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. Author manuscript; available in PMC: 2013 Feb 1.
Published in final edited form as: Addiction. 2012 Feb;107(2):263–275. doi: 10.1111/j.1360-0443.2011.03657.x

Table 1.

DSM-IV Criteria

DSM-IV Nicotine Dependence
A. Part 1 AND Part 2
Part 1. A maladaptive pattern of nicotine use, leading to clinically significant impairment or distress, as manifested by three(or more) of the following occurring at the same time within a 12 month period:
  1. Tolerance, as defined by either of the following:
    1. absence of nausea, dizziness, and other characteristic symptoms despite using substantial amounts of nicotine.
    2. diminished effect observed with continued use of the same amount of nicotine-containing products.
  2. Withdrawal as manifested by either of the following:
    1. the characteristic withdrawal syndrome for nicotine (refer to Criteria A and B of the criteria sets for Withdrawal from the specific substances)
    2. nicotine (or a closely related) substance is taken to relieve or avoid withdrawal symptoms.

  3. Nicotine is often taken in larger amounts or over a longer period than was intended.

  4. There is a persistent desire or unsuccessful efforts to cut down or control nicotine use

    Note: “persistent desire” not operationalized

  5. A great deal of time is spent in activities necessary to obtain nicotine(e.g., visiting multiple doctors or driving long distances), use nicotine(e.g., chain-smoking), or recover from its effects

  6. Important social, occupational, or recreational activities are given up or reduced because of nicotine.

  7. Nicotine use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by nicotine.

Part 2. Features of nicotine withdrawal: A maladaptive pattern of nicotine use occurring as manifested by three(or more) symptoms at any time in the same 12-month period.
Diagnostic criteria for nicotine withdrawal:

  1. Daily use of nicotine for at least several weeks, and,

  2. Abrupt cessation of nicotine use, or reduction in the amount of nicotine used, followed within 24 hours by four or more of the following signs:
    1. Irritability, frustration, or anger
    2. Anxiety,
    3. Difficulty concentrating,
    4. Restlessness
    5. Decreased heart rate
    6. Increased appetite or weight gain
    7. Dysphoric or depressed mood
    8. Insomnia

Note. The symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Also, the symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.