Nicotine Dependence and Peripheral Arterial Disease: A Case of Behavioral Resistance to Limb-Saving Advice

Peripheral arterial disease (PAD) is a manifestation of systemic atherosclerosis strongly linked to tobacco use. Nicotine dependence contributes not only to disease progression but also to poor adherence to treatment and lifestyle modification. We report a 56-year-old male with advanced PAD and long-standing nicotine dependence who continued smoking despite repeated counseling and the impending risk of limb loss. Psychiatric evaluation revealed severe nicotine dependence with low motivation to quit and behavioral resistance. This case illustrates the bidirectional relationship between substance use and chronic medical illness. Persistent tobacco use worsens vascular outcomes, while dependence-related behaviors undermine adherence to medical advice. Evidence-based psychiatric interventions such as motivational interviewing and pharmacotherapy remain underutilized in such cases. Integrating psychiatric care into vascular management is crucial for improving outcomes in PAD patients with nicotine dependence.