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The absence of DSM-IV nicotine dependence in moderate-to-heavy daily smokers

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Abstract

Background

Current theoretical models of nicotine dependence assume a close relationship between use and dependence; however, previous data suggest that many daily smokers fail to develop nicotine dependence.

Objectives

To determine what percentage of daily smokers fail to meet DSM-IV criteria for nicotine dependence within their lifetime, how non-dependence relates to duration and quantity of cigarette use, and whether other tobacco use and/or specific dependence criteria differentiate never-dependent and dependent smokers.

Methods

Cross-sectional data collected via personal interview from a nationally representative sample of 8213 past year daily smokers were analyzed.

Results

Approximately 39.4% of daily smokers never reached nicotine dependence. While the probability of remaining non-dependent decreased with smoking quantity and duration since the onset of daily smoking, a substantial portion of individuals (37.7%) who reported smoking ≥10 cigarettes per day and began smoking daily ≥10 years prior, remained never nicotine dependent.

Conclusions

The absence of nicotine dependence in heavy daily smokers may result from limitations in the measurement of dependence and/or nicotine exposure. Alternatively, some individuals may be relatively resistant to becoming nicotine dependent despite extensive use. The latter explanation would have important implications for understanding the nature of nicotine dependence.

Section snippets

Background

Current theories of nicotine dependence focus on the neurobiological effects of nicotine, stimuli paired with nicotine delivery and the repeated performance of nicotine use behaviors as primary determinants of nicotine dependence (Balfour, 2004, Caggiula et al., 2002, Tiffany, 1990). An assumption of these theories is that dependence is closely related to the duration and quantity of use. While nicotine use is a necessary requirement for nicotine dependence and the rates of dependence increase

Sample

A nationally representative sample of 43,093 non-institutionalized adults in the United States age 18 and older were personally interviewed from August 2001 to May 2002 as part of the National Epidemiologic Study on Alcohol and Related Conditions (NESARC), described in detail elsewhere (Grant et al., 2004b). Preliminary analyses focused on 18,013 individuals who reported smoking >100 lifetime cigarettes confirmed previous reports (Breslau et al., 2001) indicating that the onset of daily smoking

Results

In a large, nationally representative sample of past year daily smokers, 39.4% failed to meet criteria for nicotine dependence within their lifetime. Univariate logistic regression revealed that the probability of remaining never nicotine dependent decreased linearly with increasing past year smoking quantity (β = −0.077, OR: 0.926, p < 0.0001) and years since the onset of daily smoking (β = −0.036, OR: 0.965, p < 0.05) (Fig. 1). Quadratic and cubic effects failed to reach significance and were not

Discussion

Conceptualization and measurement of nicotine dependence has been extensively discussed. Numerous measures have been put forward that differ in their theoretical underpinnings, whether they are dichotomous or continuous, and whether they are single or multi-dimensional (Piper et al., 2006). Here, non-dependent cases could have resulted from insensitivity (i.e., false negatives) of the AUDADIS-IV assessment of DSM-IV dependence, due to its dichotomous structure, operationalization of DSM-IV

Acknowledgements

The National Epidemiologic Survey of Alcohol and Related Conditions (NESARC) was designed and conducted by the National Institute on Alcoholism and Alcohol Abuse (NIAAA). Data analysis was supported by grant K01 DA15454 from the National Institute of Drug Abuse (Dierker) and an Investigator Award from the Patrick & Catherine Weldon Donaghue Medical Research Foundation (Dierker).

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Supplementary material relevant to the methods used in the study described here can be found by accessing the online version of this paper at http://dx.doi.org by entering doi:10.1016/j.drugalcdep.2006.11.019.

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