Notably, DSM does not directly assess any of these. The DSM addresses heaviness of tobacco use by asking whether “nicotine is often taken in larger amounts or over a longer period than was intended.” This does not clearly assess heaviness of use, but complicates the matter with reference to intention. The DSM-IV attempts to address loss of control (see Table 1, questions 3 & 4). However, it is unclear that the criteria are clear enough, or permit sufficiently accurate scoring, so as to assess this dimension well. Finally, the DSM criteria do not assess automaticity and in DSM-IV, does not include measures of craving. This suggests that the DSM does not assess important facets of TD [7, 17, 18, 26].
