TABLE 3-1 Socioecologic Model and Levels of Influence for Military and Veteran Populations

Level of Influence

Military Population

Veteran Population


Soldier, seaman, airman, marine



Military unit, unit commander, family, friends, health-care provider

Family, friends, health-care provider, co-workers


Installation personnel or commander; military treatment facility, TRICARE health-care facility

Employer, veteran service organization; local VA health-care facility, local community


DoD: Army, Navy, Marine Corps, Air Force, Office of the Assistant Secretary of Defense (Health Affairs); Congress; tobacco industry

VA, Congress, state government, tobacco industry

Nicotine Addiction

In this report, dependence and addiction are used interchangeably. They are considered equivalent because they describe similar neurochemical and behavioral processes that sustain drug use (US Surgeon General, 1988), and they indicate a loss of control over drug-taking behavior—the principal characteristic of drug addiction. Definitions of and criteria for drug dependence or addiction have been put forth by numerous health organizations and authorities. According to WHO, drug dependence is “a behavioral pattern in which the use of a given psychoactive drug is given a sharply higher priority over other behaviors which once had a significantly higher value” (No Author, 1982)—in other words, the drug has come to control behavior to an extent that is considered detrimental to the individual. Specific criteria have been defined and developed for nicotine dependence and nicotine withdrawal by the American Psychiatric Association (2000) and for tobacco dependence and tobacco withdrawal by WHO (1992).

The 1988 surgeon general’s report The Health Consequences of Smoking: Nicotine Addiction also presented criteria for drug dependence (US Surgeon General, 1988). In addition to a user’s behavior being controlled by a drug, the surgeon general’s criteria require that the drug produce psychoactive effects and that there be evidence that the drug-taking behavior is reinforced by these effects. Nicotine is associated with well-known pleasurable psychoactive effects, such as arousal, relaxation,

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