In Reply

Epidemiological studies have satisfactorily confirmed a dose–response relation between the consumed amount of tobacco or alcohol and the risk of illness. Research has shown that no safe threshold exists regarding tobacco consumption, but that only complete abstinence is considered as safe regarding health (1). Even moderate amounts of alcohol can increase the risk for a range of severe disease (2).

The problematic consumption (indication of dependence) of tobacco and alcohol as an independent diagnosis requiring treatment needs to be distinguished from the risk of subsequent disease because of one’s own substance consumption or external extraneous exposure (for example, passive smoking). Furthermore, the criteria for diagnosing problematic consumption of tobacco or alcohol (misuse or dependence) are not based on the amount consumed but on the somatic, psychological, and negative social consequences of substance use.

Using amounts consumed as diagnostic criteria is still the subject of controversial discussion (3). Among others, using amounts consumed would have the advantage of a continuous measure.

For the diagnosis, differentiating between problematic and non-problematic consumption is highly relevant as the modality of further treatment is based crucially on whether and which diagnosis exists. The treatment plan for a person with signs of alcohol dependence differs from that of a person with increased disease risk who does not show any signs of dependence.

Independently of the definition of problematic or non-problematic consumption—or dependence or otherwise—the implementation of preventive measures aiming to reduce consumption is of great importance, so as to reduce the hazards and risk of tobacco and alcohol consumption in as sustained a manner as possible.