Light Smokers May Not Escape Nicotine Addiction

Summary: Those who consider themselves to be light smokers, in that they smoke between one to four cigarettes a day, meet the criteria for nicotine addiction.

Source: Penn State

Even people who consider themselves to be casual cigarette smokers may be addicted, according to current diagnostic criteria. Researchers at Penn State College of Medicine and Duke University found that many light smokers — those who smoke one to four cigarettes per day or fewer — meet the criteria for nicotine addiction and should therefore be considered for treatment.

“In the past, some considered that only patients who smoke around 10 cigarettes per day or more were addicted, and I still hear that sometimes,” said Jonathan Foulds, professor of public health sciences and psychiatry and behavioral health, Penn State. “But this study demonstrates that many lighter smokers, even those who do not smoke every day, can be addicted to cigarettes. It also suggests that we need to be more precise when we ask about cigarette smoking frequency.”

According to Jason Oliver, assistant professor of psychiatry and behavioral sciences, Duke University, when assessing nicotine addiction — clinically referred to as ‘tobacco use disorder’ — clinicians are encouraged to fully assess the 11 criteria listed in the 5th edition of the Diagnostic and Statistical Manual (DSM-5). As a shortcut, he said, clinicians more typically ask smokers how many cigarettes they smoke per day.

“Lighter smoking is correctly perceived as less harmful than heavy smoking, but it still carries significant health risks,” Oliver said. “Medical providers sometimes perceive lighter smokers as not addicted and, therefore, not in need of treatment, but this study suggests many of them may have significant difficulty quitting without assistance.”

The researchers examined an existing data set from the National Institutes of Health, including more than 6,700 smokers who had been fully assessed to find out if they met the DSM-5 criteria for tobacco use disorder. They found that 85% of the daily cigarette smokers were addicted to some extent — either mild, moderate or severe addiction.

“Surprisingly, almost two thirds of those smoking only one to four cigarettes per day were addicted, and around a quarter of those smoking less than weekly were addicted,” Foulds said.

The researchers found that the severity of cigarette addiction, as indicated by the number of criteria met, increased with the frequency of smoking, with 35% of those smoking one-to-four cigarettes per day and 74% of those smoking 21 cigarettes or more per day being moderately or severely addicted.

This shows white smoke against a black background
They found that 85% of the daily cigarette smokers were addicted to some extent — either mild, moderate or severe addiction. Image is in the public domain

The findings appeared Dec. 22 in the American Journal of Preventive Medicine.

“This was the first time that severity of cigarette addiction has been described across the full range of cigarette use frequency,” said Foulds, a Penn State Cancer Institute researcher.

Oliver added that the study highlights the high prevalence of tobacco use disorder even among those considered to be light smokers and provides a basis from which treatment can begin to target this population.

“Previous research has found that non-daily smokers are more likely than daily smokers to make a quit attempt,” Oliver said. “Clinicians should ask about all smoking behavior, including non-daily smoking, as such smokers may still require treatment to successfully quit smoking. Yet, it is unclear the extent to which existing interventions are effective for light smokers. Continued efforts to identify optimal cessation approaches for this population remain an important direction for future research.”

Funding: The National Institute on Drug Abuse supported this research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Jonathan Foulds has done paid consulting for pharmaceutical companies involved in manufacturing smoking-cessation medications (e.g., GlaxoSmithKline, Johnson & Johnson); and has acted as a deposed and compensated expert witness on behalf of plaintiffs suing cigarette manufacturers.

About this addiction research news

Source: Penn State
Contact: Sara LaJeunesse – Penn State
Image: The image is in the public domain

Original Research: Closed access.
Association Between Cigarette Smoking Frequency and Tobacco Use Disorder in U.S. Adults” by Jason A. Oliver, PhD and Jonathan Foulds, PhD. American Journal of Preventive Medicine


Association Between Cigarette Smoking Frequency and Tobacco Use Disorder in U.S. Adults

Cigarette smoking remains a major cause of premature death and nicotine dependence is a major barrier to smoking cessation. The DSM-5 is the primary guide to psychiatric diagnoses in the U.S. The 5th revision, released in 2013, replaced the term nicotine dependence and instead assigns the diagnosis tobacco use disorder (TUD) to individuals experiencing clinically significant impairment, as indicated by meeting at least 2 of 11 specified criteria. Clinical practice guidelines encourage clinicians to routinely assess and treat tobacco use and dependence. Patient’s self-reported smoking rate is often used to guide clinical decision making, but surprisingly, no previous report has described the proportion of cigarette smokers who meet DSM-5 TUD criteria across the full range of cigarette use patterns in a representative sample of the U.S. population. Lighter smoking is frequently perceived as less harmful. Consequently, such smokers may be less likely to be identified by medical providers and less likely to receive appropriate treatment. Information on the true prevalence of TUD in this population can directly inform clinical practice.

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