic disorder, making dependence syndrome and withdrawal state this category's entire practical focus — assessed by the same six criteria as every other substance in this block.