Measures of tobacco dependence have failed to demonstrate the expected relationships with important smoking-related criteria (see [1
]). As a result, researchers have attempted to refine the conceptualization and measurement of this concept. Over the past 6 years several new measures have emerged, including the Hooked on Nicotine Checklist (HONC; [2
]), the Cigarette Dependence Scale (CDS; [3
]), the Nicotine Dependence Syndrome Scale (NDSS; [4
]) and the Wisconsin Inventory of Smoking Dependence Motives (WISDM-68; [5
]). It is hoped that these newer tools will reconcile the theoretical importance of the tobacco dependence construct with its modest empirical support.
The criteria for nicotine dependence in the current Diagnostic and Statistical Manual of Mental Disorders
(i.e. the DSM-IV; [6
]) have also been the focus of recent study (e.g. [7
]), and it has been suggested that these criteria be considered for modification in the upcoming DSM-V (e.g. [9
]). Indeed, evidence for the validity of the DSM-IV criteria for nicotine dependence is limited (see [1
]). The DSM-IV diagnosis of nicotine dependence requires the presence of at least three of the following seven criteria during the past year: (i) tolerance; (ii) withdrawal; (iii) using more than intended; (iv) difficulty controlling use; (v) spending a great deal of time (obtaining or using nicotine); (vi) giving up activities; and (vii) use despite harm.
One possible modification of DSM criteria for nicotine dependence was offered recently by Hughes [9
], who noted that the same dependence criteria are applied across all drugs of abuse, based on the notion that all substances share common features of problematic use. However, Hughes suggested that not all DSM-IV criteria apply to nicotine dependence. The author proposed that only withdrawal, difficulty controlling use and use despite harm are applicable to nicotine dependence. This assertion was based on observations that these three features are common among cigarette smokers, whereas the remaining four criteria are more common among other drugs of abuse (e.g. [10
A second potential modification of DSM criteria lies in negative reinforcement models of addiction (e.g. [12
]) that emphasize the primacy of tolerance and withdrawal (see [14
]). In short, these models posit that drug dependence is marked principally by these two features, which are the result of the homeostatic adaptation of the nervous system to chronic drug use. In its definition of substance dependence, the DSM-IV underscores tolerance and withdrawal, and dictates that the presence of these symptoms indicate ‘physiological dependence’ [6
]. Although neither tolerance nor withdrawal are necessary or sufficient for a diagnosis of dependence in the DSM-IV, nicotine dependence criteria based on models of negative reinforcement might focus solely on these two symptoms.
In addition to having immediate implications for the DSM-V, an investigation of nicotine dependence criteria would lend suggestions to similar diagnostic frameworks such as the International Classification of Diseases
], and would provide insight into the essential features of tobacco dependence. To our knowledge, no previous studies have compared novel sets of DSM items to the complete diagnostic criteria.
The goals of the current investigation were to test the concurrent and predictive validities of the nicotine-applicable criteria offered by Hughes [9
] and the negative reinforcement model criteria against the validity of the full DSM-IV criteria for nicotine dependence. Data were drawn from three randomized clinical trials of tobacco dependence. Regression analyses were used to compare the subset criteria offered by Hughes and the negative reinforcement model to the full DSM-IV criteria in predicting baseline smoking-related characteristics (e.g. cigarettes smoked per day) and treatment outcome (i.e. smoking status). If either of the two subsets of specific criteria encapsulates the key features of tobacco dependence, then these criteria should explain a significant and robust amount of the variance in baseline smoking-related characteristics and treatment outcome, and the remaining DSM-IV criteria should provide for a marginal addition in explained variance. If neither subset encompasses the core characteristics of tobacco dependence, then we should find that the addition of the remaining DSM-IV criteria provide for a marked increase in explained variance.