Nicotine use disorders in DSM-V

Evidence-based changes planned for DSM-5 substance use disorders (SUDs) include combining dependence and three of the abuse criteria into one disorder and adding a criterion indicating craving. DSM-IV did not include a category for nicotine abuse, but data were found to help the DSM-5 Substance Disorders Workgroup evaluate whether aligning the nicotine use disorder criteria with the other substances in DSM-5 had empirical support. Item response theory and other types of analyses were conducted in U.S. and Israeli general population data to determine the advisability of these changes in the criteria for nicotine use disorder. When dependence criteria only were examined, they formed a unidimensional structure. Adding the three abuse criteria and craving maintained this unidimensionality, with abuse and dependence criteria arrayed across the severity spectrum. Statistical tests indicated that the addition of the abuse criteria significantly increased the amount of information available compared to a criteria set consisting of nicotine dependence only. Strong associations with clinically relevant covariates (level of smoking, smoking shortly after awakening) further supported the combination of nicotine dependence, abuse, and craving criteria as a dimension representing a single nicotine use disorder. Based on this evidence, the DSM-5 Substance Disorders Workgroup has proposed aligning the DSM-5 criteria for nicotine use disorders with the criteria for the other substance use disorders.