We believe that the DSM-IV criteria do not provide for clear items or scoring. For instance, Criterion 4 asks about “persistent desire to cut down. . . or control tobacco use” – but the definition of “persistent” could vary greatly from one clinician or one patient to another. Criterion 6 addresses “important social, occupational, or recreational activities…given up or reduced because of nicotine.” Applying this to smoking is difficult, since one can often smoke during social, occupational, and recreational activities. On the other hand, if one interprets the criterion broadly, to include, e.g., missing part of a movie or a meeting in order to smoke, it is hard to imagine any regular smoker for whom this has not been true. Thus, interpretation is crucial for this criterion; what makes the activity important and how much must participation be reduced? The ambiguity of the DSM criteria can be compared with some of the items of the FTND, an alternative dependence instrument; the FTND items, by comparison, seem much more straightforward (e.g., items 1 & 4; see Table 2). ○The criteria should address constructs that are theoretically and empirically central to dependence.
