The DSM criteria, presented in Table1, need significant revision. Evidence shows that the criteria and the scoring strategies recommended in recent versions of the DSM have not performed well relative to other measures of tobacco dependence. (A similar charge can be laid against the ICD-10 criteria because the two systems are highly similar [7]). Researchers have produced alternative instruments to assess dependence, such as the Fagerstrom Test of Nicotine Dependence [FTND], the Nicotine Dependence Symptom Scale [NDSS], the Wisconsin Inventory of Smoking Dependence Motives [WISDM], and the Hooked on Nicotine Checklist [HONC] [8, 9]. These, especially the FTND, have achieved much wider use than the DSM criteria, likely because of their ease of use and their superior prediction of important outcomes.
