Table 3 DSM 5 criteria [7]

A problematic pattern of tobacco use leading to clinically significant impairment or distress

 1. Tobacco is taken in larger amounts or over a longer period than was intended.

As benders do not occur with tobacco, this criterion is met when the user has failed in an attempt to quit or cut down.

 2. There is a persistent desire or unsuccessful efforts to cut down or control tobacco use.

The user has failed in an attempt to quit or cut down.

 3. A great deal of time is spent in activities necessary to obtain or use tobacco.

Such as chain smoking, or minors loitering in front of a store asking adults to buy tobacco for them.

 4. Craving, or a strong desire or urge to use tobacco.

This criterion would be met by individuals at the craving or needing stages of physical dependence.

 5. Recurrent tobacco use resulting in a failure to fulfill major role obligations at work, school, or home.

As tobacco is not intoxicating, this criterion is not particularly relevant to tobacco.

 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).

 7. Important social, occupational, or recreational activities are given up or reduced because of tobacco use.

This would typically happen when a short latency to withdrawal makes a person uncomfortable when smoking is not allowed.

 8. Recurrent tobacco use in situations in which it is physically hazardous (e.g., smoking 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 use generally reflects failed attempts at cessation.

 10. Tolerance, as defined by either of the following:

  a. A need for markedly increased amounts of tobacco to achieve the desired effect.

As tobacco is not intoxicating, this criterion does not apply to tobacco use.

  b. A markedly diminished effect with continued use of the same amount of tobacco.

A shortening of the latency to withdrawal indicates that a cigarette has a markedly diminished effect on sustaining the asymptomatic phase of withdrawal.

 11. Withdrawal, as manifested by either of the following:

  a. The characteristic withdrawal syndrome for tobacco. (See Table 2)

Physical dependence can be present long before it is of sufficient severity to cause at least 4 withdrawal symptoms.

  b. Tobacco (or a closely related substance, such as nicotine) is taken to relieve or avoid withdrawal symptoms.

Wanting, craving and needing are withdrawal symptoms. Smoking in response to these symptoms indicates smoking to relieve withdrawal.