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Clearing the Smoke: Assessing the Science Base for Tobacco Harm Reduction
medication use is a result of the desire to prevent relapse to cigarettes or an addiction to the product can be difficult. The “addictiveness” of a drug can also be determined by the extent to which relapse occurs among those individuals who have tried to stop using it. In addition, various animal and human laboratory methods have been developed to assess the abuse liability of a drug, including measurement of psychoactive or stimulus effects and determination of whether a drug is a reinforcer (positive or negative) leading to preference for a drug or drug self-administration (Bozarth, 1987; Balster, 1991; U.S. DHHS, 1988).
According to Food and Drug Administration (FDA) guidelines, abuse liability is determined by two primary factors (see deWit and Zacny, 1995). One is the likelihood of repeated use, which is determined by the drug’s psychoactive, positive reinforcing effects and the extent to which it can relieve withdrawal symptoms as a result of chronic use. Repeated use may also be determined by the degree of unpleasant effects associated with drug use. The second factor is the incidence of adverse short- and long-term consequences as a result of use. Drugs with a greater number of adverse consequences are thought to be more likely to have abuse liability than those with fewer adverse effects.
Measures and Surveys of Dependence. Surveys and instruments have been used to assess the amount and frequency of use (e.g., daily use, regular use) and whether an individual is dependent on a drug based on specific diagnostic criteria. These measurement tools have been used to determine the extent to which dependence occurs within a general population and among those who have been exposed to or have experimented with the drug. In addition, these diagnostic tools for dependence have been used to determine whether dependence on nicotine is a dose-related phenomenon. Both DSM-IIIR and DSMIV (APA, 1987,1994) and the World Health Organization (WHO) International Diagnostic Code-10 (IDC-10) (WHO, 1991) are the commonly used criteria to assess for nicotine dependence. According to the DSM and the IDC-10, substance dependence, including nicotine, results in several behavioral and cognitive characteristics and physiological manifestations (see Table 9–2). The primary criteria for dependence based on these definitions include a strong desire to take the drug for periods longer than intended, problems controlling its use, use despite negative consequences or having a higher priority than other activities or obligations, tolerance, and physical withdrawal (APA, 1994; WHO, 1991). Not all criteria have to be met, nor is any one criteria critical to satisfy a diagnosis of dependence. In the 1988 Surgeon General’s report The Health Consequences of Smoking: Nicotine Addiction, the primary criteria for drug dependence included (1) highly controlled or compulsive use of a drug, (2) psychoactive effects from the drug, and (3) drug-reinforced behavior. Additional criteria, similar to those listed in DSM-IV and IDC,