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Evaluating the validities of different DSM-IV-based conceptual constructs of tobacco dependence*


  • *

    Data in the following manuscript were derived from three clinical trials. Two of these trials are registered with the National Institutes of Health (NIH), and can be accessed at; ‘Maintaining Abstinence in Chronic Cigarette Smokers’ (identifier: NCT00087880) and ‘Maintaining Nonsmoking: Older Smokers’ (identifier: NCT00086385). Per NIH regulations, the third trial was not entered into a publicly accessible database because it was funded by a multiple project center grant and hence exempt from the registration requirement.

Peter S. Hendricks, 401 Parnassus Avenue, TRC Box 0984, San Francisco, CA 94143, USA. E-mail:


Aim  To compare the concurrent and predictive validities of two subsets of DSM-IV criteria for nicotine dependence (tolerance and withdrawal; withdrawal; difficulty controlling use; and use despite harm) to the concurrent and predictive validity of the full DSM-IV criteria.

Design  Analysis of baseline and outcome data from three randomized clinical trials of cigarette smoking treatment.

Setting  San Francisco, California.

Participants  Two samples of cigarette smokers (n = 810 and 322), differing with regard to baseline characteristics and treatment received, derived from three randomized clinical trials.

Measurements  DSM-IV nicotine dependence criteria were measured at baseline with a computerized version of the Diagnostic Interview Schedule for DSM-IV (DIS-IV). Additional baseline measures included the Fagerström Test of Nicotine Dependence (FTND), number of cigarettes smoked per day, breath carbon monoxide (CO) level, the Minnesota Nicotine Withdrawal Scale (MNWS), the Michigan Nicotine Reinforcement Questionnaire (M-NRQ) and the Profile of Mood States (POMS). Seven-day point-prevalence abstinence was assessed at week 12.

Findings  Full DSM-IV criteria displayed greater concurrent validity than either of the two subsets of criteria. However, DSM-IV symptoms accounted for only a nominal amount of the variance in baseline smoking-related characteristics and were unrelated to smoking abstinence at week 12. Cigarettes smoked per day was the only significant predictor of abstinence at week 12.

Conclusions  Although the findings do not provide a compelling alternative to the full set of DSM-IV nicotine dependence criteria, its poor psychometric properties and low predictive power limit its clinical and research utility.