The relatively poor psychometric properties of DSM-IV nicotine dependence criteria do not necessarily indicate that these criteria are not valid indicators of the dependence construct. Rather, the chief shortcoming of DSM-IV items may be the manner in which they are assessed. The dichotomous scoring of each item may mask the true range of symptom severity and reduce the power of the DSM-IV (see [34,35]), and because the DSM-IV uses single items to assess symptom domains, item-specific error may be exaggerated (see [29]). These limitations may attenuate the reliability and validity of the measure. Indeed, the CDS [3], which incorporates some of the DSM-IV items and measures them in a continuous manner, demonstrates good reliability.
