Perhaps one approach lies in contemporary theories that regard dependence as a continuous construct with multiple degrees of severity (see [38]). This view is some-what incompatible with the psychiatric diagnostic model upon which the DSM-IV and similar measures (e.g. [15]) are based. However, the possible benefit to the DSM of assessing each nicotine dependence criterion on a continuum should be explored. Moreover, our results suggest that a continuous measure of consumption (e.g. cigarettes smoked per day) may have its place in such a measurement system. Nevertheless, until the DSM shows improvement, clinicians and researchers alike should continue to incorporate multiple, alternative measures of tobacco dependence.
