From the Guidelines
The DSM-5-TR criteria for Nicotine Use Disorder requires meeting at least 2 of 11 specific criteria within a 12-month period, as supported by the most recent and highest quality study 1. These criteria include:
- using nicotine in larger amounts or longer than intended;
- persistent desire or unsuccessful efforts to cut down;
- spending significant time obtaining, using, or recovering from nicotine;
- experiencing cravings;
- failing to fulfill major obligations due to use;
- continued use despite social problems;
- giving up important activities because of use;
- using in physically hazardous situations;
- continued use despite physical or psychological problems;
- tolerance (needing more nicotine for the same effect);
- and withdrawal symptoms when stopping use. The severity is classified as mild (2-3 symptoms), moderate (4-5 symptoms), or severe (6+ symptoms) 1. Nicotine use disorder is diagnosed when a pattern of problematic nicotine use leads to clinically significant impairment or distress, as indicated by studies aligning nicotine criteria with other substance use disorders 1. This diagnosis helps clinicians identify individuals who may benefit from cessation interventions like nicotine replacement therapy (patches, gum, lozenges), medications such as varenicline or bupropion, and behavioral counseling to address the physiological and psychological aspects of nicotine dependence. The alignment of criteria for tobacco use disorder with those for other substance use disorders has been supported by item response theory analysis, showing a unidimensional latent trait and increased information over DSM-IV nicotine dependence criteria 1.
From the Research
DSM-5-TR Criteria for Nicotine Use Disorder
The DSM-5-TR criteria for nicotine use disorder include:
- Nicotine dependence criteria from DSM-IV
- Three abuse criteria: neglect of roles, hazardous use, and interpersonal problems
- Craving 2 The criteria indicate one latent trait, and evidence supports the validity of each criterion and the criteria as a set 2, 3.
Key Features of DSM-5-TR Criteria
Key features of the DSM-5-TR criteria for nicotine use disorder include:
- A lower threshold for diagnosis (≥ 2 criteria)
- Severity levels: mild, moderate, and severe 3
- Inclusion of craving as a criterion, which improves validity and clinical relevance 3
Comparison with DSM-IV Criteria
The DSM-5-TR criteria for nicotine use disorder have been compared with DSM-IV criteria, and findings suggest that:
- DSM-5-TR criteria are more discriminating than DSM-IV criteria 2
- DSM-5-TR criteria lead to increased prevalence of binary nicotine use disorder (two or more criteria) over DSM-IV nicotine dependence 2
- DSM-5-TR criteria demonstrate concurrent and prospective validity, with stronger associations with validators such as cigarette consumption and craving 3