Should criteria for drug dependence differ across drugs?


John R. Hughes, University of Vermont, Department of Psychiatry, Ira Allen School, 38 Fletcher Place, Burlington, VT 05401–1419, USA. E-mail:


Aim  To examine the pros and cons of using the same diagnostic criteria for dependence across all drugs versus using dependence criteria specific to the drug of interest.

Methods  A qualitative review of the similarities and differences in nicotine versus alcohol and opiate dependence is used as an example of the utility of using generic versus drug-specific criteria.

Results  Many scientists implicitly recognize that nicotine dependence is different when they do not include nicotine dependence when studying ‘drug dependence’. Nicotine and alcohol/opiate dependence have many similarities (e.g. both can cause withdrawal). Among the several differences, the most important is that nicotine dependence does not cause acute behavioral impairment. Some of the generic dependence criteria do not apply to nicotine dependence (e.g. giving up activities to use the drug) and some well-validated measures of nicotine dependence (e.g. time to first cigarette) are not included in the generic criteria.

Conclusion  Empirical tests of the relative utility of generic versus drug-specific criteria are needed.