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UW-CTRI Research Director Tim Baker is co-author of a commentary published in the journal Addiction that recommends changes to the Diagnostic and Statistical Manual of Mental Disorders (DSM, the psychological reference guide for professionals) pertaining to nicotine dependence.
The authors suggest a number of alterations, including:
- Listing craving as a nicotine-withdrawal symptom and include it in other drug-withdrawal syndrome descriptions. Withdrawal-associated craving is highly predictive of clinical outcomes.
- Measuring an individual’s time-to-first-cigarette after awakening and total cigarettes smoked per day in DSM field trials to allow comparisons between these proposed standards and current DSM criteria. Also consider parallel measures of urgency and heaviness-of-use for other drug dependencies.
- Change the name from “nicotine use disorder” to “tobacco use disorder.”
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“The current DSM criteria for substance dependence arose from observations and theory regarding alcohol and opioid dependence,” the authors wrote. “Nicotine dependence differs from alcohol and opioid dependencies in several respects. Nicotine use does not cause behavioral intoxication and, thus, the major harm from nicotine dependence is from physical, not behavioral or social, problems. In addition, the DSM-IV criteria possess less validity in predicting key consequences of nicotine dependence (e.g. relapse) than do nicotine-specific measures such as time-to-first-cigarette after awakening and cigarettes smoked per day.”
Hughes JR, Baker TB, Breslau N, Covey L, Shiffman S. Applicability of DSM Criteria to Nicotine Dependence (commentary). Addiction. 2011;106:894-5
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