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Chunk #7 — Evaluating DSM-IV with Regard to Core Outcomes

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DSM criteria for tobacco use disorder and tobacco withdrawal: a critique and proposed revisions for DSM-5.
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Recent research has identified several characteristics of tobacco use patterns that appear to be core dependence features, including tobacco use that: a) is heavy (e.g., many cigarettes smoked with relatively short periods of abstinence; [8, 11, 12], also cf. [13]), b) is perceived to be beyond conscious control (i.e., is automatic), c) is relatively distinct from intentional, instrumental uses of tobacco (e.g., to control affect or socialize), and d) manifests with strong and repetitive cravings [14–16]. This is illustrated by the fact that, when dependence or smoking patterns are assessed with multidimensional scales, the subscales that carry the greatest predictive validity (e.g., for relapse) are those that assess craving severity and a pattern of heavy tobacco use (e.g., the “Drive” and “Tolerance” scales of the NDSS and WISDM [9, 17, 18]). Recent work shows that the covariation of the 13 subscales of the WISDM can be accounted for by just two factors [19], with the principal factor comprising four subscales, Tolerance, Loss of Control, Automaticity, and Craving, that together form a “primary dependence” measure. These four subscales measure the extent