The American Psychiatric Association (APA) DSM-IV attempts to achieve the above goals by via assessment of seven dependence criteria perceived to co-occur with problematic drug use; see Table 1: e.g., presence of tolerance to tobacco effects, occurrence of withdrawal symptoms, difficulty controlling or stopping tobacco use, and so on. Diagnosis requires the clinician to determine whether 3 or more of the 7 main criteria (Part 1) occur simultaneously within a 12 month period. There is no clear guidance as to how the clinician acquires this information. Therefore, diverse item wordings and delivery methods have been used in DSM based assessment.2 This creates some uncertainty about whether research results reflect the worth of the items, the criteria themselves, or both.
