remission if the individual is both in remissi on and on maintenance therapy. “In a controlled
environment” applies as a further specifier of re mission if the individual is both in remission
and in a controlled environment (i.e., in early remission in a controlled environment or in sus-
tained remission in a controlled environment). Examples of these environments are closely su-
pervised and substance-free jails, therapeutic communities, and locked hospital units. 
Diagnostic Features
Tobacco use disorder is common among individu als who use cigarettes and smokeless to-
bacco daily and is uncommon among individuals who do not use tobacco daily or who use
nicotine medications. Tolerance to tobacco is exemplified by the disappearance of nausea
and dizziness after repeated intake and with a more intense effect of tobacco the first time
it is used during the day. Cessation of to bacco use can produce a well-defined withdrawal
syndrome. Many individuals with tobacco use disorder use tobacco to relieve or to avoid
withdrawal symptoms (e.g., after being in a sit uation where use is restricted). Many indi-
viduals who use tobacco have tobacco-relat ed physical symptoms or diseases and con-
tinue to smoke. The large majority report crav ing when they do not smoke for several hours.
Spending excessive time usin g tobacco can be exemplified by chain-smoking (i.e., smok-
ing one cigarette after another with no time between cigarettes). Because tobacco sources
are readily and legally available, and because nicotine intoxication is very rare, spending a
great deal of time attempting to procure toba cco or recovering from its effects is uncom-
mon. Giving up important social, occupational , or recreational acti vities can occur when
an individual forgoes an activity because it occurs in tobacco use–restricted areas. Use of