RSU Prof. Elmārs Rancāns co-authors chapter in one of world’s best-known psychiatry textbooks

 ‘After more than 10 years of collaboration with Prof. Douglas Ziedonis from the University of New Mexico, US, I was honoured to co-author the chapter "Disorders due to substance use: nicotine” in the textbook Tasman's Psychiatry,’ says Prof. Elmārs Rancāns, Head of the Rīga Stradiņš University (RSU) Department of Psychiatry and Narcology, adding that it is one of the most prestigious textbooks on psychiatry in the world.

About the textbook

Tasman's Psychiatry has been published since 1996. The 168 chapters of the latest edition from 2024 span a total of 5,519 pages. These chapters were written by over 500 internationally acclaimed experts, editors, and writers from around the world. The book’s contents have been completely updated and expanded with nearly 40 new chapters on digital mental health services and technologies, treatment issues in specific populations and settings, and on prevention, systems of care, and psychosocial aspects of treatment. Earlier editions have been called ‘the best current textbook of psychiatry’ by the New England Journal of Medicine and ‘the gold standard’ by the American Journal of Psychiatry.

 ‘Work on the 49-page chapter was comprehensive and lengthy, but the satisfaction and pride of having our skills and knowledge recognised is immeasurable,’ 

states Prof. Rancāns.

The destructive effects of nicotine

The chapter “Disorders Due to Substance Use: Nicotine” provides a comprehensive overview of nicotine use disorders, often referred to as tobacco use disorders. Smoking is a common public health problem and a major cause of death worldwide, as it causes a wide range of health problems and incurable diseases.

Nicotine addiction causes more than eight million deaths each year, including those caused by passive smoking. It is closely linked to diseases such as cancer, cardiovascular diseases, and chronic respiratory diseases.

Despite public health efforts to reduce smoking, the burden of nicotine addiction remains huge.

How addiction develops 

Nicotine addiction results from the substance’s interaction with the brain’s reward system.

Nicotine affects the part of the brain that makes you feel good and happy, just like when you receive a prize. The brain therefore gets used to nicotine and asks for it again and again.

This mechanism is further complicated by genetic and neurobiological factors that influence individual’s susceptibility to addiction and the severity of abstinence, or the unpleasant sensations experienced when an addict stops using nicotine.

A diagnosis of tobacco use disorder is made considering certain criteria from diagnostic systems for mental disorders such as Diagnostic and Statistical Manual of Mental Disorders (5th edition) by the American Psychiatric Association, and International Classification of Diseases (11th edition). The Fagerstrom Test for Nicotine Dependence is also a convenient screening tool that helps to assess the severity of dependence.

Treatment: options and limitations

Treatment options for tobacco use disorders have evolved considerably to include nicotine replacement therapy, medicine such as bupropion and varenicline, and various methods to help people change their behaviour to quit smoking.

Innovations such as harm reduction strategies, mobile apps and neurostimulation techniques are promising, but need to be more widely implemented and evaluated.

Problems still persist, especially when it comes to treating psychiatric comorbidities such as depression or attention deficit and hyperactivity disorder (ADHD), as these diagnoses make it even more difficult to stop using nicotine and it is more likely that patients will start using again after having quit. In addition, people with inadequate health care often face limited access to effective treatment.

 E-cigarettes and vaping cause new problems

The growth in e-cigarette usage and the prevalence of vaping have brought new difficulties, including increased interest in nicotine among young people and uncertain long-term health effects.

These products blur the boundary between the aids to quit smoking and the route to further nicotine use, highlighting the need for a comprehensive strategy to reduce these risks. Tackling nicotine dependence requires a multifaceted, equal approach that combines innovative treatment methods and also makes them widely available.