Defining and Assessing Nicotine Dependence in Humans
Abstract
‘Addiction’ and ‘dependence’ are used synonymously by most researchers and defined as a reward-seeking (usually drug taking) behaviour that has become out of control. The diagnosis has been based on the alcohol dependence syndrome identified 30 years ago by Edwards and Gross and includes tolerance, craving, withdrawal symptoms, difficulty controlling use, important activities given up, and continuation despite harmful consequences. A substantial proportion of smokers are addicted by reference to these criteria. However, it is possible to improve on both the definition and its assessment. This paper proposes that addiction is more usefully regarded as a symptom of potentially a range of underlying pathologies involving the ‘motivational system’. Even among smokers there is heterogeneity in the pathology that makes it difficult for them to abstain voluntarily and this has important implications for treatment. For example, there will be smokers for whom the pathology involves a largely reversible effect of nicotine in creating an ‘acquired drive’, others for whom nicotine has induced long-term changes that make life less comfortable in its absence, and others whose smoking is more situationally driven. Assessment of addiction should first quantify the degree to which the behaviour dominates the individual's repertoire and then assess the underlying pathology in the motivational system. A framework for doing this is discussed.
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The strength of nicotine hunger can be usefully assessed by recording how soon after waking the smoker first lights up a cigarette.
“The strength of this can be usefully assessed by recording how soon after waking the smoker first lights up a cigarette (17,18).”
From The Multiple Facets of Cigarette Addiction and What They Mean for Encouraging and Helping Smokers to Stop (2009) · cites this paper as [18]
Wanting to smoke (enjoyment of smoking) deters quit attempts while needing to smoke (anticipated relief from nicotine hunger) and cue-driven impulses to smoke (experienced as 'urges') lead to relapse after the quit attempt has been started.
“There is evidence emerging that wanting to smoke (enjoyment of smoking) deters quit attempts while needing to smoke (anticipated relief from nicotine hunger) and cue driven impulses to smoke (experienced as 'urges') lead to relapse after the quit attempt has been started (18,24).”
From The Multiple Facets of Cigarette Addiction and What They Mean for Encouraging and Helping Smokers to Stop (2009) · cites this paper as [18]
Cited by
Sorted by citations
Kotz, D., & West, R. (2008) · Tobacco Control · doi:10.1136/tc.2008.025981 · Cited by 399 · see citing works
Self-citationSelf-perceived smoking motives and their correlates in a general population sample
Fidler, J. A., & West, R. (2009) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntp120 · Cited by 194 · see citing works
Self-citationCanadian and English students' beliefs about waterpipe smoking: a qualitative study
Roskin, J., & Aveyard, P. N. (2009) · BMC Public Health · doi:10.1186/1471-2458-9-10 · Cited by 180 · see citing works
“Perhaps the most important manifestation of addiction is difficulty stopping using waterpipes should a person choose to do so[15].”
Aveyard, P. N., & West, R. (2007) · BMJ · doi:10.1136/bmj.39252.591806.47 · Cited by 146 · see citing works
Self-citationWest, R. (2009) · COPD: Journal of Chronic Obstructive Pulmonary Disease · doi:10.1080/15412550903049181 · Cited by 145 · see citing works
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“This suggests that the DSM does not assess important facets of TD [7, 17, 18, 26].”
BackgroundInfluentialMotives for smoking and their correlates in clients attending Stop Smoking treatment services
McEwen, A., West, R., & McRobbie, H. (2008) · Nicotine & Tobacco Research · doi:10.1080/14622200802027248 · Cited by 120 · see citing works
Self-citationUsing mediational models to explore the nature of tobacco motivation and tobacco treatment effects.
Piper, M. E., Federman, E. B., McCarthy, D. E., Bolt, D. M., Smith, S. S., Fiore, M. C., & Baker, T. B. (2008) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.117.1.94 · Cited by 105 · see citing works
“However, there is now considerable evidence that there is, in fact, a strong relation between severity of tobacco withdrawal symptoms and relapse (McCarthy, Piasecki, Fiore, & Baker, 2006; Piasecki et al., 2000; West, 2005).”
BackgroundShould criteria for drug dependence differ across drugs?
Hughes, J. R. (2006) · Addiction · doi:10.1111/j.1360-0443.2006.01588.x · Cited by 86 · see citing works
West, O., Hájek, P., & McRobbie, H. J. (2011) · Psychopharmacology · doi:10.1007/s00213-011-2341-1 · Cited by 58 · see citing works
The Wisconsin Predicting Patients' Relapse questionnaire
Bolt, D. M., Piper, M. E., McCarthy, D. E., Japuntich, S. J., Fiore, M. C., Smith, S. S., & Baker, T. B. (2009) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntp030 · Cited by 47 · see citing works
Do ex-smokers report feeling happier following cessation? Evidence from a cross-sectional survey
Shahab, L., & West, R. (2009) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntp031 · Cited by 47 · see citing works
Self-citationPathways to precision medicine in smoking cessation treatments
Chen, L., Horton, A. C., & Bierut, L. J. (2016) · Neuroscience Letters · doi:10.1016/j.neulet.2016.05.033 · Cited by 44 · see citing works
Stavem, K., Røgeberg, O. J., Olsen, J. A., & Boe, J. (2008) · Addiction · doi:10.1111/j.1360-0443.2008.02278.x · Cited by 31 · see citing works
Peckham, E. J., Man, M., Mitchell, N., Li, J., Becque, T., Knowles, S. E., Bradshaw, T., Planner, C., Parrott, S., Michie, S., et al. (2015) · Health Technology Assessment · doi:10.3310/hta19250 · Cited by 31 · see citing works
“Community psychiatrist 26 (57) 25 (49) 73 87 Clinical psychologist 7 (15) 7 (14) 79 205 CPN 18 (39) 13 (25) 278 140 CAMHS worker/STAR worker or advocate 10 (22) 8 (16) 745 228 Counsellor (NHS, school/college or private) 3 (7) 4 (8) 30 78 Family therapist 2 (4) 0 (0) 10 0 Art/drama/music/occupational therapist 3 (7) 8…”
Implementing a hospital-based smoking cessation programme: Evidence for a learning effect
Raupach, T., Shahab, L., Neubert, K., Felten, D., Hasenfuss, G. P., & Andreas, S. (2007) · Patient Education and Counseling · doi:10.1016/j.pec.2007.10.005 · Cited by 28 · see citing works
“Consistent with previous research, multivariate analysis showed that lower nicotine dependence, the absence of depressive symptoms and the use of NRT were all predictive of successful continuous abstinence [20,21].”
MethodBonevski, B., Paul, C. L., D’Este, C. A., Sanson‐Fisher, R., West, R., Girgis, A., Siahpush, M., & Carter, R. (2011) · BMC Public Health · doi:10.1186/1471-2458-11-70 · Cited by 21 · see citing works
“A number of factors are likely to influence an individual’s motivation to smoke and quit [7-17,25].”
BackgroundInfluentialSelf-citationLindson, N., Coleman, T. J., Docherty, G., Hájek, P., Lewis, S., Lycett, D., McEwen, A., McRobbie, H. J., Munafo, M. R., Parrott, S., et al. (2014) · Trials · doi:10.1186/1745-6215-15-296 · Cited by 18 · see citing works
“These questions are both strongly correlated with the FTND, and predict successful smoking cessation more strongly than the FTND or other alternatives, such as the Questionnaire of Smoking Urges (QSU) [29,30].”
BackgroundMethodAssociation between Positivity and Smoking Cessation
Grassi, M., Alessandri, G., Pasquariello, S., Milioni, M., Enea, D., Ceccanti, M., Nencini, P., & Caprara, G. V. (2014) · BioMed Research International · doi:10.1155/2014/780146 · Cited by 18 · see citing works
“occur when smokers believe that quitting smoking means to lose an important source of enjoyment [14, 15] and that this eventually has the potential for making them less happy [16].”
BackgroundWhat lessons can be learned from tobacco control for combating the growing prevalence of obesity?
West, R. (2007) · Obesity Reviews · doi:10.1111/j.1467-789x.2007.00334.x · Cited by 17 · see citing works
“Most smokers enjoy smoking and believe that it serves a number of useful purposes: helping with stress, keeping weight down, social bonding and so on (7,8).”
BackgroundSelf-citationShmulewitz, D., Wall, M. M., Aharonovich, E., Спивак, Б., Weizman, A., Frisch, A., Grant, B. F., & Hasin, D. S. (2013) · Psychological Medicine · doi:10.1017/s0033291712002954 · Cited by 17 · see citing works
“2004), but different from those in clinical samples (West, 2005 ; Hendricks et al. 2008), suggesting the need for additional studies in clinical samples with higher disorder severity.”
BackgroundPeckham, E. J., Arundel, C., Bailey, D., Crosland, S., Fairhurst, C. M., Heron, P., Hewitt, C. E., Li, J., Parrott, S., Bradshaw, T., et al. (2019) · Health Technology Assessment · doi:10.3310/hta23500 · Cited by 15 · see citing works
Genomics and personalized medicine: CHRNA5-CHRNA3-CHRNB4 and smoking cessation treatment
Chen, L., & Bierut, L. J. (2013) · Journal of Food and Drug Analysis · doi:10.1016/j.jfda.2013.09.041 · Cited by 15 · see citing works
Evaluation of a smoking cessation service in elective surgery
Saxony, J., Cowling, L., Catchpole, L., et al. (2016) · Journal of Surgical Research · doi:10.1016/j.jss.2016.11.056 · Cited by 13 · see citing works
A Testable Prognostic Model of Nicotine Dependence
Ramoni, R. B., Saccone, N. L., Hatsukami, D. K., Bierut, L. J., & Ramoni, M. F. (2009) · Journal of Neurogenetics · doi:10.1080/01677060802572911 · Cited by 13 · see citing works
Begh, R. A., Munafo, M. R., Shiffman, S. S., Ferguson, S. G., Nichols, L., Mohammed, M. A., HOLDER, R. L., Sutton, S. R., & Aveyard, P. N. (2013) · BMC Public Health · doi:10.1186/1471-2458-13-1176 · Cited by 13 · see citing works
“The MPSS was preferred over other measures such as the Questionnaire of Smoking Urges because of its superiority in predicting treatment outcomes [43,44].”
MethodRobson, D., Cole, F., Jalasi, S., Boojharut, B., Smith, S. M. R., Thompson, S., Jones, M., & Haddad, M. (2012) · Journal of Clinical Nursing · doi:10.1111/j.1365-2702.2012.04222.x · Cited by 12 · see citing works
“The SMQ is used in the Smoking Toolkit study (West 2006), a series of monthly surveys designed to provide information on smoking and cessation patterns amongst smokers in England.”
MethodNicotine preloading for smoking cessation: the Preloading RCT
Aveyard, P. N., Lindson, N., Tearne, S., Adams, R. L., Ahmed, K., Alekna, R., Banting, M., Healy, M., Khan, S. S. F., Rai, G., et al. (2018) · Health Technology Assessment · doi:10.3310/hta22410 · Cited by 12 · see citing works
“This, in turn, undermines the learnt association between smoking and brain reward, making extinction of the reinforced behaviour more likely.(9)”
BackgroundHorn, K. A., Dearfield, C. T., Johnson, S. B., Krost, K., Patiño, S. R., Gray, T. R., Crandell, I., & Bernat, D. H. (2021) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2021.101600 · Cited by 11 · see citing works
“(Tate and Stanton, 1990; Ho, 1989; West and Corrigall, 2006) Nicotine dependence.”
Jhanjee, S., Jain, R., Jain, V., Gupta, T., Mittal, S., Goelz, P. M., & Schnoll, R. A. (2015) · Journal of Psychoactive Drugs · doi:10.1080/02791072.2015.1075092 · Cited by 7 · see citing works
“Nicotine withdrawal leads to cravings and a continued desire to smoke (West et al. 2006; Hughes 2007), and a strong relation between severity of withdrawal symptoms and relapse has been shown in some studies (McCarthy et al. 2006; West 2005).”
ResultPsychological Characteristics and Smoking Cessation Outcomes in a Sample of Greek Smokers
Stefanidou, A., Bouros, D. E., Livaditis, M., Pataka, A., & Argyropoulou-Pataka, P. (2014) · Current Psychology · doi:10.1007/s12144-014-9241-6 · Cited by 4 · see citing works
The effect of an acute bout of exercise on smoking topography
Schneider, T. (2012) · Scholarship@Western (Western University) · Cited by 1 · see citing works
Understanding the Roles of Genetic and Environmental Influences on the Neurobiology of Nicotine Use
Prom‐Wormley, E. C., Langi, G. G., Clifford, J. S., & Real, J. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-805373-7.00023-2 · Cited by 1 · see citing works
Confronting smokers with previously undetected airflow limitation for smoking cessation
Kotz, D. (2008) · doi:10.26481/dis.20081121dk · Cited by 1 · see citing works
- Self-citation
When Tobacco and Cannabis Use Motives Interact: Implications for Dependence and Quitting.
Barré, T., Cazorla, G., Leroy, V., Maradan, G., Couderc, C., de Ternay, J., Magnani, C., Carrieri, P., & Protopopescu, C. (2026) · Substance Use & Misuse · doi:10.1080/10826084.2026.2723589
- Authors
- West, R.
- Affiliations
- Cancer Research UK (GB)
- Corresponding author
- West, Robert
- ORCID
- West, Robert
- Venue
- Novartis Foundation Symposia
- Publisher
- Wiley
- Published
- 2006-04-13
- Pages
- 36-58
- ISSN
- 1528-2511 (ISSN-L)
- 1935-4657
- OpenAlex
- W1564914258
- Cited by
- 36
- References
- 0
- Citations by year
- 2026: 1 · 2021: 1 · 2019: 1 · 2018: 1 · 2017: 1 · 2016: 2 · 2015: 2 · 2014: 3 · 2013: 3 · 2012: 2
- Type
- other
- Language
- en
- Open access
- closed
- Locations
- Novartis Foundation symposium (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Nicotinic Acetylcholine Receptors Study
- Keywords
- nicotine dependence, addiction, smoking, motivation system, addiction assessment, nicotine tolerance, craving, withdrawal symptoms, addiction treatment
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