Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

110 III. SUBSTANCES OF ABUSEDEFINITIONSHenningfield (1986) compared tobacco dependence to other forms of drugdependence and concluded that there are more similarities than differences. Henoted that (1) tobacco dependence, like other forms of drug dependence, is acomplex process, involving interactions between drug and nondrug factors; (2)tobacco dependence is an orderly and lawful process governed by the same factorsthat control other forms of drug self-administration; (3) tobacco use, likeother forms of drug use, is sensitive to dose manipulation; (4) development oftolerance (diminished response to repeated doses of a drug or the requirementfor increasing the dose to have the same effect) and physiological dependence(termination of nicotine followed by a syndrome of withdrawal phenomena)when nicotine is repeatedly administered is similar to the development of toleranceand dependence of other drugs of abuse; and (5) tobacco, like many othersubstances of abuse, produces effects often considered a utility or benefit to theuser (e.g., relief of anxiety or stress, avoidance of weight gain, alteration inmood).Although the similarities between tobacco or nicotine dependence andother forms of drug dependence are noteworthy, there are features of tobaccouse that make it unique. In contrast to many other drugs of abuse, tobacco productsare legal and readily available. When used as intended, tobacco productslead to disease and death. Unlike alcohol, a legal drug that can be consumedsocially and in moderation without ill effects, all levels of tobacco use are harmful(U.S. Department of Health and Human Services, 1988).Large sums of money are spent each year to advertise and market tobaccoproducts, particularly cigarettes. This adds an important dimension to tobaccodependence not present to the same degree with other substances, with the possibleexception of alcohol. Few children in our society grow up free of BigTobacco’s reach, which provides unique opportunities for the tobacco companiesto teach them about the virtues of tobacco, the manner in which it shouldbe used, and the role it should play in their daily lives. So pervasive is the positiveimagery associated with cigarette smoking that it is almost impossible todistinguish between the reinforcing qualities of cigarettes that derive from pastconditioning and learning and those that derive solely from nicotine.DIAGNOSISAccording to the fourth edition of the Diagnostic and Statistical Manual of MentalDisorders (DSM-IV; American Psychiatric Association, 1994), nicotinedependence is considered to be a substance-related disorder. The key features ofsubstance dependence are a cluster of cognitive, behavioral, and physiologicalsymptoms indicating that the individual continues use of the substance despite