Table 1.

Diagnostic and Statistical Manual of Mental Disorders, 5th Edition criteria for tobacco use disorder, modified for e-cigarettes.

Criterion	Wording for tobacco addiction	Wording for e-cigarette addiction
1	Tobacco is often taken in larger amounts or over a longer period than was intended.	E-cigarettes are often used with greater nicotine dosage or for longer than intended.
2	There is a persistent desire or unsuccessful efforts to cut down or control tobacco use.	There is a persistent desire or unsuccessful efforts to reduce or control e-cigarette use.
3	A great deal of time is spent in activities necessary to obtain or use tobacco.	A great deal of time is spent in activities necessary to obtain or use e-cigarettes or e-cigarette equipment.
4	Craving, or a strong desire or urge to use tobacco.	Craving, or a strong desire or urge to use e-cigarettes.
5	Recurrent tobacco use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., interference with work).	Repeated e-cigarette use resulting in failure to fulfill important responsibilities at work, school, or home (e.g., interference with work).
6	Continued tobacco use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of tobacco (e.g., arguments with others about tobacco use).	Continued e-cigarette use despite ongoing or repeated social or interpersonal problems caused or exacerbated by the effects of e-cigarettes (e.g., arguing with others about e-cigarette use).
7	Important social, occupational, or recreational activities are given up or reduced because of tobacco use.	Important social, professional, or recreational activities are abandoned or curtailed because of e-cigarette use.
8	Recurrent tobacco use in situations in which it is physically hazardous (e.g., smoking in bed).	Recurrent e-cigarette use in which it is physically hazardous (e.g., e-cigarette use in bed).
9	Tobacco 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 tobacco.	Continued e-cigarette use despite knowledge of a persistent or recurring physical or psychological problem that is likely caused or exacerbated by e-cigarettes.
10	Tolerance, as defined by either of the following: a. A need for markedly increased amounts of tobacco to achieve the desired effect. b. A markedly diminished effect with continued use of the same amount of tobacco.	Tolerance, as defined by any of the following: a. A desire for a marked increase in e-cigarette dosage to achieve the desired effect. b. A significantly reduced effect with continued use of the same e-cigarette dosage.
11	Withdrawal, as manifested by either of the following: a. The characteristic withdrawal syndrome for tobacco (refer to Criteria A and B of the criteria set for tobacco withdrawal). b. Tobacco (or a closely related substance, such as nicotine) is taken to relieve or avoid withdrawal symptoms.	Withdrawal symptoms, as manifested by any of the following: a. Characteristic withdrawal syndrome related to e-cigarettes (irritability, frustration, anger, anxiety, difficulty concentrating, increased appetite, restlessness, depressed mood, insomnia). b. E-cigarettes (or nicotine in the case of nicotine-containing e-cigarettes) are used to relieve or avoid withdrawal symptoms.